SESSION TYPE: Sleep PostersPRESENTED ON: Wednesday, October 24, 2012 at 01:30 PM - 02:30 PM

PURPOSE:

To study Sleep-Related Breathing Disorders in Patients with Schistosomal Cor-Pulmonale.

METHODS:

All patients were subjected to thorough history and clinical examination and lab tests for Schistosomiasis. All patients has sleep study, Arterial blood gases, echocardiography, and radiological examination in form of chest Xray and CT.

RESULTS:

The present study was carried out on ten patients with schistosomal Cor-pulmonale; three females and seven males and compaired with ten non smoker healthy volunteers with no cardiorespiratory co-morbidities. They are matched with the patients as regard age, sex and BMI. The Mean age of patients group was 43.70±8.04, weight in patients group was 65.0±14.20 Kgm, and Mean± SD height in patients group was 1.66 ± 0.11 M . As regard patients's complains related to underlying sleep disorders breathing; ESS of patients was ranging 4.0 -12.0 with mean + SD 7.60 ±3.10. loud snoring was present in 6 patients, choking attacks at night was present in 3 patients, Unrefreashing sleep was present in 9 presents, restless sleep was present in 7 patients, nocturia was present in 6 patients, morning headach in 8 patients, apneic episodes seen by bed partner in 3 patients, recurrent arousal was present in 8 patients, depression was present in 4 patients, insomnia was present in all patients except no. (6) and dry tongue was present in 4 patients.

CONCLUSIONS:

Sleeping disorders are not uncommon in patients with Schistosomal Cor-Pulmonale.

CLINICAL IMPLICATIONS:

Further studies are needed in patients with Schistosomal Cor-Pulmonale to evaluate the sleep disorders.DISCLOSURE: The following authors have nothing to disclose: Emad IbrahimNo Product/Research Disclosure InformationAlexandria Faculty of Medicine, Alexandria, Egypt.

Abstract

Objective:

The current study was carried out to investigate the impact of atherosclerosis on lower urinary tract function in the male patients with lower urinary tract symptoms (LUTS). Patients and methods: This prospective study evaluated 110 male patients aged 55-75 years who were presented with LUTS. All patients underwent general and local investigations. The atherosclerosis was assessed by ultrasound examination of the carotid artery. Patients then were divided into two groups: non-atherosclerosis group (Group 1) and atherosclerosis group (Group 2). The two groups were compared regarding voiding and storage parameters.

Results:

Mean patient age were 67.9 ± 5.9 years. The average age and number of Group 1 was 65.7 ± 4.3, n = 51. The average age and number of Group 2 was 68.7 ± 5.3, n = 59. There were no significant differences in age, prostate volume, blood pressure, International Prostate Symptom Score, Voiding symptom score and Storage symptom score between the two groups. Blood serum triglycerides were significantly lower in Group 1 than Group 2 while HDL cholesterol were significantly higher in Group 1 than Group 2 0.97 ± 0.5 and 1.43 ± 0.2 mmol/L, versus 1.46 ± 0.7 and 1.28 ± 0.3 mmol/L, respectively. Qmax denotes significant decrease in Group 2 compared with Group 1 12.5 ± 6.3 versus 17.6 ± 6.5, respectively (p < 0.01). While in post-voiding residual urine, there was a significant increase in Group 2 compared with Group 1 82.2 ± 15.4 versus 51.4 ± 12.7, respectively (p < 0.01). Daytime voided urine denotes a significant decrease in Group 2 176 ± 48, compared with Group 1 221.2 ± 79 (p < 0.01). Daytime frequency and nocturia, were significantly higher in Group 2, compared with Group 1 8.90 ± 2.8 versus 7.16 ± 3.11, respectively, and 3.1 ± 1.2 versus 1.92 ± 1.12, respectively (p < 0.05).

Conclusion:

The atherosclerosis disease play a significant role in the impairments of both voiding and storage function in male patients with LUTS irrelevant to the age.

