Ambulatory Females Research Articles

PD05-01 DISTINCT PHENOTYPES OF BLADDER PAIN IDENTIFIED IN THE MULTIDISCIPLINARY APPROACH TO THE STUDY OF CHRONIC PELVIC PAIN RESEARCH NETWORK DATASET

You have accessJournal of UrologyCME1 Apr 2023PD05-01 DISTINCT PHENOTYPES OF BLADDER PAIN IDENTIFIED IN THE MULTIDISCIPLINARY APPROACH TO THE STUDY OF CHRONIC PELVIC PAIN RESEARCH NETWORK DATASET Oluwarotimi Nettey, Nicholas Jackson, and A. Lenore Ackerman Oluwarotimi NetteyOluwarotimi Nettey More articles by this author , Nicholas JacksonNicholas Jackson More articles by this author , and A. Lenore AckermanA. Lenore Ackerman More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003229.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Patients with chronic urologic pelvic pain present a unique challenge as their underlying condition is largely a diagnosis of exclusion. In the present analysis, we extend symptom cluster definitions from a pilot study evaluating bladder pain among ambulatory females to a multicenter prospectively recruited dataset using unsupervised machine learning techniques to assess the stability and reproducibility of these bladder pain phenotypes. METHODS: Unsupervised machine learning techniques were applied to patient reported symptoms extracted from the female Genitourinary Pain Index and Interstitial Cystitis Symptom and Problems Indices. Responses from 130 premenopausal female subjects without current opioid use enrolled in the Multidisciplinary Approach to the Study of Chronic Pelvic Pain (MAPP) research network were analyzed. Symptom clusters generated from the MAPP multisite cohort (MC) were compared to previously published pilot data results to assess for alignment and concordance. RESULTS: Symptom clusters included a nonurological pelvic pain group with localized pain unrelated to the micturition cycle (NUPP-MC), a myofascial pelvic pain group (MFP-MC) with stranguria, sensation of incomplete bladder emptying, urinary urgency and high symptom bother/severity, and a bladder specific-pain group (BPS-MC) with pain worsened by bladder filling and relieved by bladder emptying.Cluster comparisons demonstrated concordance by subtype between local and multisite cohorts on various domains of bladder pain (Figure 1). MFP–MC patients had more pain severity (p<0.001), diffuse body pain involvement (p=0.02), pelvic floor tenderness (p=0.01), and increased number of flares (p=0.009). MFP-MC cluster assignation was associated with severe sexual dysfunction, impaired relationship scores as well as sleep and anxiety disturbances. CONCLUSIONS: Patient reported symptoms can be utilized to perform deep phenotyping and identify distinct subgroups of perceived bladder pain. Phenotypic clusters appear stable both in a single institutional pilot cohort and a larger multi-site study. Further validation of these phenotypes and their associations with response to therapy will clarify how to target treatment of bladder pain. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e148 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Oluwarotimi Nettey More articles by this author Nicholas Jackson More articles by this author A. Lenore Ackerman More articles by this author Expand All Advertisement PDF downloadLoading ...

The efficacy of oral iron treatment in Somalian nonpregnant female patients with mild/moderate iron deficiency anemia.

Objective: To evaluate the efficacy of oral ferrous sulfate therapy in non-pregnant women with iron deficiency anemia in Somalia, which is one of the poorest and undeveloped countries in the world. Study Design: Cross Sectional. Setting: Turkey Recep Tayyip Erdogan Hospital, Mogadishu, Somalia. Period: December 2018 to June 2019. Material &amp; Methods: The study included 117 ambulatory females between 18 and 41 years with iron deficiency anemia diagnosed with a hemoglobin level between 9 and 12g/dL and a serum ferritin level below of 15 ng/ml. The patients received ferrous sulfate 200 mg twice daily. Hemoglobin levels of the patients were measured at 2,4,8, and 12 weeks after the start of treatment, and ferritin levels were measured at 4,8 and 12 weeks. Results: The mean baseline hemoglobin and ferritin values were 9.71+1. 01 g/dl and 6.59+3,63 ng/ml, respectively. After 2,4,8 and 12 weeks of treatment, the mean hemoglobin values were increased to 10.58 g/dl, 11.53g/dl, 12.24g/dl and 12.85 g/dl, respectively. At 12 weeks, 79% of participants had normalized hemoglobin concentrations. (&gt;12 gr/dl). Conclusion: In conclusion, the present study also demonstrated that in patients with mild-moderate IDA oral ferrous sulfate is an effective and better-tolerated treatment. At the same time, oral ferrous sulfate treatment is cost-effective.

