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  <front>
    <article-meta>
      <title-group>
        <article-title>A prospective observational study of urinary incontinence in hemiplegia and prostate cancer patients with treatment regimen</article-title>
      </title-group>
      <contrib-group content-type="author">
        <contrib contrib-type="person">
          <name>
            <given-names>Dr. Kanamala Arun Chand Roby</given-names>
          </name>
          <email>ijamscr@gmail.com</email>
          <xref ref-type="aff" rid="aff-1"/>
        </contrib>
      </contrib-group>
      <aff id="aff-1">
        <institution>Department of Pharmacy Practice, Sree Chaitanya Institute of Pharmaceutical Sciences</institution>
        <country>India</country>
      </aff>
      <history>
        <date date-type="received" iso-8601-date="2020-08-10">
          <day>10</day>
          <month>08</month>
          <year>2020</year>
        </date>
        <date data-type="published" iso-8601-date="2020-08-10">
          <day>10</day>
          <month>08</month>
          <year>2020</year>
        </date>
      </history>
    </article-meta>
  </front>
  <body>
    <fig>
      <graphic mimetype="image" mime-subtype="jpeg" xlink:href="image1.jpeg"/>
    </fig>
    <p>
      <bold>www.ijamscr.com</bold>
    </p>
    <sec id="sec-1">
      <title>A prospective observational study of urinary incontinence in hemiplegia and prostate cancer patients with treatment regimen</title>
      <sec id="sec-1_1">
        <title>Dr. Kanamala Arun Chand Roby, Dr. Kudipudi Harinadha Baba, Sandireddy Nikhil Reddy, Bandela. Sandeep, Bathini. Srinivas, Mukkera. Ajay Yadav</title>
        <p>
          <italic>Department of Pharmacy Practice</italic>
          <italic>, </italic>
          <italic>Sree</italic>
          <italic>Chaitanya</italic>
          <italic> Institute of Pharmaceutical Sciences</italic>
        </p>
        <p><bold>*Corresponding Author</bold>: <bold>Dr. </bold><bold>Kanamala</bold><bold>Arun</bold><bold> Chand Roby</bold></p>
        <sec id="sec-1_1_1">
          <title>Abstract</title>
          <p>Urinaryincontinence is a condition in which urgency of urine takes place without any intimation in a condition with effects of stroke, epilepsy, prostate cancer and often makes a sense which results in cause of depression and psychiatric illness. Renal incontinence occurred unknowingly to the person and leads to severe infections; it’s also a type of disease known as bed wetting. </p>
          <sec id="sec-1_1_1_1">
            <title>Materials and methods</title>
          </sec>
          <sec id="sec-1_1_1_2">
            <title>Study design</title>
            <p>Our study was hospital based prospective observational study conducted in tertiary care hospital.</p>
          </sec>
          <sec id="sec-1_1_1_3">
            <title>Study procedure</title>
            <p>The study was done by collecting information by using patient case sheets, based on the data a questionnaire is prepared according to the guidelines of WHO and HRQOL. Nearly data of 72 patients were included in the study with all the details of past medical history and the treatment regimen and laboratory parameters with frequency are collected.</p>
          </sec>
          <sec id="sec-1_1_1_4">
            <title>Sampling method</title>
            <p>All the patients of age above 36-70 years are included in the study with renal incontinence as a major condition. </p>
          </sec>
          <sec id="sec-1_1_1_5">
            <title>Study duration</title>
            <p>The duration of the study was 11 months from September 2016 to August 2017.</p>
          </sec>
          <sec id="sec-1_1_1_6">
            <title>Study materials</title>
          </sec>
          <sec id="sec-1_1_1_7">
            <title>Patient consent form</title>
            <p>Consent was collected by using self designed patient consent form and consent was made into three languages (English, Telugu and Hindi).</p>
          </sec>
          <sec id="sec-1_1_1_8">
            <title>Ethical approval</title>
            <p>The study was approved by institutional ethical committee and tertiary care hospital.</p>
          </sec>
          <sec id="sec-1_1_1_9"/>
          <sec id="sec-1_1_1_10">
            <p>A data was analyzed by demographic details, reason for admission, duration of therapy, causes of renal incontinence, side effects and complications with therapies and therapy outcome with laboratory parameters was analyzed by using different statical software’s and the result was summarized.</p>
          </sec>
          <sec id="sec-1_1_1_11">
            <title>Results</title>
