scholarly journals A COMPARATIVE STUDY OF EFFICACY OF SILODOSIN AND TAMSULOSIN INPATIENT OF URETERIC CALCULI

2020 ◽  
pp. 1-3
Author(s):  
Sanjeev Kumar ◽  
Vishwa Prakash Jha ◽  
N. K. Mishra ◽  
Debarshi Jana
Keyword(s):  
Clearance Rate ◽  
Randomized Study ◽  
Plain Radiograph ◽  
P Value ◽  
Ureteric Stone ◽  
Expulsion Rate ◽  
Stone Clearance ◽  
Ureteric Calculi ◽  
Group A ◽  
Group B

Objective: To compare the efficacy of Silodosin and Tamsulosin as a medical expulsive therapy , in the management of ureteric stone in the term of stone clearance and stone expulsion time. Patients and method A prospective randomized study was conducted on 60 patient aged>15 year who had unilateral or bilateral ureteic stone < 6 mm or 6mm . patient were divided in two group.Group A receivedTamsulosin (0.4mg) and group B received Silodosin (8 mg) daily for 28 days .the patient were followed up by ultrasonography, plain radiograph of kidney, ureter and bladder and IVU . Results: There is significantly higher stone clearance rate of 73% in Group A VS in group B of 90%(p value<0.05). Group B also showed a significant advantage for stone expulsion time. No severe complication were recorded during the treatment period. In Group A, out of 30 patient, 8 patient required ureteroscopic removal of stone or open ureterolithotomy but in groupB , only 3 patient required the same. Conclusion: Our data show that silodosin is more effective than tamsulosin in the management of ureteric stone < 6mm or 6mm for stone clearance rate and stone expulsion rate.

scholarly journals Extracorporeal Shockwave Lithotripsy with Tamsulosin in Clearance of Upper Ureteral Calculi- A Randomized Control Clinical Trial

2020 ◽  
Vol 23 (1) ◽  
pp. 36-42
Author(s):  
Md Safiul Alam Babul ◽  
Md Waliul Islam ◽  
Shariful Islam Khan ◽  
Mohammad Habibur Rahman ◽  
Anup Roy Chowdhury ◽  
...  
Keyword(s):  
Clearance Rate ◽  
Ureteral Stones ◽  
P Value ◽  
Ureteric Stone ◽  
Stone Size ◽  
Stone Clearance ◽  
Extracorporeal Shock Wave ◽  
Group A ◽  
Randomized Control ◽  
Group B

Background of the study: Urolithiasis has an incidence in the world of about 5% and the probability of a recurrence within 5–7 years is 50% (Parmar, 2004). Exact data about its prevalence is not known in Bangladesh but it is quite common as seen in outpatient department. It is more common in northern part of the country, male suffer more than female (M:F: 3:1) (Salam, 2002). Symptomatic ureteral calculi represent the most common condition encountered by an urologist in an emergency setting (Pak, 1998). Intervention is recommended for individuals with larger stones, especially greater than 5 mm (Kupeli et al., 1998). The treatment of this pathology was revolutionized with the introduction, in the late 1980s, of extracorporeal shock wave lithotripsy (ESWL), a non-invasive technology that has become one of the primary treatments for urinary stones. Its success rates vary depending on stone size and location and by the type of lithotripter employed. Medical expulsion therapy (MET) can play a key role in support of ESWL: specifically, expulsion is done by diuretics, calcium antagonists, anti-edema agents, and alpha-blockers. A few studies have reported their effectiveness (Borghi et al., 1994, Cervenakov et al., 2002, Porpiglia et al., 2002,Dellabella et al., 2003). Objective: This study is carried out to find out the role of Tamsulos in stone clearance in patientswith upper ureteral stone after extracorporeal shock wave lithotripsy (ESWL). Methods & Material: This randomized control clinical trialwas performed in Department of Urology, National Institute of Kidney Diseases and Urology, Sher-EBangla Nagar, Dhaka during the period from July 2015 to June 2017. A total of 70 cases with upper ureteric stone were included during the study period. Patients were selected randomly in every alternate sequence, odd numbers for experimental group, Tamsulosin+ ESWL, group A & even numbers for control group, only ESWL, group B. Stone clearance rate, number of ESWL session and stone expulsion time were evaluated. Results: In this study showed complete stone clearance one month after ESWL in Group A was 16(89%) and Group B was 16(84.21%) for stone size 6 to 10 mm. Comparison of clearance rate between two groups in stone size 6 to 10 mm was not statistically significant (p value >.05). Complete stone clearance one month after ESWL in Group A was 13(76%) and Group B was 07(43.75%) for stone size 11 to 15 mm. Comparison of clearance rate between two groups in stone size 11 to 15 mm was statistically significant (p value <.05). In this study requirement of number of ESWL sessions according to the stone size showed, in case of 6 to 10 mm stone size, average ESWL sessions 1.28±0.5 in Group A and 1.53±0.7 in Group B and in case of 11to 15 mm stone size, average ESWL sessions 1.29±0.5 in Group A and 1.62±0.7 in Group B. Comparison of ESWL sessions between two groups were statistically significant (p value <.05). In this study mean expulsion time of stone in Group A was 22.34±12.23 days and in Group B was 32.34±21.96 days. Comparison of stone expulsion time between two groups were statistically significant (p value <.05). Conclusion: Tamsulosin results in increased stone-free rates and in lower percentages of patients requiring re-treatment. Tamsulosin can be self-administered and can play a key role in the choice between tamsulosin after ESWL and only ESWL for upper ureteric stone disease treatment. Use of tamsulosin makes the expulsive medical therapy suitable for improving overall outcomes of ESWL treatment for upper ureteral stones. Tamsulosin helps in clearance of upper ureteral stones after ESWL. Bangladesh Journal of Urology, Vol. 23, No. 1, January 2020 p.36-42

