This document summarizes the pathogenesis of interstitial cystitis (IC). It discusses how IC was originally described in the 1800s and defines how it is currently classified. The pathogenesis is multifactorial and may involve infection, inflammation, autoimmunity, mast cell involvement, defects in the bladder surface, and neurobiological factors. The document also reviews diagnostic criteria, epidemiology, associated disorders, potential etiologies, and pathological findings of IC.
Successful implantation requires
a receptive endometrium,
a normal embryo at the blastocyst developmental stage and
a synchronized dialogue between maternal and embryonic tissues
Successful implantation requires
a receptive endometrium,
a normal embryo at the blastocyst developmental stage and
a synchronized dialogue between maternal and embryonic tissues
bladder pain syndrome is highly prevalent. it is a diagnosis of exclusion. the biggest hurdle in management is diagnosis. more often than not patients suffering with BPS move from pillar to post, from a clinician to another, often getting urethral dilatations, receiving NSAIDS and even antipsychotics (having been labelled as 'psychiatric' patient).
once diagnosis is made, treatment is multipronged and based on phenotype - the concept is called UPOINT. interstitial cystitis is a small but significant minority (moreover ulcerative type) of BPS.
Gabapentin, amitriptyline and pentosan polysulfate are cornerstone pharmacotherapeutic agents for IC/BPS
Undergraduate course lectuers in Obstetrics&Gynecology
Prepared by DR Manal Behery
Assistant Professor in OB&GYNE ,Faculty of medicine,Zagazig University
bladder pain syndrome is highly prevalent. it is a diagnosis of exclusion. the biggest hurdle in management is diagnosis. more often than not patients suffering with BPS move from pillar to post, from a clinician to another, often getting urethral dilatations, receiving NSAIDS and even antipsychotics (having been labelled as 'psychiatric' patient).
once diagnosis is made, treatment is multipronged and based on phenotype - the concept is called UPOINT. interstitial cystitis is a small but significant minority (moreover ulcerative type) of BPS.
Gabapentin, amitriptyline and pentosan polysulfate are cornerstone pharmacotherapeutic agents for IC/BPS
Undergraduate course lectuers in Obstetrics&Gynecology
Prepared by DR Manal Behery
Assistant Professor in OB&GYNE ,Faculty of medicine,Zagazig University
2021-TTO FARMACOLOGICO COMPARACION DE CALIDAD PARA CISTITIS INTERSTICIAL.pdfENOLAGUY1
nterstitial cystitis (IC)/bladder pain syndrome (BPS) is a frustrating disease of chronic
bladder pain associated with lower urinary tract symptoms. Although there are many proposed
treatment algorithms, the uncertainty as to their etiology has a negative impact on the therapeutic
outcome. Oftentimes combination therapy of drugs with different mechanisms of action will be utilized
to relieve the symptoms. With the various treatment options available to patients and providers, there is
an ever-growing need to implement drug efficacy as well as safety to promote best practice in use of
the approved drug
Interstitial nephritis, also known as tubulointerstitial nephritis, is inflammation of the area of the kidney known as the interstitium, which consists of a collection of cells, extracellular matrix, and fluid surrounding the renal tubules.[1] In addition to providing a scaffolding support for the tubular architecture, the interstitium has been shown to participate in the fluid and electrolyte exchange as well as endocrine functions of the kidney.[1] There are a variety of known factors that can provoke the inflammatory process within the renal interstitium, including pharmacologic, environmental, infectious and systemic disease contributors. The spectrum of disease presentation can range from an acute process to a chronic condition with progressive tubular cell damage and renal dysfunction.
Wergner’s Granulomatosis(WG) is a condition of systemic vasculitis in which the presence of circulating AntiNeutrophil Cytoplasmic Antibody which attacks small and medium sized blood vessels. A female of age 39 was admitted with ear itching and drainage was diagnosed as WG with the help of laboratory and radiologic findings.
Abstract—In Italy the hydatid disease is more prevalent and new cases are highlighted more frequently in Sicily, Sardinia, (Italy). Aim of this study is to put the indication in search of iaditea nature in both spleen swelling and muscle tendon.
