Current Approach to Overactive Bladder, Issues & Management by Prof. Haleema A. Hashmi, Obstetrician & Gynaecology, Liaquat National Hospital & Medical College, Karachi, Pakistan.
Urinary incontinence general health issue causing trouble to many people due to infrequent urination. here homoeopathy management discussed for incontinence.
Overactive bladder, DR Sharda Jain Lifecare Centre Lifecare Centre
OAB OAB is not synonymous with detrusor overactivity as the former is a symptom based diagnosis whilst the latter is an urodynamic diagnosis.
It has been estimated that 64% of patients with OAB have urodynamically proven detrusor overactivity and that 83% of patient with detrusor overactivity have symptoms suggestive of OAB.
Urinary incontinence general health issue causing trouble to many people due to infrequent urination. here homoeopathy management discussed for incontinence.
Overactive bladder, DR Sharda Jain Lifecare Centre Lifecare Centre
OAB OAB is not synonymous with detrusor overactivity as the former is a symptom based diagnosis whilst the latter is an urodynamic diagnosis.
It has been estimated that 64% of patients with OAB have urodynamically proven detrusor overactivity and that 83% of patient with detrusor overactivity have symptoms suggestive of OAB.
Urinary incontinence simply means involuntary leaking of urine.
Incontinence can range from leaking just a few drops of urine to complete emptying of the bladder.
Social and hygienic problem.
Urinary incontinence and pelvic organ prolapseDR MUKESH SAH
Pelvic organ prolapse (POP) and stress urinary incontinence (SUI) coexist in up to 80 percent of women with pelvic floor dysfunction [1]. While these conditions are often concurrent, one may be mild or asymptomatic, which makes selection of the optimal surgical procedure(s) challenging. Prolapse repair can unmask urinary incontinence in previously continent women or worsen existing SUI symptoms [2].
Souvenir Book of 2nd Biennial International Hybrid Conference of PUGA” which ...Usman Hingoro
Souvenir Book of 2nd Biennial International Hybrid Conference of PUGA” which was held on 20th & 21st March 2021 at Arena Club, Karachi, Pakistan. Pakistan Urogynaecologists Association.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Antimicrobial stewardship to prevent antimicrobial resistanceGovindRankawat1
India is among the nations with the highest burden of bacterial infections.
India is one of the largest consumers of antibiotics worldwide.
India carries one of the largest burdens of drug‑resistant pathogens worldwide.
Highest burden of multidrug‑resistant tuberculosis,
Alarmingly high resistance among Gram‑negative and Gram‑positive bacteria even to newer antimicrobials such as carbapenems.
NDM‑1 ( New Delhi Metallo Beta lactamase 1, an enzyme which inactivates majority of Beta lactam antibiotics including carbapenems) was reported in 2008
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
3. Frequency,
including nocturia
Urgency
Urge
incontinence
OAB
“OAB is defined as urgency, with or without urge incontinence, and
usually with frequency and nocturia”
OAB = overactive bladder; ICS = International Continence Society.Abrams P. Urology. 2003;62(Suppl 5B):28-37.
4. l Urgency: The complaint of a sudden, compelling desire to pass
urine that is difficult to defer
l Urge incontinence: The complaint of involuntary leakage of
urine accompanied or immediately preceded by urgency
l Frequency: Usually accompanies urgency with or without urge
incontinence and is the complaint by the patient who considers
that he/she voids too often by day
l Nocturia: Usually accompanies urgency with or without urge
incontinence and is the complaint that the individual has to
wake at night one or more times to void
Abrams P, et al. Urology. 2003;61:37-49.
5. Increased Frequency
and Reduced
Intervoid Interval
Nocturia
Urgency
1
Incontinence
Reduced Volume Voided per Micturition
1
2 2
1. Proven direct effect
2. Effect correlated with urgency but inconsistent due to multifactorial etiology of the symptom
Reference: Chapple CR et al. Br J Urol (2005) 95: 335-340
6. Symptoms of OAB are due to involuntary contractions
of the detrusor muscles during the filling phase of the
micturation cycle.
Mediated by acetylcholine induced stimulation of
bladder muscarinic receptors
Muscarinic receptors M2 – M3 are demonstrated to
cause direct smooth muscle contraction
M3 receptor is responsible for the normal micturition
contraction.
8. 0
5
10
15
20
25
30
35
40
45
40–44 45–49 50–54 55–59 60–64 65–69 70–74 75+
Age (years)
Prevalence(%)
EU SIFO Study
Men
Women
l 17% of the adult population have symptoms of OAB
l Prevalence of OAB increases with age
l Similar prevalence among men and women (women may
present more)
Source: Milsom et al. 2001
9. Prevalence of OAB in women of reproductive age is 16.9%,
30.9% women over 65 years.
Frequency 8.5%
Urgency 65%
Urinary Incontinence 36%
10. Outflow obstruction Hypothesis:
Outflow obstruction lead to partial denervation
Reduction in acetyl cholinesterase staining nerves in
obstructed human bladder.
Muscle strips from patient, with detrusor over activity
exhibit super-sensitivity to acetylcholine
It causes alteration of the contraction properties of
the detrusor muscle.
Individual cells are more irritable when synchronus
activation is damaged.
11. The patho-physiology of idiopathic and obstructive
overactive bladder is different
Neurogenic hypothesis is controversial
Detrusor develops post junctional super sensitivity due
to partial denervation, with reduced sensitivity to
stimulation to electrical stimulation of its nerve supply,
but a greater sensitivity to stimulation with Ach.
If obstruction is relieved the detrusor can return to
normal behaviour, renervation may also occur.
12. Relaxation of urethra is known to precede
contraction of the detrusor in women with detrusor
over-activity
Not proved by experiments done by southerst &
Brown.
