scholarly journals The Testosterone Effect on Metabolic and Urologic Outcomes in Patients with Nonfunctioning Pituitary Macroadenomas and Hypogonadotropic Hypogonadism

2019 ◽  
Vol 2019 ◽  
pp. 1-6
Author(s):  
Guadalupe Vargas-Ortega ◽  
Gabriel Pérez-Villarreal ◽  
Andrés Ramírez de Santiago ◽  
Lourdes Balcázar-Hernández ◽  
Victoria Mendoza-Zubieta ◽  
...  
Keyword(s):  
Cardiovascular Risk ◽  
Sexual Function ◽  
Metabolic Profile ◽  
Care Center ◽  
Hypogonadotropic Hypogonadism ◽  
Tertiary Care ◽  
Specific Antigen ◽  
Urinary Tract Symptoms ◽  
Retrospective Clinical Study ◽  
Testosterone Effect

Objective. To evaluate cardiovascular risk, metabolic profile, low urinary tract symptoms (LUTS), and sexual function in patients with nonfunctional pituitary macroadenoma (NFPMA) and hypogonadotropic hypogonadism with testosterone therapy (TTh). Methods. A retrospective clinical study at a tertiary care center was performed in 101 men with NFPMA, HH, and TTh; metabolic profile, cardiovascular risk, International Prostate Symptoms Score (IPSS), and International Index of Erectile Function 5 (IIEF-5) scores were evaluated before initiation of TTh and at the last checkup with TTh. Results. Age was 49.3 ± 8.8 years; T before TTh was 195 ng/mL (101–259) vs. 574 (423–774) at the last checkup. The time of TTh administration was 34 months (12–72). An increase in triglyceride levels (200 (153–294) vs. 174 (134–233) mg/dL; p=0.03), dyslipidemia (40% vs. 52%; p=0.03), and MetS (25% vs. 34%; p=0.05) was corroborated. A statistical difference in the Globorisk score and cardiovascular (CV) risk stratification was not found. IIEF-5 score was 15.5 ± 6.5 vs. 17.8 ± 5.3 (p=0.11). An improvement in penetration quality (2.0 ± 1.5 vs. 2.6 ± 1.3; p=0.05), erection after penetration (1.8 ± 1.2 vs. 2.5 ± 1.6; p=0.02), completion of intercourse (1.8 ± 1.2 vs. 2.4 ± 1.3; p=0.03), and satisfaction of sexual intercourse (1.8 ± 1.3 vs. 2.5 ± 1.5; p=0.01) was evidenced. IPSS score was 6 (IQR 2–10) vs. 7 (IQR 4–12); p=0.30. A lower rate of intermittency (14% vs. 3%; p=0.02), urgency (39% vs. 16%; p=0.01), and episodes of nocturia (18% vs. 4%; p=0.02) was found. An increase of hematocrit (44.1 ± 4.4 vs. 47.3 ± 4.4%; p=0.001), hemoglobin (14.9 ± 1.4 vs. 15.9 ± 1.4 g/dL; p=0.001), and prostatic specific antigen (0.59 (0.43–1.19) vs. 0.82 (0.45–1.4) ng/mL; p=0.02) was evidenced during TTh. Conclusion. TTh in young men with NFPMA improves LUTS, sexual function, and some metabolic parameters, and it is relatively safe in the prostatic context.

Cardiac risk factors and events in patients with prostate cancer commencing androgen deprivation therapy: Analysis from a tertiary care center in the Middle East.

2021 ◽  
Vol 39 (6_suppl) ◽  
pp. 73-73
Author(s):  
Mona Hassan ◽  
Talar Telvizian ◽  
Mostafa Abohelwa ◽  
Hadi Skouri ◽  
Deborah Mukherji
Keyword(s):  
Prostate Cancer ◽  
Risk Factors ◽  
Cardiovascular Risk ◽  
Middle East ◽  
Cardiovascular Events ◽  
Care Center ◽  
Tertiary Care ◽  
Tertiary Care Center ◽  
Cardiac Events ◽  
Artery Disease

