Pressure Symptoms Research Articles

Hereditary Multiple Exostoses: A Case Report

Background: Hereditary Multiple Exostoses (HME) is a rare bone disease, usually associated with deformity and pressure symptoms. It is an autosomal dominant disorder characterized by the development of benign tumors growing outward from the metaphyses of long bones and can lead to considerable psychosocial problems. Thus, We report a rare case of HME with some peculiar features, in a 16- year-old Moroccan pupil, manifested with a six year history of multiple swellings on the trunk, the pelvic and scapular belt, and both upper and lower limbs, with no sign of malignancy or pressure symptoms. The patient had also a family history of similar swellings. Radiological findings showed the presence of multiple exostoses in these localisations. Biopsy of one of the lesions confirmed the presence of osteochondroma on histopathology. Though rare, HME do occur in our environment. The treatment is individualized, with small asymptomatic or minimally symptomatic lesions followed up and only supportive care provided. Larger symptomatic lesions may cause major physical handicap and may be resected.

Thyroid functional autonomy — sclerotherapy and radioactive iodine therapy: case report

Thyroid functional autonomy (TFA) is the most frequent reasons of subclinical or manifest thyrotoxicosis. Diagnosis of the causes of thyrotoxicosis (destruction or increased functional activity of the thyroid tissue in nodular and diffuse thyroid pathology) is a key point in determining the management of patients with this pathology. Scintigraphy is the method of choice in differential diagnosis of the causes of thyrotoxicosis assessing the functional state of the thyroid gland. Thyroid scintigraphy can be performed using 99mTc-pertechnetate. After normalization of the level of thyroid hormones is confirmed, radical treatment is recommended. It could be surgery or radioactive iodine therapy (RAI). In some cases, especially in the elderly women, TFA is combined with thyroid nodules (TN), which can cause pressure symptoms, cosmetic complaints, and thyroid dysfunction. Minimally invasive treatments, such as percutaneous ethanol injection (PEI) sclerotherapy, has been proposed, especially for pressure symptoms and cosmetic complaints, as an alternative to surgery. The presented clinical case will demonstrate the possibility of use sclerotherapy and RAI for the successful treatment of TFA with TN.

Cervical Fibroids: A Surgical Challenge

ABSTRACT Leiomyomas are the most common benign tumors affecting the female reproductive tract and constitute around 18–20% of all the uterine pathologies that are seen in women of reproductive age group. Based on their location in the uterus, fibroids can be uterine, cervical, and ligamentary, of which the cervical fibroids are the rarest and make up only around 2–2.5% of the total incidence of fibroids. Large cervical fibroids generally give a typical appearance of “Lantern on St. Paul’s dome,” where the small size uterus sits on top of the cervical fibroid mimicking the lantern on the dome of the famous St. Paul’s Cathedral of Russia. We report here a case series of cervical fibroids who reported to the gynecology OPD of our institute. The first patient was a 41-year-old lady who presented with complaints of heavy menstrual bleeding for the last 2 years. Clinical findings as well as imaging confirmed a 24-week size large cervical fibroid along with surprise element in form of double ureters on right side on intravenous urogram(IVU). Our second patient was a peri-menopausal lady with heavy menstrual bleeding(HMB)for 2 months and cervical fibroid of 16-week size gravid uterus on examination. The third patient was a 37-year-old lady with heavy menstrual bleeding with pressure symptoms in the form of retention of urine. Clinically, a 16-week size cervical fibroid was present which after surgery revealed STUMP on histopathology. All patients were managed surgically with uneventful postoperative recovery.

