This document provides an overview of urinary incontinence. It begins by outlining the learning objectives, which are to understand normal bladder function, define different types of incontinence, understand their pathophysiology and assessments, and review management options. It then defines continence and incontinence. The main types of incontinence discussed are stress urinary incontinence, urgency urinary incontinence, and overflow incontinence. Risk factors, evaluations including history, exams, and tests are explained. Management options covered include lifestyle changes, pelvic floor exercises, medications, and surgeries like sling procedures.
Vaginal prolapse is a condition in which structures such as the uterus, rectum, bladder, urethra, small bowel, or the vagina itself may begin to prolapse, or fall out of their normal positions.
Sometimes during pregnancy, there may be swelling of the kidneys called HYDRONEPHROSIS. Which can sometimes leads to complications in the mother and fetus. Contact female urology DOCTOR in Hyderabad to get best treatment, without effecting your baby’s growth.
Urinary incontinence presentation people's health 10 10NeilBaum
Urinary incontinence is a condition that is devastating to men and women who are affected by this problem. Help is available. These slides discuss treatment options for this problem.
In absence of standardised criteria diagnosis of lower urinary tract dysfunction is difficult in women. Comprehensive urodynamics including pressure-flow study, urethral pressure profilometry, EMG as well as video coordination (or separately done MCUG) are often required. pelvic floor dysfunction (so called dysfunctional voiding), bladder neck obstruction and urethral stricture are differential diagnoses. initial treatment of dysfunctional voiding includes behavioural modification, pelvic floor relaxation exercises, medications, treatment of constipation. further treatment includes inj Botox into sphincter and sacral neuromodulation.
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.
describes its definition, causes, clinical manifestations, diagnosis and rx.
feedback and inquiries; gufuabdikadir96@gmail.com
Urinary incontinence affects millions of people.Urinary incontinence is leakage of urine you can’t control. Also referred to as loss of bladder control. No matter what you call it, if you have it, you may feel like you’re the only one because people don’t really talk about it. But you’re not alone.
Vaginal prolapse is a condition in which structures such as the uterus, rectum, bladder, urethra, small bowel, or the vagina itself may begin to prolapse, or fall out of their normal positions.
Sometimes during pregnancy, there may be swelling of the kidneys called HYDRONEPHROSIS. Which can sometimes leads to complications in the mother and fetus. Contact female urology DOCTOR in Hyderabad to get best treatment, without effecting your baby’s growth.
Urinary incontinence presentation people's health 10 10NeilBaum
Urinary incontinence is a condition that is devastating to men and women who are affected by this problem. Help is available. These slides discuss treatment options for this problem.
In absence of standardised criteria diagnosis of lower urinary tract dysfunction is difficult in women. Comprehensive urodynamics including pressure-flow study, urethral pressure profilometry, EMG as well as video coordination (or separately done MCUG) are often required. pelvic floor dysfunction (so called dysfunctional voiding), bladder neck obstruction and urethral stricture are differential diagnoses. initial treatment of dysfunctional voiding includes behavioural modification, pelvic floor relaxation exercises, medications, treatment of constipation. further treatment includes inj Botox into sphincter and sacral neuromodulation.
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.
describes its definition, causes, clinical manifestations, diagnosis and rx.
feedback and inquiries; gufuabdikadir96@gmail.com
Urinary incontinence affects millions of people.Urinary incontinence is leakage of urine you can’t control. Also referred to as loss of bladder control. No matter what you call it, if you have it, you may feel like you’re the only one because people don’t really talk about it. But you’re not alone.
After ingesting food and fluids, our body eliminates waste products through the urinary system and the gastrointestinal system. Nurses provide care for patients with commonly occuring elimination alterations, including urinary tract infections, urinary incontinence, urinary retention, constipation, diarrhea, and bowel incontinence. This chapter will provide an overview of these alterations and the associated nursing care.
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
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
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
Factory Supply Best Quality Pmk Oil CAS 28578–16–7 PMK Powder in Stockrebeccabio
Factory Supply Best Quality Pmk Oil CAS 28578–16–7 PMK Powder in Stock
Telegram: bmksupplier
signal: +85264872720
threema: TUD4A6YC
You can contact me on Telegram or Threema
Communicate promptly and reply
Free of customs clearance, Double Clearance 100% pass delivery to USA, Canada, Spain, Germany, Netherland, Poland, Italy, Sweden, UK, Czech Republic, Australia, Mexico, Russia, Ukraine, Kazakhstan.Door to door service
Hot Selling Organic intermediates
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
2. At the end you should be able to
Understand normal bladder function
Define different types of incontinence
Understand the pathophysiology of different types of
incontinence
Outline the assessment of incontinence
Understand different types of management options
2
3. What is continence?
Continence is the ability to pass urine or faeces voluntarily
in a socially acceptable place.
The continent person can:
recognize the need
identify the correct place
hold on until he reaches the correct place
reach the correct place
pass urine or faeces when he gets there
Incontinence - involuntary loss of urine which is
objectively demonstrable & is social and hygienic
problem.