Characteristic behaviors associated with gait of individuals with Rett syndrome

Background Individuals with Rett syndrome (RTT) exhibit impaired motor performance and gait performance, leading to decreased quality of life. Currently, there is no robust observational instrument to identify gait characteristics in RTT. Current scales are limited as individuals with intellectual disorders may be unable to understand instructions. Our primary purpose was to utilize video analysis to characterize the behaviors associated with walking in individuals with RTT and explore the relationship between behaviors during overground and during treadmill walking. Methods Fourteen independently ambulatory females with RTT were video-taped and observed during overground and treadmill walking. Their gait was codified into an observational checklist to reveal prominent features associated with gait in this population. Results Participants exhibited similar rates of freezing, veering, and hand stereotypies between overground and treadmill walking; however, freeze duration was shortened during treadmill walking. Toe walking was prominently exhibited during overground, but not treadmill walking. During both walking modes, participants required extensive external motivation to maintain their walking patterns. Conclusions Results identify several gait characteristics observable during overground and treadmill walking. In general, participants behaved similarly during overground and treadmill walking. We conclude that both overground and treadmill walking are appropriate tools to evaluate gait in this population. Implications for rehabilitation Locomotor rehabilitation may increase the quantity of walking performed by the patients, which can alleviate negative effects of the sedentary lifestyle commonly observed in patients with Rett syndrome (RTT). Video analysis of natural walking can be an effective tool to characterize gait in patients with RTT which does not require particular instructions which may not be fully understood. Both overground and treadmill walking are appropriate means of evaluating gait in individuals with RTT.

Kinematics associated with treadmill walking in Rett syndrome

Background and purpose Individuals with Rett syndrome suffer from severely impaired cognitive and motor performance. Current movement-related therapeutic programs often include traditional physical therapy activities and assisted treadmill walking routines for those individuals who are ambulatory. However, there are no quantitative reports of kinematic gait parameters obtained during treadmill walking. The purpose of this research was to characterize the kinematic patterns of the lower limbs during treadmill walking as speed was slowly increased. Methods Seventeen independently ambulatory females diagnosed with a methyl-CpG-binding protein 2 gene mutation walked on a motorized treadmill while joint kinematics were obtained by a camera-based motion capture system and analysis software. Results Stride times progressively decreased as treadmill speeds increased. There were significant main effects of speed on sagittal knee and hip ranges of motion and hip velocity. There were large joint asymmetries and variance values relative to other ambulatory patient populations, although variance values decreased as walking speed increased. Conclusions The results indicate that individuals with Rett syndrome can adapt their kinematic gait patterns in response to increasing treadmill speed, but only within a narrow range of speeds. We suggest that treadmill training for ambulatory individuals with Rett syndrome may promote improved walking kinematics and possibly provide overall health benefits. Implications for rehabilitation Walking is an activity that can counter the negative impacts of the sedentary lifestyle of many individuals with disabilities, including those individuals with Rett syndrome. Documentation of the lower limb kinematic patterns displayed during walking by ambulatory females with Rett syndrome can be used by clinicians to evaluate their patients’ gait performance in response to therapeutic and pharmacological interventions designed to promote walking. The ability to adapt to increases in treadmill speed suggests that a training program of treadmill walking may be effective in promoting improved gait performance in individuals with Rett syndrome.

