Search results for: overalctive bladder

Authors: J. B. Sharma, Vivek Kakkar, Sunesh Kumar, K. K. Roy, Rajesh Kumari, Kavita Pandey, Smriti Hari

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Background: Stress urinary incontinence (SUI) is a common problem affecting the quality of life of women. Methods: It is a prospective study conducted over 40 women of SUI by endovaginal ultrasound on rest and Valsalva preoperatively and six months postoperatively for levator hiatus, pubovisceral thickness, urethral length, and bladder neck position. A 24-hour pad test was also performed on all women at the same time for grading of SUI. Treatment given was medical in 4 (10%), Burch colposuspension in 18 (45%), and tension-free obturator tape in 18 (45%). Results: Mean age, parity, and body mass index in the study were 41.60 years, 2.73, and 24.2 kg/m², respectively. All 40 (100%) patients had SUI, with the mean duration of symptoms being 4.04 years. On the 24-hour pad test, mild SUI was in 4 (10%), moderate SUI in 33 (82.5%), and severe SUI in 3 (7.5%), with mean preoperative 24-hour pad test being 36.69 gm which significantly reduced to 9.79 gm postoperatively (p 0.001). There was a significant change in levator hiatus and pubovisceral thickness with the treatment of SUI. Overall urethral length increased, but there was a significant decrease in urethral length on Valsalva after the treatment (0.40 versus 0.28 cm, p 0.04) and a significant reduction in bladder neck descent after Valsalva after treatment (0.41 cm versus 0.27 cm, p 0.001). Conclusion: Endovaginal ultrasound and 24-hour pad test are useful diagnostic modalities for SUI diagnosis and to see the impact of treatment.

Keywords: stress urinary incontinence, endovaginal ultrasound, 24-hours pad test, pubovisceral muscle thickness

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Authors: Hossain A., Miah S., Ray P. K.

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Introduction: Single channel and tri-channel applicators are used in the traditional treatment of cervical cancer. Total reference air kerma (TRAK) and treatment outcomes in high-dose-rate brachytherapy for cervical cancer using single-channel and tri-channel applicators were the main objectives of this retrospective study. Material and Methods: Patients in the radiotherapy division who received brachytherapy, chemotherapy, and external radiotherapy (EBRT) using single and tri-channel applicators were the subjects of a retrospective cohort study from 2016 to 2020. All brachytherapy parameters, including TRAK, were calculated in accordance with the international protocol. The Kaplan Meier method was used to analyze survival rates using a log-rank test. Results and Discussions: Based on treatment times of 15.34 (10-20) days and 21.35 (6.5-28) days, the TRAK for the tri-channel applicator was 0.52 cGy.m² and for the single-channel applicator was 0.34 cGy.m². Based on TRAK, the rectum, bladder, and tumor had respective Pearson correlations of 0.082, 0.009, and 0.032. The 1-specificity and sensitivity were 0.70 and 0.30, respectively. At that time, AUC was 0.71. The log-rank test showed that tri-channel applicators had a survival rate of 95% and single-channel applicators had a survival rate of 85% (p=0.565). Conclusions: The relationship between TRAK and treatment duration and Pearson correlation for the tumor, rectum, and bladder suggests that TRAK should be taken into account for the proper operation of single channel and tri-channel applicators.

Keywords: single-channel, tri-channel, high dose rate brachytherapy, cervical cancer

Procedia PDF Downloads 104

Authors: Awais Naeem, Osama Shakeel, Faizan Ullah, Abdul Wahid Anwer

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Introduction: To study the clinic-pathological factors, diagnostic factors and survival of extra-pulmonary small cell carcinoma. Methodology: From 1995 to 2017 all patients with a diagnosis of extra-pulmonary small cell carcinoma were included in the study. Demographic variables and clinic-pathological factors were collected. Management of disease was recorded. Short and long term oncological outcomes were recorded. All data was entered and analyzed in SPSS version 21. Results: A total of 14 patients were included in the study. Median age was 53.42 +/- 16.1 years. There were 5 male and 9 female patients. Most common presentation was dysphagia in 16 patient among esophageal small cell carcinoma and while other patient had pain in abdomen. Mean duration of symptoms was 4.23+/-2.91 months .Most common site is esophagus (n=6) followed by gall bladder(n=3). Almost all of the patients received chemo-radiotherapy. Majority of the patient presented with extensive disease. Five patients (35.7%) died during the follow up period, two (14.3%) were alive and rest of the patients were lost to follow up. Mean follow up period was 22.92 months and median follow up was 15 months. Conclusion: Extra-pulmonary small cell carcinoma is rare and needs to be managed aggressively. All patients should be treated with both systemic and local therapies.

Keywords: small cell carcinoma of esophagus, extrapulmonary small cell carcinoma, small cell carcinoma of gall bladder, small cell carcinoma of rectum, small cell carcinoma of stomach