scholarly journals Comparative Study Between Holmium: Yag Laser and Pneumatic Lithotripsy in the Management of Upper Ureteric Stone

2020 ◽  
Vol 22 (2) ◽  
pp. 160-165
Author(s):  
Md Ashif Chowdhury ◽  
Md Shahidul Islam ◽  
SM Shameem Waheed ◽  
Md Abdur Rakib ◽  
Faruk Hossain ◽  
...  
Keyword(s):  
Clearance Rate ◽  
Ureteric Stone ◽  
Yag Laser ◽  
Stone Clearance ◽  
Pneumatic Lithotripsy ◽  
Proximal Migration ◽  
Intracorporeal Lithotripsy ◽  
Wide Range ◽  
Group A ◽  
Group B

Background:Among various intracorporeal lithotripters, Pneumatic lithotriptorhas become the widely used tool for the treatment of ureteric stones. Recently the Holmium:YAG laser has been used with a wide range of potential urological applications, including intracorporeal lithotripsy of ureteric stones. Objective: To compare the treatment of upper ureteric stone between laser and pneumatic lithotripsy. Materials and methods: One hundred patients with upper ureteric stone who underwent ureteroscopic lithotripsy in the Department of Urology, CMH, Dhakafrom October 2012 to September 2015 were enrolled in this study. Patients were divided into two groups. Group A (LL) were treated with holmium: YAG laser and Group B (PL) were treated with pneumatic lithotripsy. Two procedures were compared in term of stone fragmentation, stone clearance rate, duration of lithotripsy, complications and duration of post operativehospital stay. Patients were monitored as outpatients after one month and after three months with a kidney ureter and bladder radiograph and ultrasonograph. Patients with migrated fragments or incomplete clearance underwent an auxiliary procedure such as Extra Corporeal shock wave lithotripsy (ESWL). Results: Mean stone size was 1.36 ± 0.36 cm in group A (LL) and 1.37± 0.36 cm in group B (PL). The immediate stone clearance rate was significantly higher inGroup A (94.0%) than Group B (76.0%). Fragments proximal migration were 6.0% in LL group and 24.0% in PL group. Use of stone retrieval equipments (baskets, forceps) was 16.0% and 64.0% in LL and PL group respectively (p<0.05) and stone fragments clearance requiring auxiliary procedures were 6% and 24% (p<0.05) in LL and PL group respectively. The mean lithotripsy time 40.46 ± 19.25 min and 36.86 ± 14.83 min and mean period of post operative hospital stay was 2.32 ± 1.22 days and 2.44 ± 1.18 days in the LL and PL group respectively. Periprocedural complications like hemorrhage, mucosal disruption/ perforation were almost same in both groups. Conclusion: In this study stone clearance and fragmentation of stone in Holmium:YAG assisted ureteroscopy was significantly higher than pneumatic lithotripsy group. The need for auxiliary procedure like ESWL for proximally migrated fragments was significantly less inHolmium:YAG assisted ureterocopy compared with pneumatic lithotripsy. Bangladesh Journal of Urology, Vol. 22, No. 2, July 2019 p.160-165

scholarly journals Comparison of stone clearance rate in patients with distal ureteric stones, undergoing URS with and without a safety guide wire.

