Journal Issue: Volume: 12, No 3, Issue 47, JULY-SEPT, 2014
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Volume
Number
Issue Date
2014
Journal Title
Journal ISSN
1812-2027
Journal Volume
Articles
Outcomes of Transurethral Resection of the Prostate in Benign Prostatic Hyperplasia Comparing Prostate Size of more than 80 Grams to Prostate Size less than 80 Grams
(Kathmandu University, 2014) Joshi, HN; de Jong, IJ; Karmacharya, RM; Shrestha, B; Shrestha, R
ABSTRACT
Background
Benign prostatic hyperplasia is a condition occurring in elderly men in which the
prostate gland is enlarged, hence the condition also known as benign enlargement
of prostate. Benign hyperplasia can lead to both obstructive and irritative symptoms.
Transurethral resection of prostate (TURP) still remains the gold standard modality
of surgical treatment of obstructive lower urinary tract symptoms due to Benign
hyperplasia.
Objectives
The objective of this study was to evaluate the outcomes of TURP in large prostate
(>80 grams) in comparison to small prostate (<80 grams) in terms of efficacy, safety
and complications.
Methods
A total of 65 cases included in this prospective study, which were operated by a
single surgeon with conventional monopolar TURP using standard technique. Intra
-operative and post-operative complications, pre and post- operative quality of
life (QoL) and international prostate symptom score (IPSS), operative time, time
to removal of catheter and hospital stay were evaluated between small and large
prostate gland volumes.
Results
Out of 65 cases, 30 were with large prostate size i.e. 80 grams or more (group 1),
and 35 cases were with small prostate size than 80 grams size (group 2). Mean age
was 71.8 SD ± 6.9 years in group 1 and 68.2 SD ± 12.7 years in group 2. The mean
preoperative volume of prostate was 88.8 grams (range 80-115 grams) in group 1
and 40.3 (range 20-65 grams) in group 2. The mean preoperative post void residual
volume of urine (PVRU) was 244 ml SD ± 190.8 ml in group 1 and 117 ml ± 70.3 ml
in group 2. Mean resection time in group 1 was 110 (range 90-130) minutes and in
group 2 it was 90 minutes (range 55-115) minutes. There were quite satisfactory
improvements in IPSS and QoL. No significant complications were observed except
TUR syndrome in 2 cases from group 2, which were managed well in postoperative
period.
Conclusion
With meticulous resection and intra-operative haemostasis using continuous out
flow resectoscope, conventional monopolar TURP is equally safe and effective in
large size prostate as compare in small size.
KEY WORDS
Benign prostatic hyperplasia, obstructive lower urinary tract, prostate, transurethral
resection of prostate.
Movement Disability: Situations and Factors Influencing Access to Health Services in the Northeast of Thailand
(Kathmandu University, 2014) Wongkongdech, A; Laohasiriwong, W
ABSTRACT
Background
Persons with movement disability (PWMDs) are the biggest group of persons
with disabilities (PWDs) with needs helps especially on health. There has been no
evident to show health services accessibility situation of PWMDs in the Northeast of
Thailand, the biggest region.
Objective
This study aimed to explore the current situation of accessibility to health services
among PWMDs, and factors influencing such access.
Method
This cross-sectional study used a multistage stratified random sampling to select
462 subjects from the national registered PWMDs poll to response to a structured
questionnaire. This study complies with the principles of the Declaration of Helsinki
and was approved by the Khon Kaen University Ethics Committee for Human
Research prior to the data collection.
Result
We found that most of PWMDs (66%) had overall health service accessibility at
medium level. Factors influencing the access to health services were living in rural
area (adj. mean diff.= -24.01; 95 % CI: -45.88 to-2.31; p-value=0.032), high income
(adj. mean diff.=0.002; 95 % CI: 0.001 to 0.005; p-value = 0.044), and having offspring
or spouse as care givers (adj. mean diff.=40.44; 95% CI: 7.69 to 73.19; p-value=0.044;
and adj. mean diff.=48.99; 95%CI: 15.01-82.98; p-value=0.016, respectively). PWMDs
who lived in rural areas had better access to health services especially to the sub-
district health promoting hospital than those in the urban area.
Conclusion
Accessibly to health services of PWMDs still limited. Income, care givers and
residential areas had influences on their access.
KEY WORDS
Domain of accessibility, health service, movement disability
Modifiable Demographic Factors that Differentiate Bronchiolitis from Pneumonia in Nepalese Children Less Than Two Years – A Hospital Based Study
(Kathmandu University, 2014) Malla, T; Poudyal, P; Malla, KK
ABSTRACT
Backgroud
Bronchiolitis and pneumonia is an important cause of mortality and
morbidity in children. Various risk factors make these children more
prone for this illness. There is limited data on the risk factors from this
part of the world. Moreover there is a significant clinical overlap between
bronchiolitis and pneumonia thus necessitating the need for evaluating
their demographic difference.