Material and Method Patients observed during the period 2007-2009 at the Surgical Clinic III and Digestive Surgery, Policlinico G Rodolico were explored for Hydatid cyste at various sites. Diagnosis of cysts ecchinococcus occurred primarily for various four reasons either for compression of bodies involved or for eosinophilia or for instrumental investigation or for anaphylactic reaction to rupture of cysts. Biological diagnosis is based on serology rather than isolation of the parasite (indirect diagnosis);
Results Patients attended during the period 2007-2009 Hydatid cyst was found in 0.5% of all cases in liver along with 4 in the lung, 3 in splenic, 2 in the mammary and 2 in the chest wall No 2. The Surgical treatment with the complete removal of the cyst with a satisfactory postoperative course in the absence of cases of relapse of the disease and by following the therapeutic act, the assumption of mebendazole 50mg / kg / day for 3 weeks at a dose of 400mg for 4 months
Conclusions There is a need to define diagnostic methods with high specificity and sensitivity, which can provide a valid diagnostic aid for the cases clinically difficult to diagnose. And the final diagnosis must then also be based on the development of immunological methods that allow the determination of specific antibodies in the serum and their titration and / or the circulating antigen determination.
This is a presentation by Dada Robert in a Your Skill Boost masterclass organised by the Excellence Foundation for South Sudan (EFSS) on Saturday, the 25th and Sunday, the 26th of May 2024.
He discussed the concept of quality improvement, emphasizing its applicability to various aspects of life, including personal, project, and program improvements. He defined quality as doing the right thing at the right time in the right way to achieve the best possible results and discussed the concept of the "gap" between what we know and what we do, and how this gap represents the areas we need to improve. He explained the scientific approach to quality improvement, which involves systematic performance analysis, testing and learning, and implementing change ideas. He also highlighted the importance of client focus and a team approach to quality improvement.
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Bills have a main role in point of sale procedure. It will help to track sales, handling payments and giving receipts to customers. Bill splitting also has an important role in POS. For example, If some friends come together for dinner and if they want to divide the bill then it is possible by POS bill splitting. This slide will show how to split bills in odoo 17 POS.
The Roman Empire A Historical Colossus.pdfkaushalkr1407
The Roman Empire, a vast and enduring power, stands as one of history's most remarkable civilizations, leaving an indelible imprint on the world. It emerged from the Roman Republic, transitioning into an imperial powerhouse under the leadership of Augustus Caesar in 27 BCE. This transformation marked the beginning of an era defined by unprecedented territorial expansion, architectural marvels, and profound cultural influence.
The empire's roots lie in the city of Rome, founded, according to legend, by Romulus in 753 BCE. Over centuries, Rome evolved from a small settlement to a formidable republic, characterized by a complex political system with elected officials and checks on power. However, internal strife, class conflicts, and military ambitions paved the way for the end of the Republic. Julius Caesar’s dictatorship and subsequent assassination in 44 BCE created a power vacuum, leading to a civil war. Octavian, later Augustus, emerged victorious, heralding the Roman Empire’s birth.
Under Augustus, the empire experienced the Pax Romana, a 200-year period of relative peace and stability. Augustus reformed the military, established efficient administrative systems, and initiated grand construction projects. The empire's borders expanded, encompassing territories from Britain to Egypt and from Spain to the Euphrates. Roman legions, renowned for their discipline and engineering prowess, secured and maintained these vast territories, building roads, fortifications, and cities that facilitated control and integration.
The Roman Empire’s society was hierarchical, with a rigid class system. At the top were the patricians, wealthy elites who held significant political power. Below them were the plebeians, free citizens with limited political influence, and the vast numbers of slaves who formed the backbone of the economy. The family unit was central, governed by the paterfamilias, the male head who held absolute authority.
Culturally, the Romans were eclectic, absorbing and adapting elements from the civilizations they encountered, particularly the Greeks. Roman art, literature, and philosophy reflected this synthesis, creating a rich cultural tapestry. Latin, the Roman language, became the lingua franca of the Western world, influencing numerous modern languages.