Procedia PDF Downloads 160

Authors: Sahar Nasr, Lin Li, Edwin Wang

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Bladder cancer (BLCA) is known as the 13th cause of death among cancer patients worldwide, and ~575,000 new BLCA cases are diagnosed each year. Urothelial carcinoma (UC) is the most prevalent subtype among BLCA patients, which can be categorized into muscle-invasive bladder cancer (MIBC) and non-muscle-invasive bladder cancer (NMIBC). Currently, various therapeutic options are available for UC patients, including (1) transurethral resection followed by intravesical instillation of chemotherapeutics or Bacillus Calmette-Guérin for NMIBC patients, (2) neoadjuvant platinum-based chemotherapy (NAC) plus radical cystectomy is the standard of care for localized MIBC patients, and (3) systematic chemotherapy for metastatic UC. However, conventional treatments may lead to several challenges for treating patients. As an illustration, some patients may suffer from recurrence of the disease after the first line of treatment. Recently, immune checkpoint therapy (ICT) has been introduced as an alternative treatment strategy for the first or second line of treatment in advanced or metastatic BLCA patients. Although ICT showed lucrative results for a fraction of BLCA patients, ~80% of patients were not responsive to it. Therefore, novel treatment methods are required to augment the ICI response rate within BLCA patients. It has been shown that the infiltration of T-cells into the tumor microenvironment (TME) is positively correlated with the response to ICT within cancerous patients. Therefore, the goal of this study is to enhance the infiltration of cytotoxic T-cells into TME through the identification of target genes within the tumor that are responsible for the non-T-cell inflamed TME and their inhibition. BLCA bulk RNA-sequencing data from The Cancer Genome Atlas (TCGA) and immune score for TCGA samples were used to determine the Pearson correlation score between the expression of different genes and immune score for each sample. The genes with strong negative correlations were selected (r < -0.2). Thereafter, the correlation between the expression of each gene and survival in BLCA patients was calculated using the TCGA data and Cox regression method. The genes that are common in both selected gene lists were chosen for further analysis. Afterward, BLCA bulk and single-cell RNA-sequencing data were ranked based on the expression of each selected gene and the top and bottom 25% samples were used for pathway enrichment analysis. If the pathways related to the T-cell infiltration (e.g., antigen presentation, interferon, or chemokine pathways) were enriched within the low-expression group, the gene was included for downstream analysis. Finally, the selected genes will be used to calculate the correlation between their expression and the infiltration rate of the activated CD+8 T-cells, natural killer cells and the activated dendric cells. A list of potential target genes has been identified and ranked based on the above-mentioned analysis and criteria. SUN-1 got the highest score within the gene list and other identified genes in the literature as benchmarks. In conclusion, inhibition of SUN1 may increase the tumor-infiltrating lymphocytes and the efficacy of ICI in BLCA patients. BLCA tumor cells with and without SUN-1 CRISPR/Cas9 knockout will be injected into the syngeneic mouse model to validate the predicted SUN-1 effect on increasing tumor-infiltrating lymphocytes.

Keywords: data analysis, gene expression analysis, gene identification, immunoinformatic, functional genomics, transcriptomics

Procedia PDF Downloads 159

Authors: Firas Rashad Al-Samarai

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Introduction: Benign prostatic hyperplasia (BPH) is a common condition as men get older. An enlarged prostate gland can cause uncomfortable urinary symptoms, such as blocking the flow of urine out of the bladder. It can also cause bladder, urinary tract, or kidney problems. Objective: to evaluate the efficacy and interaction of tamsulosin with finasteride treatment on induced benign prostate hyperplasia (BPH) in mice. Methods: BPH was induced by subcutaneous injection of testosterone propionate (20 mg/kg) for 30 days. Eighty-five mice were divided into five groups. The first group (G1): twenty-five mice induced BPH treated with tamsulosin orally and divided into five equal subgroups with doses (0.017, 0.052, 0.087, 0. 123, and 0.158) mg/kg, the second group (G2): twenty-five mice induced BPH treated with finasteride orally and divided into five equal subgroups with doses (0.175, 0.527, 0.878, 1.23, and 1.580) mg/kg. the third group (G3): twenty-five mice induced BPH treated with a combination of tamsulosin with finasteride orally, and divided into five equal subgroups with doses (0.0085, 0.0875), (0.026, 0.2635), (0.0435, 0.439) , (0.0615, 0.615) and ( 0.079 , 0.790 ) mg/kg respectively. Fourth group (G4): five mice induced BPH and treated distilled water. Fifth group (G5): five mice were not inducing BPH and without any treatment. Results: The results showed a gradual significant increase in prostate weight % and prostate index % Inhibitions until reached saturation in the last two doses of tamsulosin, finasteride, and combination groups, the maximum effective dose of tamsulosin and finasteride were (0.156) and (1.495) mg/kg respectively. Moreover, the effective dose of the combination (tamsulosin and finasteride) was estimated (0.06876, 0.6876) mg/kg, respectively, as well as the type of interaction was synergism and the value of the combination index was 0.046. Conclusions: We concluded that the combination of tamsulosin with finasteride showed a synergistic effect in BPH treatment by minimizing the side effect of each drug as s result of decreasing the dose of each one.

Keywords: Tamsulosin, Finasteride, combination, BPH

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Authors: Eugene Demidenko, John Seigne, Igor Sokolov

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Multiple instance classification is a known machine learning tech-nique when only a bag of features is labeled. The method of binary multiple instance classification, termed multiple instance logistic regression (LR), received the most attention as a well-defined statistical model. This algorithm is realized in several computer languages, including R (milr) and MATLAB. This work suggests improving this model, which is called the one-hit multiple instance LR. Unlike the existing ap-proach, where unknown labels are treated as missing observations, our model directly implements the ML approach. As such, it is methodologically straightforward and computationally stable, especially when features are highly correlated and/or bags are heterogeneous. Since the one-hit LR admits a closed form for the log-likelihood function, an efficient Fisher scoring algorithm applies with the variances of the regres-sion coefficients computed through the inverse of the Fisher information matrix at the final iteration. Numerical experiments demonstrate the superiority of the one-hit LR in terms of regression coefficients and classification accuracy. Another advantage of our approach is developing the optimal probability threshold for classification (the traditional threshold equals 0 5). The one-hit LR is illustrated with a noninvasive bladder cancer identification where each patient, in the multiple instance terminol-ogy ’bag,’ contains feature images of multiple cells from a urine sample of the same individual. We show that the one-hit LR with two Atomic Force Microscopy (AFM) image features leads to a perfect (AUC=1) or almost perfect (AUC=0.978) classifica-tion of normal and cancer patients among 20 individuals. The -value 0.0018 confirms that the latter AUC is unlikely to be obtained by chance.

