Efficacy and safety of desmopressin on frequency and urgency in female patients with overactive bladder and nocturia, current clinical features and outcomes: A systematic review

Objective To evaluate the efficacy and safety of desmopressin on frequency and urgency in female patients with overactive bladder(OAB)and nocturia.Methods A selective database search was conducted to validate the effectiveness of desmopressin in patients with OAB and nocturia.Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were utilised.The meta-analysis included 378 women(five studies)with OAB.The clinical outcomes and adverse events were analysed.Results The treatment strategy of all the studies included can be divided into three categories:(1)The effect of desmopressin compared with baseline,(2)desmopressin compared with placebo,and(3)desmopressin and anticholinergic combination versus desmopressin monotherapy.There was a significant(50%)reduction in nocturia and urgency episodes after using desmopressin alone.Combined desmopressin and anticholinergic led to a decrease in the frequency of nocturia voids when only using anticholinergic(65%vs.33.2%).The time increased in the middle to the first nightly voids in the combination arm(65.11 min;p=0.045).The mean incidence(standard deviation)of leak-free episodes was higher under desmopressin than under placebo in the first 4 h(62%[35%]vs.48%[40%])and in the first 8 h(55%[37%]vs.40%[41%]).The safety profile was comparable between treatments.Conclusion Available data indicate that desmopressin is efficacious in significantly reducing nighttime urine production,episodes of nocturia,and urgency episodes.The affectivity of the combination therapy was very high with least side effects for the treatment of OAB/nocturnal polyuria.

Just What Is Narrative Urgency?

This paper takes as its main point of departure a body of empirical research on reading and text processing,and makes particular reference to the type of experiments conducted in Egidi and Gerrig(2006)and Rapp and Gerrig(2006).Broadly put,these experiments(i)explore the psychology of readers’preferences for narrative outcomes,(ii)examine the way readers react to characters’goals and actions,and(iii)investigate how readers tend to identify with characters’goals the more‘urgently’those goals are narrated.The present paper signals how stylistics can productively enrich such experimental work.Stylistics,it is argued,is well equipped to deal with subtle and nuanced variations in textual patterns without losing sight of the broader cognitive and discoursal positioning of readers in relation to these patterns.Making particular reference to what might constitute narrative‘urgency’,the article develops a model which amalgamates different strands of contemporary research in narrative stylistics.This model advances and elaborates three key components:a Stylistic Profi le,a Burlesque Block and a Kuleshov Monitor.Developing analyses of,and informal informant tests on,examples of both fiction and film,the paper calls for a more rounded and sophisticated understanding of style in empirical research on subjects’responses to patterns in narrative.

A national survey of lower urinary tract symptoms in Jordan

Objective To determine the prevalence of lower urinary tract symptoms(LUTS)and their severity population in Jordan.Methods This cross-sectional survey was conducted using a paper-based survey between August and September in 2019.The study was carried out in the health care centers or hospitals in three different regions of Jordan:North(Irbid and Jarash),Middle(Amman,Madaba,Salt,and Zarqa),and South(Karak and Aqaba).Results To estimate the prevalence of LUTS,two definitions were used,including the first definition(presence of any LUTS regardless of the degree of severity)and the second definition(presence of any LUTS that occurs half the time or more).According to the first definition,1038(89.9%)reported LUTS(male:47.3%,female:52.7%),while 763(66.1%)reported LUTS according to the second definition(male:45.6%,female:54.4%).According to the International Prostate Symptom Score characterization,73.9%had nocturia and 62.9%reported daytime increased frequency.Conclusion LUTS are highly prevalent among the Jordanian population,and more than half of them have nocturia or daytime increased frequency as most frequently reported symptoms.

Is Ultrasound the Urologist’s Stethoscope in the Outpatient Clinic?

Ultrasound is a non-invasive diagnostic imaging modality that has become the urologist’s stethoscope in the outpatient clinic for diagnosis and monitoring of various urological pathologies. Objectives: Check if office ultrasound is beneficial in the outpatient clinic, helpful in the management, affected by the economic crisis, and determine in which condition it is sufficient. Materials and Methods: Between 2012 and 2022, one thousand files were prospectively collected randomly. Many objectives were chosen to evaluate the impact of the economic crisis on the use of ultrasound, identify the clinical conditions where ultrasound is beneficial, determine the conditions where ultrasound was sufficient, and determine if ultrasound findings were helpful for management. Results: The economic crisis did not impact the use of ultrasound, when the chief complaint was flank pain, 56.7% had positive findings. In 54%, ultrasound was helpful to avoid the need for further imaging, and in 93.5%, ultrasound was helpful in the management of patients. When the chief complaint was LUTS, 25.6% had positive findings while 82.9% did not require further imaging, in 78.6%, ultrasound was helpful in the management. In the case of hematuria, 60.7% had positive findings, 20% did not need further imaging, and 81% of ultrasounds were helpful in the management. When patients present with urgency 31% had positive findings, 93.7% did not require more imaging and 76% of ultrasounds were helpful in management. In the case of dysuria as the chief complaint, 35.8% had positive findings, 77.7% did not need more imaging, and helpful in the management of 62.8%. Conclusion: Ultrasound is a valuable cost-effective tool in the outpatient clinic urology clinic for diagnosing and monitoring. It is safe, painless, and can be repeated easily which makes it the precious Urologist’s stethoscope.

