HISTOPATHOLOGICAL EXAMINATIONS PROFILE OF BLADDER DISEASES IN DR. SOETOMO GENERAL ACADEMIC HOSPITAL FROM JANUARY 2015 TO DECEMBER 2019

Objective: This study aimed to analyze the profile of bladder disease in Soetomo General Hospital based on histopathological examination. Material & Methods: This study was using secondary data. Histopathological examination data of patients with bladder disease were evaluated based on age, gender, and histopathological types. Results: There were 419 patients with bladder abnormalities. Non-neoplasm bladder diseases were found in 62 patients consisted of 56 patients (90.32%) with cystitis and 6 patients (9.67%) with glandular cystitis. Neoplastic bladder diseases were found in 357 patients and were divided into benign and malignant neoplasm. Benign neoplasms were found in 11 patients consisted of 5 patients (45.45%) with UP and 6 patients (54.54%) with IUP. Malignant neoplasms were found in 340 patients consisted of 300 patients (88.23%) with urothelial carcinoma, 26 patients (7.64%) with adenocarcinoma, 14 patients (4.12%) with SCC. Moreover, six male patients with PUNLMP were also reported. Conclusion: Histopathological examination in patients with bladder abnormalities shows that neoplastic bladder diseases (357/419, 85.20%) were more common than non-neoplastic bladder disease (62/419, 14.80%).

Chronic bladder diseases: overactive bladder and interstitial cystitis/bladder pain syndrome

Background: Overactive bladder (OAB) and interstitial cystitis/bladder pain syndrome (IC/BPS) are debilitatingchronic bladder diseases that affect patients’ quality of life. Their etiologies and clinical phenotypes vary, and management strategies should be selected after excluding the possibilities of other pathological conditions with careful consideration of a multidisciplinary integrated approach to ensure optimal success.Current Concepts: OAB is a symptom complex characterized by urinary urgency and frequency and nocturia with or without urge incontinence, and its key symptom is urinary urgency. IC/BPS has symptoms similar to lower urinary tract symptoms (LUTS) associated with OAB but also has distinctly different symptoms, including the key symptom of an unpleasant sensation or pain perceived to be related to the urinary bladder associated with LUTS. Recent studies have revealed that these key symptoms of OAB or IC/BPS are also observed in some patients with other diseases. Patients showing no evidence of bacterial infection on urine culture and experiencing LUTS or pain for more than 6 weeks should be considered as having OAB or IC/BPS. Treatment strategies for OAB and IC/BPS focus on managing LUTS and bothersome pain. Noninvasive management should be considered initially, whereas surgical options should be considered only after conservative treatment failure.Discussion and Conclusion: OAB and IC/BPS symptoms overlap considerably in many patients. A more accurate differentiation of symptoms, including LUTS, would help achieve better treatment outcomes.

Citrate therapy for ur olithiasis in postmenopausal women

A tendency towards growing life expectancy in old age can be clearly observed in most countries of the world over the past number of decades. This tendency is also seen in our country. Despite the fact that people started living longer, which would seem to be a good indicator of the country’s socio-economic development, the doctors have encountered a rather difficult challenge to overcome. The question at issue is that health specialists are faced with many somatic diseases due to the fact that people started living longer. When life expectancy was much less, many of them have never encountered such a volume of diseases. Today, the share of the elderly in the population has significantly increased and they live longer, which, accordingly, has an impact on the number of nosological units in the clinical practice of almost any health specialist. This article is focused on the issue of non-decreasing incidence of urinary tract diseases; in particular, the challenges of bladder stone disease (BSD) are considered. According to the latest data, the disease prevalence does not tend to decrease. Moreover, the incidence of BSD in women has increased significantly, although this pathological condition is more typical for men. In light of the fact that female patients spend about a third of their lives in the postmenopausal period, it is worth paying special attention to some features of the woman’s body functioning during this time period due to the likelihood of the formation of an inflammatory process, which often mediates the development of the BSD. Older female patients are often concerned about inflammatory bladder diseases, which can lead to the development of BSD by ascending infection in the future. Therefore, it is crucially important to know what therapeutic capabilities doctors have today to effectively fight the BSD.

