Background: Urolithiasis is the third common disease of the urinary tract after UTIs and pathological diseases of the prostate. The objective of this study was to compare the efficacy of doxazosin versus tamsulosin in lower ureteric stone expulsion in adult population of District Dera Ismail Khan, Pakistan.Materials Methods: This non-randomized control trial was conducted in the Department of Urology, Gomal Medical College, Dera Ismail Khan, Pakistan from February 2020 to December 2020. The 252 patients included in our study were divided in to two groups. The patients in experimental group received Tab. doxazosin 4 mg daily for 4 weeks and Tab. diclofenac sodium 50 mg B.D for 5 days and then on need basis. The patients in control group received Cap. tamsulosin 0.4 mg daily for 4 weeks and similarly Tab. diclofenac sodium 50 mg as in experimental group. All the patients were followed regularly for expulsion of ureteric stones for four weeks. Sex, age and stone size were matching, while stone expulsion was a research variable. Hypothesis was verified by McNemar chi-square test.Results: Out of 252 patients, 113 (89.68%) patients in experimental group, while 77 (61.11%) patients in control group passed the stones. There was statistically significant difference in efficacy in doxazosin group as compared to tamsulosin group (p-value=.0001).Conclusion: The use of doxazosin as the medical expulsion therapy for the lower ureteric stone proved to be more effective as compared to tamsulosin as demonstrated by our results.
Background: Urinary stone disease is one of the commonest urological diseases worldwide. The objective of this study was to compare the efficacy of alfuzosin versus control group in upper ureteric stone expulsion in adult population of district Lahore, Pakistan.Materials Methods: This trial was conducted in Department of Urology, Sheikh Zayed Hospital, Lahore, Pakistan form January 2017 to June 2017. All adult patients with upper ureteric stone size 5-10 mm were eligible. Those with multiple stones, having fever, severe pain, history of surgery in past two weeks and growth on urine culture or pyuria were excluded. Experimental and control groups each had 30 patients. Experimental group received Tab. alfuzosin 10 mg daily for four weeks and Tab. diclofenac sodium 50 mg SOS for acute pain. The control group received Tab. diclofenac sodium 50 mg SOS for acute pain. We followed all patients for four weeks for expulsion of ureteric stones by X-ray KUB or CT KUB. Sex, age and stone size were matching variables. Stone expulsion (yes, no) was research variable. We compared count of stone expulsion between two groups by using McNemar chi-square test at alpha 0.5 using GraphPad.Results: Out of 30 patients in experimental group, 23 (76.67%) were men and seven (23.33%) women and out of 30 in control group, 20 (66.67%) were men and 10 (33.33%) women, almost similar in both groups. Mean age in experimental group was 39.45±10.33 years and in control group it was 37.38±8.28 years, almost similar in both groups. Mean stone size was 7.45±1.47 (5-10) mm in the experimental and 7.28±1.68 (5-10) mm in control group, being comparable in both the groups. In experimental group, stone expulsion was achieved in 23 (76.67%) cases and not in seven (23.33%) cases and in control group, it was achieved in 16 (53.33%) cases and not in 14 (46.67%) cases. There was statistically no significant difference in efficacy of alfuzosin versus control group (p=.1213).Conclusion: Our study showed no difference in efficacy of alfuzosin versus control group for upper ureteric stone expulsion in adult population of district Lahore, Pakistan.
4935 Background: Myelodysplasticsyndromes (MDS) are a heterogeneous group of hematopoietic diseases characterized by peripheral blood cytopenias and increased apoptosis of precursor cells in the marrow. Current therapies are focused on disease control, with no cure other than allogeneic stem cell transplantation. Decitabine is known to act as a hypomethylator while lenalidomide has multiple affects, including actions on the stromal marrow cell interaction. It is hypothesized that the combination of decitabine with lenalidomide may show synergistic results. Thus we performed a phase 1 study to estimate the maximally tolerated dose of lenalidomide in combination with decitabine in patients with high risk MDS. Methods: Adults with primary or secondary MDS, including all subcategories and IPSS risk categories of INTERM-2 or High were eligible, including those who had prior therapy even if they progressed with prior exposure to hypomethylators. Patients also must have had CrCl 3 60ml/min, and liver function test 2 3 × ULN. Following a standard phase 1 3+3 design, patients received decitabine 20mg/m2 over one hour intravenously daily for 5 days, with cycles repeated every 28 days. Lenalidomide was given in cohorts at doses of 5mg, 10mg, or 15mg daily for days 1–21 of the 28 day cycle. Patients were analyzed during the first cycle for dose limiting toxicity and responders that did not have a DLT could continue until progression or toxicity required discontinuation. DLT was defined as any non-heme grade 3 toxicity (CTC v. 4) that was study related lasting 3 7 days or grade 4 of any duration or Neutropenia or thrombocytopenia 3 grade 3 due to study agents >14 days. Results: Patients and disease characteristics are noted in the table below. Twelve evaluable patients were treated, 5 had prior therapy (all included a hypomethylator). The combination seems tolerable, though toxicities included the following: 4 patients had a grade 3 febrile neutropenia (2 in cohorts 1 and 3 each), 2 with grade 2 rash (1 cohorts 1 and 3 each), and 4 with grade 3 anorexia/fatigue (1 cohort 1, 2 cohort 2, 1 cohort 3). With median duration of follow up for survivors of 6 months (2–38months) the median number of cycles of therapy was 4 (1–16) with 3 continuing on therapy at this time. Responses were noted at all dose levels, including those with prior hypomethylator exposure (see table 1): 3 (25%) complete responders, 1 partial responder (8%), and 3 (25%) with stable disease. The Median duration of response was 5 months (1–21) with 3 continuing in response. Conclusion: In patients with high risk MDS, the combination of decitabine and lenalidomide is tolerable and provides encouraging response rates in this population. The MTD was determined as decitabine 20mg/m2 daily for 5 days with lenalidomide 10mg daily for days 1–21 of a 28 day cycle. Larger studies of this combination are warranted. *MTD Disclosures: Rizzieri: Celgene: Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau. Beaven:Celgene: Research Funding.
Aim: To compare the success of slow rate with fast rate extracorporeal shock wave lithotripsy in the treatment of urolithiasis. Study design: Randomized controlled trial Place & duration of study: Department of Urology, Shaikh Zayed Hospital, Lahore from 1st October 2010 to 30th April 2011. Methodology: One hundredpatients who were divided in two equal groups i.e. Group A in which patients received treatment with slow rate extracorporeal shock wave lithotripsy and group B in which patients received treatment with fast rate extracorporeal shock wave lithotripsy. Results: The success rate of slow rate extracorporeal shock wave lithotripsy was 76 % and that of fast rate extracorporeal shock wave lithotripsy was 48% (p-<0.05). Conclusions: The slow rate extracorporeal shock wave lithotripsy is better than fast rate extracorporeal shock wave lithotripsy for elimination of urolithiasis. Keywords: Extracorporeal shock wave lithotripsy; slow rate ESWL; fast rate ESWL
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