2021 ◽  
Vol 28 (12) ◽  
Author(s):  
Zulfiqar Ahmad ◽  
Kaleem Ullah ◽  
Bilal Ahmed ◽  
Safdar Saeed ◽  
Usman Qamar ◽  
...  
Keyword(s):  
Clearance Rate ◽  
Guide Wire ◽  
Ureteral Stones ◽  
P Value ◽  
Medical Sciences ◽  
Stone Clearance ◽  
Group A ◽  
Group B ◽  
Study Setting ◽  
Distal Ureteric Stones

Objective: To compare stone clearance rate in patients with distal ureteric stones, undergoing URS with safety guide wire and without safety guide wire. Study Design: Randomized Clinical Trial study. Setting: Department of Urology, Pir Abdul Qadir Shah Institute of Medical sciences. Period: January, 2020 to December 2020. Material & Methods: The study patients fulfilling the inclusion criteria were divided into two groups using the lottery method. Group A: Patients underwent URS with insertion of safety guidewire (SGW). Group B: These patients underwent URS without safety guidewire (SGW). Patients in both groups were compared for stone clearance. Results: Mean age in Group A was 37.79±12.44 years and in Group B were 33.31±11.48 years. Group wise distribution of gender showed 79 (73.83%) male and 28 (26.17%) females in Group A and 70(65.42%) male and 37 female (34.57%) in Group B. In comparison of both groups, 65.42% stone clearance was noted in Group A while 78.50% stone clearance was found in Group B and p-value found to be significant (P=0.033). Conclusion: Our study concluded that stone clearance in patients with distal ureteral stones undergoing URS without SGW is higher in comparison to URS with SGW, without any added advantage.

scholarly journals COMPARISON OF THE SUCCESS OF EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY (ESWL) WITH AND WITHOUT DJ STENTING IN PROXIMAL URETERIC STONE

2020 ◽  
Vol 11 (2) ◽  
pp. 21-24
Author(s):  
Dr. Mudassar Saeed Pansota
Keyword(s):  
Shock Wave ◽  
Extracorporeal Shock Wave Lithotripsy ◽  
Shock Wave Lithotripsy ◽  
P Value ◽  
Ureteric Stone ◽  
Extracorporeal Shock Wave ◽  
Dj Stent ◽  
Group A ◽  
Group B ◽  
Average Size

BACKGROUND & OBJECTIVE: There is disagreement in the use of ureteral double-J stent before the extracorporeal shock wave lithotripsy (ESWL), although most of the urologists suggest using stent in shock wave lithotripsy technique for stones bigger than 20mm, for preventing the risk of developing steinstrasse. To compare the success of ESWL with and without DJ stenting in proximal ureteric stone. METHODOLOGY: A total of 60 patients form both genders, between 15 to 55 years of age, with a single proximal ureteric stone, were included. Patients with solitary functioning kidney, multiple stones, pregnancy, pyonephrosis and sepsis were excluded. In Group-A, ESWL without DJ stenting was completed while in Group-B, ESWL with DJ stent placement was done. In all patients, at least 4 sessions were done fortnightly. Patients were followed regularly and final success was noted after one month of completion of ESWL sessions. RESULTS: The mean age was 36.85 ± 8.61 years. From 60 patients, 29 (48.33%) were men and 231 (51.67%) were women.Mean body mass index (BMI) was 28.30±2.20 kg/m . The average size of the stone was 12.47 ± 2.57 mm. Success (according to stone removal) of Group-A (ESWL without DJS) was seen in 26 (86.67%) patients while in Group-B (ESWL with DJS) was seen in 16 (53.33%) patients with P-value of 0.005. CONCLUSION: This study concluded that success (in terms of stone clearance) of extracorporeal shock wave lithotripsy (ESWL) without DJ stenting is higher compared to with DJ stenting in upper ureteric stone.