Drug Release Profiles of Mitomycin C Encapsulated Quantum Dots–Chitosan Nanocarrier System for the Possible Treatment of Non-Muscle Invasive Bladder Cancer

Nanotechnology-based drug delivery systems are an emerging technology for the targeted delivery of chemotherapeutic agents in cancer therapy with low/no toxicity to the non-cancer cells. With that view, the present work reports the synthesis, characterization, and testing of Mn:ZnS quantum dots (QDs) conjugated chitosan (CS)-based nanocarrier system encapsulated with Mitomycin C (MMC) drug. This fabricated nanocarrier, MMC@CS-Mn:ZnS, has been tested thoroughly for the drug loading capacity, drug encapsulation efficiency, and release properties at a fixed wavelength (358 nm) using a UV–Vis spectrophotometer. Followed by the physicochemical characterization, the cumulative drug release profiling data of MMC@CS-Mn:ZnS nanocarrier (at pH of 6.5, 6.8, 7.2, and 7.5) were investigated to have the highest release of 56.48% at pH 6.8, followed by 50.22%, 30.88%, and 10.75% at pH 7.2, 6.5, and 7.5, respectively. Additionally, the drug release studies were fitted to five different pharmacokinetic models including pesudo-first-order, pseudo-second-order, Higuchi, Hixson–Crowell, and Korsmeyers–Peppas models. From the analysis, the cumulative MMC release suits the Higuchi model well, revealing the diffusion-controlled mechanism involving the correlation of cumulative drug release proportional to the function square root of time at equilibrium, with the correlation coefficient values (R2) of 0.9849, 0.9604, 0.9783, and 0.7989 for drug release at pH 6.5, 6.8, 7.2, and 7.5, respectively. Based on the overall results analysis, the formulated nanocarrier system of MMC synergistically envisages the efficient delivery of chemotherapeutic agents to the target cancerous sites, able to sustain it for a longer time, etc. Consequently, the developed nanocarrier system has the capacity to improve the drug loading efficacy in combating the reoccurrence and progression of cancer in non-muscle invasive bladder diseases.

Complications of Laproscopic Cholecystectomy in Patients of Acute Cholecystitis

Objective: To determine the complications of laparoscopic cholecystectomy in patients of acute cholecystitis. Study Design: Prospective study. Place & Duration: Department of Surgery, Lady Reading Hospital, Peshawar for duration of six months from January 2020 to June 2020. Methods: Total 120 patients of both genders with ages 20 to 60 years were included in this study. Patients’ detailed demographics were recorded after taking written consent. Patients with history of abdominal surgery were excluded. All the patients underwent laparoscopic cholecystectomy for gall bladder diseases. Post-operative pain was analyzed by VAS. Complications were recorded at 5th postoperative day. Data was analyzed by SPSS 24.0. Results: Out of 120 patients 30 (25%) patients were males and 75% patients were females. Most of the patients 50 (41.67%) were in the age group 31 to 40 years followed by 37 (30.83%) patients were ages between 41 to 50 years. 70 (58.33%) patients had surgical size port incision was 5mm and 50 (41.67%) patients had 10mm. Mean pain score was 2.24+1.1 at 5th postoperative day. Wound infection was found in 10 (8.33%). Port site hernia was found in 12 (10%). Conclusion: Laparoscopic cholecystectomy is safe and effective treatment procedure with no major complications. Keywords: Laparoscopic Cholecystectomy, Acute Cholecystitis, Wound Infection, Port Site Hernia, Pain