Keywords: AUC, classification accuracy, classification p-value, Fisher information, ML, ROC curve

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Authors: Chernet Mulugeta, Girma Seyoum, Yeshineh Demrew, Kehabtimer Shiferaw

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Background: Obstetric fistula (OF) is a serious medical condition that includes an abnormal opening between the vagina and bladder (vesico-vaginal fistula) or the vagina and rectum (recto-vaginal fistula). It is usually caused by prolonged obstructed labour. Despite its serious health and psychosocial consequences, there is a paucity of evidence regarding the time it takes to heal from OF. Objective: The aim of this study was to assess the time to cure from obstetric fistula and its predictors among women admitted to Addis Ababa Hamlin Fistula Hospital, Addis Ababa, Ethiopia. Methodology: An institution-based retrospective cohort study was conducted from January 2015 to December 2020 among a randomly selected 434 women with OF in Addis Ababa Hamlin Fistula Hospital. Data was collected using a structured checklist adapted from a similar study. The open data kit (ODK) collected data was exported and analyzed by using STATA (14.2). Kaplan Meir was used to compare the recovery time from OF. To identify the predictors of OF, a Cox regression model was fitted, and an adjusted hazard ratio with a 95% confidence interval was used to estimate the strength of the associations. Results: The average time to recover from obstetric fistula was 3.95 (95% CI: 3.0-4.6) weeks. About ¾ of the women [72.8% (95% CI - 0.65-1.2)] were physically cured of obstetric fistula. Having secondary education and above [AHR=3.52; 95% CI (1.98, 6.25)] compared to no formal education, having a live birth [AHR=1.64; 95% CI (1.22, 2.21)], having an intact bladder [AHR=2.47; 95% CI (1.1, 5.54)] compared to totally destructed, and having a grade 1 fistula [AHR=1.98; 95% CI (1.19, 3.31)] compared to grade 3 were the significant predictors of shorter time to cure from an obstetric fistula. Conclusion and recommendation: Overall, the proportion of women with OF who were not being cured was unacceptably high. The time it takes for them to recover from the fistula was also extended. It connotes us to work on the identified predictors to improve the time to recovery from OF.

Keywords: time to recovery, obstetric fistula, predictors, Ethiopia

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Authors: Muhammad Isa Khan, Jalil Ur Rehman, Muhammad Afzal Khan Rao, James Chow

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Purpose: This study investigates the dose-volume variations in planning target volume (PTV) and organs-at-risk (OARs) using different collimator angles for smart arc prostate volumetric modulated arc therapy (VMAT). Awareness of the collimator angle for PTV and OARs sparing is essential for the planner because optimization contains numerous treatment constraints producing a complex, unstable and computationally challenging problem throughout its examination of an optimal plan in a rational time. Materials and Methods: Single arc VMAT plans at different collimator angles varied systematically (0°-90°) were performed on a Harold phantom and a new treatment plan is optimized for each collimator angle. We analyzed the conformity index (CI), homogeneity index (HI), gradient index (GI), monitor units (MUs), dose-volume histogram, mean and maximum doses to PTV. We also explored OARs (e.g. bladder, rectum and femoral heads), dose-volume criteria in the treatment plan (e.g. D30%, D50%, V30Gy and V38Gy of bladder and rectum; D5%,V14Gy and V22Gy of femoral heads), dose-volume histogram, mean and maximum doses for smart arc VMAT at different collimator angles. Results: There was no significance difference found in VMAT optimization at all studied collimator angles. However, if 0.5% accuracy is concerned then collimator angle = 45° provides higher CI and lower HI. Collimator angle = 15° also provides lower HI values like collimator angle 45°. It is seen that collimator angle = 75° is established as a good for rectum and right femur sparing. Collimator angle = 90° and collimator angle = 30° were found good for rectum and left femur sparing respectively. The PTV dose coverage statistics for each plan are comparatively independent of the collimator angles. Conclusion: It is concluded that this study will help the planner to have freedom to choose any collimator angle from (0°-90°) for PTV coverage and select a suitable collimator angle to spare OARs.

Keywords: VMAT, dose-volume histogram, collimator angle, organs-at-risk

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Authors: Marin Kanarev, Delyan Stoyanov, Ivanna Popova, Nadezhda Petrova

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Thanks to increased survival rates in patients bearing oncological malignancies due to recent developments in anti-cancer therapies and diagnostic techniques, observation of clinical cases of metachronous cancers is more common and can provide more in-depth knowledge of their development and, as a result, help clinicians apply suitable therapy. This unusual case of three metachronous tumors presented the opportunity to follow their occurrence, progression, and treatment thoroughly. A 77-year-old male presented with carcinoma ventriculi of the pylorus region, which was surgically removed via upper subtotal stomach resection, a lateral antecolical gastro-enteroanastomosis, and a subsequent Braun anastomosis. An EOX chemotherapy regimen followed. A CT scan four months later showed no indication of recurrence or dissemination. The same scan, performed as a part of the follow-up plan two years later, showed an indication of neoplastic growth in the urinary bladder. After the patient had been directed to a urologist, the suspicion was confirmed, and the growth was histologically diagnosed as a carcinoma of the urinary bladder. An immunohistochemistry test showed an expression of PDL1 of less than 5%, which resulted in treatment with GemCis chemotherapy regimen that led to full remission. Two years and seven months after the first surgery, a CT scan showed again that the two carcinomas were gone. However, four months later, elevated tumor markers prompted a PET/CT scan, which showed data indicative of recurring neoplastic growth in the region of the stomach cardia. It was diagnosed as an adenocarcinoma infiltrating the esophagus. Preoperative chemotherapy with the ECF regimen was completed in four courses, and a CT scan showed no progression of the disease. In less than a month after therapy, the patient underwent laparotomy, debridement, gastrectomy, and a subsequent mechanical terminal-lateral esophago-jejunoanasthomosis. It was verified that the tumor originated from metastasis from the carcinoma ventriculi, which was located in the pylorus. In conclusion, this case report highlights the importance of patient follow-up and studying recurring neoplastic growth. Despite the absence of symptoms, clinicians should maintain a high level of suspicion when evaluating the patient data and choosing the most suitable therapy.

Keywords: carcinoma, follow-up, metachronous, neoplastic growth, recurrence

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Authors: Meisam Omidi, M. Mirijalili, Mohammadmehdi Choolaei, Z. Sharifi, F. Haghiralsadat, F. Yazdian

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In this work, we have used arrays of micromechanical piezoresistive cantilever with different geometries to detect carcinoembryonic antigen (CEA), which is known as an important biomarker associated with various cancers such as the colorectal, lung, breast, pancreatic, and bladder cancer. The sensing principle is based on the surface stress changes induced by antigen–antibody interaction on the microcantilevers surfaces. Different concentrations of CEA in a human serum albumin (HSA) solution were detected as a function of the deflection of the beams. According to the experiments, it was revealed that microcantilevers have surface stress sensitivities in the order of 8 (mJ/m). This matter allows them to detect CEA concentrations as low as 3 ng/mL or 18 pM. This indicates the fact that the self-sensing microcantilever approach is beneficial for pathological tests.

