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On average approximately half of patients do not adhere to

On average, approximately half of patients do not adhere to prescribed treatment regimens (Beardon et al., 1993). Studies have shown that poor adherence to beta-blockers or statin in post-MI patients can lead to an increased risk of morbidity and mortality (Kirking et al., 1995; Fincham and Wertheimer, 1988). After MI, several strategies including early follow up and sending printed reminders to patients were proposed to improve adherence (Jackevicius et al., 2002). Studies on non-adherence found that 1–21% of prescriptions were unfilled or not claimed from hospital pharmacies (Craghead and Wartski, 1991; Skutnik and Katsanis, 1997). In other studies, non-adherence to medications has been shown to increase mortality and hospitalizations (Jackevicius et al., 2007; Jackevicius et al., 2008).


We did not experience any dropouts through the study. The demographic and anthropometric characteristics of the participants were shown in Table 1. The mean age was 53±2.1years. For the subjects with or without multiple cardiovascular risk factors adequate adherence was found to be 69.9% and 30.1%, respectively. The correlation between adherence and patient’s income was statistically significant among intermediate and high income patients. However, no such relation was documented in low income patients (Table 1).

Cardiovascular diseases and hypertension are associated with enormous economic and personal burden through increased risk of stroke and kidney disease (Cherry et al., 2008; James et al., 2014; Go et al., 2013). The treatment of CVDs has been unequivocally shown to positively impact patient-related outcomes leading to reductions in stroke and heart failure (Chobanian et al., 2003).
In the current study, the predicting and estimated risk factors for non-adherence to prescribed cardiovascular medications were identified. Considering gender, our results indicated that males were less compliant with cardiovascular medications than females (Wang et al., 2005).Besides, education and high income also provide good adherence to drug regimens.
In patients who are treated with cardiovascular drug regimens, we have identified contributory factors to non-adherence as missed treatment doses or day(s), failure to report non-adherence, or interrupted treatment regimens. Besides, we have found 40% more adherence in patients over 65years as compared to those under 65years, which was in DNA Damage DNA Repair Library to the study by Monane et al., (1996).
Healthcare professionals have to shorten regimens where possible (Murphy et al., 2003; Black, 1999). Besides, they must educate their patients about the significance of adhering to their prescribed regimens. In accordance with currently available evidence, our findings highlighted that some patients lack medication knowledge and this is the major cause for poor adherence (Mini et al., 2012). In general, poly-pharmacy has major impact on adherence to cardiovascular medications (Stone et al., 2001; Golin et al., 2002) and the most frequent reason for non-adherence was multiple medications (poly-pharmacy) herein. Our current interventions succeeded in weaning patients’ negative beliefs, improving motivational barriers, indication of recall barrier and indication of access barrier to adherence and the improvement was sustained throughout the study period.
A retrospective study reported that compared to concurrent two-pill therapy single-pill combination therapy (contained in one pill dosage form) provided 20% higher adherence and more subjects from the single-pill combination therapy continued to take prescribed medication for 12months (Dezii, 2000; Haynes et al., 2008). In an electronic monitoring study conducted on 149 patients receiving cardiovascular medications, only dosing frequency (p=0.0001) but not drug class (P=0.71) was associated with medication adherence in the adjusted analysis. The authors have suggested that providers may consider using once daily formulations to optimize adherence and should assess adherence among all treated patients with uncontrolled hypertension (Moise et al., 2014). Thus, a plausible strategy to improve adherence to medications may include considering a combination single-pill therapy where applicable. In another study conducted by Castellano et al. (2014), the researchers suggested that use of a poly-pill strategy met the primary end point for adherence for secondary prevention following an acute MI (Castellano et al., 2014a). This was also evident for present study patients with poly-pharmacy and multiple adherence risk factors. Major trials are being conducted and they will hopefully provide definitive evidence on the efficacy of the poly-pill in reducing cardiovascular events in a cost-effective manner. The results of these trials will determine whether a poly-pill strategy can suppress the CVD pandemic and will potentially provide the evidence to implement in cost-effective, easy, simple, and innovative solution for the global burden of CVDs (Castellano et al., 2014).

br If then and Therefore by

If , then and . Therefore, by Theorem 2.7 we have the following corollaries.

