This document summarizes the evidence-based approach to managing male benign prostatic enlargement. It discusses the terminology, natural history, and management of lower urinary tract symptoms. The main treatment options for LUTS/BPO that are supported by evidence include alpha-1 adrenoceptor antagonists, 5-alpha reductase inhibitors, and combination therapy with both. Guidelines aim to guide best practice and provide consensus based on evidence.
Primary sclerosing cholangitis (PSC) is a chronic, idiopathic, cholestatic liver disease characterized histologically by peribiliary inflammation and fibrosis.
It can lead to end stage cirrhosis and is a recognized risk factor for hepatobiliary cancers
Dr Chris Jenkins, Consultant Haematologist, University Hospital of the North Midlands
Dr Andrew Stewart, Consultant Haematologist, The Royal Gwent Hospital
Primary sclerosing cholangitis (PSC) is a chronic, idiopathic, cholestatic liver disease characterized histologically by peribiliary inflammation and fibrosis.
It can lead to end stage cirrhosis and is a recognized risk factor for hepatobiliary cancers
Dr Chris Jenkins, Consultant Haematologist, University Hospital of the North Midlands
Dr Andrew Stewart, Consultant Haematologist, The Royal Gwent Hospital
Uncommon cause of secondary amenorrhea and hirsutism: Steroid cell tumor of o...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
All manuscripts are subject to rapid peer review. Those of high quality (not previously published and not under consideration for publication in another journal) will be published without delay.
'Use of linked health care data for research: experiences with the Hampshire ...Health Innovation Wessex
The fifth presentation delivered at the 'Big Data in health and care: using data to gain new insights’ event, hosted by Wessex Academic Health Science Network (AHSN) on 19 April 2015.
Prof. Nicholas Harvey's presentation from Osteoporosis 2016: Calcium, with or without vitamin D supplementation, is not associated with ischaemic heart disease or cardiac death: the UK Biobank cohort.
Find out more at: https://nos.org.uk/conference
Frank de Vries's presentation from Osteoporosis 2016: The epidemiology of mortality after fragility fracture in England and Wales.
Find out more at: https://nos.org.uk/conference
Background: The Oxford Classification of IgAN was developed in 2009. Subsequent validation studies found that M and E lesions were less predictive of ESRD. Varying reproducibility and lack of sufficient clinical relevance have since then resulted in several larger studies like the VALIGA study which addressed some of the shortcomings of the Oxford Classification. We had previously reported on a 30 year follow up study of 102 patients with IgA nephritis (IgAN) to validate the Oxford Classification and we showed that E and S lesions of the Oxford MEST were predictive of patients likely to develop renal failure during the initial 5 years of the disease whereas M and T scores were predictive of late renal failure as shown in our 30 years follow up of these patients. In this follow up study we explore how we could expand the relevant histological features of the MEST score as well as include some clinical indices to make the Oxford Classification more relevant clinically.
Uncommon cause of secondary amenorrhea and hirsutism: Steroid cell tumor of o...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
All manuscripts are subject to rapid peer review. Those of high quality (not previously published and not under consideration for publication in another journal) will be published without delay.
'Use of linked health care data for research: experiences with the Hampshire ...Health Innovation Wessex
The fifth presentation delivered at the 'Big Data in health and care: using data to gain new insights’ event, hosted by Wessex Academic Health Science Network (AHSN) on 19 April 2015.
Prof. Nicholas Harvey's presentation from Osteoporosis 2016: Calcium, with or without vitamin D supplementation, is not associated with ischaemic heart disease or cardiac death: the UK Biobank cohort.
Find out more at: https://nos.org.uk/conference
Frank de Vries's presentation from Osteoporosis 2016: The epidemiology of mortality after fragility fracture in England and Wales.
Find out more at: https://nos.org.uk/conference
Background: The Oxford Classification of IgAN was developed in 2009. Subsequent validation studies found that M and E lesions were less predictive of ESRD. Varying reproducibility and lack of sufficient clinical relevance have since then resulted in several larger studies like the VALIGA study which addressed some of the shortcomings of the Oxford Classification. We had previously reported on a 30 year follow up study of 102 patients with IgA nephritis (IgAN) to validate the Oxford Classification and we showed that E and S lesions of the Oxford MEST were predictive of patients likely to develop renal failure during the initial 5 years of the disease whereas M and T scores were predictive of late renal failure as shown in our 30 years follow up of these patients. In this follow up study we explore how we could expand the relevant histological features of the MEST score as well as include some clinical indices to make the Oxford Classification more relevant clinically.
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.
It is considerable cycle variability in the adolescent years. Regular ovulatory menstrual cycles occur every 21 to 35 days and last up to 7 days, with an average blood loss of 25 to 69 mL. Many patients complain of menstrual problems that actually fall within normal variations. In the first year after menarche, 50% of cycles are anovulatory, but 80% still fall in the normal range for duration. By the third year of menarche, 95% of menstrual cycles fall into this range. Charting the menstrual flow on a calendar can be helpful to clarify normal versus abnormal cycles. Cycles that fall outside of the norm should be evaluated for underlying pathology. There are multiple causes for abnormal uterine bleeding in adolescents, the most likely cause is dysfunctional uterine bleeding (DUB) due to an immature hypothalamic-pituitary-ovarian (HPO) axis, causing an ovulatory cycles and irregular bleeding
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- 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
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.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
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
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
These lecture slides, by Dr Sidra Arshad, offer a quick overview of 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 leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
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. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
4. Synopsis
Management of Male Benign Prostatic Enlargement
•Terminology
•Natural History
•Management of male LUTS
•What are we treating?
