Predictors of urinary retention in benign prostate hyperplasia

Background: Acute urinary retention (AUR) is one of the most significant complications or long-term outcomes of benign prostatic hyperplasia (BPH). Because of the high prevalence of BPH and its effect on the patient's quality of life, additional research is needed to better predict the risk factors of AUR. The study was aimed to find out the incidence and factors responsible for retention of urine in BPH.Methods: It was a prospective study, conducted at a medical college after the approval from IEC. The study included the patients admitted to the surgical wards admitted with the symptoms of lower urinary tract symptom and presented with acute urinary retention. Duration of the study was 2 months. A total 40 patients were studied over this duration. The outcome of the study was analyzed by these factors: Age in years, Symptom severity, Prostate Volume on DRE and USG Grade.Results: The mean age of presentation was 64.87±7.85 with median age of 65 years (range 45-82 years) with mean IPSS score of 17.45and the mean PVR was 110.80 ± 85.52 with median 110 (range 0-500). Maximum number of patients having Grade 3 and 4 enlargements had PSA level 9-12 ng/ml. The PSA levels and the grade of enlargement on USG were statistically significant (p-0.004).Conclusions: Out of the four factors considered to be the independent risk factors, all of them have positive correlation with the symptom of acute urinary retention. None of these four factors i.e. age in years, symptom severity, prostate Volume on DRE and USG grade could establish significant correlation.

Update on hypertrophic cardiomyopathy and a guide to the guidelines

Hypertrophic cardiomyopathy (HCM) is the most common inherited cardiovascular disorder, affecting 1 in 500 individuals worldwide. Existing epidemiological studies might have underestimated the prevalence of HCM, however, owing to limited inclusion of individuals with early, incomplete phenotypic expression. Clinical manifestations of HCM include diastolic dysfunction, left ventricular outflow tract obstruction, ischaemia, atrial fibrillation, abnormal vascular responses and, in 5% of patients, progression to a 'burnt-out' phase characterized by systolic impairment. Disease-related mortality is most often attributable to sudden cardiac death, heart failure, and embolic stroke. The majority of individuals with HCM, however, have normal or near-normal life expectancy, owing in part to contemporary management strategies including family screening, risk stratification, thromboembolic prophylaxis, and implantation of cardioverter-defibrillators. The clinical guidelines for HCM issued by the ACC Foundation/AHA and the ESC facilitate evaluation and management of the disease. In this Review, we aim to assist clinicians in navigating the guidelines by highlighting important updates, current gaps in knowledge, differences in the recommendations, and challenges in implementing them, including aids and pitfalls in clinical and pathological evaluation. We also discuss the advances in genetics, imaging, and molecular research that will underpin future developments in diagnosis and therapy for HCM

Predictors of urinary retention in benign prostate hyperplasia

Background: Acute urinary retention (AUR) is one of the most significant complications or long-term outcomes of benign prostatic hyperplasia (BPH). Because of the high prevalence of BPH and its effect on the patient's quality of life, additional research is needed to better predict the risk factors of AUR. The study was aimed to find out the incidence and factors responsible for retention of urine in BPH.Methods: It was a prospective study, conducted at a medical college after the approval from IEC. The study included the patients admitted to the surgical wards admitted with the symptoms of lower urinary tract symptom and presented with acute urinary retention. Duration of the study was 2 months. A total 40 patients were studied over this duration. The outcome of the study was analyzed by these factors: Age in years, Symptom severity, Prostate Volume on DRE and USG Grade.Results: The mean age of presentation was 64.87±7.85 with median age of 65 years (range 45-82 years) with mean IPSS score of 17.45and the mean PVR was 110.80 ± 85.52 with median 110 (range 0-500). Maximum number of patients having Grade 3 and 4 enlargements had PSA level 9-12 ng/ml. The PSA levels and the grade of enlargement on USG were statistically significant (p-0.004).Conclusions: Out of the four factors considered to be the independent risk factors, all of them have positive correlation with the symptom of acute urinary retention. None of these four factors i.e. age in years, symptom severity, prostate Volume on DRE and USG grade could establish significant correlation.

Adjunctive Antithrombotic Therapy for Patients With Aortic Stenosis Undergoing Transcatheter Aortic Valve Replacement.

Importance: Transcatheter aortic valve replacement (TAVR) is an established alternative to surgery for patients with severe symptomatic aortic stenosis. Adjunctive antithrombotic therapy used to mitigate thrombotic risks in patients undergoing TAVR must be balanced against bleeding complications, since both are associated with increased mortality. Observation: Stroke risk associated with TAVR is lower than that associated with surgical aortic valve replacement in recent trials including patients at intermediate or low risk, but it is constant beginning at the time of implant and accrues over time based on patient risk factors. Patients with aortic stenosis undergoing TAVR also have a sizable risk of life-threatening or major bleeding. Although dual antiplatelet therapy for 3 to 6 months after TAVR is the guideline-recommended regimen, this practice is not well supported by current evidence. In patients with no indication for oral anticoagulation, current registry-based evidence suggests that single antiplatelet therapy may be safer than dual antiplatelet therapy. Similarly, oral anticoagulation monotherapy appears superior to anticoagulation plus antiplatelet therapy in those where oral anticoagulant use is indicated. To date, no risk prediction models have been established to guide antithrombotic therapy. Conclusions and Relevance: Despite the growing volume of TAVR procedures to treat patients with severe aortic stenosis, evidence for adjunctive antithrombotic therapy remains rather scarce. Ongoing clinical trials will provide better understanding to guide antithrombotic therapy