Roman architecture and engineering achievements were monumental. They perfected the arch, vault, and dome, constructing enduring structures like the Colosseum, Pantheon, and aqueducts. These engineering marvels not only showcased Roman ingenuity but also served practical purposes, from public entertainment to water supply.
Operation “Blue Star” is the only event in the history of Independent India where the state went into war with its own people. Even after about 40 years it is not clear if it was culmination of states anger over people of the region, a political game of power or start of dictatorial chapter in the democratic setup.
The people of Punjab felt alienated from main stream due to denial of their just demands during a long democratic struggle since independence. As it happen all over the word, it led to militant struggle with great loss of lives of military, police and civilian personnel. Killing of Indira Gandhi and massacre of innocent Sikhs in Delhi and other India cities was also associated with this movement.
Synthetic Fiber Construction in lab .pptxPavel ( NSTU)
Synthetic fiber production is a fascinating and complex field that blends chemistry, engineering, and environmental science. By understanding these aspects, students can gain a comprehensive view of synthetic fiber production, its impact on society and the environment, and the potential for future innovations. Synthetic fibers play a crucial role in modern society, impacting various aspects of daily life, industry, and the environment. ynthetic fibers are integral to modern life, offering a range of benefits from cost-effectiveness and versatility to innovative applications and performance characteristics. While they pose environmental challenges, ongoing research and development aim to create more sustainable and eco-friendly alternatives. Understanding the importance of synthetic fibers helps in appreciating their role in the economy, industry, and daily life, while also emphasizing the need for sustainable practices and innovation.
Read| The latest issue of The Challenger is here! We are thrilled to announce that our school paper has qualified for the NATIONAL SCHOOLS PRESS CONFERENCE (NSPC) 2024. Thank you for your unwavering support and trust. Dive into the stories that made us stand out!
Ethnobotany and Ethnopharmacology:
Ethnobotany in herbal drug evaluation,
Impact of Ethnobotany in traditional medicine,
New development in herbals,
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Role of Ethnopharmacology in drug evaluation,
Reverse Pharmacology.
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It is possible to hide or invisible some fields in odoo. Commonly using “invisible” attribute in the field definition to invisible the fields. This slide will show how to make a field invisible in odoo 17.
2. Interstitial cystitis (IC) is a clinical diagnosis
primarily based on symptoms of
urgency/frequency and pain in the bladder
3. Joseph Parrish (1836) –
“tic doloureux of the bladder.”
Skene (1887) used the term interstitial
cystitis to describe an inflammation that has
“destroyed the mucous membrane partly or
wholly and extended to the muscular
parietes.”
4. ICS Definition
Painful bladder syndrome (PBS) - “the
complaint of suprapubic pain related to
bladder filling, accompanied by other
symptoms such as increased daytime and
night-time frequency, in the absence of
proven urinary infection or other obvious
pathology”
5. The ICS reserves the diagnosis of IC for
patients with “typical cystoscopic and
histological features,” without further
specifying these.
Recent international consultations have
agreed that the nomenclature of “interstitial
cystitis” be revised to “painful bladder
syndrome/interstitial cystitis.”
6. NIDDK Diagnostic Criteria for
Interstitial Cystitis
To be diagnosed with interstitial cystitis, patients
must have either glomerulations on cystoscopic
examination or a classic Hunner ulcer, and they
must have either pain associated with the bladder
or urinary urgency.
An examination for glomerulations should be
undertaken after distention of the bladder under
anesthesia to 80 to 100 cm H2O for 1 to 2 minutes.
The bladder may be distended up to two times
before evaluation.
7. The glomerulations must be diffuse—
present in at least three quadrants of the
bladder—and there must be at least 10
glomerulations per quadrant.
The glomerulations must not be along the
path of the cystoscope.