Keywords: micromechanical biosensors, carcinoembryonic antigen (CEA), surface stress

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Authors: Madeleine Elder, Aye Htun

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Background: Myiasis is the parasitic infestation of body tissues by fly larvae. It predominantly occurs in poor socioeconomic regions of tropical and subtropical countries where it is associated with poor hygiene and sanitation. Cutaneous and wound myiasis are the most common presentations whereas urogenital myiasis is rare, with few reported cases. Case: a 26-year-old primiparous woman with a low-risk pregnancy presented to the emergency department at 37+3-weeks’ gestation after passing a 2cm black larva during micturition, with 2 weeks of mild vulvar pruritus and dysuria. She had travelled to India 9-months prior. Examination of the external genitalia showed small white larvae over the vulva and anus and a mildly inflamed introitus. Speculum examination showed infiltration into the vagina and heavy white discharge. High vaginal swab reported Candida albicans. Urine microscopy reported bacteriuria with Enterobacter cloacae. Urine parasite examination showed myiasis caused by Clogmia albipunctata species of fly larvae from the family Psychodidae. Renal tract ultrasound and inflammatory markers were normal. Infectious diseases, urology and paediatric teams were consulted. The woman received treatment for her urinary tract infection (which was likely precipitated by bladder irritation from local parasite infestation) and vaginal candidiasis. She underwent daily physical removal of parasites with cleaning, speculum examination and removal, and hydration to promote bladder emptying. Due to the risk of neonatal exposure, aspiration pneumonitis and facial infestation, the woman was steroid covered and proceeded to have an elective caesarean section at 38+3-weeks’ gestation, with delivery of a healthy infant. She then proceeded to have a rigid cystoscopy and washout, which was unremarkable. Placenta histopathology revealed focal eosinophilia in keeping with the history of maternal parasites. Conclusion: Urogenital myiasis is very rare, especially in the developed world where it is seen in returned travellers. Treatment may include systemic therapy with ivermectin and physical removal of parasites. During pregnancy, physical removal is considered the safest treatment option, and discussion around the timing and mode of delivery should consider the risk of harm to the foetus.

Keywords: urogenital myiasis, parasitic infection, infection in pregnancy, returned traveller

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Authors: Emma Plante, Charles Ekwunwa, Diego Illanes

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Introduction: Serum Sickness-Like Reaction (SSLR) is an inflammatory immune response characterized by a rash, polyarthralgias, and fever. SSLR usually occurs in response to a new medication (most commonly antibiotics, anticonvulsants, or antiinflammatory agents) and is believed to involve the formation of drug-specific immune complexes. Here we present a case of a 16-year-old female patient who developed an SSLR in response to the D-mannose-containing over-the-counter supplement, Uqora, used to promote bladder health. Methodology: The methodology for this study included a thorough literature search for other cases of SSLR associated with D-Mannose containing products. Data collection was performed through a review of the patient’s medical record, including history, physical examination, relevant laboratory results, and treatment plan. Findings: A 16-year-old female with a history of overactive bladder and anemia presented with a diffuse urticarial rash, headaches, joint pain, and swelling for three days. Her medications included oral contraceptive pills, iron, mirabegron, UQora, and a probiotic. Physical examination revealed a diffuse urticarial rash, and her musculoskeletal exam revealed swelling and tenderness in her wrists. Her CBC, basic metabolic panel, liver function panel, lyme titers, and urinalysis were all within normal limits. The patient was referred to an allergist, who diagnosed her with SSLR. All medications were discontinued, and she was treated with a 7-day course of prednisone and cetirizine. Her symptoms resolved, and her medications were slowly resumed sequentially over several months. However, UQora triggered a recurrence of her symptoms, and it was identified as the culprit medication. Consequently, UQora was permanently discontinued, and the patient has remained symptom-free. Conclusion: This case report describes the first documented case of SSLR caused by UQora (active ingredient D-mannose). D-Mannose is a monosaccharide found in many plants and fruits, and it is commonly used to prevent urinary tract infections. While the clinical features and timeline, in this case, were typical of SSLR, UQora as the trigger was highly unusual. Clinicians should be aware of the diverse triggers of SSLR and the importance of prompt identification and management to enhance patient safety. It is possible D-mannose was not the trigger, and further research is necessary to better understand the potential therapeutic applications of D-mannose, as well as the potential risks and interactions.

Keywords: serum sickness-like reaction, d-mannose, hypersensitivity reaction, urticaria

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Authors: Arundhathi S., Poongodi R.

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Tumor-infiltrating lymphocytes (TILs) are indicative of the local immune response against tumor proliferation and metastasis. Emerging as a significant marker of immune reactivity, TILs are utilized to evaluate prognostic outcomes across various malignancies, including colon, ovarian, lung, bladder, and breast cancers. In breast cancer (BC), TILs are particularly relevant for assessing tumor response to therapy in both adjuvant and neoadjuvant settings, with a prominent role in triple-negative breast cancer (TNBC), where they have been associated with improved outcomes. As such, TILs are recognized as an independent marker of favorable prognosis in several tumor types, underscoring their potential as a tool in personalized cancer therapy.

Keywords: breast cancer, intratumoral TIL, stromal TIL, tumor infiltrating lymphocytes

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Authors: S. Zolghadri, M. Naderi, H. Yousefnia, B. Alirzapour, A. R. Jalilian, A. Ramazani

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Nowadays, 68Ga-DOTATOC has been known as a potential agent for the detection of neuroendocrine tumours and it has indicated higher sensitivity compared with the 111In-Octeroetide. The aim of this study was to evaluate the effectiveness of this new agent in the diagnosis of adenocarcinoma breast cancer. 68Ga-DOTATOC was prepared with the radiochemical purity of higher than 98% and by the specific activity of 39.6 TBq/mmol. 37 MBq of the complex was injected intravenously into the BULB/c mice with adenocarcinoma breast cancer. PET/CT images were acquired after 30, 60 and 90 min post injection demonstrated significant accumulation in the tumour sites. Also, considerable activity was observed in the kidney and bladder as the main routs of excretion. Generally, the results showed that 68Ga-DOTATOC can be considered as a suitable complex for diagnosis of the adenocarcinoma breast cancer using PET procedure.