scholarly journals Efficacy of Tamsulosin and Alfuzosin in Management of Distal Ureteral Stones

Med Phoenix ◽  
2021 ◽  
Vol 6 (1) ◽  
pp. 10-13
Author(s):  
Bimochan Piya ◽  
Abhishek Bhattarai
Keyword(s):  
Urinary Tract ◽  
Side Effects ◽  
Diclofenac Sodium ◽  
Study Groups ◽  
Ureteral Stones ◽  
Control Group ◽  
P Value ◽  
Expulsion Rate ◽  
Group A ◽  
Group B

Introduction: Urinary tract calculi are the most frequent condition in urology clinics worldwide. The overall prevalence is about 5 % and lower urinary tract stones account for 70% among them. Medical expulsive therapy has been used to treat distal ureteric stone as it reduces symptoms and facilitates stone expulsion. The aim of this study is to evaluate and compare the efficacy of tamsulosin and alfuzosin as medical therapy in ureteric stones. Materials and Methods: A total of 87 patients with distal ureteral stones of size ≤10 mm were randomly divided into 3 groups. Group A patients (n-30) received 0.4 mg of tamsulosin daily, group B patients (n-29) received 10 mg of alfuzosin daily and group C patients (n-28) received 75 mg of diclofenac sodium. Patients in all groups received diclofenac sodium for one week and then as required. Follow-up was done on a weekly basis for 4 weeks. The stone expulsion rate, time for stone expulsion, and side-effects were recorded in each group. Results: The mean stone size (5.66, 5.79, 5.67) mm and age (29.1, 30.31, 29.4) were comparable in each group. The stone expulsion rate was 83.3%, 79.3%, and 50% in groups A, B, and C respectively.  It showed that both the study groups (Group A and Group B) were effective than the control group (p-value 0.006 and 0.02 respectively) but there was no difference between tamsulosin and alfuzosin (p-value 0.69). The duration of stone expulsion was 11.5 days, 11.8 days, and 17.3 days for Group A, B, and C respectively. The drugs related side effects reported by patients were mild and transient. Conclusion:  The use of tamsulosin and alfuzosin for the medical treatment of ureteric stones proved to be safe and effective and neither did have any significant benefits over the other.

scholarly journals A comparative study for the effectiveness of Tamsulosin alone versus Tamsulosin plus Tadalafil combination as an expulsive medical treatment in the management of lower ureteric calculous in Al-Diwaniyah teaching hospital

2019 ◽  
Vol 10 (2) ◽  
pp. 1551-1555
Author(s):  
Ahmed Abdulameer Alwan ◽  
Hussain T. Ajeel ◽  
Ahmed Hamza Abd
Keyword(s):  
Medical Treatment ◽  
Equal Treatment ◽  
Expulsion Rate ◽  
Treatment Groups ◽  
Ureteric Calculi ◽  
Group A ◽  
Male Patients ◽  
Group B ◽  
Urology Clinic

To evaluate the efficacy & safety of tamsulosin alone versus tamsulosin plus tadalafil combination as expulsive medical treatment of distal ureteric calculus. From March 2015 utile March 2017, two hundred patients (one hundred thirty males and seventy females), who attended the outpatient urology clinic and presented with stones size 5 to 10 mm in distal ureteric part, have been randomly allocated into two equal treatment groups. Group A treated with tamsulosin alone, and group B treated with tamsulosin plus tadalafil. Both treatments were given for a maximum of six weeks’ duration. The rate and time to the calculous passage, type of analgesic use, adverse effects of the drugs, number of outpatient urology clinic visits for pain, and follow-up were noted. Both treatment groups have higher expulsion rate with a lower time to expulsion with no statistically significant differences between them (p=0.350, p=0.074, respectively). Group B showed a significantly lower rate in admission to the hospital for pain and need for analgesia than in group A. no dangerous adverse events had been observing in both groups. Additional benefit seen in group B was the improvement in erectile function regarding male patients. Using tamsulosin and tadalafil as an expulsive medical treatment for distal ureteric calculous is safe and efficacious. Such combination therapy may provide additional advantages in cases of erectile dysfunction co-exist with distal ureteric calculi.