Association between academic pressure, NR3C1 gene methylation, and anxiety symptoms among Chinese adolescents: a nested case-control study

BackgroundAcademic pressure is a prevalent stressor among Chinese adolescents and is often linked to anxiety symptoms, although the underlying mechanism remains unclear. This study aimed to investigate the association between NR3C1 gene methylation, academic pressure, and anxiety symptoms among Chinese adolescents.MethodsThis nested-case control study included 150 adolescents (boys: 38.7%; baseline age: 12–17 years) from a school-based longitudinal study of Chinese adolescents. Cases (n = 50) were defined as those with anxiety symptoms at both baseline and follow-up, while controls (n = 100) were randomly selected from those without anxiety symptoms at both timepoints. The cases and controls were 1:2 matched by age. Academic pressure, anxiety symptoms, and potential covariates were measured using a self-report questionnaire. Peripheral whole blood samples were collected from each participant for the detection of cortisol level (i.e., morning serum cortisol level) and DNA methylation. The methylation analysis included a total of 27 CpG units at the NR3C1 promoter region.ResultsThe final adjusted models showed that students with heavy academic pressure at baseline were at a higher risk of anxiety symptoms at follow-up compared to those with mild academic pressure (β estimate: 6.24 [95% CI: 3.48 ~ 9.01]). After adjusting for covariates, the methylation level of one CpG unit (NR3C1-16 CpG10) in NR3C1 differed significantly between cases and controls (F = 6.188, P = 0.014), and the difference remained significant after correction for multiple testing (P < 0.025). The adjusted regression models showed that moderate (β estimate = 0.010 [95% CI: 0.000 ~ 0.020], P = 0.046) and heavy (β estimate = 0.011 [95% CI: 0.001 ~ 0.020], P = 0.030) academic pressure were significantly associated with the methylation level of NR3C1-16 CpG 10. Further mediation analysis demonstrated that the association of academic pressure and anxiety symptoms was significantly mediated by the methylation of NR3C1-16 CpG 10 (β estimate for indirect effect = 0.11 [95% CI: 0.005 ~ 0.32]; indirect/total effect = 8.3%).ConclusionThe present study suggests that NR3C1-16 CpG 10 DNA methylation might be a potential mechanism that partially explains the lasting effects of academic pressure on subsequent anxiety symptoms among adolescents. Further studies with larger sample sizes are recommended to replicate this finding.

Infarto de la arteria cerebral posterior secundario a oclusión aguda de la arteria carótida interna

Bases: los principales síntomas del compromiso de la arteria carótida interna son la amaurosis fugax y aquellos que se deben a un compromiso de las arterias cerebral media y anterior.&#x0D; Métodos: se trata de un hombre de 79 años diabético e hipertenso que se presentó con un cuadro que sugería un compromiso de la arteria cerebral media izquierda. Se documentó una obstrucción aguda de la arteria carótida interna izquierda, con infartos del territorio de la arteria coroidea anterior y la cerebral posterior del mismo lado; en el estudio se halló una fuente cardioembólica.&#x0D; Conclusión: si bien la obstrucción aguda de la arteria carótida interna se asocia sobre todo a síntomas visuales y de compromiso de la circulación anterior, se puede relacionar también con infartos de la arteria cerebral posterior.

ABCDEG Stress Echocardiography in Aortic Stenosis.

Rest and stress echocardiography (SE) plays a pivotal role in the evaluation of valvular heart disease. The use of SE is recommended in valvular heart disease when there is a mismatch between resting transthoracic echocardiography findings and symptoms. In aortic stenosis (AS), rest echocardiographic analysis is a stepwise approach that begins with the evaluation of aortic valve morphology and proceeds to the measurement of the transvalvular aortic gradient and aortic valve area (AVA) using continuity equations or planimetry. The presence of the following three criteria suggests severe AS: AVA < 1.0 cm2, a peak velocity > 4.0 m/s, or a mean gradient > 40 mmHg. However, in approximately one in three cases, we can observe a discordant AVA < 1 cm2 with a peak velocity < 4.0 m/s or a mean gradient <40 mmHg. This is due to reduced transvalvular flow associated with LV systolic dysfunction (LVEF < 50%) defined as "classical" low-flow low-gradient (LFLG) AS or normal LVEF "paradoxical" LFLG AS. SE has an established role in evaluating LV contractile reserve (CR) patients with reduced LVEF. In classical LFLG AS, LV CR distinguished pseudo-severe AS from truly severe AS. Some observational data suggest that long-term prognosis in asymptomatic severe AS may not be as favorable as previously thought, offering a window of opportunity for intervention prior to the onset of symptoms. Therefore, guidelines recommend evaluating asymptomatic AS with exercise stress in physically active patients, particularly those younger than 70 years, and symptomatic classical LFLG severe AS with low-dose dobutamine SE. A comprehensive SE assessment includes evaluating valve function (gradients), the global systolic function of the LV, and pulmonary congestion. This assessment integrates considerations of blood pressure response, chronotropic reserve, and symptoms. StressEcho 2030 is a prospective, large-scale study that employs a comprehensive protocol (ABCDEG) to analyze the clinical and echocardiographic phenotypes of AS, capturing various vulnerability sources which support stress echo-driven treatment strategies.