8. Exclusion criteria
1. Bladder capacity of greater than 350 mL on
awake cystometry
2. Absence of an intense urge to void with the
bladder filled to 100 mL of gas or 150 mL of
liquid filling medium
3. The demonstration of phasic involuntary
bladder contractions on cystometry
4. Duration of symptoms less than 9 months
5. Absence of nocturia
9. 6. Symptoms relieved by antimicrobial agents,
urinary antiseptic agents, anticholinergic agents,
or antispasmodic agents
7. A frequency of urination while awake of
less than 8 times per day
8. A diagnosis of bacterial cystitis or prostatitis
within a 3-month period
9. Bladder or ureteral calculi
10. Active genital herpes
10. 11. Uterine, cervical, vaginal, or urethral cancer
12. Urethral diverticulum
13. Cyclophosphamide or any type of chemical
cystitis
14. Tuberculous cystitis
15. Radiation cystitis
16. Benign or malignant bladder tumors
17. Vaginitis
18. Age younger than 18 years
11. EPIDEMIOLOGY
Prevalence estimates per 100,000 persons
United States: 35-24,000
Netherlands: 7
Finland: 10.6-450
Japan: 1.2
An accurate country-by-country
determination of PBS/IC prevalence and
incidence is difficult to perform at the
present time
12. EPIDEMIOLOGY
Female to male ratio = 5:1
Median age at onset is 40 years.
Late deterioration in symptoms is unusual.
There is a 50% temporary spontaneous
remission rate, with a mean duration of 8
months.
13. The incidence of childhood bladder
problems is 10 times higher in IC patients
versus controls.
The incidence of a history of urinary tract
infection is twice that of controls.
IC patients have a lower quality of life than
dialysis patients
15. Etiology and Pathogenesis
PBS/IC has a multifactorial etiology that
may act predominantly through one or more
pathways resulting in the typical symptom-
complex
16.
17. Infection
The symptom-complex looks to the patient
and physician like an infectious process
Diagnosis of PBS/IC is made only after a
patient has been treated with antibiotics for
presumed urinary tract infection without
resolution of symptoms
18. The epidemiology of urinary tract infection
and its predominance in women mirror the
IC data
Infectious etiology could not be identified
19. Inflammation/Autoimmunity
Immune/neuroimmune mechanisms may
have an important role in the pathogenesis
of PBS/IC.
Excessive release of sensory nerve
neurotransmitters and mast cell
inflammatory mediators is thought to be
responsible for the development and
propagation of symptoms .
20. Inflammation results in altered nerve growth
factor and in morphologic changes in
sensory and motor neurons
Such neuroplasticity may explain the
long-term symptoms and pain after
inflammation subsides
21. Oravisto (1980) provided strong circumstantial
evidence of autoimmunity
- Chronic course of disease
- Absence of infection
- Pathologic findings
- Occurrence of antinuclear antibodies
- Responses to corticosteroids
But the paucity of activated lymphocytes is
against an autoimmune process.
22. Anderson and colleagues (1989)
Although IC patients demonstrated a nonspecific
increase in antibody formation, this was not
significantly different from a similar group of other
urologic patients.
The lack of specificity indicates the immunologic
findings are likely secondary to inflammation
rather than a primary etiology
23. The exact role of autoimmunity in IC
remains controversial
Although the immune system remains a
target for therapy, no clear indication of a
primary role for autoimmunity as the cause
of IC has been observed
24. Mast Cell Involvement
Simmons (1961) was the first to suggest mast
cells as a cause of IC
Mast cells have frequently been reported to
be associated with IC, both as a
pathogenetic mechanism and as a
pathognomonic marker
25. Mast cells may serve as the final common
pathway through which the symptomatic
condition is expressed.
Mast cells produce histamine.
Histamine release in tissue causes pain,
hyperemia, and fibrosis, all notable features
of IC
26. Mast cells are strategically localized in the
urinary bladder close to blood vessels,
lymphatics, nerves and detrusor smooth
muscle
Mast cells are not specific for IC
IC is a syndrome with neural, immune, and
endocrine components in which activated
mast cells play a central, although not
primary, pathogenetic role in many patients
27. Bladder Glycosaminoglycan Layer and
Epithelial Permeability
Parsons(1990) hypothesized and popularized
the concept that IC in a subset of patients is
the result of some defect in the epithelial
permeability barrier of the bladder surface
glycosaminoglycans
28. The GAG layer functions as a permeability and
antiadherence barrier
In the absence of this protective layer in the
urinary bladder, its susceptibility to infection
would increase and the production of nitric oxide
and substance P increases.