Exercise training effects on memory and hippocampal viscoelasticity in multiple sclerosis: a novel application of magnetic resonance elastography.

Cognitive impairment is common and debilitating among persons with multiple sclerosis (MS) and might be managed with exercise training. However, the effects of exercise training on viscoelastic brain properties in this population are unknown. The present pilot study adopted a single-blind randomized controlled trial (RCT) design and is the first to examine the effect of an aerobic exercise training intervention on learning and memory and hippocampal viscoelasticity using magnetic resonance elastography (MRE) in persons with MS. Eight fully ambulatory females with MS were randomly assigned into exercise training intervention or waitlist control conditions. The intervention condition involved 12weeks of supervised, progressive treadmill walking exercise training. All participants underwent measures of learning and memory (i.e., California Verbal Learning Test-II; CVLT-II) and further underwent MRE scans for measurement of shear stiffness (μ) and damping ratio (ξ) of the hippocampus before and after the 12-week period. Overall, there were small-to-moderate intervention effects on CVLT-II performance (d=0.34) and large intervention effects on hippocampal μ (d=0.94) and hippocampal ξ (d=-1.20). Change in CVLT-II scores was strongly associated with change in μ (r=0.93, p<0.01) and ξ (r=-.96, p<0.01) of the hippocampus. This small pilot RCT provides exciting proof-of-concept data supporting progressive treadmill walking exercise training for potentially improving learning and memory and underlying hippocampal viscoelastic properties in persons with MS. This is important given the high prevalence and burden of MS-related memory impairment.

Japanese guideline for clinical research of antimicrobial agents on urogenital infections: Second edition.

Japanese guideline for clinical research of antimicrobial agents on urogenital infections: Second edition.

Systematically developed pilot randomized controlled trial of exercise and cognition in persons with multiple sclerosis

ABSTRACTCognitive impairment is common and debilitating among persons with multiple sclerosis (MS) and might be managed with exercise training. The present pilot study adopted a single-blind randomized controlled trial (RCT) design and is the first to examine the effect of a systematically developed, progressive treadmill walking exercise training intervention on cognition among fully ambulatory persons with MS. Ten fully ambulatory females with MS were randomly assigned into exercise training intervention or waitlist control conditions. The intervention condition involved 12 weeks of supervised, progressive chronic treadmill walking exercise training. Participants underwent measures of cognition (i.e., cognitive processing speed (CPS), executive function), walking performance, and cardiorespiratory fitness before and after the 12-week period; baseline and follow-up assessments were performed by blinded assessors. Overall, there were large intervention effects on CPS (d = 0.95), walking performance (d = 0.76), and cardiorespiratory fitness (d > 1.08). The change in cardiorespiratory fitness was significantly associated with change in CPS (r = .60), but not walking performance. This small pilot RCT provides preliminary proof-of-concept data supporting progressive treadmill walking exercise training for potentially improving CPS, walking performance, and cardiorespiratory fitness in fully ambulatory persons with MS, and that improved fitness might be a possible mechanism for improved CPS.

Head Pre-Cooling Improves Symptoms of Heat-Sensitive Multiple Sclerosis Patients

Damage to the central nervous system by Multiple Sclerosis (MS) leads to multiple symptoms, including weakness, ambulatory dysfunction, visual disturbances and fatigue. Heat can exacerbate the symptoms of MS whereas cooling can provide symptomatic relief. Since the head and neck areas are particularly sensitive to cold and cooling interventions, we investigated the effects of cooling the head and neck for 60 minutes on the symptoms of MS. We used a double blinded, placebo controlled, cross-over study design to evaluate the effects of head and neck cooling on six heat-sensitive, stable, ambulatory females with MS (Extended Disability Status Scale 2.5-6.5). To isolate the effects of perceived versus physiological cooling, a sham cooling condition was incorporated, where subjects perceived the sensation of being cooled without any actual physiological cooling. Participants visited the clinic three times for 60 minutes of true, sham, or no cooling using a custom head and neck cooling hood, followed by evaluation of ambulation, visual acuity, and muscle strength. Rectal and skin temperature, heart rate, and thermal sensation were measured throughout cooling and testing. Both the true and sham cooling elicited significant sensations of thermal cooling, but only the true cooling condition decreased core temperature by 0.37 °C (36.97 ± 0.21 to 36.60 ± 0.23 °C). True cooling improved performance in the six minute walk test and the timed up-and-go test but not visual acuity or hand grip strength. Head and neck cooling may be an effective tool in increasing ambulatory capacity in individuals with MS and heat sensitivity.