Hurthle cell carcinoma: a rare variant of thyroid malignancy - a case report.

The authors present a case of a 49-year-old female with a known case of chronic obstructive pulmonary disease and hypertension who presented to our hospital with anterior neck swelling for 4 months that has gradually increased over the time. Physical examination, laboratory test, various radiological imaging, and cytological study led to the diagnosis of Hurthle cell neoplasm. With prompt diagnosis, she was admitted and surgery was done that include right hemithyroidectomy. Though it is a rare type of thyroid malignancy, early diagnosis and proper treatment has shown a very good prognosis. Hurthle cell carcinoma initially presents with a single, painless palpable mass in the thyroid with pressure symptoms in advanced cases including dysphagia, dyspnea, and hoarseness. Pain, rapid growth, or significant compressive symptoms are suggestive of an invasive one. This case highlights on rarity of disease, presentation, and availability of treatment modality.

Digestive, anorectal, and urogenital functions in patients with type 2 diabetes mellitus, impaired glucose tolerance and normal glucose tolerance: Association with autonomic neuropathy.

Gastrointestinal disorders including constipation and fecal incontinence are common in type 2 diabetes and may derive from diabetic autonomous neuropathy, severe intestinal bacterial overgrowth, or a dysfunctional anorectal sphincter. The present study aims to characterize the correlation between these conditions. Patients with type 2 diabetes, prediabetes and normal glucose tolerance were included. Anorectal function was assessed with high-resolution anorectal manometry. Patients were screened for autonomous neuropathy by measuring olfactory, sweat, and erectile dysfunction as well as heart rate variability. Constipation and fecal (in-)continence were evaluated using validated questionnaires. Breath tests were used to assess severe intestinal bacterial overgrowth. We included 59 participants (32 (54.2%) type 2 diabetes, 9 (15.3%) prediabetes and 18 (30.5%) normal glucose tolerance). Presence of autonomous neuropathy, severe bacterial overgrowth and symptoms of constipation and incontinence was comparable. HbA1c was correlated with an increased anorectal resting sphincter pressure (r = 0.31, P = 0.019) and constipation symptoms (r = 0.30, P = 0.031). In patients with long- standing diagnosis of type 2 diabetes significantly higher values for maximum anorectal resting pressure (∆ = +27.81 ± 7.84 mmHg, P = 0.0015) and baseline pressure (∆ = 20.50 ± 9.74 mmHg, P = 0.046) were found compared with normal glucose tolerance, but not with prediabetes. Long-standing type 2 diabetes increases anorectal sphincter activity, and constipation symptoms are associated with higher HbA1c levels. The lack of an association of symptoms with autonomous neuropathy suggests glucotoxicity as the primary mechanism.

Endoscopic third ventriculostomy for the management of children with cerebrospinal fluid disorders, ventriculomegaly, and associated Chiari I malformation