Keywords: adenocarcinoma breast cancer, 68Ga, octreotide, imaging

Procedia PDF Downloads 343

Authors: Birsel Canan Demirbag, Kıymet Yesilcicek Calik, Hacer Kobya Bulut

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Objective: This study was conducted to evaluate the problems of women over 65 with incontinence diagnosis. Methods: This descriptive study was conducted with women over 65 with incontinence diagnosis in four Family Health Centers in a city in Eastern Black Sea region between November 1, and December 20, 2015. 203, 107, 178, 180 women over 65 were registered in these centers and 262 had incontinence diagnosis at least once and had an ongoing complaint. 177 women were volunteers for the study. During home visits and using face-to-face survey methodology, participants were given socio-demographic characteristics survey, Sandvik severity scale, Incontinence Quality of Life Scale, Urogenital Distress Inventory and a questionnaire including challenges experienced due to incontinence developed by the researcher. Data were analyzed with SPSS program using percentages, numbers, Chi-square, Man-Whitney U and t test with 95% confidence interval and a significance level p <0.05. Findings: 67 ± 1.4 was the mean age, 2.05 ± 0.04 was parity, 44.5 ± 2.12 was menopause age, 66.3% were primary school graduates, 45.7% had deceased spouse, 44.4% lived in a large family, 67.2% had their own room, 77.8% had income, 89.2% could meet self- care, 73.2% had a diagnosis of mixed incontinence, 87.5% suffered for 6-20 years % 78.2 had diuretics, antidepressants and heart medicines, 20.5% had urinary fecal cases, 80.5% had bladder training at least once, 90.1% didn’t have bladder diary calendar/control training programs, 31.1% had hysterectomy for prolapse, 97.1'i% was treated with lower urinary tract infection at least once, 66.3% saw a doctor to get drug in the last three months, 76.2 could not go out alone, 99.2 % had at least one chronic disease, 87.6 % had constipation complain, 2.9% had chronic cough., 45.1% fell due to a sudden rise for toilet. Incontinence Impact Questionnaire Average score was (QOL) 54.3 ± 21.1, Sandvik score was 12.1 ± 2.5, Urogenital Distress Inventory was 47.7 ± 9.2. Difficulties experienced due to incontinence were 99.5% feeling of unhappiness, 67.1% constant feeling of urine smell due to failing to change briefs frequently, % 87.2 move away from social life, 89.7 unable to use pad, 99.2% feeling of disturbing households / other individuals, 87.5% feel dizziness/fall due to sudden rise, 87.4% feeling of others’ imperceptions about the situation, % 94.3 insomnia, 78.2 lack of assistance, 84.7% couldn’t afford urine protection briefs. Results: With this study, it was found out that there were a lot of unsolved issues at individual and community level affecting the life quality of women with incontinence. In accordance with this common problem in women, to facilitate daily life it is obvious that regular home care training programs at institutional level in our country will be effective.

Keywords: health problems, incontinence, incontinence quality of life questionnaire, old age, urinary urogenital distress inventory, Sandviken severity, women

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Authors: G. Meccariello, L. Della Ragione

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The exposure to outdoor air pollution causes lung cancer and increases the risk of bladder cancer. Because air pollution in urban areas is mainly caused by transportation, it is necessary to evaluate pollutant exhaust emissions from vehicles during their real-world use. Nevertheless their evaluation and reduction is a key problem, especially in the cities, that account for more than 50% of world population. A particular attention was given to the slope variability along the streets during each journey performed by the instrumented vehicle. In this paper we dealt with the problem of describing a quantitatively approach for the reconstruction of GPS coordinates and altitude, in the context of correlation study between driving cycles / emission / geographical location, during an experimental campaign realized with some instrumented cars. Finally the slope analysis can be correlated to the emission and consumption values in a specific road position, and it could be evaluated its influence on their behaviour.

Keywords: air pollution, driving cycles, GPS signal, slope, emission factor, fuel consumption

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Authors: T. Al-Alawi, N. Shorbaji, E. Rashaidi, M.Alidrisi

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Purpose/Objective(s): The main purpose of this study is to analyze the planning of SBRT treatments for localized prostate cancer with 6FFF and 10FFF energies to see if there is a dosimetric difference between the two energies and how we can increase the plan efficiency and reduce its complexity. Also, to introduce a planning method in our department to treat prostate cancer by utilizing high energy photons without increasing patient toxicity and fulfilled all dosimetric constraints for OAR (an organ at risk). Then toevaluate the target 95% coverage PTV95, V5%, V2%, V1%, low dose volume for OAR (V1Gy, V2Gy, V5Gy), monitor unit (beam-on time), and estimate the values of homogeneity index HI, conformity index CI a Gradient index GI for each treatment plan.Materials/Methods: Two treatment plans were generated for15 patients with localized prostate cancer retrospectively using the CT planning image acquired for radiotherapy purposes. Each plan contains two/three complete arcs with two/three different collimator angle sets. The maximum dose rate available is 1400MU/min for the energy 6FFF and 2400MU/min for 10FFF. So in case, we need to avoid changing the gantry speed during the rotation, we tend to use the third arc in the plan with 6FFF to accommodate the high dose per fraction. The clinical target volume (CTV) consists of the entire prostate for organ-confined disease. The planning target volume (PTV) involves a margin of 5 mm. A 3-mm margin is favored posteriorly. Organs at risk identified and contoured include the rectum, bladder, penile bulb, femoral heads, and small bowel. The prescription dose is to deliver 35Gyin five fractions to the PTV and apply constraints for organ at risk (OAR) derived from those reported in references. Results: In terms of CI=0.99, HI=0.7, and GI= 4.1, it was observed that they are all thesame for both energies 6FFF and 10FFF with no differences, but the total delivered MUs are much less for the 10FFF plans (2907 for 6FFF vs.2468 for 10FFF) and the total delivery time is 124Sc for 6FFF vs. 61Sc for 10FFF beams. There were no dosimetric differences between 6FFF and 10FFF in terms of PTV coverage and mean doses; the mean doses for the bladder, rectum, femoral heads, penile bulb, and small bowel were collected, and they were in favor of the 10FFF. Also, we got lower V1Gy, V2Gy, and V5Gy doses for all OAR with 10FFF plans. Integral dosesID in (Gy. L) were recorded for all OAR, and they were lower with the 10FFF plans. Conclusion: High energy 10FFF has lower treatment time and lower delivered MUs; also, 10FFF showed lower integral and meant doses to organs at risk. In this study, we suggest usinga 10FFF beam for SBRTprostate treatment, which has the advantage of lowering the treatment time and that lead to lessplan complexity with respect to 6FFF beams.