Stone accumulation overlying vaginal mesh exposure:A case report

BACKGROUND Vaginal stones are rare with current literature limited to case reports.Vaginal stones are classified as primary or secondary stones.Primary stones form in the vagina when there is urinary stasis.Secondary stones form in the presence of a vaginal foreign body that acts as a nidus for the deposition of urinary salts.Foreign bodies,such as surgical mesh,make vaginal stone formation more likely,particularly in patients with urinary incontinence and conditions that predispose them to urinary calculi formation.CASE SUMMARY A 71-year-old female with a history of sacrocolpopexy,hyperaldosteronism,and urgency urinary incontinence presented with vaginal stone accumulation overlying two areas of vaginal sacrocolpopexy mesh exposure.The vaginal stones were initially removed to permit examination,but the stones reaccumulated at the site of the exposed mesh,later requiring definitive surgical management.CONCLUSION Patients with vaginal mesh exposure and conditions that predispose them to kidney stones are not ideal candidates for expectant management of mesh exposure,particularly if they have coexisting urinary incontinence.These individuals should be counseled about possible vaginal stone accumulation,and surgical management should be considered.

Transplant benefit for patients with hepatocellular carcinoma

Although liver transplantation is theoretically the best treatment for hepatocellular carcinoma(HCC),it is limited by the realities of perioperative complications,and the shortage of donor organs.Furthermore,in many cases there are available alternative treatments such as resection or locoregional therapy.Deciding upon the best option for a patient with HCC is complicated,involving numerous ethical principles including:urgency,utility,intention-to-treat survival,transplant benefit,harm to candidates on waiting list,and harm to living donors.The potential contrast between different principles is particularly relevant for patients with HCC for several reasons:(1)HCC candidates to liver transplantation are increasing;(2)the great prognostic heterogeneity within the HCC population;(3)in HCC patients tumor progression before liver transplantation may significantly impair post transplant outcome;and(4)effective alternative therapies are often available for HCC candidates to liver transplantation.In this paper we suggest that allocating organs by transplant benefit could help balance these competing principles,and also introduce equity between patients with HCC and nonmalignant liver disease.We also propose a triangular equipoise model to help decide between deceased donor liver transplantation,living donor liver transplantation,or alternative therapies.

Clinical overview of hypertensive crisis in children

Hypertensive emergencies and hypertensive urgencies in children are uncommonly encountered in the pediatric emergency department and intensive care units, but the diseases are potentially a life-threatening medical emergency. In comparison with adults, hypertension in children is mostly asymptomatic and most have no history of hypertension. Additionally, measuring accurate blood pressure values in younger children is not easy. This article reviews current concepts in pediatric patients with severe hypertension.

Seeking Health Information Online:The Moderating Effects of Problematic Situations on User Intention

Purpose： This study investigates how online user intention in searching health information is affected by problematic situations.Design/methodology/approach： Based on the Theory of Reasoned Action, the Technology Acceptance Model, and Sense-making theory, we propose two dimensions of problematic situations： urgency and severity of health issues being searched online. Data were collected through a questionnaire survey among 214 Wuhan University students and analyzed using hierarchical regression analysis.Findings： Perceived usefulness, perceived ease of use, and subjective norm can influence user intention to seek health information online. The urgency of problematic situations has a negative moderating effect on the relationship between perceived ease of use and user intention and the relationship between subjective norm and user intention. The severity of problematic situations has a negative moderating effect on the relationship between subjective norm and user intention.Research limitations： The respondents of the survey are limited to students in one Chinese university, so whether this study＇s results can be applied to another population or not remains to be verified. In addition, only two dimensions of problematic situations are considered in this study. Practical implications： The paper puts forward the moderating effect of problematic situations and verifies it, which is the compensation for online health information-seeking behavior research. Besides, our analyses have implications for professional design of health care systems and related consumer information searches, and improve their performance. Originality/value： Previous work has reported the effects of problematic situation on user intention to seek health information online, ignoring its influence on other factors. This empirical study extends that work to identify the influence of problematic situation when seeking intention-behavior data in two dimensions, urgency and severity.