Objectives: Our objective was to review the outcomes of children with CIM and associated cerebrospinal fluid (CSF) disorders and ventriculomegaly undergoing endoscopic third ventriculostomy (ETV) as a primary intervention.Materials and methods: A retrospective, single-center, observational cohort study was conducted of consecutive children with CIM with associated CSF disorders and ventriculomegaly treated first by ETV between January 2014 and December 2020.Results: Raised intracranial pressure symptoms were the most frequent in ten patients, followed by posterior fossa and syrinx symptoms in three cases. One patient had a later stoma closure and required a shunt insertion. The success rate of the ETV in the cohort was 92% (11/12). There was no surgical mortality in our series. No other complications were reported. The median herniation of the tonsils was not statistically different in the pre vs. post-operative MRI (1.14 vs. 0.94, p=0.1). However, the median Evan’s index (0.4 vs. 0.36, p<0.01) and the median diameter of the third ventricle (1.35 vs. 0.76, p<0.01) were statistically different between the two measurements. The preoperative length of the syrinx did not change significantly compared with the postoperative (5 vs. 1; p=0.052); nevertheless, the median transverse diameter of the syrinx did improve significantly after the surgery (0.75 vs. 0.32, p=0.03).Conclusions: Our study supports ETV's safety and effectiveness for managing children with CSF disorders, ventriculomegaly, and associated CIM

Endoscopic Fenestration of an Intra-ventricular Arachnoid Cyst in a Young Male – A Rare Entity

Introduction: Among intracranial space-occupying lesions, arachnoid cysts compromise 1% only. Abnormal collection of cerebrospinal fluid occurs in these types of cysts leading to pressure symptoms. Developmental abnormalities of cerebrospinal structures in early fetal life lead to the primary type of arachnoid cysts, while the second type of arachnoid cyst is formed after some neurological insult like head injury, tumor, meningitis, or brain surgery. In 60 – 90% of cases, the primary type predominates and presents with pressure symptoms before the age of 20 years. The adjudged incidence is 1.4% in adults, the least frequent being intraventricular location. Clinical Case: A 23-year-old male presented with a long-standing left-sided cranial vault headache, right-sided focal seizures, and progressive right- hemiparesis. Neurological evaluation revealed upper motor neuron signs on the right side of the body. A computerized axial tomography raised the suspicion of an arachnoid cyst for which magnetic resonance imaging was done which revealed a large intraventricular cyst of lateral ventricles causing mass effect over the ipsilateral hemisphere and mild obstructive hydrocephalous. Surgical intervention was required as per symptomology (intractable headache, seizures, and hemiparesis) and large cyst size. Conclusion: Cerebrospinal fluid accumulation in the brain's arachnoid layer causes non-cancerous arachnoid cysts. Larger cysts may push on brain tissue and cause neurological difficulties. MRI may diagnose arachnoid cysts, and treatment options include cystoperitoneal shunt, craniotomy, and neuro-endoscopic fenestration, the least invasive. Cyst size and location determine therapy. In this example, endoscopic treatment reduced symptoms and consequences.

Primary bilateral macronodular adrenocortical hyperplasia (PBMAH) patient with ARMC5 mutations

BackgroundPrimary bilateral macronodular adrenocortical hyperplasia (PBMAH) is a highly heterogeneous disease with divergent manifestations ranging from asymptomatic subclinical Cushing syndrome (CS) to overt Cushing syndrome with severe complications. ARMC5 mutations occur in 20 to 55% PBMAH patients usually with more severe phenotypes. Different ARMC5 mutations might be associated with diverse phenotypes of PBMAH.Case presentationA 39-year-old man was admitted to our hospital with progressive weight gain and severe hypertension. He presented typical CS and its classical metabolic and bone complications like hypertension and osteoporosis. The laboratory results showed high levels of cortisol and low levels of ACTH. Low- and high-dosed dexamethasone suppression tests were negative. Contrast-enhanced computed tomography (CT) revealed multiple bilateral irregular macronodular adrenal masses. Adrenal venous sampling (AVS) confirmed that the right adrenal gland with larger nodules secreted more hormone that the left side did. Right adrenalectomy and subsequent contralateral subtotal resection were conducted. His blood pressure and CS symptoms as well as comorbidities including backache and muscle weakness improved. Whole exome sequencing identified one ARMC5 germline mutation (c.1855C > T, p. R619*), five ARMC5 somatic mutations (four novel mutations) in his right and left adrenal nodules.ConclusionsThis PBMAH patient was identified with one ARMC5 germline mutation and five different somatic ARMC5 mutations (four novel mutations) in the different nodules of the bilateral adrenal masses. AVS combined with CT imagine could be helpful to determine the dominant side for adrenalectomy. Genetic testing is important for the diagnosis and management of the patient with PBMAH.