A 47-year-old man presented with a 5-year history of slowly progressive gait disorder with clumsiness and unsteadiness during walking, as well as stiffness and cramping pain in his legs. He also had erectile dysfunction and nocturia. He denied sensory deficits and other focal neurologic or systemic symptoms. He had a medical history of hypogonadism, diagnosed 1 year before the onset of the gait disorder, attributed to a bilateral orchiectomy due to a testicular tumor, performed elsewhere when he was 37. He was receiving IM testosterone injections every 3 weeks. His family medical history included pes cavus in his mother and siblings, otherwise unremarkable.

PURPOSE:

This systematic review focuses on the relationship between nocturia and depression/anxiety. Our objective is to provide an overview of current data regarding the epidemiology, pathophysiology, and patient management implications of the association between nocturia and depression/anxiety.

MATERIALS AND METHODS:

Pubmed, Web of Science, and Embase were queried in July 2012 to identify abstracts, original, review and editorial articles on nocturia and mood disorders, specifically depression and anxiety. The search was conducted using the following keywords: "nocturia", "depression", and "anxiety". We complied with the Assessment of Multiple Systemic Reviews instrument. We retrieved a total of 500 records with 95, 81, and 324 from Pubmed, Web of Science, and Embase, respectively.

RESULTS:

Cross sectional (level 3) data indicate that nocturia and depression/anxiety are strongly associated. One prospective study contends that depression leads to nocturia in a unidirectional relationship. Nocturia poses a greater risk for depression in men versus women. Results are conflicting regarding the effect of SSRI's on nocturia.

CONCLUSIONS:

The results of this systematic review suggest a bidirectional association between depression and nocturia. The relationship between anxiety and noctuira is less clear. Practicing clinicians should consider administering a brief self-administered scale to assess for depression in nocturia patients.

Recent studies have investigated a combination of two antimuscarinics for adult neurogenic bladder managed with clean intermittent catheterization or pediatric refractory overactive bladder (OAB). We assessed the efficacy and tolerability of this strategy in adults with idiopathic OAB.We reviewed 49 patients with idiopathic OAB who received combined antimuscarinic medication. Patients had serially received different kinds of antimuscarinics as monotherapy, but wished to take combined medication due to a lack of sufficient subjective improvement in urgency, even with dosage escalation. Efficacy was measured by changes of episodes of urgency, daytime voiding, nocturia and mean voided volume before and after the addition of the second antimuscarinic.The mean duration of combined medication was 9.3 months. After adding the second antimuscarinic, urgency per day decreased from 3.8 to 1.9 (p < 0.001) and daytime voiding decreased from 10.4 to 7.4 (p < 0.001). The number of nocturia episodes and the mean voided volume also improved, although there was no statistical significance. Efficacy did not differ between the 29 cases, with non-selective and non-selective drugs and 20 cases with non-selective and M3 selective drugs. Thirty-three (67.3%) patients reported to have benefited from combined medication. Maximal flow rate and post-void residual volume did not change in either of the sexes. Eleven (22.4%) patients discontinued the combination due to continued ineffectiveness and dry mouth.This retrospective study suggests that combined medication can help adults with refractory idiopathic OAB. Combined medication was tolerated in most of our patients.

INTRODUCTION:

Paracoccidioidomycosis is a systemic mycosis in Latin America that can affect various organs. Few case reports of paracoccidioidomycosis affecting the prostate are found in the literature.

CASE PRESENTATION:

We present the case of a 79-year-old Caucasian man with a six-month history of irritative symptoms of the prostate (urgency, frequency and nocturia) and difficulty initiating urination that progressed to urinary retention and the use of a urinary catheter. The anatomopathological analysis of the transurethral resection of the prostate revealed chronic granulomatous prostatitis of fungal etiology (paracoccidioidomycosis) with extensive necrosis. The patient began treatment with itraconazole at a dose of 100mg/day for six months. Radiography of the thorax revealed bilaterally diffuse nodular reticular interstitial lesions. The patient progressed to respiratory failure and was sent to the intensive care unit, but suffered a cardiopulmonary arrest and was pronounced dead.

CONCLUSIONS:

Due to the high incidence of paracoccidioidomycosis in countries like Brazil, urologists should suspect blastomycosis in all patients with symptoms of lower urinary obstruction with chronic abacterial prostatitis. Considering that paracoccidioidomycosis has the potential to affect various organs, following diagnosis, the treatment must be initiated as soon as possible.