Keywords: FFF beam, SBRT prostate, VMAT, prostate cancer

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Authors: Gulten Yilmaz, A. Beril Tugrul, Mustafa Demir, Dogan Yasar, Bayram Demir, Bulent Buyuk

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A Positron Emission Tomography (PET) is a radioisotope imaging technique that illustrates the organs and the metabolisms of the human body. This technique is based on the simultaneous detection of 511 keV annihilation photons, annihilated as a result of electrons annihilating positrons that radiate from positron-emitting radioisotopes that enter biological active molecules in the body. This study was conducted on ten patients in an effort to conduct patient-related experimental studies. Dosage monitoring for the bladder, which was the organ that received the highest dose during PET applications, was conducted for 24 hours. Assessment based on measuring urination activities after injecting patients was also a part of this study. The MIRD method was used to conduct dosage calculations for results obtained from experimental studies. Results obtained experimentally and theoretically were assessed comparatively.

Keywords: PET/CT, TLD, MIRD, dose measurement, patient doses

Procedia PDF Downloads 523

Authors: Jeffrey A. Humenik

Abstract:

Environmental, Limited Liability Corporation (EMR) provided civil construction services to the U.S. Army Corps of Engineers, Kansas City District, for the placement of a protective riprap blanket on the west bank of the Smoky Hill River, construction of 2 shore abutments and the construction of a 140 foot long sill wall spanning the Smoky Hill River in Salina, Kansas. The purpose of the project was to protect the riverbank from erosion and hold back water to a specified elevation, creating a pool to ensure adequate water intake for the municipal water supply. Geotextile matting and riprap were installed for streambank erosion protection. An inflatable bladder (AquaDam®) was designed to the specific river dimension and installed to divert the river and allow for dewatering during the construction of the sill walls and cofferdam. AquaDam® consists of water filled polyethylene tubes to create aqua barriers and divert water flow or prevent flooding. A challenge of the project was the fact that 100% of the sill wall was constructed within an active river channel. The threat of flooding of the work area, damage to the aqua dam by debris, and potential difficulty of water removal presented a unique set of challenges to the construction team. Upon completion of the West Sill Wall, floating debris punctured the AquaDam®. The manufacturing and delivery of a new AquaDam® would delay project completion by at least 6 weeks. To keep the project ahead of schedule, the decision was made to construct an earthen cofferdam reinforced with rip rap for the construction of the East Abutment and East Sill Wall section. During construction of the west sill wall section, a deep scour hole was encountered in the wall alignment that prevented EMR from using the natural rock formation as a concrete form for the lower section of the sill wall. A formwork system was constructed, that allowed the west sill wall section to be placed in two horizontal lifts of concrete poured on separate occasions. The first sectional lift was poured to fill in the scour hole and act as a footing for the second sectional lift. Concrete wall forms were set on the first lift and anchored to the surrounding riverbed in a manner that the second lift was poured in a similar fashion as a basement wall. EMR’s timely decision to keep the project moving toward completion in the face of changing conditions enabled project completion two (2) months ahead of schedule. The use of inflatable bladders is an effective and cost-efficient technology to divert river flow during construction. However, a secondary plan should be part of project design in the event debris transported by river punctures or damages the bladders.

Keywords: abutment, AquaDam®, riverbed, scour

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Authors: Diwei Lin, Amanda Jh. Tan

Abstract:

We present a very rare case of de novo large cell neuroendocrine carcinoma of the prostate (LCNEC) in an 84-year-old male on a background of high-grade, muscle-invasive transitional cell carcinoma of the bladder. While NE tumours account for 1% to 5% of all cases of prostate cancer and scattered NE cells can be found in 10% to 100% of prostate adenocarcinomas, pure LCNEC of the prostate is extremely rare. Most LCNEC of the prostate is thought to originate by clonal progression under the selection pressure of therapy and refractory to long-term hormonal treatment for adenocarcinoma of the prostate. De novo LCNEC is only described in case reports and is thought to develop via direct malignant transformation. Limited data in the English literature makes it difficult to accurately predict the prognosis of LCNEC of the prostate. However, current evidence suggesting that increasing NE differentiation in prostate adenocarcinoma is associated with a higher stage, high-grade disease, and a worse prognosis.

Keywords: large cell neuroendocrine cancer, prostate cancer, refractory cancer, medical and health sciences

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Authors: Yousif M. Yousif Abdallah, Mohamed E. Gar-Elnabi, Abdoelrahman H. A. Bakary, Alaa M. H. Eltoum, Abdelazeem K. M. Ali

Abstract:

The study was established to measure the amount of radiation outside the treatment field in external beam radiation therapy using day method of dose calculation, the data was collected from 89 patients of cervical carcinoma in order to determine if the dose outside side the irradiation treatment field for spleen, liver, both kidneys, small bowel, large colon, skin within the acceptable limit or not. The cervical field included mainly 4 organs which are bladder, rectum part of small bowel and hip joint these organ received mean dose of (4781.987±281.321), (4736.91±331.8), (4647.64±387.1) and (4745.91±321.11) respectively. The mean dose received by outfield organs was (77.69±15.24cGy) to large colon, (93.079±12.31cGy) to right kidney (80.688±12.644cGy) to skin, (155.86±17.69cGy) to small bowel. This was more significant value noted.

