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ABSTRACT Introduction: The efficacy of alpha-blockers as medical expulsive therapy (MET) is well established. However, it is not known which of the three most commonly used alpha-blockers (tamsulosin, alfuzosin and silodosin) is the most efficacious. With this study we aimed to assess the efficacy of the three commonly used alpha-blockers as MET for distal ureter stones. Materials and Methods: For this review, we searched multiple databases such as PubMed/Medline, Scopus, Embase, OviD SP, CINAHL, and web of science to identify all the relevant randomized studies comparing the efficacy of tamsulosin, alfuzosin, and silodosin. Preferred reporting items for systematic reviews for network meta-analysis (PRISMA-NMA) were followed while conducting this review and the study protocol was registered with PROSPERO (CRD42020175706). Results: In this review, 31 studies with 7077 patients were included. Compared to placebo all the treatment groups were more effective for both stone expulsion rate (SER) and stone expulsion time (SET). For both SER and SET, silodosin had the highest SUCRA (94.8 and 90.4) values followed by alfuzosin (58.8 and 64.9) and tamsulosin (46.2 and 44.5). The incidence of postural hypotension was similar with all the drugs, whereas, the incidence of retrograde ejaculation was significantly higher for silodosin. Overall confidence for each comparison group in this review ranged from "very low" to "moderate" according to the CINeMA approach. Conclusion: Among the three commonly used alpha-blockers silodosin is the most efficacious drug as MET for lower ureter stones followed by alfuzosin and tamsulosin.
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ABSTRACT Introduction: There is an ongoing need to identify various pathological factors that can predict various survival parameters in patients with upper tract urothelial carcinoma (UTUC). With this review, we aim to scrutinize the impact of several pathological factors on recurrence free survival (RFS), cancer-specific survival (CSS) and overall survival (OS) in patients with UTUC. Materials and Methods: Systematic electronic literature search of various databases was conducted for this review. Studies providing multivariate hazard ratios (HR) for various pathological factors such as tumor margin, necrosis, stage, grade, location, architecture, lymph node status, lymphovascular invasion (LVI), carcinoma in situ (CIS), multifocality and variant histology as predictor of survival parameters were included and pooled analysis of HR was performed. Results: In this review, 63 studies with 35.714 patients were included. For RFS, all except tumor location (HR 0.94, p=0.60) and necrosis (HR 1.00, p=0.98) were associated with worst survival. All the pathological variables except tumor location (HR 0.95, p=0.66) were associated with worst CSS. For OS, only presence of CIS (HR 1.03, p=0.73) and tumor location (HR 1.05, p=0.74) were not predictor of survival. Conclusions: We noted tumor grade, stage, presence of LVI, lymph node metastasis, hydronephrosis, variant histology, sessile architecture, margin positivity and multifocality were associated with poor RFS, CSS and OS. Presence of CIS was associated with poor RFS and CSS but not OS. Tumor necrosis was associated with worst CSS and OS but not RFS. Tumor location was not a predictor of any of the survival parameters.
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ABSTRACT Introduction: Tramadol has been used for the treatment of premature ejaculation, however, the studies published for the same are not well designed. The primary objective of this study was to explore the literature pertaining to the use of tramadol in patients with PE to determine its safety and efficacy in this population. Materials ande methods: Systematic literature search of various electronic databases was conducted to include all the randomized studies and quasi-randomized studies. Standard PRISMA (Preferred reporting Items for Systematic reviews and Meta-analysis) guidelines were pursued for this review and study protocol was registered with PROSPERO (CRD42019123381). Results: Out of 9 studies included in this review, 5 were randomized controlled trials, and rests of the 4 studies were quasi-randomized studies. Tramadol resulted in significantly higher improvement of IELT with the mean difference (MD) of 139.6 seconds and confidence interval (CI) 106.5-172.6 seconds with a p-value of p <0.00001. All dosages except 25mg fared well as compared to placebo. Tramadol fared better than placebo at 1 month, 2 months, and 3 months after initiation of therapy as compared to the placebo. Tramadol group had reported a significantly higher number of adverse events with treatment as compared to placebo but none of them were serious. Conclusion: Tramadol appears to be an effective drug for the management of PE with a low propensity for serious adverse events. However, evidence obtained from this study is of low to moderate quality. Furthermore, effective dose and duration of therapy remain elusive.