Early Morbidity and Perioperative Course of Neonates with Esophageal Atresia and Tracheoesophageal Fistula in a Tertiary Pediatric Surgical Center

Background: The management of infants (infs.) with esophageal atresia and tracheoesophageal fistula (EA ± TEF) is demanding and complex. The aim of this study was to evaluate early morbidity, the timing of surgery, and the results of surgery. Patients and Method: We collected data of 30 consecutive infs. treated for EA ± TEF between 2006 and 2014. Results: The median gestational age was 38 weeks (12 preterm), and the median Birth Weight (BW) was 2660 g (4 infs. had a BW 1500 g). The median Apgar score at 10 minutes was 10 (range 7 - 10). The median umbilical artery pH (UapH) was 7.30. According to the Spitz classification, 19 infs. were group 1, 9 infs. were group 2, and 2 infs. were group 3. Surgical repair was performed in 29 cases (25 EA;4 isolated TEF). Once the infs. arrived at the pediatric surgery department, surgery was postponed overnight in 11 cases. The duration of postoperative (p.o.) mechanical ventilation was significantly shorter for operations performed on day 2 after delivery. Twenty-four infs. (83%) underwent surgery within 2 days after delivery, and 5 infs. had later surgery. Chest drains (p.o.) for pneumothorax were inserted in 6 infs. (21%), and gastrostomy was performed in 6 cases (21%). No re-thoracotomy was required. The median length of hospital stay was 17.5 days (6 to 120). The incidence of p.o. mortality was 1 in 29 (3%). Discussion: The majority of the infs. presented growth retardation (indicated by low birth weight) and a stable immediate postnatal course. The data from this study support the concept of early but not emergent surgery for the majority of infs. with EA ± TEF. However, a remarkable rate of perioperative morbidity must be taken into account. Conclusion: Surgery for EA ± TEF can be performed safely during the first postnatal days with exception of very unstable preterm infants.

PRELIMINARY EXPLORATION OF DEVELOPMENT STRATEGY OF PUDONG IN SHANGHAI

The article, in a comprehensive view, explores the strategic vantages, strategic urgency, strategic goals, strategic planning as well as strategic steps.

Management of Venous Priapism: Experience of Sylvanus Olympio University Hospital in Lomé(TOGO)

Objective: To study the diagnostic, etiological, therapeutic and evolutionary aspects of patients received at the Sylvanus Olympio Hospital in Lomé for venous priapism. Patients and Methods: A cross sectional study, over 5 years (2012-2016), of 27 cases of low flow priapism treated at the Chu Sylvanus Olympio in Lomé. Results: The mean age of the patients was 28.14 years ± 8.6. The average time of consultation was 106 hours (04 days 10 hours) ± 208.02. In our study, 4 (14.81%) patients consulted before the 6th hour and 20 (74%) patients consulted after the 24th hour. The blood count required in all patients revealed a case of chronic myeloid leukemia. Hemoglobin electrophoresis resulted in 23 (85.1%) cases of sickle cell disease. The management was medico-surgical. After an average follow-up of 11 months, erectile function was evaluated in 18 patients, and erectile dysfunction was noted in 10 (55.5%) patients.

Sacral neuromodulation therapy of the lower urinary tract: A review of the literature and unanswered questions

Objective: To review the evidence surrounding Sacral Neuromodulation therapy and delineate areas that will need more research. Methods: An extensive search was performed on the available literature on SNM for lower urinary tract dysfunction. Based on the results of the search, the mechanisms of action, indications, technique, and patient characteristics of therapy failures and success are presented and discussed. Results: SNM is accepted by the FDA since 1997 for the treatment of lower urinary tract dysfunction. As it is a relatively new procedure, there are variations in the technique of lead placement, generator choice, testing interval, patient selection, time to explantation, and definitions of therapy failures and successes. Conclusions: SNM is a safe and therapeutic option for the treatment of urgencyfrequency syndrome, urge incontinence, and idiopathic urinary retention. However, there are multiple unanswered questions that require extensive research.

Hematologic Emergencies

Hematological emergencies are defined as acute life-threatening conditions in hematological diseases due to benign blood disorders or hematological malignancies or as a result of its treatment. This article deals of the most common emergencies encountered by hematologists. Emerging clinical situations, predictable or not, are common in the treatment of hematological diseases. However, the rapid development of new targeted drugs in cancer medicine has led to an increase in chronically ill cancer and hematology patients, who are being treated aggressively despite significant comorbidities and higher age. This development will lead to an increase in the number of hematologic emergencies, and these patients will be seen by various specialists. The knowledge of most hematological emergencies is crucial in daily practice. In this review, we discuss the epidemiology, pathophysiology and clinical with an emphasis on the early diagnosis and treatment of these conditions that can significantly affect the patient’s clinical outcome.