            <p>Out of 81patients 72 patients are willing to give the information regarding the condition out of which 18 females, 54 males are included in the study with a mean age of 22-60 years and suffered with Hemiplegia, seizures and prostate cancer (prostatomegaly) and the treatment regimen was tabulated as below.</p>
          </sec>
          <sec id="sec-1_1_1_12">
            <title>Discussion</title>
            <p>Outof 72 patients who are suffering with renal incontinence are of age group 22-60 and both sexes with secondary education level and nutritional level of mostly average. The reasons for admission in the hospital are due to Hemiplegia and diabetes mellitus. The duration of renal incontinence is higher in below 3 years. The classes of drugs prescribed for renal incontinence are mostly anticholinergics and alpha blockers. The complications are mostly due to hemiplegic drugs and urinary tract infections, the treatment for renal incontinence is Darifencin and all the laboratory parameters and therapies, counseling aids was analyzed and discussed. </p>
          </sec>
          <sec id="sec-1_1_1_13">
            <title>Conclusion</title>
            <p>Our study concluded that the people suffer with renal incontinence is due to Hemiplegia, prostate cancer and seizures. The condition is mainly due to drugs used for Hemiplegia. The side effects, complications and surgeries cannot show any effect. The main stay is to counsel the patient and take measures to overcome renal incontinence. The physician should know the exact cause of renal incontinence before providing the treatment. As we are the clinical pharmacist we should give the detail description of the condition to maintain the life better to overcome renal incontinence.</p>
            <p>Keywords:Hemiplegia, Renal incontinence, Prostate cancer<bold>.</bold></p>
          </sec>
        </sec>
        <sec id="sec-1_1_2">
          <title>Introduction</title>
          <p>Renal incontinence is an involuntary loss of urine that is objectively demonstrable and is a social or hygienic problem. Affects physical, psychological, social well being which reduces the quality of life. Though it occurs more often as people get older, urinary incontinence isn't an inevitable consequence of aging. If urinary incontinence affects your daily activities, don't hesitate to see your doctor. For most people, simple lifestyle changes or medical treatment can ease discomfort or stop urinary incontinence. The main types of incontinence are stress incontinence, urge incontinence, overflow incontinence, functional incontinence [1-5].</p>
          <sec id="sec-1_1_2_1">
            <title>Stress incontinence</title>
            <p>Urine leaks when people exert pressure on your bladder by coughing, sneezing, laughing, exercising and lifting something heavy.</p>
          </sec>
          <sec id="sec-1_1_2_2">
            <title>Urge incontinence</title>
            <p>This is a condition where sudden, intense urge to urinate followed by an involuntary loss of urine. People may need to urinate often, including throughout the night. Urge incontinence may be caused by a minor condition, such as infection, or a </p>
            <p>more-severe condition such as a neurologic disorder or diabetes.</p>
          </sec>
          <sec id="sec-1_1_2_3">
            <title>Overflow incontinence</title>
            <p>Frequent or constant dribbling of urine due to a bladder that doesn't empty completely.</p>
          </sec>
          <sec id="sec-1_1_2_4">
            <title>Functional incontinence</title>
            <p>A physical or mental impairment keeps people from making it to the toilet in time [6-10].</p>
          </sec>
        </sec>
        <sec id="sec-1_1_3">
          <title>Materials and methods</title>
          <sec id="sec-1_1_3_1">
            <title>Study design</title>
            <p>Our study was hospital based prospective observational study conducted in tertiary care hospital.</p>
          </sec>
          <sec id="sec-1_1_3_2">
            <title>Study procedure</title>
            <p>The study was done by collecting information by using patient case sheets, based on the data a questionnaire is prepared according to the guidelines of WHO and HRQOL. Nearly data of 72 patients were included in the study with all the details of past medical history and the treatment regimen and laboratory parameters with frequency are collected [11-15].</p>
          </sec>
          <sec id="sec-1_1_3_3">
            <title>Sampling method</title>
            <p>All the patients of age above 36-70 years are included in the study with renal incontinence as a major condition. </p>
          </sec>
          <sec id="sec-1_1_3_4">
            <title>Study duration</title>
            <p>The duration of the study was 11 months from September 2016 to August 2017.</p>