Comparison of the pre-dilution and post-dilution methods for online hemodiafiltration.

Online hemodiafiltration (OL-HDF) is a treatment modality using diffusion and ultrafiltration. There are two types of dilution methods in OL-HDF: pre-dilution, which is commonly provided in Japan, and post-dilution, which is commonly provided in Europe. The optimal OL-HDF method for individual patients is not well studied. In this study, we compared the clinical symptoms, laboratory data, spent dialysate, and adverse events of pre- and post-dilution OL-HDF. We conducted a prospective study of 20 patients who underwent OL-HDF between January 1, 2019 and October 30, 2019. Their clinical symptoms and dialysis efficacy were evaluated. All patients underwent OL-HDF every 3months in the following sequence: first pre-dilution, post-dilution, and second pre-dilution. We evaluated 18 patients for the clinical study and 6 for the spent dialysate study. No significant differences in spent dialysates regarding small and large solutes, blood pressure, recovery time, and clinical symptoms were observed between the pre- and post-dilution methods. However, the serum α1-microglobulin level in post-dilution OL-HDF was lower than that in pre-dilution OL-HDF (first pre-dilution: 124.8 ± 14.3mg/L; post-dilution: 116.6 ± 13.9mg/L; second pre-dilution: 125.8 ± 13.0mg/L; first pre-dilution vs. post-dilution, post-dilution vs. second pre-dilution, and first pre-dilution vs. second pre-dilution: p = 0.001, p < 0.001, and p = 1.000, respectively). The most common adverse event was an increase in transmembrane pressure in the post-dilution period. Compared to pre-dilution, the post-dilution method decreased the α1-microglobulin level; however, there were no significant differences in clinical symptoms or laboratory data.

Diagnosis and Management of Pineal Germinoma: From Eye to Brain.

Pineal germinomas can be very complex in terms of presentation, diagnosis, and management. This review attempts to simplify this complexity in an organized manner, addressing the anatomic relationships that provide the basis for the uniqueness of pineal germinoma. Ocular findings and signs and symptoms of elevated intracranial pressure are the keys to suspecting the diagnosis and obtaining the necessary imaging and cerebrospinal fluid studies. Other symptoms can suggest spread beyond the pineal region. Surgery may only be needed to obtain tissue for a definitive diagnosis, as germinoma is highly responsive to chemotherapy and focused radiation therapy. Hydrocephalus, usually related to tumor obstruction of the cerebral aqueduct, may also need to be addressed. Outcome for pineal germinoma is usually excellent, but relapse can occur and may require additional intervention. These issues are detailed in this review.

MP74-19 THE PREOPERATIVE DYSLIPIDEMIA AND HIGH OVERACTIVE BLADDER SYMPTOM SCORE PREDICT DE NOVO OVERACTIVE BLADDER AFTER ROBOT-ASSISTED RADICAL PROSTATECTOMY

