Role of tolterodine in management of over active bladder [OAB] in different age groups

To assess the efficacy of tolterodine in management ofnon neurogenic overactive bladder in all ages and both sexes, also to evaluate the expected side effects and compliance of the patients with such anticholinergic drug. In prospective study one hundred patients 43 females, 50 males, and 7 children entered in the study all came complaining of symptoms of OAB to the urology clinic, all had a base line pressure flow studies except the children. After the initial evaluation, all patients were treated by tolterodine [Detrusitol] 2mg twice daily and in some resistant cases it may increase into three times daily, basically for three months period extends to 6 months in partially responded patients and repeated for those with relapsed after being good responders. Of the 100 patients, complete response occurred in 63 [63%], partial response in 27 [27%], and no response in 10 [10%], with the female population showed the majority of responders, followed by non bladder outflow obstruction [B.O.O] male patients, also in pediatric patients it shows considerable response

Some immunological studies and HLA-DRB1 in hepatitis C virus-related necrolytic acral erythema

Necrolytic acral erythema [NAE] is unique in its acral location and strong association with hepatitis C virus [HCV] and altered immunological junctions. The aim of the present work was to evaluate HLA DRB1 alleles and association of some parameter of immune system functions [complements C3 and C4, antismooth muscle antibody [ASMA] and antinuclear antibody [ANA] in NAE. Response of cutaneous lesion to low dose interferon alpha [3 million unit [MU] / week] and hydroxychloroquine was also evaluated. This study included 22 patients with HCV- related NAE [group I], 45 chronic hepatitis C without NAE [group II as pathological controls] and 45 healthy subjects [group III, normal controls]. ANA was positive more in patients than normal controls [18.2% vs 0%, P <0.003], however no significant difference was seen between patients groups. ASMA was positive significantly more in patients with NAE than HCV patients, and in both patients groups than normal controls 59.1%, 17.3% and 0%; P<0.001 and 0.0001 respectively]. A significant decrease in C3 and C4 was found in NAE patients than HCV patients without NAE, [P<0.01] and in both patients groups than normal controls [P<0.001]. NAE was associated with HLA -DRB1 03, [77.7%, 16 of 22 vs 24.2%, 11 of 45 of normal controls, Pc <0.0009 and 35.6% 16 of 45 HCV patients without NAE, Pc=0.03. Clinical improvement and significant decrease in ALT [P<0.001] was observed in NAE patients after two months of interferon alpha and hydroxychloroquine therapy. Necrolytic acral erythema [NAE] appears to be an immune mediated response in chronic HCV patients, associated with, lower C3 and C4 and higher frequency of positive ASMA. The results suggest that the development of HCV related ANE is associated with HLA-DRB1 03 marker. And low dose interferon alpha [3 MU per week] and hydroxychloroquine are good treatment modalities for NAE