Objective
To evaluate the modifiable demographic risk factors for bronchiolitis and
pneumonia in children less than 2 years.
Method
A prospective, comparative hospital based study undertaken during March
2012- March 2013 in Manipal Teaching Hospital, Pokhara. Altogether 200
cases of bronchiolitis and 200 cases of pneumonia, in the age group of 2 to
24 months, were randomly selected for comparison of risk factors as per
a predesigned proforma. A ‘p’ value of <0.05 was considered statistically
significant. Data was analyzed by using SPPS version 16.
Result
The significant risk factors for bronchiolitis were age < 6 months (p<0.001),
prematurity (p<0.001),male(P<0.04), younger maternal age (p< 0.009),
poor maternal knowledge (p<0.013), air pollution and lack of ventilation
(p<0.001), exposure to cooking fuel – kerosene (p<0.007), firewood
(p<0.001) , tobacco smoke (p<0.001), overcrowding (0.008), winter
season (p<0.015), domestic pets (p<0.003), low birth weight (p<003), use
of animal milk (p<0.001).The significant risk factors for pneumonia were
age 13 months- 24 months, maternal age 26- 35 yrs (p<0.009), female (p<
0.04), malnutrition, lack of Vitamin A supplementation and immunization
(p<0.001).
Conclusion
Most of the risk factors for bronchiolitis and pneumonia identified in this
study were modifiable; hence could be prevented to decrease the burden
of both the diseases.
KEY WORD
ALRI, bronchiolitis, pneumonia, risk factors
Prevalence of Peripheral Arterial Disease (PAD) in End Stage Renal Disease (ESRD) Patients on Hemodialysis: A Study from Central Nepal
(Kathmandu University, 2014) Ghimire, M; Pahari, B; Das, G; Sharma,SK; Das, GC
ABSTRACT
Background
Peripheral arterial disease is a common condition in the hemodialysis population
with an estimated prevalence ranging from 17-48%. Many studies have been
conducted to know the prevalence of peripheral vascular disease in hemodialysis
population. However no such study has been conducted so far in Nepal.
Objective
This study was carried out with an objective to assess the prevalence of Peripheral
Arterial Disease in End Stage Renal Disease Patients on Hemodialysis.
Method
Fifty patients with a diagnosis of End Stage Renal Disease (irrespective of the
underlying cause), and those who were on hemodialytic support for more than
3 months were studied over a period of one year. Peripheral arterial disease
was diagnosed on the basis of the ankle –brachial index, which was the ratio
of the resting systolic blood pressure in the arteries of the ankle to that of the
brachial artery, measured by using a standard mercury manometer with a cuff of
appropriate size and the Doppler ultrasound. Patients with ankle –brachial index
≤0.9 were considered positive for peripheral arterial disease.
Result
A total of 50 End Stage Renal Disease patients were analyzed. The mean age of the
patient was 49.81±12.63 years. The age range was from 18- 79 years. Majority of
them were males 64% (n=32). Peripheral arterial disease defined by ankle –brachial
index ≤0.9 was present in 30% (n=15) of patients. The three major cause of End
Stage Renal Disease in the study population was Chronic Glomerulonephritis 40 %
(n=20), Type 2 Diabetes Mellitus 28 % (n=14) and Hypertension 24 % (n=12). Type 2
Diabetes Mellitus was the commonest cause 53% (n=8) of End Stage Renal Disease
in patients with peripheral arterial disease followed by hypertension 33% (n=5).
On univariate analysis, peripheral arterial disease was found to be significantly
associated with age >40 years (p value= 0.003; OR=14.8; CI=1.75-125.27), Type
2 Diabetes Mellitus (p value= 0.009; OR=5.4; CI=1.44-21.14), parasthesia of
lower limbs (p value= 0.001; OR=10; CI-2.31-43.16), and intact PTH >300 ng/ml
(p value =0.006; OR=5.7; CI=1.55-21.50). However on multivariate analysis only
parasthesia of lower limbs and intact PTH >300 ng/ml were significantly and
independently associated with peripheral arterial disease, while other variables
were not significant.
Conclusion
Peripheral arterial disease was common occurrence in End Stage Renal Disease
patients on hemodialysis. Ankle –brachial index needs to be included as a routine
assessment in End Stage Renal Disease patients to detect peripheral arterial
disease at its earliest.
KEY WORDS
Ankle–brachial index, end stage renal disease (ESRD), hemodialysis peripheral
vascular disease