You have accessJournal of UrologyCME1 Apr 2023MP74-19 THE PREOPERATIVE DYSLIPIDEMIA AND HIGH OVERACTIVE BLADDER SYMPTOM SCORE PREDICT DE NOVO OVERACTIVE BLADDER AFTER ROBOT-ASSISTED RADICAL PROSTATECTOMY Hitomi Imai, Hidenori Akaihata, Yuki Harigane, Kei Yaginuma, Yu Endo, Yuki Yoshida, Yuta Matsuoka, Akifumi Onagi, Kanako Matsuoka, Seiji Hoshi, Tomoyuki Koguchi, Junya Hata, Yuichi Sato, Masao Kataoka, and Yoshiyuki Kojima Hitomi ImaiHitomi Imai More articles by this author , Hidenori AkaihataHidenori Akaihata More articles by this author , Yuki HariganeYuki Harigane More articles by this author , Kei YaginumaKei Yaginuma More articles by this author , Yu EndoYu Endo More articles by this author , Yuki YoshidaYuki Yoshida More articles by this author , Yuta MatsuokaYuta Matsuoka More articles by this author , Akifumi OnagiAkifumi Onagi More articles by this author , Kanako MatsuokaKanako Matsuoka More articles by this author , Seiji HoshiSeiji Hoshi More articles by this author , Tomoyuki KoguchiTomoyuki Koguchi More articles by this author , Junya HataJunya Hata More articles by this author , Yuichi SatoYuichi Sato More articles by this author , Masao KataokaMasao Kataoka More articles by this author , and Yoshiyuki KojimaYoshiyuki Kojima More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003348.19AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Some patients have de novo overactive bladder (de novo OAB) after robot-assisted radical prostatectomy (RARP). It is possible that the preoperative characteristics of the patient contribute to onset of de novo OAB after RARP. The aim of this study is to determine whether the preoperative characteristics of the patients affect the de novo OAB after RARP. METHODS: Patients without OAB who underwent RARP for localized prostate cancer at our hospital between February 2013 and October 2020 were included in this study. At 12 months after RARP, these patients were divided into the OAB-free group and de novo OAB group according to absence or presence of OAB. The preoperative age, blood pressure, obesity (BMI≥25 kg/m2), dyslipidemia (LDL-C/HDL-C ratio ≥2.5), HbA1c, uroflowmetry parameter, prostate volume (PV) and overactive bladder symptom score (OABSS) were compared between the OAB-free group and de novo OAB group. RESULTS: A total of 404 patients (67.0±5.3 years) entered the study (OAB-free group: 338 patients, de novo OAB group: 66 patients). The percentage of patients with dyslipidemia was significantly higher in the de novo OAB group than in the OAB-free group (OAB-free group vs de novo OAB group: 32.0% vs 45.5%, p=0.04). The total OABSS was significantly higher in the de novo OAB group than in the OAB-free group (OAB-free group vs de novo OAB group: 2.1±1.4 points vs 3.2±1.6 points, p<0.01). The other preoperative characteristics of the patients were not significant differences between two groups. CONCLUSIONS: We demonstrated that preoperative dyslipidemia, which was defined as LDL-C/HDL-C ratio ≥2.5 in this study, and high OABSS contributed to de novo OAB after RARP. Recent studies have demonstrated that dyslipidemia contributes to the lower urinary tract dysfunction. Several studies have also reported that elevated LDL-C/HDL-C ratio is associated with progression of atherosclerosis1). The atherosclerosis is well known to cause OAB by chronic bladder ischemia. The preoperative elevated LDL-C/HDL-C ratio may cause de novo OAB after RARP through chronic bladder ischemia. The patients with preoperative high OABSS might have bladder instability although they were not diagnosed as OAB. The bladder instability might become worse after RARP, resulting in de novo OAB. The preoperative dyslipidemia and high OABSS may be useful marker of de novo OAB after RARP. Source of Funding: 1) Noike H, et al: Relationships between intravascular ultrasonographic findings and coronary risk factors in patients with normal coronary angiography. J Cardiol. 2005;45:1-10 © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1078 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Hitomi Imai More articles by this author Hidenori Akaihata More articles by this author Yuki Harigane More articles by this author Kei Yaginuma More articles by this author Yu Endo More articles by this author Yuki Yoshida More articles by this author Yuta Matsuoka More articles by this author Akifumi Onagi More articles by this author Kanako Matsuoka More articles by this author Seiji Hoshi More articles by this author Tomoyuki Koguchi More articles by this author Junya Hata More articles by this author Yuichi Sato More articles by this author Masao Kataoka More articles by this author Yoshiyuki Kojima More articles by this author Expand All Advertisement PDF downloadLoading ...