Clinical benefits of sequential administration of docetaxel and intermittent erlotinib as a second-line therapy for advanced non-small cell lung cancer (NSCLC): A phase II randomized study.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e18049-e18049
Author(s):  
Francisco Aparisi ◽  
Alfredo Sanchez-Hernandez ◽  
Vicente Giner ◽  
José Muñoz-Langa ◽  
Gaspar Esquerdo ◽  
...  
Keyword(s):  
Overall Survival ◽  
Phase Ii ◽  
Advanced Nsclc ◽  
Randomized Study ◽  
Stage Iv ◽  
Primary Objective ◽  
P Value ◽  
Sequential Administration ◽  
Group A ◽  
Group B

e18049 Background: Patients (p) with advanced NSCLC have few treatment options after progressing to 1st-line platinum doublet chemotherapy. Several preclinical and phase I studies have suggested that sequential administration of erlotinib (E) and docetaxel could avoid possible negative interactions and optimize the benefit obtained against NSCLC. This randomized phase II was designed to address the clinical benefit obtained with the use of sequential administration of docetaxel and intermittent E. Methods: 70 p with advanced NSCLC progressing to previous PDC for advanced disease were randomized (1:1): Group A (n = 34): Docetaxel 75 mg/m2 day 1 and intermittent E (day 2-16), up to 4 cycles, followed by E in monotherapy; and Group B (n = 36): E in monotherapy. Treatment was administered until unacceptable toxicity or disease progression. Primary endpoint: rate of p free of progression at 6 months; secondary endpoints: progression-free survival (PFS), overall survival (OS), disease control rate (DCR) and safety. The study has completed enrolment. At the date of cut-off for this communication, data of 60 patients were available: 30 in Group A/30 in Group B. Results: Baseline characteristics: non-adenocarcinoma (60.3%), current/former smokers (95%), male (90%) and stage IV (87.9%). 6 months PFS: 13.5% in the sequential arm. PFS: 2.7 months (m) in Group A (95% CI 2.1 – 3.8) and 2 m in Group B (95% CI 1.7 – 2.4) p value 0.08. Median OS: 11.0 m (95% CI 4.5 – 13.4) in group A and 4.7m (95% CI 2.5 – 6.6) in Group B with a p value 0.02. DCR: 44.4% in the experimental group whereas in the E one was 30.8%. Adverse events (AEs), including skin rash and diarrhea, were all generally tolerable. Of interest, the low number of p developing neutropenia in the D + E arm. Conclusions: Although the primary objective has not been met, an encouraging benefit on survival has been shown in the exploratory analysis, with a median overall survival of 11 months for patients treated with the sequential regimen (p value 0.02). Final data will be presented during the meeting.

A COMPARATIVE RANDOMIZED STUDY TO EVALUATE THE ROLE OF DRAINS IN ELECTIVE AND EMERGENCY ABDOMINAL SURGERIES

2021 ◽  
pp. 40-41
Author(s):  
Ajai Kumar ◽  
Alankar Jaiswal ◽  
Prakhar Pratap ◽  
Bhasker Chowdhary
Keyword(s):  
Randomized Study ◽  
Gastrointestinal Surgery ◽  
Surgical Techniques ◽  
P Value ◽  
Complication Rates ◽  
Abdominal Drain ◽  
Prophylactic Drainage ◽  
Group A ◽  
Group B

Background: Abdominal drainage following gastrointestinal surgery has often been a matter of contention. Advances in surgical techniques and perioperative patient care have consistently decreased postoperative complication rates. Aim: To determine the evidence-based value of prophylactic drainage versus non drainage in gastrointestinal surgeries and relative complications and morbidity associated with it. Material and Methods: A total of 82 patients were included in our study. All patients were divided into two groups- Group A and Group B randomly. Post-operatively patients were monitored and evaluated based on pre-determined outcome measures. Results: In our study out of 82 patints no signicant difference was seen (p value>0.01) when drain was compared to non drainage in routine surgeries with respect to ileus duration, anastomotic leak, surgical site infection, mortality, etc. Conclusions: When abdominal drain is routinely put, with its associated consequences, no clinical benet is derived. Therefore drainage in abdominal surgeries should not be routinely used in all patients however it can be used selectively in specic patients with clear indications.

scholarly journals COMPARISON OF THE EFFICACY (IN TERMS OF STONE EXPULSION) OF TAMSULOSIN VERSUS NIFEDIPINE IN DISTAL URETERIC STONE