          </sec>
          <sec id="sec-1_1_3_5">
            <title>Inclusion criteria</title>
            <list list-type="order">
              <list-item>
                <p>Patients suffered with stroke</p>
              </list-item>
              <list-item>
                <p>Patients suffering age above 36</p>
              </list-item>
              <list-item>
                <p>Patients of both sexes.</p>
              </list-item>
            </list>
          </sec>
          <sec id="sec-1_1_3_6">
            <title>Exclusion criteria</title>
            <list list-type="bullet">
              <list-item>
                <p>off-sane minded</p>
              </list-item>
              <list-item>
                <p>Pediatrics, coma tic patients</p>
              </list-item>
            </list>
          </sec>
        </sec>
        <sec id="sec-1_1_4">
          <title>Study materials</title>
          <sec id="sec-1_1_4_1">
            <title>Patient consent form</title>
            <p>Consent was collected by using self designed patient consent form and consent was made into three languages (English, Telugu and Hindi).</p>
          </sec>
          <sec id="sec-1_1_4_2">
            <title>Ethical approval</title>
            <p>The study was approved by institutional ethical committee and tertiary care hospital.</p>
          </sec>
          <sec id="sec-1_1_4_3">
            <title>Data analysis</title>
            <p>A data was analyzed by demographic details, reason for admission, duration of therapy, causes of renal incontinence, side effects and complications with therapies and therapy outcome with laboratory parameters was analyzed by using different statical software’s and the result was summarized.</p>
          </sec>
        </sec>
        <sec id="sec-1_1_5">
          <title>RESULTS</title>
          <p>Out of 81patients 72 patients are willing to give the information regarding the condition, out of which 54 were males, 18 were females are included in the study, suffered with Hemiplegia, seizures and prostate cancer (prostatomegaly) and the treatment regimen and the therapeutic outcomes with side effects was tabulated as below [16-18].</p>
          <p>
            <bold>Table 1: Shows Demographic details of the patient </bold>
            <bold>which</bold>
            <bold> include the age, sex, marital status, nutritional status and employment.</bold>
          </p>
          <table-wrap>
            <table>
              <tr>
                <td>
                  <bold>Demographics</bold>
                </td>
                <td>
                  <bold>No. of patients</bold>
                </td>
                <td>
                  <bold>Percentage (%)</bold>
                </td>
              </tr>
              <tr>
                <td>Age         22-30        30-40        40-50        50-60Sex         Male         FemaleMarital status        Married         Unmarried Education level       Primary        Secondary        TertiaryNutritional status        Poor        Average        Excellent Employment        Employed        Unemployed </td>
                <td>08122527541864082436120935281755</td>
                <td>11.116.634.737.5752588.811.133.35016.612.548.638.823.676.3</td>
              </tr>
            </table>
          </table-wrap>
          <p>
            <bold>Table 2: Shows the reasons for admission of patients in the hospital.</bold>
          </p>
          <table-wrap>
            <table>
              <tr>
                <td>
                  <bold>Reasons for admission</bold>
                </td>
                <td>
                  <bold>No. of patients</bold>
                </td>
                <td>
                  <bold>Percentage</bold>
                </td>
              </tr>
              <tr>
                <td>HemiplegiaDiabetes mellitusProstate cancerPsychiatric illnessAnxiety</td>
                <td>2321121105</td>
                <td>31.929.116.615.26.9</td>
              </tr>
            </table>
          </table-wrap>
          <p>
            <bold>Table 3: Shows the duration of incontinence patients are suffering with percentage</bold>
          </p>
          <table-wrap>
            <table>
              <tr>
                <td>
                  <bold> Duration of incontinence</bold>
                </td>
                <td>
                  <bold>No. of patients</bold>
                </td>
                <td>
                  <bold>Percentage</bold>
                </td>
              </tr>
              <tr>
                <td>6 months1 year Below 3 yearsBelow 6 yearsAbove 6 years </td>
                <td>1314211608</td>
                <td>1819.429.122.211.1</td>
              </tr>
            </table>