Clinico-pathological features and surgical management of multinodular goitre

Background: Enlargement of thyroid gland is the most common manifestation of thyroid disease. Most of the patients come from endemic zones. This study was designed to study various aspects of clinicopathological presentations of multinodular goitre and their optimal surgical management. Methods: This was a prospective observational study of 50 cases of multinodular goitre with an adequate follow up to look for epidemiological parameters such as clinical presentation, pathological behaviour and modality of management including post operative complications over a period of 02 years. Results: Females were predominant in number over males with a sex ratio 24:1. FNAC was done for all patients and was found to be 100% accurate. Majority of the patients were treated with total thyroidectomy (56%), followed by hemithyroidectomy (44%). Complications included wound infection (4%) and seroma formation (4%). Conclusions: Multi nodular goitre is more common in females and majority are in the age group of 31-39 years. The chief complaint in majority of the patients is swelling in front of the neck and few patients with pressure symptoms. FNAC is an invaluable, minimally invasive, highly accurate and cost-effective procedure for preoperative diagnosis and management of multinodular goitre. The main indication for surgery in MNG is cosmetic problem and total thyroidectomy is the ideal treatment of MNG with minimal complications.

Assessment of bladder pressure and discomfort symptoms: How do overactive bladder differ from interstitial cystitis/bladder pain syndrome patients?

BackgroundTo better understand the sensation of bladder “pressure” and “discomfort”, and how they are similar or distinct from the “pain” and “urgency” symptoms in IC/BPS and OAB.MethodsIC/BPS and OAB patients rated their bladder pain, pressure, discomfort, and urinary urgency on separate 0–10 numeric rating scales (NRS). Their NRS ratings were compared between IC/BPS and OAB, and Pearson correlations were performed.ResultsAmong IC/BPS patients (n = 27), their mean numeric ratings of pain, pressure, discomfort, and urinary urgency were almost identical (6.6 ± 2.1, 6.0 ± 2.5, 6.5 ± 2.2, and 6.0 ± 2.8 respectively). The three-way correlations between pain, pressure, or discomfort were very strong (all > 0.77). Among OAB patients (n = 51), their mean numeric ratings of pain, pressure, and discomfort (2.0 ± 2.6, 3.4 ± 2.9, 3.4 ± 2.9) were significantly lower than urgency (6.1 ± 2.6, p < 0.001). The correlations between urgency and pain, and between urgency and pressure were weak in OAB (0.21 and 0.26). The correlation between urgency and discomfort was moderate in OAB (0.45). The most bothersome symptom of IC/BPS was bladder/pubic pain, while the most bothersome symptom of OAB was urinary urgency and daytime frequency.ConclusionsIC/BPS patients interpreted bladder pain, pressure, or discomfort as the similar concepts and rated their intensity similarly. It is unclear whether pressure or discomfort provide additional information beyond pain in IC/BPS. Discomfort may also be confused with urgency in OAB. We should re-examine the descriptors pressure or discomfort in the IC/BPS case definition.

Caregiver, secondary victim: outcome of caring for patients with COVID -19: a qualitative content analysis study

BackgroundConsidering the importance of caring for patients with COVID -19 at home and the majority of care being the responsibility of family caregivers, it is necessary to identify and assess the problems during the implementation of patient care in family caregivers. Therefore, the present study was conducted to discover the different consequences of caring for patients with COVID-19 in family caregivers.MethodUsing Purposive sampling, 15 female family caregivers were included in the study. This study was conducted between 2021 and 2022 in Iran. Unstructured face-to-face and virtual interviews were used to collect data until data saturation was reached. Data were analyzed through Granheim and Lundman conventional content analysis approach.ResultsThe analysis of data related to the outcome of caring for patients with COVID -19 in family caregivers, led to the extraction of six subcategories: " caregivers experiencing physical symptoms ", "perception of extra pressure and psychological symptoms in the caregiver", "disruption in marital relations", "feeling of homelessness and rejection" and " role pressure due to lack of family support". The subcategories led to the development of the main category "caregiver, the secondary victim", which is experienced by family caregivers during the provision of care for patients with COVID -19.ConclusionFamily caregivers experience high levels of negative consequences from providing care to patients with COVID-19. Therefore, more attention should be paid to all dimensions of caregiver health such as physical, mental, and marital to provide quality care to patients finally.