Keywords: radiation dose, cervical carcinoma, day’s methods, radiation medicine

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Authors: Jer-Yuh Liu, Je-Chiuan Ye, Jin-Ming Hwang

Abstract:

Protein kinase C alpha (PKCα) is a key signaling molecule in human cancer development. As a therapeutic strategy, targeting PKCα is difficult because the molecule is ubiquitously expressed in non-malignant cells. PKCα is regulated by the cooperative interaction of the transcription factors myeloid zinc finger 1 (MZF-1) and Ets-like protein-1 (Elk-1) in human cancer cells. By conducting tissue array analysis, herein, we determined the protein expression of MZF-1/Elk-1/PKCα in various cancers. The data show that the expression of MZF-1/Elk-1 is correlated with that of PKCα in hepatocellular carcinoma (HCC), but not in bladder and lung cancers. In addition, the PKCα down-regulation by shRNA Elk-1 was only observed in the HCC SK-Hep-1 cells. Blocking the interaction between MZF-1 and Elk-1 through the transfection of their binding domain MZF-160–72 decreased PKCα expression. This step ultimately depressed the epithelial-mesenchymal transition potential of the HCC cells. These findings could be used to develop an alternative therapeutic strategy for patients with the PKCα-derived HCC.

Keywords: protein kinase C alpha, myeloid zinc finger 1, ets-like protein-1, hepatocellular carcinoma

Procedia PDF Downloads 229

Authors: Messis A., Adjebli A., Ayeche R., Talbi M., Tighilet K., Louardiane M.

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Cancers are the second cause of death worldwide. Prevalence and incidence of cancers is getting increased by aging and population growth. This study aims to predict and modeling the evolution of breast, Colorectal, Lung, Bladder and Prostate cancers over the period of 2014-2019. In this study, data were analyzed using time series analysis with double exponential smoothing method to forecast the future pattern. To describe and fit the appropriate models, Minitab statistical software version 17 was used. Between 2014 and 2019, the overall trend in the raw number of new cancer cases registered has been increasing over time; the change in observations over time has been increasing. Our forecast model is validated since we have good prediction for the period 2020 and data not available for 2021 and 2022. Time series analysis showed that the double exponential smoothing is an efficient tool to model the future data on the raw number of new cancer cases.

Keywords: cancer, time series, prediction, double exponential smoothing

Procedia PDF Downloads 93

Authors: Yousif Mohamed Y. Abdallah, Eltayeb Wagi Allah Eltayeb, Mohamed E. Gar-elnabi, Mohamed Ahmed Ali

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To characterize coronary artery obstruction and related findings in ischemic heart patients using cardiac scintigraphy for the identification of myocardial ischemia, 146 patients were studied at basal conditions and also asked for fasting after night till the intravenous injection of the radiopharmaceutical. After the injection time about 15 to 20 minutes, the patient should eat a fatty meal and chocolate for the good excretion of the gall bladder, to evaluate the performance and regional wall motion of the left ventricle (LV). The results showed that the body mass index percentage in this sample was in range of 43.05 to 61.05. The number of patients who were catheter candidates were 56 with 43% and the patients that were not candidate to cathode were 74 patients with 57% of all patients. For the group of patients where type of ischemia was assessed, 29.5% of patients had reversible posterior and inferior wall, 15.1% of patients had fixed large from apex to base, 9.6% of patients had mild basal inferior wall, 4.8 % of patients had mild anterior wall, 6.2% of patients had antro-septal and 34.9% of patients had moderate ischemia.

Keywords: myocardial ischemia, myocardial scintigraphy, contrast ventriculography, coronary artery obstruction

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Authors: Kalimullah Khan, Samina Roohi, Mohammad Rafi, Rizwana Zahoor

Abstract:

Labeling of 5-Aminolevulinic acid (5-ALA) with 99 mTc was achieved by using tin chloride dihydrate (Sncl2.2H2O) as reducing agent. Radiochemical purity and labeling efficiency was determined by Whattman paper No.3 and instant thin layer chromatographic strips impregnated with silica gel (ITLC/SG). Labeling efficiency was dependent on many parameters such as amount of ligand, reducing agent, pH, and incubation time. Therefore, optimum conditions for maximum labeling were selected. Stability of 99 mTc- 5-ALA was also checked in fresh human serum. Tissue bio-distribution of 99 mTc-5-ALA was evaluated in Spargue Dawley rats. 5-ALA was 98% labeled with 99 mTc under optimum conditions, i.e. 100µg of 5-ALA, pH: 4, 10µg of Sncl2.2H2O and 30 minutes incubation at room temperature. 99 mTc labelled 5- ALA remained stable for 24 hours in human serum. Bio-distribution study (%ID/gm) in rats revealed that maximum accumulation of 99 mTc-5-ALA was in liver, spleen, stomach and intestine after half hour, 4 hours, and 24 hours. Significant activity in bladder and urine indicated urinary mode of excretion.

Keywords: 99mTc-ALA, aminolevulinic acid, quality control, radiopharmaceuticals

Procedia PDF Downloads 387

Authors: Adel Yasky, Waseem Al-Talalwah, Shorok Al Dorazi, Roger Soames

Abstract:

The internal pudendal artery is a standard branch of the anterior division of the internal iliac artery. The current study includes 41 cadavers to investigate the origin and branches of the internal pudendal artery and its clinical significances. The internal pudendal artery arose directly from the anterior division of the internal iliac artery in 48.3% while it arose indirectly in 48.5%. However, the internal pudendal artery arose from the posterior division of internal iliac artery in 1.6%. Moreover, it arose internal iliac artery bifurcation site in 1.6%. Further, the internal pudendal artery supplied the urinary bladder in 17.1%. Also, the internal pudendal artery supplied the rectum 33.5% respectively. It gave uterine and vaginal arteries in 9.4% and 7.8% respectively. Finally, it supplied the sciatic nerve via giving lateral sacral branch in 1.6%. Internists, surgeons and radiologists have to be aware of the variability to decrease iatrogenic injury. Therefore, unnecessary proximal ligation should be avoided at the site of indirect origin of the internal pudendal artery to prevent sciatic neuropathy. Further, intrapelvic bleeding as result of laceration of internal pudendal branches during hysterectomy, prostatectomy or proctectomy should be expected. Therefore, this study increases the awareness of surgeons leading to minimize iatrogenic faults,