2019 ◽  
Vol 10 (4) ◽  
pp. 21-25
Author(s):  
Mudassar Saeed Pansota ◽  
Sharmeen Shafqat ◽  
Shafqat Ali Tabassum et al.
Keyword(s):  
Ureteral Stone ◽  
Solitary Kidney ◽  
Developed Countries ◽  
P Value ◽  
Ureteric Stone ◽  
Distal Ureteral Stone ◽  
Group A ◽  
The One ◽  
Group B ◽  
Ureteral Surgery

ABSTRACT:INTRODUCTION: In western prosperous countries, a great research has been done on these two medicines in urolithiasis. Extent of disease is varying from developing countries to developed countries, specially due to late identification of diseases, late in examination which enhances the consequences of disease in ureteral stone or in any other disease. OBJECTIVES: To compare the efficacy (in terms of stone expulsion) of tamsulosin versus nifedipine in victims with distal ureteral stone. MATERIAL AND METHOD: All of 86 patients with distal ureteric stone, 20 to 50 years of both genders were included. Patients with proximal ureteric stricture, gross hydronephrosis, previous ureteral surgery and solitary kidney were excluded. After informed, written consent, all selected cases were divided in two groups by lottery method. In group A patients, tamsulosin was given while in group B patients, nifedipine was given. All patients were followed weekly by the researcher till 4 weeks and ultrasonography in both groups was done by the one consultant radiologist for evaluation of efficacy. RESULTS: Mean age was 32.29 ± 6.81 years. Out of these 86 patients, 53 (61.63%) were male and 33 (38.37%) were females with. Mean size of stone was 6.69±1.49 mm. Stone expulsion was seen in 37 (86.05%) patients in group A (tamsulosin group) and 25 (58.14%) patients in group B (nifedipine group) with p-value of 0.004. CONCLUSION: This survey concluded that efficacy (in terms of stone expulsion) of tamsulosin is better as compared to nifedipine in distal ureteric stone

scholarly journals Primary prophylaxis of hepatic encephalopathy in decompensated cirrhosis: Low dose vs. full dose rifaximin

2019 ◽  
Vol 35 (5) ◽  
Author(s):  
Shahid Sarwar ◽  
Bushra Muhyuddin ◽  
Abdul Aleem ◽  
Muhammad Arif Nadeem
Keyword(s):  
Hepatic Encephalopathy ◽  
Low Dose ◽  
Randomized Study ◽  
Primary Prophylaxis ◽  
Decompensated Cirrhosis ◽  
P Value ◽  
Female Ratio ◽  
Full Dose ◽  
Group A ◽  
Group B

Objective: To compare efficacy of high vs low dose rifaximin for primary prophylaxis of portosystemic encephalopathy (PSE) in decompensated liver cirrhosis. Methods: In a quasi-experimental double blind randomized study at Services Institute of Medical Sciences (SIMS), Lahore from August 2017 to August 2018, patients of decompensated cirrhosis with no previous PSE were randomized to receive twice daily rifaximin 200mg in Group-A and 550mg in Group-B. Patients were followed for 6 months for development of PSE. Results: In 75 included patients, mean age was 53.8(±10.7) years and male/female ratio was 0.97/1(37/38). After randomization, 34 (45.3%) patients were included in Group-A and 41 (54.7%) patients in Group-B. During 6 month follow up 24 (32%) patients developed PSE, 12 (35.2%) in Group-A and 12 (29.2%) in Group-B, difference was not significant (p value 0.57). In 6 months, 13 (17.3%) patient died, 6 (17.6%) in Group-A and 7 (17.07%) patients in Group-B, difference not significant (p value 0.94). Patients who died had higher bilirubin (p < 0.00), higher serum creatinine (p 0.05), high CTP score (p 0.04) and worse MELD score (p 0.004). Conclusion: Rifaximin is not effective for primary prophylaxis of overt hepatic encephalopathy in decompensated cirrhosis patients. doi: https://doi.org/10.12669/pjms.35.5.549 How to cite this:Sarwar S, Muhyuddin B, Aleem A, Nadeem MA. Primary prophylaxis of hepatic encephalopathy in decompensated cirrhosis: Low dose vs. full dose rifaximin. Pak J Med Sci. 2019;35(5):---------. doi: https://doi.org/10.12669/pjms.35.5.549 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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