•What is the evidence base?
8. Prevalence of Individual LUTS
in Men and Women
Nocturia: waking to void ≥ 1 times per night
Frequency: subject feels he/she urinates too often during the day
Irwin DE, et al. Abstract presented at EAU 2006.
.
Storage Voiding
Post-
micturition
Men Women
Prevalence,%
48.5
10.8
6.7 5.5
8.4 8.8
6.7
14.2 13.4
5.5
54.2
12.8
7.3
12.6
7.1 6.3
3.9
9.8
12.2
3.1
0
10
20
30
40
50
60
9.
10. Impact Of LUTS On Partners’ QoL
Worry that patient may have cancer 71%
Worry about patient’s need for surgery 66%
Social life affected by patient’s symptoms 47%
Become tired because of waking at night 42%
Worsening sex life 66%
Upset by the distress the partner suffers 66%
Sells et al. BJU Int 2000;85:440-5
11.
12. What is the problem?
BPE
Enlargement
All Men
> 40 yrs
BOO
Obstruction LUTS /
Bother
Histologic
BPH
14. Natural History
• 16% of those with BPH have no change
in symptoms
• 38% were better
• Retention is uncommon
• with a follow up ranging 2.6 - 5 years
Isaacs 1990
15. Predictors of progression in MTOPS
Crawford ED et al. J Urol 2006;175:1422-7
Parameter Baseline value in placebo group
Qmax < 10.6 mL/s P=0.011
Age ≥ 62 years P=0.0002
Prostate volume ≥ 31 mL P<0.0001
PSA ≥ 1.6 ng/mL P=0.0009
Postvoid residual ≥ 39 mL P=0.0008
*Clinical progression defined as ≥4 point increase in IPSS, AUR, incontinence, renal
insuffiency, recurrent urinary tract infection
Risk of clinical progression* at median follow-up of 4.5 years
16. Net reduction of stiffness
No, I cannot get an erection
ED Increases with Age and LUTS
0
10
20
30
40
50
60
70
80
90
100
2 2 5
1812
26
46
53
6 6 11
19
32
43
53
64
16 19
31
45
41
50
52
45
50- 59 years 60- 69 years 70- 79 years
%
LUTS
Rosen R et al. Program Abstracts of the American Urological Association 2002 Annual Meeting (Abstract 500161).
18. Clinical need
• An increasing number of men aged 60 years
and over have moderate to severe LUTS.
• Prevalence increases with age, so this figure
will continue to rise
• Wide variation in clinical practice
19. Drivers for taking treatment decisions in
LUTS/BPO?
Risk of disease
progression
ComorbiditiesRisk of complications
Severity / type of
LUTS
QoL
20. Managing a chronic, progressive condition is about
maintaining quality of life
Natural History
Symptoms
Progression events
Treatment efficacy
Reduction in symptoms
Reduction in progression risk
Health-relatedQoL
Time
Side Effects of
Treatments
24. Why have Guidelines/Recommendations?
• To guide best practice
• To provide a basis for education
• To summarise consensus
• To provide a basis for medicolegal assessment
• To regulate practice and wherever possible cut
costs
27. National Societies Endorsement
www.uroweb.org/guidelines
1. The Algerian Association of Urology
2. The Argentinian Society of Urology
3. The Armenian Association of Urology
4. The Austrian Urological Society
5. The Belarusian Association of Urology
6. La Sociedad Chilena de Urología
7. La Sociedad Colombiana de Urología
8. The Cyprus Urological Association
9. The Czech Urological Society
10. The Dutch Association of Urology
11. The German Urological Association
12. The Hellenic Urological Association
13. The Hong Kong Urological Association
14. The Hungarian Urological Association
15. The Indonesian Urological Association
16. The Italian Association of Urology
17. The Kosova Urological Association
18. The Latvian Association of Urology
19. The Macedonian Association of Urology
20. The Malaysian Urological Association
21. The Polish Urological Association
22. The Portuguese Urological Association
23. The Russian Society of Urology
24. The Slovenian Urological Association
25. The Swedish Urology Association
26. The Spanish Association of Urology
27. The Taiwan Urological Association
28. The Turkish Association of Urology
29. The Ukrainian Association of Urology
Hot off the press :
30. French Association of Urology (AFU)
31. British Association of Urology (BAUS)
28. Clinical Guidelines
Clinical Guidelines are becoming more influential as an important tool to
improve clinical care, unification of healthcare provision and managing resources
across Europe
In clinical guidelines, a balanced view of risks and benefits (free of bias) is
needed, in which preferences of patients, clinical practice and healthcare policy
needs are matched with science
Many recommendations in clinical guidelines are not well tailored to Individual
patient care needs and much work needed to impact shared decision-making
The EAU Guidelines Office’s aim is to meet the most stringent requirements
set for clinical practice guidelines
29.
30. LUTS/BPO medical treatment options
• α1-adrenoceptor (AR) antagonists
– Men with bothersome LUTS who have not developed serious complications
• 5α-reductase inhibitors (5α-RI)
– Men with bothersome LUTS who have not developed serious complications
– Only recommended for men with enlarged prostates
• Combination therapy: α1-AR antagonists + 5α-RI
– Men with bothersome LUTS who have not developed serious complications
– Men with enlarged prostates
• Combination therapy: α1-AR antagonists + PDE5?
– Incomplete dataset
• Phytotherapy
– Not recommended; lack of scientific evidence regarding efficacy and safety
Abrams P et al. J Urol 2009;181:1779-87