Efficacy of paroxitine for the management of premature ejaculation

Premature ejaculation is a common male sexual disorder and has been managed by psychosexual counseling, topical anesthetics and pharmacological treatments. We evaluated the efficacy of paroxetine, a potent and highly selective serotonin reuptake inhibitor, antidepressant in patients with premature ejaculation. This comparative study was carried out in the Department of Urology, Nishtar Hospital, Multan for 3 months. A total of 100 patients complaining of premature ejaculation were selected and randomly grouped-A and B. Patients in group-A received 20 mg paroxetine [n-50] and in group-B placebo for 3 first weeks regularly then on demand for 3 months. Pretreatment evaluation included history, physical examination, intra-vaginal ejaculation latency time and satisfaction with sexual intercourse. Efficacy of 2 treatments was assessed at 3 weeks and 3 months at study end point where patient reported impression of change was recorded. Trial was completed by 39 patients in each group [78%], Analysis revealed a difference in WELT increase in 2 groups. In group-A IVELT increased after paroxetine from 1 mm 10 sec to 4 min 17 sec at 3 weeks and 4 mm 6 sec at 3 months while in placebo group IVELT increase from 1 mm 1 sec at beginning to 1 min 15 sec at 3 weeks and 1 min 8 sec at c months [2 tail sig .000]. Regarding patient reported impression of change there was 2 category improvement in 56.4% patients in paroxetine group while 12.8% in placebo group. Paroxetine has significantly better results in terms of IVELT and intercourse satisfaction. Further studies are required to draw final conclusions on the efficacy of this drug in PE

Reversible central pontine myelinolysis in nephrotic syndrome

Central pontine myelinosys [CPM] is a pathological and clinical syndrome due to destruction of medullated sheaths with relative sparing of the axis cylinders and nerve cells in the pons. Clinicaly it is characterised by rapidly evolving quadriplegia and pseudobulbar palsy. In children, the most common etiology is the rapid correction of hyponatremia, and rarely other disorders like adrenal insufficiency, hyperglycaemic coma, liver disease and leukemia have been associated with CPM. The condition is often fatal and survivors have been reported to suffer from permanent neurological deficit in the form of 'locked in' stated. We report a girl who developed steroid resistant nephrotic syndrome, and during the course of her illness became hyponatremic also. Over enthusiastic correction of the latter, she developed CPM but recovered totally in a few days