Ref:
Sutherst JR etal, The effect on the bladder pressure of sudden entry of fluid into
the posterior urethra. Br J Urol 1978; 50: 406-9.
13. Brading & Turner Suggested that common feature in
all cases of detrusor over-activity is partial
denervation of detrusor which alters the properties of
smooth muscle resulting in coordinated myogenic
contraction of the whole detrusor.
Charton etal suggested that primary defect in the
Idiopathic and neuropathic bladder is a loss of nerves
accompanied by hypertrophy of the cells and
increased production of elastin and collagen within
the muscle fascicles.
Ref:
1. Brading AF, Turner WH. The unstable bladder: towards a common mechanism. Br. J
Urol 1994; 73: 3-8.
2. Charlton RG, Morley AR, etal, Focal changes in nerve, muscle and connective tissue in
normal and unstale human bladder. BJU Int 1999; 84 953-60.
14. The role of the afferent activation in the urothelium
and sub-urothelial myofibroblasts has been
investigated as a factor in pathophysiology of detrusor
over-activity.
Studies revealed that ATP is released from the
urothelium by bladder distension evoking neuronal
discharge leading to bladder contraction.
In addition prostanoids and nitric oxide are
synthesised locally in urothelium and also released by
bladder distension.
15. Multiplicity of symptoms
Urgency
Daytime frequency
Nocturia
Urgency incontinence
Exclude other causes of frequency & urgency
16. History
Abdominal examination
abdominal mass
full bladder
Pelvic examination
demonstrable stress incontinence
oestrogen status, vulval excoriation
associated pathology
Rule out neurological lesion
Examine cranial nerves and S2, S3 & S4 outflow to rule
out multiple sclerosis
17. Idiopathic detrusor overactivity
Urinary tract infection
Stress urinary incontinence
Interstitial cystitis
Renal stone
Bladder tumours
Overflow incontinence with retention
External pressure (pregnancy, fibroids, pelvic mass)
Secondary to medical conditions (diabetes, myeloma)
Iatrogenic (diuretics and other drugs, post hysterectomy)
Psychosocial (dementia, physical disability)
18. Urine analysis
Micturition diary
Symptoms questionnaire
QOL Questionnaire
Uroflowmetry
Pad test
Urodynamics
19. Recurrent urinary tract infections
Haematuria – calculus, tumour
Painful symptoms
Short duration of symptoms
Symptoms persist inspite of treatment e.g. recurrent UTI
20. The International Continence Society (ICS) has defined
the following three types of urinary diary on the basis
of the recorded parameters:
Micturition charts record only the times of micturition, day
and night, for at least 24 h.
Frequency-volume charts record the volumes voided and the
time of each micturition, day and night, for at least 24 h.
Bladder diaries record the times of micturition and voided
volumes, as well as other information, such as incontinence
episodes, pad usage, fluid intake, degree of urgency, and the
degree of incontinence.
21. Frequency
Nocturia
Total Voided Volume
Nocturnal Voided Volume
Total Intake
Functional Bladder Capacity
Mean Voided Volume
Type of fluid ingested
22.
23. Modified bladder diary De Wachter and Wyndaele
No desire to void
Normal desire to void
Strong desire to void
Urgent desire to void
24. In order to measure urgency severity urgency scoring
systems can be used such as:
Patient perception of intensity of urgency score
(PPIUS)
Urgency perception score (UPS)
Indevus Urgency Severity Scale (IUSS)
30. Therapeutic Agents Side-effects
Diuretics urgency, frequency and UI
Some calcium antagonists urgency
Benzodiazepines sedation and confusion causing
secondary incontinence
Alcohol diuresis, impaired perception of
bladder filling, OAB
Anticholinergics including
Antidepressants Opiates &
Antiparkinson drugs
urinary retention with overflow
31. Bladder Retraining – first line treatment recommended by
AUA. First described by Jeffcoate & Francis
Pelvic Floor Muscle Retraining Detrusor muscle
contraction can be inhibited by pelvic floor muscle
contraction
A meta analysis has concluded that bladder retraining is
more useful than placebo.
Too few studies to evaluate PFMT.
NICE and ICI (International consultation on Incontinence)
recommend that bladder retraining should be considered
as first line treatment in all women with OAB.
32. Botulinium Toxin Botox A
In 2011 FDA approved Botox A injections use on bladder.
In 2013 approved for treatment of OAB.
100 units injected into bladder wall muscle at 30 sites
for OAB & 200 units for neurogenic bladder.
Acts by inhibiting the parasympathetic response of Ach
from the motor neurons and inhibits detrusor
contraction.
33. Stop Aspirin 7 days before therapy
Antiplatelet therapy should be stopped
Do not give if nitrite +ve in dipstick of morning urine.
UTI should be excluded at the site of injection
No acute urinary retention at the time of treatment
Patient willing to initiate self catheterization as
there is significant risk of voiding diffeculties.
34. Minimally invasive
A small electrode is placed in both legs near medial
malleolus
Electrode connected to stimulator which generates
electric current
Every 12th week 30 minutes session is required.
35. Acts by activation of affarent sacral nerve that
inhibit para sympathetic motor neuros there by
prevents detrusor contractions.
More invasive
Requires O.T. fascilities
36. OAB, distressing condition affect QOL
The clinical diagnosis is of exclusion
Urodynamic investigations needed to demonstrate
detrusor over activity
Majority will benefit from conservative treatment
eventually requires drug therapy.
Refractory OAB treated with Botulinum Toxin, neuro
modulation
Reconstructive surgery for refractory patients – may
require ileal diversion, clam cystoplasty or detrusor
myectomy. A every small number will need with severe
morbidity.