Aims Estimate the prevalence of symptoms suggestive of overactive bladder (OAB) in women living in the Middle East to describe their demographic characteristics and explore treatment-seeking behavior. Methods Cross-sectional, population-based survey of women aged ≥ 40 years resident in Algeria, Jordan, Lebanon or Egypt. Respondents were recruited using computer-assisted telephone interview over approximately 4 months. Eligible respondents were asked to complete the OAB-V8, a validated questionnaire that explores the extent of bother from the key symptoms of OAB without clinical investigations. In addition, information regarding demographics, comorbidities and treatment behavior was collected, and respondents were stratified by age. Results A total of 2297 eligible women agreed to participate. Mean age was 54 ± 10 years; over half (59.3%) were aged 40–55 years. Overall, 53.8% of eligible women had symptoms suggestive of OAB (Jordan 58.5%; Egypt 57.5%; Algeria 49.9%; Lebanon 49.0%), with over 90% also reporting symptoms of urinary incontinence. Only 13.0% of women with symptoms suggestive of OAB were currently receiving treatment, while most (74.3%) had never been treated; these data were consistent across country and age categories. Among the untreated subgroup, almost half (48.7%) reported they were ‘not bothered by symptoms,’ while 8.4% considered OAB to be ‘part of normal aging’ and 4.7% did not know it was treatable. Conclusion A high prevalence of symptoms suggestive of OAB was observed, and the majority had symptoms of urinary incontinence. Despite the high prevalence, most women had never received treatment. Considering the potential significant impact of OAB symptoms on health, quality of life and productivity, these findings highlight an unmet medical need in the population studied. Strategies to improve treatment-seeking behavior (e.g., through education and tackling the stigma associated with OAB symptoms) may improve the diagnosis, management and health outcomes of women with OAB in the Middle East. Supplementary Information The online version contains supplementary material available at 10.1007/s12325-020-01588-4.
Ann R Coll Surg Engl 2010; 92: 489-494 489Bisphosphonate-related osteonecrosis of the jaws (BRONJ), first described by Marx, 1 is defined as jaw necrosis occurring either spontaneously or, more commonly, after simple dento-alveolar surgery in patients on bisphosphonates, commonly with the intravenous (i.v.) form of the drug. Bisphosphonates are non-metabolised analogues of pyrophosphate that localise to bone inhibiting the dissolution of hydroxyapatite crystals preventing bone resorption.2,3 Other effects include reducing blood flow and antiangiogenic properties, 4 contributing to the ischaemic changes noted in the affected jawbones. Bisphosphonates are preferentially deposited in bones with high turn-over rates, since the maxilla and mandible are sites of significant remodelling, it is possible that the levels of the drug within the jaw are selectively elevated.2 BRONJ is a multifactorial event with multicellular impairments, resulting in altered wound healing. 5Cancer patients with metastatic or primary bone lesions often develop sequential skeletal complications and hypercalcaemia of malignancy.6 Intravenous bisphosphonates are primarily used in the management of cancer-related hypercalcaemia and skeletal-related events associated with bone metastases including pain, pathological fracture, spinal cord compression, mostly with solid tumours such as breast, prostate and lung cancers.6 They are also effective in the management of lytic lesions in the setting of multiple myeloma; 7 multiple myeloma patients appear to have a uniquely elevated risk for the development of the condition as the disease itself is present in bone. 8 The most prevalent and common indication for oral bisphosphonates is osteoporosis. RESULTS Of the 41 patients, four developed BRONJ, two in maxilla, one in mandible and one bimaxillary. Patients with BRONJ were older; mean age was 69.3 ± 3.1 years compared to 62.8 ± 12.5 years (P = 0.022). Dental co-morbidities were more commonly present in patients with the disease (P = 0.038). Patients who developed BRONJ were on treatment for a longer duration of time; the mean duration of treatment was 23.5 ± 8.4 months compared to 11.9 ± 13.4 months (P = 0.10). CONCLUSIONS The results of this case series demonstrated that age and poor oral health status are significant risk factors of BRONJ for oncology patients on long-term frequent dosing schedule of i.v. bisphosphonates.
Prostate cancer (PCa) is a slow, progressive disease. Prostate specific antigen testing, screening, and aggressive case identification has made PCa the most frequently diagnosed cancer. Concerns regarding overdiagnosis and overtreatment flourish on a large scale. In order to avoid overtreatment for those in whom therapeutic intervention is not required, active surveillance for eligible patients with the use of 5-alpha reductase can be considered a safe and a promising approach to delay the progression of the disease with minimal side effects.
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