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Humanos , Masculino , Tramadol/efeitos adversos , Ejaculação Precoce/tratamento farmacológico , Resultado do Tratamento , EjaculaçãoRESUMO
Background: Laparoscopic appendectomy is more expensive and time consuming as compared to open technique. On the other hand, laparoscopic assisted appendectomy has the advantages of both the open and laparoscopic methods.Methods: This was a prospective comparative study of patients that underwent appendectomy by laparoscopic or laparoscopic assisted techniques.Results: A total of 40 patients were selected for the study. Standard laparoscopic technique was performed in 20 patients and laparoscopic assisted appendectomy was performed in 20 patients. The average operating time was 25.4±15 minutes in laparoscopic assisted appendectomy while it was 46.20±10.90 minutes in standard laparoscopic appendectomy which was statistically significant. Mean hospital stay in group A was 2.70±0.70 and in group B it was 2.10±0.70 which was not statistically significant.Conclusions: The laparoscopic-assisted method of appendix removal can be performed as efficiently as laparoscopically. It is fast and easy to perform, and it is expected to decrease the overall cost of laparoscopic appendectomy.
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Background: Every surgeon wants cosmetically acceptable scars along with optimal healing. Good tissue union and cosmetically acceptable scars are vital for ideal surgical practice. A basic need for skin closure is a good approximation. Apart from cosmetically good scars, it is also necessary that the skin closure technique should be technically easy, speedy, economical and acceptable.Methods: The study was conducted on 100 patients on whom elective abdominal surgeries were performed. Patients were divided into two groups with 50 patients in each group after matching the parameters like age, co morbid conditions, using simple random sampling technique. All operations were performed by one consultant. In group A, Skin was approximated with vertical mattress sutures while in group B, staplers were used to close the wound.Results: The age of the patients varied from 16 to 85 years. The average time taken for skin closure for suture group (A) was found to be 300sec (±20.78) and for stapler group was found to be 120sec (±16.50) respectively. Wound infection was found in 10 patients (20%). In stapler group 4 (8%) and in suture group 6 Patients (12%) had post-operative wound infection.Conclusions: Cosmesis is essential and necessary in modern surgical practice. It also reflects surgical expertise.
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Background: Diagnosis of jaundice involves a range of tests. The liver function tests are done in all to arrive at a diagnosis and then manage the case appropriately. With advancing age, the incidence of liver disease increases. Understanding these changes is important for the management of liver diseases in the elderly. We conducted this study to find the difference in mean levels of Liver enzymes in younger and older age group of patients suffering with jaundice.Methods: It was a prospective observational study. All patients admitted with jaundice in the medicine ward satisfying inclusion/exclusion criteria were enrolled. The results of liver function tests in younger age and older age participants were then compared.Results: Total 100 participants were enrolled during the study period. 53 were enrolled in group one and the rest in group two. Anorexia (90%) was the most common symptom followed by abdominal distension (54%). The total bilirubin (8.8±4.7) as well as conjugated bilirubin (3.4±2.8) were higher in group one though they were not significant statistically (p=0.10 and 0.25 respectively). Mean AST and ALT levels were much higher in group 1 and statistically significant (p values <0.004 and 0.002 respectively). Conversely the mean PT values were higher in group two (p=0.02).Conclusions: Although the symptom severity may be more in elderly, the LFTs are not deranged proportionately. So there is a need to devise separate cut offs and these have to be lower for the older age group patients with jaundice. More studies with larger sample size are required to confirm the results.
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A great effort by the editor-in-chief, Dr. A. M. Kadri, a well-known academician and teacher as well as the secretary general of IAPSM for more than three years, to compile the work of over 200 authors who are subject experts and teachers of Community Medicine from all over India. This book exhibits expertise of the subject from every nook and corner of India. It is nicely framed and the font size, print, tables, diagrams are reader friendly and pleasing to the eyes
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Background: Cephalic index exhibits sexual differences and different shapes of head. This information will be highly important for Plastic surgeons, Forensic Scientists, Anatomists, Human Biologists, Criminologists & Physical Anthropologists. Materials & Methods: The present study was observed on 200 living subjects of Jhalawar district Rajasthan (100 male and 100 female) of 18 to 25 years in the year of 2013 with the objective to study the sex differences and food habitual in cephalic index. Cephalic index was investigated with the help of head length and width with the use of spreading caliper. Results: The study showed that mean cephalic index was higher in females than in males. Conclusion: Predominant head type was dolicocephalic in both sexes.