3
4. Mechanism of continence
Bladder
Hydrostatic pressure of the
bladder(rarely exceeds
10cm H2O)
Bladder wall
tension(Compliant)- allows
filling with no pressure
increase
Transmission of
intraabdominal
pressure(Bladder intra
abdominal)
•Urethra
Intrinsic smooth and striated
muscle(Constant pressure) 1/3
Extrinsic striated muscle(Exerts
pressure during stress) 1/3
Urethral support(pubourthral
ligaments)
Haemetic seal(vascularity of
submucosal urethral plexus and
secretions) 1/3
4
5. Normal Bladder
First sensation of urge ~250ml.
Bladder capacity- 500-600ml.
Residual urine- <5oml.
Urine flow rate – 15-25mls/sec
5
7. Urinary incontinence
Urinary incontinence - Now recognized as
a clinical problem
Women more willing to talk about it.
Improved understanding of the diverse
pathophysiology of incontinence.
Advent of new treatment.
Development of urology & urogynaecology as
a specialty.
7
8. INCIDENCE
1 in 3 female age 55 or more complain of
incontinence.
1 in 10 women will have surgery for prolapse or
SI in life time. One third will need further surgery.
8
13. Risk Factors
Age
Obesity
Parity
Mode of Delivery
Family History
Smoking
Alcohol
Hormonal status and estrogen deficiency –Menopause
Pelvic floor trauma and denervation injury
obstetric trauma or
nonobstetric trauma (eg pelvic
fractures and radical surgery)
13
14. Definitions of Incontinence
• Stress Urinary incontinence
Urethral sphincter incontinence( Genuine Stress
Incontinence)
Is the involuntary loss of urine in the absence of a
detrusor contraction, the intravesical pressure exceeds
the urethral pressure. There is not an associated desire
to void.
• Overactive bladder (Detrusor Instability)
Involuntary detrusor contractions either spontaneous or
provoked which cannot be suppressed and may cause
incontinence. It is associated with a strong desire to
14
15. • Overflow Incontinence
Is an involuntary loss of urine associated with
over distension of the bladder. May present as
SI or dribble. Due to bladder outlet obstruction
or impaired detrusor contraction. More
common in males.
15
16. Mechanism of continence/Incontinence
Bladder
Hydrostatic pressure of
the bladder(rarely
exceeds 10cm H2O)
Transmission of intra
abdominal
pressure(Bladder intra
abdominal)
Bladder wall
tension(Compliant)-
allows filling with no
pressure increase
•Urethra
Haemetic seal(vascularity of
submucosal urethral plexus and
secretions) 1/3
Intrinsic smooth and striated
muscle(Constant pressure) 1/3
Extrinsic striated muscle(Exerts
pressure during stress) 1/3
Urethral support(pubourthral
ligaments)
16
17. Incontinence is seen when
Bladder pressure increases
Or
Urethral Pressure drops
Or
Both occurs
17
18. Urethral spincter incontinence)
Hypermobility
excessive descent of
bladder neck, so poor
transmission of increase
in abdominal pressure
to proximal urethra.
Intrinsic
Sphincter
Deficiency
poor urethral closure due to
scarring - surgery, childbirth,
neurological injury.
Stress Urinary Incontinence 18
21. Most common types of
incontinence for discussion
Stress Urinary Incontinence
Urgency Urinary Incontinence
• Stress Urinary Incontinence
Urethral sphincter incontinence( Genuine Stress Incontinence)
Is the involuntary loss of urine in the absence of a detrusor
contraction, the intravesical pressure exceeds the urethral pressure.
There is not an associated desire to void.
• Urgency Urinary Incontinence
Overactive bladder (Detrusor Instability)
Involuntary detrusor contractions either spontaneous or provoked
which cannot be suppressed and may cause incontinence. It is
associated with a strong desire to void.
21
22. Over Flow Incontinence
Detrusor underactivity – Detrusor
may be caused by impaired contractility of the
detrusor muscle
Bladder outlet obstruction – Bladder outlet
obstruction in women is generally caused by
external compression of the urethra.
22
23. PATIENT ASSESSMENT
History – Systemic – Fever, Drinking habits,Quality
of life.
Drugs, Medical problems
Smoking/Alcohol/Caffeine
Associated conditions – Utero Vaginal prolapse
Symptom SUI Urgency Urinary incontinence
Frequency ++
Nocturia ++
Urgency ++
Urge Incontinence ++
Stress Incontinence ++
23
27. Assessment – Clinical Tests
Bladder stress test – This test is performed with the
patient in the standing position with a comfortably full
bladder. While the examiner visualizes the urethra by
separating the labia, the patient is asked to Valsalva
and/or cough vigorously. The clinician observes
directly whether or not there is leakage from the
urethra.