73 Background: Androgen deprivation therapy (ADT) is the mainstay of treatment for advanced prostate cancer, improving symptoms and prolonging survival. There is an association between ADT use and cardiovascular events, particularly in men with pre-existing risk factors. There are no definite guidelines to stratify patients based on cardiovascular risk prior to ADT initiation. This is the first study on cardiac risks and events in patients on ADT from Lebanon and the Middle East region, a population known to have a high prevalence of cardiovascular risk factors. Methods: A retrospective chart review of 236 patients with prostate cancer who received ADT therapy at a tertiary care center in Lebanon was performed. 167 had a full set of data and were included in analysis. Cardiovascular risk factors at baseline and cardiovascular events on ADT were reviewed. Results: The median age of our cohort was 68, range 48-92 years. The majority of patients had stage 4 diseases at diagnosis (49.8%) with a median duration of 12 months on ADT. In our cohort 24.4% had body mass index > 30, 52.1% had smoking history, 27.4% were diabetic, 28.8 % had history of coronary artery disease, 10.6% had heart failure history and 54.6% had hypertension. Less than half of the patients had a documented lipid profile at baseline. Twenty two patients (9.5%) had documented cardiac events following ADT initiation. Conclusions: In this cohort of patients from the Middle East we found that one third of the population had established coronary artery disease at baseline and 9.5% had documented cardiac events on ADT initiation. Our study highlights the gaps in cardiovascular risk assessment for this high risk group of patients with prostate cancer. Risk and resource-stratified algorithms are needed before starting ADT therapy for optimal cardiovascular health. Increased awareness, collaboration and referral mechanisms between oncologists, urologist and cardiologists are also needed.

scholarly journals Prophylactic McCall Culdoplasty by a Vaginal Approach during Mini-Laparoscopic Hysterectomy

2019 ◽  
Vol 2019 ◽  
pp. 1-5 ◽  
Author(s):  
Servet Gencdal ◽  
Emine Demirel ◽  
Zeynep Soyman ◽  
Sefa Kelekci
Keyword(s):  
Sexual Function ◽  
Care Center ◽  
Tertiary Care ◽  
Laparoscopic Hysterectomy ◽  
Control Group ◽  
Apical Support ◽  
Mccall Culdoplasty ◽  
Vaginal Length ◽  
Area Of Concern ◽  
Total Vaginal Length

Background. In gynecological surgery, one particular area of concern after hysterectomy is the risk of developing an enterocele or vaginal apical prolapse. The aims of this study were to evaluate the safety and efficacy of prophylactic McCall culdoplasty (MC) performed during mini-total laparoscopic hysterectomy (mini-TLH), as well as to compare the differences in apical support, total vaginal length (TVL), and sexual function at one and two years postoperatively. Methods. Data were retrospectively reviewed for all women who underwent mini-TLH and mini-TLH + MC at a tertiary care center between August 2012 and January 2016 were from the hospital database. There were 18 women who underwent mini-TLH + MC and were considered as the study group, while 20 women who were treated with mini-TLH were considered as the control group. The primary outcome measures were the differences in apical support and TVL and impact on sexual function. Results. After mini-TLH + MC, the apical vaginal support difference was improved by 2.2 cm. The mean difference in C point was 1.03 cm in the mini-TLH group, which was not significant at two years after the operation. The vaginal vault descent at two years after operation was more prominent in the mini-TLH group than the mini-TLH + MC groups. Apical support changes at two years after the operation were more prominent in the mini-TLH group (0.5 ± 0.6 cm) than the mini-TLH + MC group (1.9 ± 1.2 cm). Conclusion. Prophylactic MC by a vaginal approach during mini-TLH is safe, satisfactory, and efficient for apical support without severe morbidity.

scholarly journals Microbiological Analysis of Urine Cultures in Women after Pelvic Reconstructive Surgery

2017 ◽  
Vol 11 (4) ◽  
pp. 212-217 ◽  
Author(s):  
Melissa L. Dawson ◽  
Meagan S. Cramer ◽  
Dana R. Thompson ◽  
Babak Vakili
Keyword(s):  
Urinary Tract ◽  
Reconstructive Surgery ◽  
Care Center ◽  
Foley Catheter ◽  
Tertiary Care ◽  
Microbiological Analysis ◽  
Pelvic Reconstructive Surgery ◽  
E Coli ◽  
Common Organism ◽  
Urinary Tract Symptoms