Bone metabolism in healthy ambulatory control premonopausal women and in epileptics on anti-convulsant drugs

Long term anti-epileptic drug use causes multiple abnormalities in calcium and bone metabolism that have been documented in both institutionalised and ambulatory patients. To assess bone metabolism in ambulatory females of reproductive age, on antiepileptic drugs. Cross sectional comparative study. Ambulatory females in reproductive age group with epilepsy and on regular follow up were compared to healthy females of similar ages not on any treatment. The mean duration of treatment for epilepsy was eight years (+/- 6.3). Majority of the patients were on enzyme inducing drugs like phenobarbital, phenytoin, carbamazepine and valproate, either alone or in combination with non-enzyme inducers like lamotrigine (98.2%). There was a significantly lower mean serum calcium and a higher alkaline phosphatase level among the patients (P = 0.002 and 0.0001 respectively) than among the comparators. The urinary marker of bone loss (mean urine calcium excretion) was also significantly raised among the patients (P=0.003). The mean lumbar BMDT-score results were not significantly different in the two groups. Long-term anti-epileptic drug use significantly affects biochemical parameters of bone metabolism. These effects on bone biochemistry markers were not reflected in lumbar spine BMD in this study.

SMALL INTESTINAL SUBMUCOSA BLADDER NECK SLINGS FOR INCONTINENCE ASSOCIATED WITH NEUROPATHIC BLADDER

We assess the results using small intestinal submucosa (SIS) for neuropathic urinary incontinence in a large single institutional experience. Ambulatory status was considered as a possible predictor of success. We retrospectively reviewed the charts of patients treated with SIS bladder neck sling procedures for neuropathic urinary incontinence with a leak point pressure less than 25 cm H2O and a minimum of 6 months followup. Continence was defined as wet (requiring pads or diapers) or dry (requiring no pads and dry underwear). Patients were classified as ambulatory (able to ambulate without assistance or using braces, crawling at home) or nonambulatory (confined to a wheelchair). Results were analyzed with regard to patient sex, ambulatory status and simultaneous bladder neck repair. A total of 21 females and 15 males 3 to 10 years old (mean age 9 years) were treated with SIS bladder neck slings (sling alone 27, bladder neck repair with SIS sling 9). Slings were performed along with reconstructive surgery in all cases (all had creation of urinary catheterizable channels and simultaneous or prior bladder augmentations). Minimum followup was 6 months (mean 15, range 6 to 42). Overall, 27 of the 36 patients (75%) are dry following bladder neck sling. In patients treated with the sling procedure alone 6 of 8 (75%) nonambulatory females and 8 of 10 (80%) ambulatory females were continent, and 3 of 4 (75%) nonambulatory males and 2 of 5 (40%) ambulatory males were dry. SIS has equivalent rates of continence compared to series using rectus fascia in patients with neuropathic urinary incontinence. The ambulatory status of males should be considered when determining which treatment option is best for the patient with myelodysplasia and neuropathic sphincteric incontinence, as in our series ambulatory males undergoing sling placement alone had a poor outcome.

Domestic violence in the emergency department: How do women prefer to disclose and discuss the issues?