Treatment of thyroid nodules with radiofrequency ablation

Thyroid Adenomas is a very common cause of pressure symptoms, swallowing difficulties and cosmetic symptoms. However, the majority of thyroid adenomas are benign, and do not need treatment if they are asymptomatic. When treatment is required, the standard treatment in most centers is surgery, typically in the form of a lobectomy (removal of a thyroid lobe). In order to avoid the risks associated with surgery: bleeding, infection, recurrent laryngeal nerve damage and postoperative hypothyroidism [1] [2], radiofrequency ablation has been introduced as a minimally invasive treatment option. Radiofrequency ablation (or RFA) is a technique in which radiofrequency energy (an electric current) is used to generate heat that destroys the cells and causes the adenoma to shrink.

Neoprzewaquinone A Inhibits Breast Cancer Cell Migration and Promotes Smooth Muscle Relaxation by Targeting PIM1 to Block ROCK2/STAT3 Pathway

Salvia miltiorrhiza Bunge (Danshen) has been widely used to treat cancer and cardiovascular diseases in Chinese traditional medicine. Here, we found that Neoprzewaquinone A (NEO), an active component of S. miltiorrhiza, selectively inhibits PIM1. We showed that NEO potently inhibits PIM1 kinase at nanomolar concentrations and significantly suppresses the growth, migration, and Epithelial-Mesenchymal Transition (EMT) in the triple-negative breast cancer cell line, MDA-MB-231 in vitro. Molecular docking simulations revealed that NEO enters the PIM1 pocket, thereby triggering multiple interaction effects. Western blot analysis revealed that both NEO and SGI-1776 (a specific PIM1 inhibitor), inhibited ROCK2/STAT3 signaling in MDA-MB-231 cells, indicating that PIM1 kinase modulates cell migration and EMT via ROCK2 signaling. Recent studies indicated that ROCK2 plays a key role in smooth muscle contraction, and that ROCK2 inhibitors effectively control the symptoms of high intraocular pressure (IOP) in glaucoma patients. Here, we showed that NEO and SGI-1776 significantly reduce IOP in normal rabbits and relax pre-restrained thoracic aortic rings in rats. Taken together, our findings indicated that NEO inhibits TNBC cell migration and relaxes smooth muscles mainly by targeting PIM1 and inhibiting ROCK2/STAT3 signaling, and that PIM1 may be an effective target for IOP and other circulatory diseases.

Blood Pressure Variation and Complication of End Stage Renal Disease Patients Undergoing Hemodialysis in RSUP Sanglah Denpasar

ABSTRACT&#x0D; Introduction: Intradialytic hypertension and intradialytic hypotension in end-stage renal disease patients undergoing regular hemodialysis are the two factors that can increase the mortality risk associated with cardiovascular disease. Aim: To know the blood pressure variability, frequency of hypertension and hypotension intradialytic, also symptoms. Method: The research’s design is observational based on primary data through six times blood pressure observation and symptom observation. It’s also based on secondary data through medical records. There are 100 respondents who have met the inclusion and exclusion criteria. Results: The majority of respondents are male (62%), 51-50 years old (31%), with pre-dialytic and dry weight around 51-70 kg (61% and 60%), PNC as the etiology (56%), and mostly 1-5 years undergoing hemodialysis (44%). The variability has shown there’s a drop of blood pressure average from pre-hemodialysis to the fourth hour of hemodialysis by 11.03 mmHg, afterwards the blood pressure average increased on post-hemodialysis by 2.98 mmHg. According to statistics, the systolic blood pressure’s coefficient of variation is 16.6%, p&lt; 0.001, the maximum value is 148.57 mmHg, the minimum value is 137.54 mmHg. The frequency of intradialytic hypertension is 19% and intradialytic hypotension is 32%. Lastly, the most common symptom is muscle cramp (13%). Conclusion: There’s a significant difference among blood pressure during hemodialysis with coefficient of variation 16,6%. The frequency of intradialytic hypertension is 19% and hypotension intradialytic is 32%. And the most common symptom is muscle cramp (13%).&#x0D; Keywords: intradialytic hypertension, intradialytic hypotension, blood pressure variability