Journal Issue: Volume: 53, No. 197 (2015)
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2015
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JNMA Print ISSN: 0028-2715; Online ISSN: 1815-672X
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Articles
Finasteride and tamsulosin combination in benign prostatic enlargement in a tertiary hospital
(Nepal Medical Association, 2015) Shrestha, Binod Bade; Karmacharya, Mikesh
Abstract
Introduction: Due to aging of the general population, prevalence of Benign Prostatic Enlargement is increasing. Symptoms of BPE may vary between the patients. Aim of the study was to analyze and compare the usefulness of combination drugs therapy and monotherapy after a trial period of six months.
Methods: Out of 100 male patients aged 45 years and above diagnosed with BPE, 92 were included in the study. Patients were randomized using computer generated random number table. Of which, 47 patients received combination therapy with Tamsulosin plus Finasteride and 45 patients received monotherapy with Tamsulosin once daily at bed time.
Results: The baseline demographic variables were comparable in both groups. The decrease in the total American Urological Association symptom score was statistically significant in the combination group (p<0.0001) as compared to monotherapy (p=0.0715) respectively. There was a statistically significant reduction in the residual urine volume with combination therapy (p<0.0001) than in patients with monotherapy (p= 0.1271).
Conclusions: The combination therapy is effective in decreasing the irritative and obstructive symptoms in patients with BPE than monotherapy.
Keywords: AUA symptom score; Benign prostatic enlargement; Finasteride; Post voidal residual urine; Tamsulosin.
Efficacy of combined antithrombotic, statins and anti-hypertensive drugs in acute ischemic stroke
(Nepal Medical Association, 2015) Poudel, Ramesh Sharma; Thapa, Lekhjung; Shrestha, Shakti; Khatiwada, Dipendra; Upadhyay, Nijan; Bhandari, Tirtha Raj; Shrestha, Asis
Abstract
Introduction: Anti-thrombotic, statins and antihypertensive drugs are commonly used for the management of acute ischemic stroke in Nepal but there is no evidence regarding their efficacy in our context. This study aims to explore the efficacy of these combined medications (anti-thrombotic, statins and antihypertensive drugs) in acute ischemic stroke patients for the first time and to assess the risk factors present in those patients.
Methods: The study was conducted on 37 acute ischemic stroke patients admitted and treated at the Neurology Department of College of Medical Sciences-Teaching Hospital, Chitwan, Nepal and they were followed at three months (90±10 days). The initial stroke severity and functional disability were evaluated at admission and at 3 months using National Institute of Health Stroke Scale (NIHSS) and Modified Rankin Scale (mRS) respectively. The outcome parameters were functional independence (mRS≤2) and mortality at three months (mRS=6). Frequency distribution, Mann-Whitney U-test and χ2 test were performed for statistical analysis.
Results: Out of 37 patients, 27 (73%) were Smoker, 22 (59.5%) had hypertension and 19 (51.4%) were alcohol consumer. The stroke severity on admission was statistically significant with functional independence (P=0.003) and mortality (P=0.015) at three month. Similarly, Rankin grade on admission was statistically significant with functional independence (P=0.001) and mortality (P=0.048) at three month. At three months, 20 (69%) survived patients were independent while mortality was seen in eight (21.6%) patients.
Conclusions: The management of acute ischemic stroke with combined anti-thrombotic, statins and antihypertensive drugs seems promising and efficacious in mild to moderately severe ischemic stroke.
Keywords: Antihypertensive; Anti-thrombotic; Efficacy ; Statins; Stroke.
Role of eosinophils in acute appendicitis
(Nepal Medical Association, 2015) Shrestha, Reshmi; Shrestha, Anju; Tiwari, Mamata; Ranabhat, Sabin; Maharjan, Sushna
Abstract
Introduction: High negative appendectomy rate still prevails on conventional histologic examination. Increased mural eosinophilic infiltrate had been observed in acute appendicitis. Present study aimed to evaluate the role of mural eosinophils in clinically suspected acute appendicitis but histological normal appendix, as an indicator of acute inflammation, alone or in association with edema and to estimate the cut off value for high eosinophil count for the diagnosis of acute appendicitis.