          </table-wrap>
          <p>
            <bold>Table 4: Shows the class of drugs prescribed for renal incontinence with percentage</bold>
          </p>
          <table-wrap>
            <table>
              <tr>
                <td>
                  <bold>Classes of drugs prescribed for incontinence </bold>
                </td>
                <td>
                  <bold>No. of patients</bold>
                </td>
                <td>
                  <bold>Percentage </bold>
                </td>
              </tr>
              <tr>
                <td>Alpha blockersAnti cholinergicAnti muscarnicSex hormoneBeta 3 adrenergic agonist </td>
                <td>7072462972</td>
                <td>97.210063.840.2100</td>
              </tr>
            </table>
          </table-wrap>
          <p>
            <bold>Table 4: Shows the class of drugs prescribed for renal incontinence with percentage</bold>
          </p>
          <p>
            <bold>Table 5: Shows the complication occurred due to incontinence in the people.</bold>
          </p>
          <table-wrap>
            <table>
              <tr>
                <td>
                  <bold>Complications due to incontinence</bold>
                </td>
                <td>
                  <bold>No. of patients</bold>
                </td>
                <td>
                  <bold>Percentage</bold>
                </td>
              </tr>
              <tr>
                <td>Blood clotBowel blockagesPneumoniaUrinary tract infectionsRenal stones</td>
                <td>1412032518</td>
                <td>19.416.64.134.725</td>
              </tr>
            </table>
          </table-wrap>
          <p>
            <bold>Table 6: Shows the causes of renal incontinence according to the condition.</bold>
          </p>
          <table-wrap>
            <table>
              <tr>
                <td>
                  <bold>Causes of incontinence</bold>
                </td>
                <td>
                  <bold>No. of patients</bold>
                </td>
                <td>
                  <bold>Percentage</bold>
                </td>
              </tr>
              <tr>
                <td>Urinary tract infectionsProstate cancerNeurological disordersChanges with ageMenopauseHysterectomyPregnancyChild birth</td>
                <td>1311121007050303</td>
                <td>1815.216.613.89.76.94.14.1</td>
              </tr>
            </table>
          </table-wrap>
          <p>
            <bold>Table 7: Shows the current therapy given for renal incontinence to manage it.</bold>
          </p>
          <table-wrap>
            <table>
              <tr>
                <td>
                  <bold>Current therapy</bold>
                </td>
                <td>
                  <bold>No. of patients</bold>
                </td>
                <td>
                  <bold>Percentage</bold>
                </td>
              </tr>
              <tr>
                <td>DarifencinDoxazosin Dutasteride Tamsulosin+dutasterideMirabegronTerazosinTolterodine tartrateSilodosin Solifenacin succinate </td>
                <td>726955647272532938</td>
                <td>10095.876.488.910010073.640.352.8</td>
              </tr>
            </table>
          </table-wrap>
          <p>
            <bold>Table 7: Shows the laboratory parameters performed to know the cause of incontinence.</bold>
          </p>
          <table-wrap>
            <table>
              <tr>
                <td>
                  <bold>Laboratory parameters </bold>
                </td>
                <td>
                  <bold>No. of patients</bold>
                </td>
                <td>
                  <bold>Percentage</bold>
                </td>
              </tr>
              <tr>
                <td>UreaCreatinineCastsUrine proteinEpithelial cellsUrine cultureCustoscopyUrodynamic studies Cystogram </td>
                <td>727272727254456336</td>
                <td>1001001001001007562.587.550</td>
              </tr>
            </table>
          </table-wrap>
          <p>
            <bold>Table 8: Shows the therapies for renal incontinence for inhibiting the condition of patient.</bold>
          </p>
          <table-wrap>
            <table>
              <tr>
                <td>
                  <bold>Therapies for renal incontinence</bold>
                </td>
                <td>
                  <bold>No. of patients</bold>
                </td>
                <td>
                  <bold>Percentage </bold>
                </td>
              </tr>
              <tr>
                <td>Regain bladder controlKegel exercisesTrain your bladderMagnesiumVitamin DPessaryQuit smokingAcupunctureHypnotherapyCut out caffeineStay hydratedGet fitBiofeedback </td>
