Pudendal (inferior rectal) innervation of the perineally transposed antropylorus in total anorectal reconstruction is feasible and may improve outcomes in selected patients with end-stage fecal incontinence.
Introduction: Menopause is a universal reproductive phenomenon which confirms the end of fertility of the women. The objectives of this study were to establish the age of natural menopause and to identify the prevalence of menopausal symptoms among the rural women attending district hospital of Nepal. Methods: This present study is a hospital based, observational cross-sectional study conducted in Outpatient department of Lamjung District Hospital, Lamjung, Nepal. The study was carried out from January 2014 till June 2014. Fifty four menopausal women were included in the study. A structured questionnaire was used and the data were analyzed using statistical package for social sciences. Results: There were 54 participants with menopausal symptoms included in the study. Age ranged from 45 to 60 years with mean 51.2 years. Approximately seventy percentages of women were in age group of above 50 years. About two-third of participants had menarche in at 11 to 13 years of age and 32 (59.5%) of females were married before 15 years of age. In the study total 22 different health problems were reported by menopausal women. The most common symptoms were backache, fatigue/tiredness, numbness and tingling of the extremities, mental exhaustion, depressive mood, bladder problems and sexual symptoms. Conclusions: The study suggests that rural middle-age and elderly women suffer from variety of health problems related to natural menopause. The health care workers should adopt a holistic approach towards management to improve the quality of life. Keywords: age; menopausal symptoms; women; district hospital. | PubMed
Sir:The efficacy of atypical antipsychotics in the treatment of psychotic disorders is well established. Although olanzapine carries an additional indication for bipolar disorder, there are cases of mania associated with risperidone 1,2 and olanzapine 3,4 treatment in some patients. We present a case report of mania that was apparently induced in a patient shortly after beginning therapy with another atypical antipsychotic, ziprasidone.Case report. Mr. A was a 20-year old man with a history of auditory hallucinations, paranoid delusions, flat affect, and social withdrawal. His symptoms worsened over several weeks, necessitating admission to our inpatient psychiatric unit. Haloperidol and risperidone trials had been attempted in the past, but he had refused treatment for 8 months prior to meeting us. Regarding this period, family members related waxing and waning of symptoms throughout, and they urged him to resume treatment. He had no history of drug/alcohol abuse, and his past medical/neurologic history was unremarkable.With the patient meeting DSM-IV-TR diagnostic criteria for schizophrenia, we began ziprasidone, 20 mg b.i.d., with 20-mg b.i.d. increases over 4 days to 80 mg b.i.d. Due to daytime sedation, his dose was changed to 160 mg h.s. That night, because he slept poorly but related no other symptoms, ziprasidone was decreased to 80 mg h.s. The following night, he displayed increased energy with elated mood. He had increased religiosity and jumped over chairs, danced, and sang on a table. Lorazepam (2 mg) was emergently administered twice over 36 hours for his agitation and manic behavior. The ziprasidone therapy was discontinued, and olanzapine therapy was initiated as he refused lithium and valproic acid. The manic symptoms resolved over 48 hours, and his psychotic symptoms resolved over 30 days. Follow-up at 3 months, during which time he was maintained on 20 mg of olanzapine daily, revealed no further symptoms of mania, although some paranoid delusions remained.On the basis of a recent literature search, this case represents the first report of mania associated with ziprasidone. Despite reports of the induction of mania by atypical antipsychotics, many authors find these agents (including ziprasidone 5 ) helpful in treating manic symptoms seen in bipolar and schizoaffective disorders. In a review of risperidone/olanzapine-induced mania, it was speculated the cause was due to 5-HT 2 /D 2 receptor occupancy. 6 However, ziprasidone differs from the older atypicals in its profound 5-HT 1D and 5-HT/norepinephrine (NE) reuptake inhibition effect-similar to amitriptyline and imipramine. Perhaps the tricyclic-like antidepressant effect of ziprasidone precipitated our patient's mania.We acknowledge that this case could represent a manic break in a patient who suffers from schizoaffective disorder. However, when the criteria proposed by Aubry et al. 6 are applied to our report, 6 of their 8 criteria favor our interpretation that ziprasidone was the cause of our patient's manic symptoms. Two criteria are n...
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