Urology

УЧЕБНО-МЕТОДИЧЕСКИЕ ПОСОБИЯУРОЛОГИЯУРОЛОГИЧЕСКИЕ БОЛЕЗН

Pain Management for Pregnant Women in the Opioid Crisis Era

Acute and chronic pain management during pregnancy, after delivery and even during lactation are challenging even for experienced physicians. This chapter intends to cover pregnancy-induced physiological changes in relation to pain conditions. It also covers the most common pain disorders in pregnancy and provides a comprehensive summary of the pharmacological and non-pharmacological options for pain management in pregnancy. Additionally, pain management in context of opioid abuse will also be covered, as high prevalence of opioid prescription is linked to the very poor maternal and fetal outcomes. The possibility of maternal opioid abuse and fetal opioid withdrawal should be known to all physicians, given its rising trends. Multimodal protocols and opioid sparing strategies are highly essential for safe pain management during pregnancy and have been discussed. This chapter is intended to be a fast and detailed review for residents, pain fellows, and physicians who seek pain control in pregnant women

The European Hematology Association Roadmap for European Hematology Research: a consensus document

The European Hematology Association (EHA) Roadmap for European Hematology Research highlights major achievements in diagnosis and treatment of blood disorders and identifies the greatest unmet clinical and scientific needs in those areas to enable better funded, more focused European hematology research. Initiated by the EHA, around 300 experts contributed to the consensus document, which will help European policy makers, research funders, research organizations, researchers, and patient groups make better informed decisions on hematology research. It also aims to raise public awareness of the burden of blood disorders on European society, which purely in economic terms is estimated at €23 billion per year, a level of cost that is not matched in current European hematology research funding. In recent decades, hematology research has improved our fundamental understanding of the biology of blood disorders, and has improved diagnostics and treatments, sometimes in revolutionary ways. This progress highlights the potential of focused basic research programs such as this EHA Roadmap. The EHA Roadmap identifies nine ‘sections’ in hematology: normal hematopoiesis, malignant lymphoid and myeloid diseases, anemias and related diseases, platelet disorders, blood coagulation and hemostatic disorders, transfusion medicine, infections in hematology, and hematopoietic stem cell transplantation. These sections span 60 smaller groups of diseases or disorders. The EHA Roadmap identifies priorities and needs across the field of hematology, including those to develop targeted therapies based on genomic profiling and chemical biology, to eradicate minimal residual malignant disease, and to develop cellular immunotherapies, combination treatments, gene therapies, hematopoietic stem cell treatments, and treatments that are better tolerated by elderly patients

Patterns of injury and violence in Yaoundé Cameroon: an analysis of hospital data.

BackgroundInjuries are quickly becoming a leading cause of death globally, disproportionately affecting sub-Saharan Africa, where reports on the epidemiology of injuries are extremely limited. Reports on the patterns and frequency of injuries are available from Cameroon are also scarce. This study explores the patterns of trauma seen at the emergency ward of the busiest trauma center in Cameroon's capital city.Materials and methodsAdministrative records from January 1, 2007, through December 31, 2007, were retrospectively reviewed; information on age, gender, mechanism of injury, and outcome was abstracted for all trauma patients presenting to the emergency ward. Univariate analysis was performed to assess patterns of injuries in terms of mechanism, date, age, and gender. Bivariate analysis was used to explore potential relationships between demographic variables and mechanism of injury.ResultsA total of 6,234 injured people were seen at the Central Hospital of Yaoundé's emergency ward during the year 2007. Males comprised 71% of those injured, and the mean age of injured patients was 29 years (SD = 14.9). Nearly 60% of the injuries were due to road traffic accidents, 46% of which involved a pedestrian. Intentional injuries were the second most common mechanism of injury (22.5%), 55% of which involved unarmed assault. Patients injured in falls were more likely to be admitted to the hospital (p < 0.001), whereas patients suffering intentional injuries and bites were less likely to be hospitalized (p < 0.001). Males were significantly more likely to be admitted than females (p < 0.001)DiscussionPatterns in terms of age, gender, and mechanism of injury are similar to reports from other countries from the same geographic region, but the magnitude of cases reported is high for a single institution in an African city the size of Yaoundé. As the burden of disease is predicted to increase dramatically in sub-Saharan Africa, immediate efforts in prevention and treatment in Cameroon are strongly warranted

Rheumatoid Arthritis and Fertile Female: A Comprehensive Review of Management During Pre-Conception, Gestation and Lactation.

Rheumatoid arthritis (RA) is a chronic inflammatory autoimmune disorder that causes significant physical disability, and it affects women three times more commonly than men. It is often seen in their childbearing years. Data on the annual incidence of the disease also suggests a very high percentage in the child-bearing age group. So understanding their problems and finding a solution will be critical for a health care professional taking care of them. Decisions about parenthood also become challenging, as they are affected by perceptions of their disease state, health care needs, and complex pharmacological treatments. There is undoubtedly a clear need to support these vulnerable women through this important period of their lives. The management of RA has revolutionized in recent years. The availability of novel therapies, such as biological agents and treatment paradigms, has substantially improved treatment outcomes for patients with RA. Unfortunately, data on the safety of many of these medications is limited, and many may be contraindicated during pregnancy and breastfeeding. To stabilize the disease before conception and to modify the drug regime, coordinated and careful planning is needed. Recent studies showed that only 20–40%  of patients with RA achieve remission by the third trimester. Although 50% may be considered to have low disease activity, nearly 20% will have worse or moderate-to-high disease activity during pregnancy and may require further therapeutic intervention. Many women commonly report postpartum relapses, making them unable to properly care for themselves and their children. A lot of women can find it difficult to access information that could help them plan for pregnancy, lactation, and early parenting concerning their chronic conditions. The accessibility and variety of the pharmacotherapeutic agents support disease control optimization before conception and contribute to the success of the female raising of children, but they should be provided with a detailed understanding of their risks and safety in the setting of pregnancy and breastfeeding. It is a hard nut to crack for healthcare providers to use individualized treatment plans not only for treating active disease but also for maintaining disease remission during the period of preconception, pregnancy, and postpartum. Through the review, we are trying to identify the various issues that rheumatologists face in taking care of women and men in the reproductive age group who wish to start a family. In addition, it explores evidence-based approaches and emphasizes the safe use of disease-modifying antirheumatic drugs and biologics in the care of pregnant and lactating women with RA. DOI: https://doi.org/10.52783/jchr.v14.i2.374

Diseases of the Abdomen and Pelvis 2018-2021: Diagnostic Imaging - IDKD Book

Gastrointestinal disease; PET/CT; Radiology; X-ray; IDKD; Davo