Assessment of Post voided Residual Urine
27
40. Pelvic floor muscle (Kegel) exercises
How To Do Kegel Exercises
When urinating, start to go and then stop. If you feel
the muscles tighten and move up, you’ve essentially
done a Kegel exercise.
If you still are not sure of which muscles are your
pelvic floor muscles, insert a finger into your vagina
and contract your muscles as if you are stopping
urination. If you feel the muscles tighten and move up
and down, you’ve found the pelvic floor muscles.
40
41. Kegel exercise, follow these steps:
Lie down on the floor, or sit, if you prefer.
Contract your pelvic floor muscles and hold it for five
seconds.
Now relax for another five seconds.
Repeat this exercise four or five times in a row, three
to four times a day.
Eventually, you want to be able to do this exercise for
10 seconds instead of five. After doing Kegel exercises
regularly every day, you should expect to see results
in eight to 12 weeks.
41
42. Provide Bio Feedback
Provide a feedback to the patient regarding the
exercises
42
44. Urethral sphincter incontinence-
(Stress incontinence) - Treatment
Medications
Duloxitine – Serotonin and noradrenaline
reuptake inhibitor
Acts by increasing urethral closure pressure and
electrical activity of the sphincter - Systematic
reviews of duloxetine in stress urinary incontinence
find that treatment is associated with improvements
in quality of life, >50 percent reductions in
incontinence episodes
Estrogens – increase periurethral blood flow,
strengthen periurethral tissues
Useful in stress and urge incontinence associated
with atrophic vaginitis
Should be given with progestin in women with
uterus
44
45. Urethral sphincter incontinence-
(Stress incontinence) - Treatment
Surgery
Sling procedure – useful intrinsic sphincter deficiency –
84% cure rate
Needle neck suspension, Burch colposuspension –
useful for urethral hypermobility – 79 – 84% cure rate
Surgery cure rate decreases by about 50% after 10
years
45
47. Sling procedure
Advantages
Treats both types of SUI
Short operating time
Outpatient
Disadvantages
Slightly increased risk of
bleeding, bowel/bladder
injury.
Requires cystoscopy
Trans Vaginal Tape
47
51. Complications of Surgery
Significant potential for severe long term voiding
problems post op - (less than 5%)
• De novo detrusor instability (7-27%)
• Erosion of synthetic materials 3%
• Lower urinary tract damage 3%
• Infection
51
52. Urethral sphincter incontinence-
(Stress incontinence) -
Treatment
Pessary
Useful in genital prolapse – uterine
or vaginal, cystocele
Indicated in women who are at high risk
for surgery, or who have had previous
surgery for incontinence
Elevates bladder neck and corrects the
vesico-urethral angle
Also increases outflow resistance by
compressing the urethra against
posteriosuperior aspect of the pubic
symphsis
52
54. Urethral sphincter incontinence-
(Stress incontinence) - Treatment
Periurethral bulking agents – involves
injection of glutaraldehyde cross-linked
bovine collagen or carbon-coated beads
under cystoscopy into an incompetent
periurethral area
UTI and transient urethral irritation are
most common side effects
40% cure rate, 67% improved
Complications – urgency, UI,
urinary retention
54
56. Management of Overactive Bladder
Lifestyle interventions
Behavioral therapies
Pharmacological therapies
Surgery
56
57. Lifestyle interventions
reduce amount and timing of fluid intake
avoid bladder stimulants such as caffeine
alcohol
avoid using diuretics just before bedtime
make toilet easier to get to – bedside commode if necessary
Loose weight if BMI > 30
Stop smoking
Avoid carbonated drinks
Treat chronic constipation and chronic cough
57
58. Behavioral Interventions
Patient Dependent Behavioral Interventions
Bladder retraining: 20% ‘dry’ rate, 75% of pts with
50% reduction in symptoms
Pelvic muscle (Kegel) exercises: 56 – 95% effective if
done about 30 -80 times/day for minimum of 6 weeks
58
60. Drug therapy for urge
incontinence*
Oxybutynin (Ditropan, Ditropan XL) – cure rate:
up to 44%, reduction rate: 9 – 54%,
Tolterodine (Detrol, Detrol LA) – Cure rate 50%
with short acting, 71% with long acting, less dry
mouth compared to oxybutynin
Propantheline Bromide(Pro-Banthine): Reduction
rate – 0 - 53%, not well tolerated by older
patients
Imipramine (Tofranil): useful for nocturnal UI,
mixed UI (urge/stress)
60
61. Beta 3 agonist – Mirabegron – 25 mg daily
(used if cannot tolerate anti muscarinic drugs)
61
62. Surgery for overactive bladder
Botulinum Injection
• Botox bladder injection is used to treat refractory cases of
overactive bladder or urge incontinence that do not respond to
medication.
• A total of 100U to 200U of Botulinum toxin A is injected into the
wall of the bladder to paralyze the bladder muscle.
• The effect is seen as early as 2 weeks after injection.
• Success rates are around 70 to 80% but the effect lasts only up
to 9 months. Repeat injections are then needed.
62