Consequently, the permeability of both the
urothelium and the blood vessels in the mucous
membrane increases and the blood flow slows due
to vasodilatation
29. Parsons reported a lower excretion of
urinary uronic acid and glycosaminoglycans
in IC patients than in normal volunteers
Hypothesized that a leaky transitional
epithelium might be absorbing these
substances to its surface
30. Parsons placed 0.4 M potassium chloride
(KCl) intravesically into normal volunteers
and IC patients.
KCl provoked the symptom in 4.5% of
normal individuals and 70% of IC patients.
Symptomatic responses were reduced in
patients on heparinoid therapy.
31. Increased mucosal permeability is
nonspecific and a consequence of bladder
inflammation (cyclophosphamide-induced
bladder injury, bacterial infection, and
cystitis /aging)
Whether increased mucosal permeability
represents a primary cause of IC or the
result of an unidentified source of
inflammation is unclear
32. Neurobiology
Inflammatory painful stimuli, especially if
repeated, can chronically alter innervation,
central pain-processing mechanisms, and
tissue responses
33. Sensory nervous system can generate some of the
manifestations of inflammation
Activation of sensory nerves trigger neurogenic
inflammation through release of neuropeptides
such as substance P, neurokinin A and CGRP
Also cause degranulation of mast cells with release
of potent mediators of inflammation and lead to
injury and increased permeability of epithelial
surfaces
An increase in nerve fibers within the
suburothelium and detrusor muscle in ulcerative
IC has been noted
34. Nervous system itself contributes to the chronic
nature of this pain syndrome, regardless of
initiating etiology
Repetitious stimulation of a peripheral nerve -
persistent NMDA receptor activation - trophic
changes spinal cord cells
Pain resulting from subsequent stimulation
becomes exaggerated and prolonged.
This “pain memory” in the spinal cord causes IC
patients to become refractory to different therapies
35. Urine Abnormalities
Access of a component of urine to the
interstices of the bladder wall, resulting in
an inflammatory response induced by toxic,
allergic, or immunologic means
36. Antiproliferative Factor (APF)
Keay (1996) discovered antiproliferative
factor (APF)- produced by the urothelium of
IC patients
APF was found to be a sensitive and
specific biomarker for IC
APF is associated with decreased production
of heparin-binding epidermal growth factor–
like growth factor (HB-EGF)
37. PBS/IC may result from an inhibition of
bladder epithelial cell proliferation caused
by the APF
Injuries to the bladder (infection, trauma,
and overdistention) in a susceptible
individual may result in PBS/IC if APF is
present
38. APF was found to be a sensitive and specific
biomarker for IC
APF can differentiate chronic pelvic pain
syndrome in men/chronic nonbacterial
prostatitis from PBS/IC
39. Other Potential Causes
Stress-
There are no data currently to suggest that
stress initiates the chronic syndrome of IC
Estrogen –
- 5:1 female to male preponderance makes
the role of the hormone potentially
important
- Estradiol augments mast cell secretion
Pelvic floor dysfunction
40. PATHOLOGY
There is no microscopic picture
pathognomonic of this syndrome
The role of histopathology in the diagnosis
of IC is primarily to exclude other possible
diagnoses
41. Although earlier reports described a chronic,
edematous pancystitis with mast cell
infiltration, submucosal ulcerations and
involvement of the bladder wall, and chronic
lymphocytic infiltrate
These cases were taken from patients with
severe disease and not representative of the
majority of cases currently diagnosed.
42. The pathologic findings in IC are not
consistent
Ulcerative IC- Pancystitis ,mucosal
ulceration and hemorrhage, granulation
tissue, intense inflammatory infiltrate,
elevated mast cell counts, and perineural
infiltrates
45. IC is a diagnosis of exclusion, excluding
other diseases that are pathologically
identifiable is the primary utility of bladder
biopsy in this group of patients.