                <td>18277245091800164518540007</td>
                <td>2537.510062.512.525002262.52575009.7</td>
              </tr>
            </table>
          </table-wrap>
          <p>
            <bold>Table 9: Shows the surgeries performed for the patients to overcome renal incontinence with outcome.</bold>
          </p>
          <table-wrap>
            <table>
              <tr>
                <td>
                  <bold>Surgeries</bold>
                </td>
                <td>
                  <bold>No. of patients</bold>
                </td>
                <td>
                  <bold>Outcomes</bold>
                </td>
                <td>
                  <bold>Percentage </bold>
                </td>
              </tr>
              <tr>
                <td>Botulinum toxin A injectionSacral nerve stimulationPosterior tibial nerve stimulationAugmentation cystoplastyUrinary diversionClean intermittent catherisationIndwelling catherisationIncontinence products</td>
                <td>1575183927</td>
                <td>EffectiveEffective No changeFailure at 1 yearEffective Infection Infection Not shown any effect</td>
                <td>1.3079.70725412.537.5</td>
              </tr>
            </table>
          </table-wrap>
          <p>
            <bold>Table 10: Shows the major drugs that causes renal incontinence and used for Hemiplegia.</bold>
          </p>
          <table-wrap>
            <table>
              <tr>
                <td>
                  <bold>Drugs which causes renal incontinence</bold>
                </td>
                <td>
                  <bold>No. of patients</bold>
                </td>
                <td>
                  <bold>Percentage </bold>
                </td>
              </tr>
              <tr>
                <td>LevetriacetamPiracetam Phenytoin </td>
                <td>452754</td>
                <td>62.537.575</td>
              </tr>
            </table>
          </table-wrap>
          <p>
            <bold>Table 11: Shows the counseling to the patients suffering with renal incontinence.</bold>
          </p>
          <table-wrap>
            <table>
              <tr>
                <td>
                  <bold>Counseling </bold>
                </td>
                <td>
                  <bold>No. of patients</bold>
                </td>
                <td>
                  <bold>Percentage </bold>
                </td>
              </tr>
              <tr>
                <td>Food incontinenceStress incontinenceCold foot cystitisMuscle weaknessNerve damageMixed incontinence</td>
                <td>727272542736</td>
                <td>1001001007537.550</td>
              </tr>
            </table>
          </table-wrap>
          <p>
            <bold>Table 12: Shows the interactions observed through the drugs given for renal incontinence.</bold>
          </p>
          <table-wrap>
            <table>
              <tr>
                <td>
                  <bold>Interactions</bold>
                </td>
                <td>
                  <bold>No. of patients</bold>
                </td>
                <td>
                  <bold>Percentage</bold>
                </td>
              </tr>
              <tr>
                <td>Rashes Skin infectionsSores Glaucoma Dementia Ulcerative colitisGERD</td>
                <td>0005120027Not seenNot seen</td>
                <td>000716.60037.5------------</td>
              </tr>
            </table>
          </table-wrap>
          <p>
            <bold>Table 13: Shows the therapy duration to overcome renal incontinence.</bold>
          </p>
          <table-wrap>
            <table>
              <tr>
                <td>
                  <bold>Duration of therapy</bold>
                </td>
                <td>
                  <bold>No. of patients </bold>
                </td>
                <td>
                  <bold>Percentage </bold>
                </td>
              </tr>
              <tr>
                <td>3 months Above 1 yearAbove 3 yearsMore than 5 years</td>
                <td>27545421</td>
                <td>37.5757529</td>
              </tr>
            </table>
          </table-wrap>
          <p>
            <bold>Table 14: Shows the therapeutic outcomes for the treatment given for renal incontinence.</bold>
          </p>
          <table-wrap>
            <table>
              <tr>
                <td>
                  <bold>Therapeutic outcomes </bold>
                </td>
                <td>
                  <bold>No. of patients </bold>
                </td>
                <td>
                  <bold>Percentage </bold>
                </td>
              </tr>
              <tr>