The purpose of this study was to survey women presenting to the emergency department (ED) and determine from them how best to identify and discuss issues of domestic violence (DV). An anonymous 10-question survey was given to ambulatory females presenting to the ED. It was conducted at two affiliated university hospital EDs, one an urban trauma center (ED 1) and the other an ED in an affluent suburban setting (ED 2). Two hundred fortythree women responded (73% response), 153 (63%) from ED 1 and 90 (37%) from ED 2. There were 21 women (9%) currently being abused, and 109 (45%) were past victims. Of all victims, 40 (36%) would only divulge DV if asked directly, 28 (25%) would volunteer this information without being asked, and 12 (11%) would not report DV even if asked. Of women who would reveal DV only if asked directly, 52 (45%) felt very comfortable disclosing this to an ED physician, although only 27 (24%) would reveal DV at a triage encounter. Of past or current victims, 43 (39%) would not disclose DV if they knew that ED personnel were required to report it. In conclusion, the ED is an appropriate setting to discuss DV issues. A significant percentage of women will disclose DV only if asked directly about it. Many victims of DV feel very comfortable discussing DV with ED physicians and nurses, although they may be less likely to reveal DV incidents at a triage encounter. Mandatory reporting laws may be an impediment to identifying cases of abuse.

Management of Rett syndrome: a ten year experience.

Over the past 10 years (1983-1993) multidisciplinary team at the Child Development and Rehabilitation Center has diagnosed and evaluated 60 females with Rett syndrome aged 13 months to 43 years. Experience with comprehensive management is discussed with focus on feeding difficulties, communication needs, hand function, scoliosis, and deformities. Clinical and radiological assessment of feeding problems is important in deciding whether therapy will allay symptoms or a gastrostomy is indicated. Hand use can be facilitated with appropriate intervention, and a coordinated effort with a communication specialist can develop systems for environmental access. Aggressive physical therapy has been very effective in preventing progression of scoliosis and avoiding surgery. Asymmetrical function is commonly recognized in ambulatory females, and is of neurogenic origin. Psychosocial support and educational plan attempts to collaborate with community services and resources.

Relation between Body Size and Bone Mineral Density with special reference to Sex Hormones and Calcium Regulating Hormones in Elderly Females.

We studied the relation between body size and bone mineral density in elderly females. The study included a total of 93 ambulatory females aged over 60 years. They were divided into 3 groups according to their body mass index (BMI; kg/m2): slender group with BMI less than 20 (n = 28), normal group with BMI of 20 to 24.9 (n = 43) and obese group with BMI greater than or equal to 25 (n = 22). Fracture incidence, bone mineral density, calcium regulating hormones and steroid hormones were studied in an intergroup comparative manner. The incidence of vertebral fracture was found to be negatively correlated with BMI (the incidences of vertebral fracture in slender, normal and obese were 78.6, 48.8 and 22.7%, respectively) and bone mineral density was also BMI-related (0.390 +/- 0.016, 0.456 +/- 0.015 and 0.493 +/- 0.018 g/cm2, respectively: p less than 0.01 in ANOVA; mean +/- SE). The number of years after menopause was shorter in patients with a higher BMI. There was no intergroup difference in serum levels of PTH, vitamin D and estrogens. On the other hand, serum levels of calcitonin, DHEA, DHEAS, delta-4 androstenedione and testosterone were found to be higher in subjects with a higher BMI. From the present results, it seems that bone mineral density is supported not only by weight-bearing stress upon bone, but also by serum levels of calcitonin and androgens in obese females.

Prediction of creatinine clearance from serum creatinine in spinal cord injury patients.

Measured endogenous creatinine clearance (Ccr) was compared with the predicted Ccr in 22 paraplegic, 36 tetraplegic and 11 ambulatory male individuals as well as 11 ambulatory females all of whom had normal renal function. While the predicted and measured values closely matched in the ambulatory patients the predicted values in the spinal cord injured patients consistently exceeded the measured values. It thus appears that the original Cockcroft and Gault formula; (formula; see text) when applied to SCI patients can be misleading. Modification of the original formula using a correction factor of 0.8 in paraplegics and 0.6 in tetraplegics was found to allow prediction of Ccr from age, sex, body weight, and serum creatinine in these patients with reasonable accuracy.

