Complex Fistula-in-Ano Extending From the Anal Canal to Mid-Thigh Treated With Combine Fistulectomy and Video-Assisted Anal Fistula Treatment (VAAFT): A Case Report.

An anal fistula is abnormal, chronic epithelial-lined communication between the anorectal lumen and the skin of the perineum or buttock. A complex fistula-in-ano is difficult to diagnose and treat; it requires careful approaches because of the high risk of complications and recurrences. We report a case of a 60-year-old male who presented with a discharging sinus on the posteromedial aspect of his left thigh for the past two years. On examination, there were two external openings on the posteromedial aspect of the left thigh, 20 cm away from the anal verge, extending toward the left buttock, with an internal opening on the right side of the anal canal at 11 o'clock in the lithotomy position. The MRI showed a fluid-filled marginally enhancing tract ascending obliquely from the skin of the posterior left thigh, passing through the left gluteus maximus to the bilateral ischioanal fossae. The distal 7 cm tract was excised, as the rest of the tract was deep, passing through the gluteus maximus. Therefore, a video-assisted anal fistula treatment (VAAFT) procedure was done for the remaining tract. The wound was left open for healing by secondary intention. The patient was monitored for six months during which time the wound healed completely.

Modeling Spatio-temporal Malaria Risk Using Remote Sensing and Environmental Factors.

BACKGROUND: Remote sensing have been intensively used across many disciplines, however, such information was limited in spatial epidemiology. METHODS: Two years (2009 & 2010) Landsat TM satellite data was used to develop vegetation, water bodies, air temperature and humidity criterion maps to model malaria risk and its spatiotemporal seasonal variation. The criterion maps were used in weighted overlay analysis to generate final categorized malaria risk map. RESULTS: Overall, 25%, 68%, 18% and 16% of the total area of Rawalpindi region was categorized as danger zone for Jun 2009, Oct 2009, Jan 2010 and Jun 2010, respectively. The malaria risk reached at its peak during the monsoon season whereas air temperature and relative humidity were the main contributing factors in seasonal variation. CONCLUSION: Malaria risk maps could be used for prioritizing areas for malaria control measures.