Methods: A prospective cross sectional study was conducted on appendectomy specimens which were categorized into three groups of classical acute appendicitis, negative appendectomy and control. HandE and Giemsa stained section were studied for the presence of mural eosinophilic infiltrate, mast cells and edema.
Results: Of total 170 cases, group 1 comprised of 68 cases, group 2 consisted of 78 cases and group 3 consisted of 24 cases. Mean eosinophil and mast cell counts in the muscularis propria were significantly higher in CAA and NA categories when compared to control group. Positive association was found between high eosinophil count and edema in CAA and NA categories. Cut off value of ≥6/ mm2 for mural eosinophil count was not significantly different in between NA and control categories.
Conclusions: Increased mural eosinophils were significantly present in acute appendicitis and clinically suspected acute appendicitis but histological normal appendix when compared with control group. Sole presence of increased mural eosinophils might represent acute inflammation. However, cut off value for high eosinophil count could not be established to suggest acute appendicitis.
Keywords: Adenomyosis; Hysterectomy; Leiomyoma; Tumour; Uterovaginal prolapse.
Patterns of lesions in hysterectomy specimens in a tertiary care hospital
(Nepal Medical Association, 2015) Vaidya, Sujan; Vaidya, Sapana Amatya
Abstract
Introduction: Hysterectomy is one of the most common gynaecological procedures performed all over the world. The most frequent indications for hysterectomy are fibroids, abnormal uterine bleeding uterovaginal prolapse and endometriosis. The objective of this study was to present the histopathological patterns of various uterine and adnexal pathologies in the hysterectomy specimens and also to correlate its pre-operative clinical diagnosis with histopathology.
Methods: This is a two-year descriptive study of hysterectomy specimens carried out in the Department of Pathology, Patan Academy of Health Sciences (PAHS), Lalitpur, Nepal. Data of all the hysterectomy specimens collected during this period was analyzed.
Results: Out of the 533 cases, fibroid was the most common indication for hysterectomy that was seen in 229 (42.94%) cases followed by uterovaginal prolapse in 101 (18.93%) cases. Leiomyoma was the most common pathology reported in 250 (46.90%) hysterectomy specimens, followed by ovarian tumours in 95 (17.82%) cases. In 17.82% (95/533) cases, no pathology was seen. Overall, the pre-operative indications in 533 cases of hysterectomy were histopathologically verifiable in 487 (91.37%) cases.
Conclusions: Though the histopathological examination correlates well with the pre-operative clinical diagnosis, a number of lesions were also encountered as pure incidental findings. Hence, it is mandatory that every hysterectomy specimen should be subjected to histopathological examination so as to ensure better post-operative management.
Keywords: Adenomyosis; Hysterectomy; Leiomyoma; Tumour; Uterovaginal prolapse.
Implementation and effectiveness of early chest tube removal during an enhanced recovery programme after oesophago-gastrectomy
(Nepal Medical Association, 2015) Bhandari, Rajeev; You Yong-hao
Abstract
Introduction: Oesophageal resection were notoriously complicated and produces a cohort of patients prone to postoperative complications and here we would like to focus on the implementation and effectiveness of early chest tube removal in ERAS after oesophago-gastrectomy considering the various aspect like pleural effusion and reducing the length of hospital stay which ultimately lead to reducing the economic burden on patient.
Methods: An ERAS programme was devised and implemented with the support of a dedicated in-hospital task-force. The patients underwent esophago-gastrectomy were randomly divided into two groups: the ERAS group and the control group (non-ERAS). The ERAS group was treated with early removal of the chest tube after surgery, and the control group was treated with traditional way and outcomes were compared between them.
Results: The length of hospital stay and the cost of hospitalization in the ERAS group were significantly lower than those in the control group（p<0.05. However, there was no statistical significant difference in the incidences of pleural effusion between the two groups（p＞0.05).
Conclusions: The introduction of early chest tube removal as an ERAS programme after oesophago-gastrectomy would not increase the risk of pleural effusion and would not increase the total length of stay and cost of hospitalisation without jeopardising patient safety or clinical outcomes.
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