BIOSOFT HELP FILES

1)      Metabolic Syndrome – central obesity (men > 102 cm or 40”, women 88 cm or 34”), triglyceride levels high (> 150 mg/dL or 1.7 mmol/L), HDL-C low levels (men < 40 mg/dL or 1.03 mmol/L women < 50 mg/dL or 1.29 mmol/L), blood pressure high (> 130/80), Fasting glucose high (=> 110 mg/dL or 6.1 mmol/L) (3 or more of above factors define metabolic syndrome according to NCEP ATP III ), according to WHO a patient must have glucose intolerance, impaired glucose tolerance, or diabetes, and/or insulin resistance together with at least 2 of the following: elevated BP (=> 140/90), elevated triglyceride levels (=> 1.7 mmol/L, => 150 mg/dL),  low HDL-C levels (< 0.9 mmol/L, < 35 mg.dL, ), central obesity (waist/hip ratio > 0.90 for males, 0.85 for females, BMI > 30 ), microalbuminuria (urinary albumin excretion rate => 20 mcg/min or albumin/creatinine > 30 mg/g)

2)      Hypothyroidism

3)      Polycystic Ovary syndrome – acne, hirsutism, elevated S. testosterone, irregular menses (anovulation or oligomenorrhea), polycystic ovaries on US scan, insulin resistance (markers of IR are acanthosis nigricans, elevated fasting serum insulin levels, obesity, IGT),  lipid abnormalities (high S. Chole, high S. Tg, high LDL, low HDL, low Apo-I), high cardiovascular risk (high incidence of MI)

4)      Sleep apnea syndrome (See under Medically Unexplained Symptoms)

(Cooppan 2005)

(NCEP ATP III 2001)

(WHO)

(Lobo and Carmina 2000)

Pattern : Urine passage -

Hesitant, interrupted, weak stream, urgency, leaking, dribbling, nocturia, 

1)      Benign enlargement of prostate – i) If AUA scores 0-7 watchful waiting monitoring AUA score changes ii) If prostate > 40 g finasteride reduce volume by 30% iii) IVS/OVS doxazosin and terazosin reduce smooth muscle tone and thus have immediate effects on urine flow and improve BPH symptoms.  Patients who do not respond to non-selective alpha-blockers may respond to selective alpha-blocker tamsulosin iv) OVS – alfuzosin, prazosin,  v) Prostate size – each finger breath equals 15-20 g of prostate, most symptomatic prostates are around 2-3 finger breaths, use index finger pad, when prostate size is large finasteride works best vi) BPH with acute urinary retention,  failed voiding trials, recurrent gross hematuria, UTI and renal failure require prostate surgery vii) If prostate > 75 g OR if bladder stones or diverticula present OR if patient cannot be positioned for transurethral surgery open prostatectomy indicated.  Rest either transurethral resection of the prostate or 1 of many minimally invasive prostate destruction procedures.  viii) BPH with LUTS medical therapy with receptor-specific alpha blockers first-line therapy, alpha 1a receptors are seen mainly in the prostate, bladder neck, and urethra, alpha 1a receptor blocker tamsulosin is the most uroselective. Prostate and hair follicle growth is androgen dependent and 5-alpha reductase inhibitors block this androgen.  It may not work in all men with symptoms, but if they work the effect is great and the initial response may take several months

2)      Malignant enlargement of prostate – hard, irregular prostate typical of Ca is felt on DRE then urgent referral is indicated.  PSA should also be measured and accompanied by the patient with a referral letter.

1)      Unexplained obstructed voiding syndrome in a female with abdominal and/or VE mass (exclude ovarian Ca if not due to fibroids, GIT, or GUS masses)

2)      Unexplained obstructed voiding syndrome in a male DRE and PSA indicated to exclude prostate Ca

3)      LUTS and rising age-specific PSA levels (even if DRE is normal)

(NCC-PC Referral Guidelines for Suspected Cancer  in Adults and Children)

(Dull et.al. 2002)

1)      Hyperthyroidism

2)      Menopause

(NICE 2007 Guideline on Heavy Menstrual Bleeding)

(NCC-PC Referral Guidelines for Suspected Cancer  in Adults and Children)

(Singer et.al. 1995)

1)      Oral candidiasis – Mx – Nystatin suspension 1 ml 4 times daily, if no response oral ketoconazole 3-6 ml/kg/day for 1 week  OR fluconazole 3 ml/kg/day PO

1)      Unexplained red and white patches of the oral mucosa that are painful swollen or  bleeding

2)      Unexplained oral ulceration lasting more than 3 weeks

3)      Unexplained oral mass lasting more than 3 weeks

4)      Unexplained tooth mobility for more than 3 weeks