Retrospective Cohort Study on Acute Care in Obstetrics and Gynecology: Analogies and Differences When Compared to Emergency Medicine

Introduction: the demand for urgent obstetric and gynecology care has progressively increased: in the United States approximately 1.4 million gynecologic visits are made to the emergency department (ED) annually, while almost 75% of women make at least 1 unscheduled visit during pregnancy. Moreover, research has recently focused on setting standards in unscheduled care, and developing quality indicators to improve patients’ health. Therefore, we investigated the characteristics of women with acute gynecological or pregnancy complaints using quality indicators developed for emergency medicine, to better define the needs of this population and improve care. Methods: Retrospective cohort study on ED, and Obstetrics and Gynecology (ObGyn) triage visits, at a tertiary care hospital in Italy, during 2012. Data were analyzed with population-averaged logistic regression and Poisson regression. Results: When compared to the 33,557 ED visits, the 9245 ObGyntriage referrals were more frequently associated with pregnancy (≤12 weeks’ gestation, OR: 30.7, 95%CI;24.5 - 38.4;>12 weeks’ gestation, OR 81.2, 95%CI;64.8 - 101.4), vaginal bleeding (OR 156.6, 95%CI;82.7 - 294.4), diurnal (night access OR 0.87, 95% CI;0.78 - 0.96) and weekday access (holiday access OR 0.87, 95%CI;0.78 - 0.95), frequent users (recurrent ED visits IRR 0.87, 95%CI;0.83 - 0.9) and lower hospital admissions (ED admission OR 1.6, 95%CI;1.4 - 1.8). Conclusion: ObGyn triage patients differed from ED users, and were at higher risk of “crowding”. Such diversities should be considered to improve female healthcare services and allocate resources more efficiently.

State of Shock: Epidemiological, Etiological and Therapeutic Aspects at the Pediatric Unit of the Medical and Surgical Emergencies of the Donka National Hospital

Introduction: The objective of this study was to write the epidemiological, etiological and therapeutic aspects of shock in children in the paediatric medico-surgical emergency unit of the National Donka Hospital. Method: This was a forward-looking, descriptive 6-month study, including all children aged 0 to 15 who were received in the paediatric medico-surgical emergency unit at The Donka National Hospital, where the shock diagnosis was retained and the patients received care. Results: In our study, 26 out of 1123 patients were received in a state of shock. Hypovolemic shock was more common at 24 (92%). Vascular filling by Ringer’s milk was the basic treatment. The 6 to 11 month age group was the most affected and the sex-ratio M/F was 1.6. The acute febrile gastroenteritis and dehydration status were the most frequent causes. The outcome was favorable in 25 patients (96%). Conclusion: Rapid and effective management would improve the vital and functional prognosis of children in shock.

Rasburicase in treating tumor lysis syndrome:An umbrella review

Tumor lysis syndrome(TLS)remains a debilitating cause of hospitalization and death in patients with cancer and is a significant challenge for healthcare providers despite advancements in its management.This umbrella review analyzed the results of meta-analyses on the use of rasburicase in the treatment of patients with cancer.A literature search was performed of five databases(PubMed,Google Scholar,Cochrane Library,Scopus,Global Index Medicus,and ScienceDirect)for articles with full texts available online.A measurement tool to assess systematic reviews 2(AMSTAR 2)was used to assess the quality of the included studies,and Review Manager software was used to conduct all statistical analyses.The systematic search identified eight relevant meta-analyses,with primary analyses including outcome data that analyzed mortality,renal failure,and comparisons with allopurinol.The pooled data showed that rasburicase effectively reduced TLS development and serum uric acid levels in children and adults with malignancies.Most outcomes did not differ significantly compared with those of allopurinol.Future trials should focus on the cost-effectiveness of rasburicase compared to that of allopurinol while including high-,intermediate-,and low-risk patients.Rasburicase is safe and effective for managing patients with TLS.However,recent large-scale meta-analyses have reported conflicting results.Most meta-analyses were graded as low to critically low as per AMSTAR 2.The analysis revealed that the benefit of rasburicase did not differ significantly from that of allopurinol,which has higher cost-effectiveness and fewer side effects.

Urban Intersection Traffic Signal Control Based on Fuzzy Logic

This paper presents a fuzzy logic adaptive traffic signal control method for an isolated four-approach intersection with through and left-turning movements. In the proposed method, the fuzzy logic controller can make adjustments to signal timing in response to observed changes. The 'urgency degree' term that can describe different user's demands for a green light is used in the fuzzy logic decision-making. In addition, a three-level fuzzy controller model decides whether to extend or terminate the current signal phase and the sequence of phases. Simulation results show that the fuzzy controller can adjust its signal timing in response to changing traffic conditions on a real-time basis and that the proposed fuzzy logic controller leads to less vehicle delays and a lower percentage of stopped vehicles.