Keywords: internal pudendal artery, inferior gluteal artery, superior gluteal artery, internal iliac artery, impotence, decreased libido

Procedia PDF Downloads 359

Authors: Jake Tempo, Stephen Brough

Abstract:

Introduction and Objectives: Urine cytology has a role in the diagnosis of urothelial cancer when used alongside cystoscopy and imaging, according to the European Association of Urology guidelines. It also has a role in the surveillance post-treatment of urothelial carcinoma. Collecting and analysing urine cytology is costly and time-consuming. We investigated the use of urine cytology in an Australian regional hospital to determine whether clinicians are following international guidelines. Materials and Methods: We analysed all urine cytology requests performed in an Australian regional hospital between 1st January 2017 and 31st December 2018. We reviewed the indication for urine cytology and the patients’ case notes to determine whether urine cytology changed management. Results: During the two-year study period, 153 patients had urine cytology analysed for a variety of indications. In no cases did cytology change the outcome of patient management significantly. In total, 69 of 153 (41%) urine cytology requests were not supported by urological society guidelines. Fifty requests were for haematuria, and twenty requests were for urothelial cancer surveillance. Seven were analysed for follow-up from previous urological investigations. Nine samples were sent for ureteric obstruction of unknown origin. Conclusion: Urine cytology, even when positive, did not significantly change management for the investigation of potential urothelial cancer, and therefore, its use as a diagnostic tool for this purpose should be reconsidered. Many cytology tests are expensive, unnecessary, and not supported by urological society guidelines.

Keywords: cytology, bladder cancer, urine, urothelial carcinoma

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Authors: Yuri Seu, Hyun Jin Park, Jin Seo Park, Yong-Suk Moon, HongtaeKim, Mi-Sun Hur

Abstract:

The present case report describes bifid ureters arising directly from the separate calyces and renal pelvis of the kidney. It was a single common ureter leading away from the bladder, which was separated into incompletely duplicated ureters near the level of the anterior superior iliac supine. These two branches then entered the left kidney through their own courses. Each ureter traveled anterior and posterior to the renal vein, respectively. These two ureters formed a Y-shaped pattern. One ureter coursed anterior to the renal vein with shorter length, and it terminated at the renal pelvis that was divided into major calices in approximately lower two thirds of the kidney. The other ureter coursed posterior to the renal vein with longer length, terminating at approximately the upper third of the kidney. The renal calices in the upper third of the kidney were directly connected to the posterior ureter, whereas the other major calices in the lower two thirds of the kidney formed the renal pelvis connecting to the anterior ureter. Thus, convergence of the major calices was separated according to the terminations of two ureters. These anomalous ureters were traced to the calices of the kidney, thereby providing a reference of a rare variation of the ureter. The bifid ureters arising from the separate calyces and renal pelvis should be considered by radiologists when evaluating images and diagnosing possible complications of these anomalies.

Keywords: bifid ureters, kidney, major calices, renal pelvis

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Authors: Liaqat Ali, Khalid Farooq, Shafieullah Khan, Nasir Orakzai, Qudratullah

Abstract:

Objectives: To determine the risk factors for high resistance of ciprofloxacin in complicated urinary tract infections. Materials and Methods: It is an analytical study that was conducted in the department of Urology (Team ‘C’) at Institute of Kidney Diseases Hayatabad Peshawar from 1st June 2012 till 31st December 2012. Total numbers of 100 patients with complicated UTI was selected in the study. Multivariate analysis and linear regression were performed for the detection of risk factors. All the data was recorded on structured Proforma and was analyzed on SPSS version 17. Results: The mean age of the patient was 55.6 years (Range 3-82 years). 62 patients were male while 38 patients were female. 66 isolates of E-Coli were found sensitive to ciprofloxacin while 34 isolates were found Resistant for ciprofloxacin. Using multivariate analysis and linear regression, an increasing age above 50 (p=0.002) History of urinary catheterization especially for bladder outflow obstruction (p=0.001) and previous multiple use of ciprofloxacin (p=0.001) and poor brand of ciprofloxacin were found to be independent risk factors for high resistance of ciprofloxacin. Conclusion: UTI is common illness across the globe with increasing trend of antimicrobial resistance for ciprofloxacin against E Coli in complicated UTI. The risk factors for emerging resistance are increasing age, urinary catheterization and multiple use and poor brand of ciprofloxacin.

Keywords: urinary tract infection, ciprofloxacin, urethral catheterization, antimicrobial resistance

Procedia PDF Downloads 357

Authors: Waziri B. I., Elkhashab M. M.

Abstract:

Background: One of the most serious consequences of spinal cord injury (SCI) is progressive deterioration of renal function mostly as a result of urine stasis and ascending infection of the paralyzed bladder. This necessitates for investigation of early changes in serum urea and creatinine and associated sex related differences in response to SCI. Methods: A total of 24 adult albino rats weighing above 150g were divided equally into two groups, a control and experimental group (n = 12) each containing an equal number of male and female rats. The experimental group animals were paralyzed by complete transection of spinal cord below T4 level after deep anesthesia with ketamine 75mg/kg. Blood samples were collected from both groups five days post SCI for analysis. Mean values of serum urea (mmol/L) and creatinine (µmol/L) for both groups were compared. P < 0.05 was considered as significant. Results: The results showed significantly higher levels (P < 0.05) of serum urea and creatinine in the male SCI models with mean values of 92.12 ± 0.98 and 2573 ± 70.97 respectively compared with their controls where the mean values for serum urea and creatinine were 6.31 ± 1.48 and 476. 95 ± 4.67 respectively. In the female SCI models, serum urea 13.11 ± 0.81 and creatinine 519.88 ± 31.13 were not significantly different from that of female controls with serum urea and creatinine levels of 11.71 ± 1.43 and 493.69 ± 17.10 respectively (P > 0.05). Conclusion: Spinal cord injury caused a significant increase in serum Urea and Creatinine levels in the male models compared to the females. This indicated that males might have higher risk of renal dysfunction following SCI.

Keywords: albino rats, creatinine, spinal cord injury (SCI), urea

Procedia PDF Downloads 147