INCIDENCE OF GALL BLADDER CARCINOMA: A RETROSPECTIVE CASE STUDY AT RIMS RANCHI

BACKGROUND: Gall bladder carcinoma is most common malignancy of the biliary tract and seventh most common gastrointestinal malignancy. Histologically most gall bladder carcinoma are pancreaticobiliary type adenocarcinoma, showing variable degrees of differentiation.The determination of the histology type of tumour and differential diagnosis from gall bladder adenocarcinoma are often difficult. It has unique significant and striking gender, geographic and ethnic variation in the incidence worldwide. MATERIAL AND METHOD: It is retrospective record based study, performed in department of Pathology RIMS, Ranchi. Study population included all cases who were operated for different pathology of gall bladder,with some common clinical presentations of upper right quadrant abdominal pain, jaundice, nausea and vomiting, from January 2018-December 2019. RESULT: Among the spectrum of gall bladder diseases most common finding was chronic cholecystitis, incidence of gall bladder carcinoma is a rare entity. In our present study female preponderance has been noted and mostly incidence is among the age group above 30 years.

Endocannabinoids in Bladder Sensory Mechanisms in Health and Diseases

The recent surge in research on cannabinoids may have been fueled by changes in legislation in several jurisdictions, and by approval for the use of cannabinoids for treatment of some chronic diseases. Endocannabinoids act largely, but not exclusively on cannabinoid receptors 1 and 2 (CBR1 and CBR2) which are expressed in the bladder mainly by the urothelium and the axons and endings of motor and sensory neurons. A growing body of evidence suggests that endocannabinoid system constitutively downregulates sensory bladder function during urine storage and micturition, under normal physiological conditions. Similarly, exogenous cannabinoid agonists have potent modulatory effects, as do inhibitors of endocannabinoid inactivation. Results suggest a high potential of cannabinoids to therapeutically ameliorate lower urinary tract symptoms in overactive bladder and painful bladder syndromes. At least part of this may be mediated via effects on sensory nerves, although actions on efferent nerves complicate interpretation. The sensory innervation of bladder is complex with at least eight classes identified. There is a large gap in our knowledge of the effects of endocannabinoids and synthetic agonists on different classes of bladder sensory neurons. Future studies are needed to reveal the action of selective cannabinoid receptor 2 agonists and/or peripherally restricted synthetic cannabinoid receptor 1 agonists on bladder sensory neurons in animal models of bladder diseases. There is significant potential for these novel therapeutics which are devoid of central nervous system psychotropic actions, and which may avoid many of the side effects of current treatments for overactive bladder and painful bladder syndromes.

Association between case signalment and disease diagnosis in urinary bladder disease in Australian cats and dogs

Urinary bladder diseases are common in dogs and cats; however, there is little published work on urinary bladder disease in Australian pets. We identified pathology records of Australian dogs and cats with urinary bladder tissue submitted to the University of Queensland Veterinary Laboratory Service during 1994–2016 ( n = 320). We described the proportion of bladder diseases in dogs and cats, and applied the less-commonly used logistic regression procedure to quantify associations between signalment variables and disease diagnosis that were evident using descriptive statistics alone. After preliminary analysis, both species were combined because of similar results. Spayed/castrated animals were 74% less likely to be diagnosed with cystitis compared with intact animals. Animals 4–11 y old were also at lower risk of being diagnosed with cystitis compared with younger or older animals. Male animals were at increased risk of neoplasia compared to females, which contrasts with reports from North America and Europe. There was increased risk for developing neoplasia with progressive age, with up to 20 times higher odds in the > 11-y age group. Logistic regression modeling provided unique insight into proportionate morbidity of urinary bladder diseases in Australian dogs and cats.

Erectile Dysfunction: an Integrative Approach

For many years, integrative medicine has tried to provide a more global vision by integrating the different biological and physiological systems of the human body in the management of its dysfunctions. This approach, which appears quite new, allows a throughout integration of the diseases within a patient and no more despite the patient. It will be a question of integrating the patient’s different organs into their body again in order to get to the heart of the problem in a metabolic and structured manner. This approach is quite interesting in urology as well and concerns number of pathologies like prostate, kidney and bladder diseases as well as functional problems. Moreover, certain new areas of concern like androgenic deficiencies as well as erectile dysfunction and ejaculatory problems are in the target of this new approach. It is at this level that integrative and functional medicine takes its place by allowing a global approach to the patient’s problem and by focusing the initial care on the prevention of risk factors and natural and alternative treatments before prescription of chemical molecules.