Background/Aims: The rate of urinary tract infection (UTI) after pelvic reconstructive surgery ranges from 9 to 48% and the most common uropathogen is Escherichia coli (E. coli). The aim of the study is to identify the predominant uro-pathogen from urine cultures in women undergoing pelvic reconstructive surgery. Methods: A retrospective review was conducted on women who underwent pelvic reconstructive surgery at a tertiary care center from July 2013 to June 2015. Data was collected from each postoperative visit to evaluate urinary tract symptoms, culture results and treatment in the 3-month postoperative interval. Results: There were 880 cases reviewed (mean age of 59.6 years) during the study period. The most common organism in positive cultures was E. coli after surgery. The total UTI rate was 11.3%. Patients discharged with a Foley catheter had a UTI rate of 65.6% (p = 0.003). Diabetes, neurologic disease, tobacco use, recurrent UTIs and breast or gynecologic cancers had no significant association with UTI after surgery. Conclusion: The most common organism identified is E. coli. Almost 12% of patients will develop a UTI after pelvic reconstructive surgery. The results of this study can influence management of lower urinary tract symptoms in the postoperative period.

scholarly journals Evaluation of ‘Visual prostate symptom score’ in men with benign enlargement of prostate in a tertiary care center in midwestern Nepal

2017 ◽  
Vol 18 (2) ◽  
pp. 6-10
Author(s):  
Dipesh Kumar Gupta
Keyword(s):  
Symptom Score ◽  
Care Center ◽  
Tertiary Care ◽  
Medical Personnel ◽  
Educational Status ◽  
Medical College ◽  
Symptom Evaluation ◽  
Number Of Patients ◽  
Urinary Tract Symptoms ◽  
One Year

Introduction: Quantification of lower urinary tract symptoms (LUTS) in patients with benign enlargement of prostate (BEP) is required to initiate and regulate treatment. Among many, International Prostate Symptom Score (IPSS) is standard though it is time consuming and difficult to understand by many patients. A recent Visual Prostate Symptom Score (VPSS) which is presumed to be simpler and well understood by patients with lower educational status has been in use.Methods: This is a prospective observational study conducted in Nepalgunj Medical College, Nepalgunj. In a total of 79 patients, 25 patients of LUTS because of other causes were excluded and 54 patients clinically diagnosed with BEP were enrolled for the study over a period of one year. Symptom evaluation was done in all with both IPSS and VPSS and uroflowmetry parameters were also recorded. The IPSS and VPSS were compared with each other and also with uroflowmetry parameters.Results: Mean age of the patients was 67 years and mean prostate volume was 48 gm. The patients who mostly were farmers had median eighth grade of education. Fourteen were illiterates and 40 were literate patients. Significant number of patients required assistance of a medical personnel to complete IPSS (p= <0.001) including those in literate group as well (p= <0.001). Time taken to complete VPSS was significantly less (p= 0.019). Total IPSS correlated with total VPSS ((r= +0.36; p=0.007). There was negative and significant correlation of VPSS with uroflowmeter parameters while IPSS failed to do so.Conclusion: VPSS is an easy and reliable tool to assess symptom severity in cases of BEP presenting with LUTS. It has the added advantage of utility in assessment of LUTS in patients with lower educational status. Moreover, the patients take shorter time to complete the questionnaire.  Journal of Society of Surgeons of Nepal, 2015; 18 (2), page: 6-10

scholarly journals Evaluation of ‘Visual prostate symptom score’ in men with benign enlargement of prostate in a tertiary care center in midwestern Nepal

2017 ◽  
Vol 18 (2) ◽  
pp. 7
Author(s):  
Dipesh Kumar Gupta
Keyword(s):  
Symptom Score ◽  
Care Center ◽  
Tertiary Care ◽  
Medical Personnel ◽  
Educational Status ◽  
Medical College ◽  
Symptom Evaluation ◽  
Number Of Patients ◽  
Urinary Tract Symptoms ◽  
One Year