                <td>PoorAverageBetterNo change</td>
                <td>24330906</td>
                <td>33.345.812.58.3</td>
              </tr>
            </table>
          </table-wrap>
        </sec>
        <sec id="sec-1_1_6"/>
        <sec id="sec-1_1_7">
          <title>Discussion</title>
          <p>Outof 72 patients who are suffering with renal incontinence are of age group 22-60(100%) and both sexes (100%) with secondary education level and nutritional level of mostly average. The reasons for admission in the hospital are due to Hemiplegia (31.9%) and diabetes mellitus (29.1%). The duration of renal incontinence is higher in below 3 years (29.1%) and below 6 years (22.2%). The classes of drugs prescribed for renal incontinence are mostly anticholinergics (100%) and alpha blockers (97.2%). The complications due to renal incontinence are mostly urinary tract infections (34.7%) and renal stones (25%). The causes of incontinence are mostly urinary tract infections (18%) and neurological disorders (16.6%). The current therapy for incontinence, the drugs mostly include Darifencin (100%), Mirabegron (100%) and Terazosin (100%). The laboratory parameters mostly performed are mainly renal examinations and electrolytes (100%) and urodynamic studies (87.5%). The therapy for renal incontinence which are mostly performed are train your bladder (100%) and magnesium, hypnotherapy (62.5%). The surgeries mostly performed are incontinence products which doesn’t show any effects (37.5%) and urinary diversion which is effective (25%). The drugs which mostly cause renal incontinence are phenytoin (75%). The counseling for incontinence is mostly stress incontinence food incontinence and cold foot cystitis (100%). The drug interactions mostly observed are dementia (37.5%). The duration of therapy to treat incontinence is higher in above 1 and 3 years (75%) and the therapeutic outcomes for incontinence seen is average (45.8%) and the therapies and counseling aids are given to the patients all the readings tabulated as above with frequency.</p>
        </sec>
        <sec id="sec-1_1_8">
          <title>Acknowledgement</title>
          <p>All thanks and praises to God Almighty for his countless, abundant and never ending blessings in completing this work. It is a proud privileged honor for us to express our hatful thanks and gratefulness to all the persons who backed us directly or indirectly through out of this research work as magnitude. Most importantly authors are thankful to patients and health care professionals.</p>
        </sec>
        <sec id="sec-1_1_9"/>
        <sec id="sec-1_1_10">
          <title>Conclusion</title>
          <p>Our study concluded that the people suffer with renal incontinence is due to Hemiplegia, prostate cancer and seizures. The condition is mainly due to drugs used for Hemiplegia. The side effects, complications and surgeries cannot show any effect. The main stay is to counsel the patient and take measures to overcome renal incontinence. The physician should know the exact cause of renal incontinence before providing the treatment. As we are the clinical pharmacist we should give the detail description of the condition to maintain the life better to overcome renal incontinence.</p>
        </sec>
        <sec id="sec-1_1_11">
          <title>References</title>
          <list list-type="bullet">
            <list-item>
              <p>Joseph T Dipiro, Robert L. Talbert, Gary C. Yee, Gary R. Matzke, Barbara G. Wells, L. Michael posey, “Pharmacotherapy – A Pathophysiologic Approach” , McGraw Hill; 7, 375-382</p>
            </list-item>
            <list-item>
              <p>Roger walker, Cate Whittlesea, “Clinical pharmacy and Therapeutics”, Churchill Livingston ; 5 ; </p>
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            <list-item>
              <p>Laurence L. Brunton, Bruce A. Chabner, Bjorn C. Knollmann, “Goodman &amp; Gilman’s - The Pharmacological Basis of Therapeutics”, 12.</p>
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            <list-item>
              <p>Eric T. Herfindal and Dick R Gourley “A textbook of therapeutics drug and disease management” 7, 472-483</p>
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            <list-item>
              <p>Abrams P, Cardozo L, Fall M, et al. The standardisation of terminology of lower urinary tract function: report from the Standardisation Sub-committee of the International Continence Society. Neurourology and Urodynamics. 21(2), 2002, 167–178.</p>
            </list-item>
            <list-item>
              <p>Thomas TM, Plymat KR, Blannin J, et al. Prevalence of urinary incontinence. British Medical Journal. 281(6250), 1980, 1243–5.</p>
            </list-item>
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