The myth of the clean catch urine specimen

Urine specimens obtained from unprepped ambulatory females who voided into an unsterile disposable plastic cup showed a 95-per cent correlation with a catheterized specimen collected from a prepped patient through a sterile cystoscope. From these data, it appears that the midstream urine specimen and its unpleasant collection routine can be eliminated. We have found that specimens collected at anytime during voiding in unsterile disposable plastic cups result in reliable urine cultures.

The effects of an environmental "enrichment" program on the behavior of institutionalized profoundly retarded children.

This study determined the effects of procedures designed to "enrich" the physical and social environment of an institutional ward on the "adaptive" and "maladaptive" child, adult, self, and object-directed behaviors of five profoundly retarded ambulatory females. Behavior observed in two treatment conditions, an environment "enriched" with toys and objects and an "enriched" environment coupled with differential reinforcement of adaptive behavior, was compared to behavior occurring in corresponding baseline or "austere" conditions and during a period of noncontingent reinforcement. The results generally revealed: (1) little change in adaptive and maladaptive child and adult-directed behavior across conditions, (2) an overall higher incidence of adaptive object-directed behavior and reduced self-directed maladaptive behavior in each treatment condition from that observed in corresponding control conditions, and (3) the use of an "enriched" environment and differential reinforcement of adaptive behavior resulted in maladaptive self-directed behavior being reduced and adaptive object-directed behavior being icreased beyond that observed in the "enriched" environment alone. These behavioral gains were largely maintained during a follow-up condition by continuing the "enriched" environment and transferring the responsibility for differential reinforcement to direct-care staff.

RADIOIMMUNOASSAY OF PLASMA TESTOSTERONE

SUMMARYA radioimmunoassay for the determination of testosterone in human plasma is described. After extraction from plasma, testosterone is separated by paper chromatography. The radioimmunoassay is performed using an antiserum to testosterone‐3‐oxime‐rabbit serum albumin and a saturated solution of ammonium sulphate is used for separation. The reliability criteria of the method in terms of precision, accuracy, sensitivity and specificity have been evaluated.The mean level of testosterone in plasma samples from nineteen normal men (age range 16–73 years) is 527±226 (±SD) ng/100 ml. In ten normal ambulatory females (in the second phase of the cycle) aged 19–35 years the mean plasma testosterone is 27±8±10±6 (±SD) ng/100 ml. In twenty‐four impotent men (aged 18–50) the testosterone level is 431±191 (mean±SD) ng/100 ml. These values are not significantly different from normal subjects.Lastly, the testosterone levels found in a few cases of male hypogonadism are reported.

HUMAN GROWTH HORMONE LEVELS IN NORMAL SUBJECTS RECEIVING AN ORAL CONTRACEPTIVE

Human growth hormone (HGH) levels were measured by a double antibody radioimmunoassay of plasma from women in both the fasting state, and after insulin-induced hypoglycemia. The tests were performed on 26 normal, ambulatory females'at rest, as a control, and also during the third treatment cycle with a combination-type oral contraceptive. It was found that the oral contraceptive elev[ill] the HGH levels. This would appear to be the mec[ill]m by which oral contraceptives alter carbohydrate metabolism.

Human Growth Hormone Levels in Normal Subjects Receiving an Oral Contraceptive

Human growth hormone (HGH) levels were measured by a double antibody radioimmunoassay of plasma from women in both the fasting state, and after insulin-induced hypoglycemia. The tests were performed on 26 normal, ambulatory females'at rest, as a control, and also during the third treatment cycle with a combination-type oral contraceptive. It was found that the oral contraceptive elev[ill] the HGH levels. This would appear to be the mec[ill]m by which oral contraceptives alter carbohydrate metabolism.