<p><strong>Introduction: </strong>Quantification of lower urinary tract symptoms (LUTS) in patients with benign enlargement of prostate (BEP) is required to initiate and regulate treatment. Among many, International Prostate Symptom Score (IPSS) is standard though it is time consuming and difficult to understand by many patients. A recent Visual Prostate Symptom Score (VPSS) which is presumed to be simpler and well understood by patients with lower educational status has been in use.</p><p><strong>Methods: </strong>This is a prospective observational study conducted in Nepalgunj Medical College, Nepalgunj. In a total of 79 patients, 25 patients of LUTS because of other causes were excluded and 54 patients clinically diagnosed with BEP were enrolled for the study over a period of one year. Symptom evaluation was done in all with both IPSS and VPSS and uroflowmetry parameters were also recorded. The IPSS and VPSS were compared with each other and also with uroflowmetry parameters.</p><p><strong>Results: </strong>Mean age of the patients was 67 years and mean prostate volume was 48 gm. The patients who mostly were farmers had median eighth grade of education. Fourteen were illiterates and 40 were literate patients. Significant number of patients required assistance of a medical personnel to complete IPSS (p= &lt;0.001) including those in literate group as well (p= &lt;0.001). Time taken to complete VPSS was significantly less (p= 0.019). Total IPSS correlated with total VPSS ((r= +0.36; p=0.007). There was negative and significant correlation of VPSS with uroflowmeter parameters while IPSS failed to do so.</p><p><strong>Conclusion: </strong>VPSS is an easy and reliable tool to assess symptom severity in cases of BEP presenting with LUTS. It has the added advantage of utility in assessment of LUTS in patients with lower educational status. Moreover, the patients take shorter time to complete the questionnaire.  </p>

scholarly journals Trephine Immuno-Histochemistry As an Useful Adjunct in Characterizing Myelonecrosis in Resource Poor Settings - a Study from India

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 5028-5028
Author(s):  
Shruti Mishra ◽  
Somanath Padhi ◽  
Rasheeda Mohamedali ◽  
Kishore Kumar
Keyword(s):  
Bone Marrow ◽  
Conflicts Of Interest ◽  
Hematologic Malignancy ◽  
Lymphoblastic Leukemia ◽  
Care Center ◽  
Tertiary Care ◽  
Specific Antigen ◽  
Bone Marrow Necrosis ◽  
Resource Poor ◽  
Immuno Histochemistry

Introduction: Myelonecrosis is defined as necrosis of myeloid tissue within the hematopoietic medullary spaces with preservation of bony trabeculae. It is a rare finding on trephine which is reported to occur in 0.37% to 6.5% of all cases [1]. Most common cause of myelonecrosis is associated neoplasia [2]. Extensive myelonecrosis can make bone marrow aspiration and further evaluation difficult, leading to delay in diagnosis and management. We describe five such interesting cases with varying degree of myelonecrosis where immune-histochemistry in the necrosed zone helped us clinch the diagnosis. Cases and methods: Clinicopathological characteristics, bone marrow morphology and Immuno-histochemistry findings are tabulated below. In all the cases trephine biopsies were fixed with 10% neutral buffered formalin and decalcification was done with 14% EDTA for 48-72hrs (as per ICSH 2008 Guidelines). In all these cases, myelonecrosis was graded and ranged from mild to moderate. The procedure used was that of a semi-quantitative one. Grade I (mild): <20% of the biopsy Grade II (moderate-intermediate): 20-50% of the biopsy Grade III (severe-extensive): >50% of the biopsy. Gomori's technique was done for reticulin staining. Fibrosis was graded as per WHO protocols. Immuno-histochemistry was done by peroxidase - anti-peroxidase technique. Immuno-histochemical findings were recorded separately by two hemato-pathologists. Expression of each marker was graded as per strength and compared with the expression in the viable zones. The gradation of expression was done in a semi-quantitative manner. Mild expression: + Moderate expression: ++ Strong expression: +++ Discussion: Out of the five cases, three were hematological malignancies and rest two are metastatic solid tumors. Myelonecrosis in all the cases was of coagulative type. Myelonecrosis was extensive in 1/5 cases, moderate in 3/5 cases and patchy or focal in 1/5 cases. We found that the necrosed tumor cells retained their antigenicity for most of the markers. It was observed that even the intensity of expression was at par with that of the viable zones. The necrosed zone in case of B-cell precursor- acute lymphoblastic leukemia showed diffuse and strong positivity for CD10, CD79a, TdT and dim positive for CD34, thus confirming the diagnosis. Similarly, in the case of Non-Hodgkin's lymphoma the expression of markers in the necrosed areas showed strong antigenic expression for CD20, CD79a and nuclear positivity for Bcl 2, Bcl 6 and Mib 1. In the myeloma case retention of CD138, CD56 and Lambda light chain restriction was noted. Interestingly, both the cases with metastasis presented with bony pain and increased ALP (Alkaline Phosphatase). While in one case associated increase in PSA (Prostate specific antigen) in serum indicated the possibility of metastasis from a prostatic primary, the other case was evaluated in the line of myeloma. Immuno-histochemistry in the trephine suggested a possibility of metastasis from an occult primary. Later, on further evaluation a primary was found in the right breast of the patient. In both the metastatic cases, the expression of Cytokeratin was strong and diffuse. PSA was expressed in dot-like pattern. Jinkala et. al(3). in their study found that malignancy was the commonest cause of myelonecrosis. They found that neoplastic aetiology in 91% cases of marrow necrosis, out of which primary hematologic malignancy constituted 60% and rest was due to metastatic solid tumours. Also, most of the studies have proved that myelonecrosis itself is a bad prognostic factor in patients. Conclusion: Thus, we conclude Immuno-histochemistry is an useful adjunct to demonstrate the retained antigenicity in myelo-necrosed tissues; and could be useful in these cases as they are usually associated with scant and difficult aspirate. It can be done easily leading to a faster diagnosis of the patient even in resource poor settings too. This will save the patient from undergoing a painful bone marrow procedure again. References: 1. Markovic SN,. Pancytopenia due to bone marrow necrosis in acute myeloid leukemia: role of reactive CD8 cells. Am J Hematol 1998; 59:74. 2. Dunn Bone marrow necrosis in 38 adult cancer patients. J Famos Med Assoc 1993;92(12): 1107-10. 3. Jinkala S.R. Myelonecrosis: A Clinicopathological Study from a Tertiary Care Center in South India over a Twelve-Year Period. Bone Marrow Research 2014; 5 Figure Disclosures No relevant conflicts of interest to declare.

scholarly journals Prevalence of Cardiovascular Risk Factors among Chronic Kidney Disease Patients Undergoing Hemodialysis in a Tertiary Care Center, Kathmandu, Nepal

2019 ◽  
Vol 21 (4) ◽  
pp. 313-318
Author(s):  
A Pokhrel ◽  
P. Gyawali ◽  
BR Pokhrel ◽  
M P Khanal ◽  
D N Manandhar ◽  
...  
Keyword(s):  
Risk Factors ◽  
Chronic Kidney Disease ◽  
Cardiovascular Risk ◽  
Calcium Phosphate ◽  
Kidney Disease ◽  
Care Center ◽  
Tertiary Care ◽  
Maintenance Hemodialysis ◽  
Tertiary Care Center ◽  
Phosphate Product

The risk of cardiovascular disease is higher in chronic kidney disease patients compared to the general population and its impact is higher in developing countries compared to the developed countries. With this background in mind, we aimed to evaluate the prevalence of different cardiovascular risk factors in patients on maintenance hemodialysis in a tertiary care center. Chronic kidney disease patients aged 18 years and above who were under maintenance hemodialysis in the hemodialysis unit of Nepal Medical College were included in the study. Pre-dialysis venous blood samples from the participants were collected and analyzed for serum calcium, phosphorus, total protein, albumin and hemoglobin. Calcium phosphate product was calculated. Out of 100 study participants, 52% were male and 48% were female. Age-wise distribution showed 38% of the participants were below 40 years. The mean age of the participants was 45.86 ± 14.4 years. Ninety-three percent had hypertension and 29% had diabetes mellitus. Hypocalcemia was present in 80%, hyperphosphatemia was seen among 81% and high calcium phosphate product was present in 33% of the participants. Low hemoglobin (< 10gm/dL) was found in 86%. The cardiovascular risk trend in the Nepalese chronic kidney disease population is fairly different compared to the western population. Participants were younger. Prevalence of hypertension and diabetes was high. The high prevalence of anemia might be due to unaffordability of the participants for regular erythropoietin therapy. Inadequately managed hyperphosphatemia despite the widespread use of phosphorus binders, is still a major clinical challenge in patients on hemodialysis.

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