Ranjini et al.  [25] obtained the DNA Damage DNA Repair Library for the Zagreb indices and coindices of the line graph of the subdivision graph of tadpole graphs, wheel graphs, and ladder graphs. Su and Xu  [26] investigated the general sum-connectivity index and general product-connectivity index of the line graph of subdivision graph of the tadpole graphs, wheel graphs, and ladder graphs.
Here we obtained expressions for general sum-connectivity index, general product-connectivity index, general Zagreb index and coindices of the line graph of subdivision graph of any graph, which generalizes the results of Ranjini et al.  [25] and Su and Xu  [26].

Authors H. S. Ramane and V. V. Manjalapur are keratinocytes grateful to the University Grants Commission (UGC), Govt. of India for support through research grant under UPE FAR-II Grant No. F 14-3/2012 (NS/PE).

br Conclusion br Conflict of interest br Introduction Urinary


Conflict of interest

Urinary incontinence is a disorder with wide-spread human and social implications, causing discomfort, shame and loss of self-confidence. Stress urinary incontinence (SUI) is one of the most common types of incontinence which mainly occurs in female patients and accounts for 50% of all incontinence cases [1].
SUI is due to urethral hypermobility, an intrinsic sphincteric deficiency or both [2]. Based on the proper understanding of the pathophysiology of female SUI, several surgical techniques for the treatment of this condition have been developed. In 1995, Ulmsten and Petros described the midurethral support concept [3], however, the use of the retropubic tape (TVT) was associated with various peri- and postoperative complications, including DNA Damage DNA Repair Library perforation, temporary or persistent retention, de-novo instability [4] and injuries to the urethra, vessels, nerves and bowel [5].
In 2001, Delorme described the transobturator tape and its passage from outside to inside (outside-in procedure) [6]. The reported results were very close to those reported for the TVT [7] with no reported vascular, nerve or bowel injuries [8]. Two years later, De Leval described the transobturator passage of the tape from inside to outside (inside-out procedure) [9].

Subjects and methods
This prospective study conducted between April 2009 and October 2012 was carried out on 85 female patients with pure or mixed stress urinary incontinence. Patients with a history of any pre-operative obstructive symptoms (difficult voiding, weak stream or a sensation of incomplete evacuation), a pre-operative residual urine volume >100ml or any neurological pathology affecting the bladder or the sphincters were excluded from the study.
The patients were admitted to the hospital on the day of surgery, and a written consent was signed by all patients. All patients underwent the TVTO procedure. The urethral catheter and the vaginal pack were removed on the first postoperative day. Patients who were unable to void or had a PVR urine volume >100ml were catheterized for 1 week. If, after this time, they were still unable to void or had a PVR urine volume >100ml, they were taught clean intermittent catheterization (CIC).
The patients were considered cured when there was no subjective or objective evidence of SUI. Post-operative bladder outlet obstruction in our study was defined as the subjective feeling of difficult voiding, a weak stream and/or the sensation of incomplete evacuation, and a PVR urine volume >100ml, a urine flow rate <15ml/s or urinary retention on examination. The following risk factors for postoperative bladder outlet obstruction were evaluated: age, history of previous incontinence surgery, parity, menopausal status, type of SUI, grade of SUI, residual urine, Qmax and PdetQmax. The data were coded and evaluated using the statistical package SPSS version 15. They were then summarized using descriptive statistics. A receiver operating characteristic (ROC) curve analysis was done to validate Qmax for the detection of voiding dysfunction. A logistic regression analysis was done to test for significant predictors of voiding dysfunction. P values ≤0.05 were considered statistically significant.
75% of our patients were cured. De-novo urgency or urge incontinence developed in 5.8% of the patients. Voiding dysfunction according to our definition developed in 24.7% of the patients. The patients’ characteristics are illustrated in Table 1. Table 2 shows the urodynamic features.
Univariate analysis of multiple preoperative clinical and urodynamic factors demonstrated that, out of all the parameters studied, only Qmax and PdetQmax were associated with postoperative bladder outlet obstruction. The mean Qmax in the patients with bladder outlet obstruction was 15.48±6.12ml/s vs 23.42±6.03ml/s in the patients without obstruction (p<0.001). The mean PdetQmax in the patients without obstruction was 22.76±3.38cmH2O vs 28.73±6.47cmH2O in the patients with obstruction (p<0.001).

Although it seems logical to consider measurement of frailty for

Although it seems logical to consider measurement of frailty for older individuals undergoing major urologic surgery such as cystectomy, our study also found that frailty has a meaningful impact on nonhome discharges among patients undergoing commonly performed less-major surgery such as transurethral resection of the prostate and laparoscopic prostatectomy. Our findings highlight the fact that among frail older individuals, surgery, big or small, can potentially have undesirable outcomes and the increased risk for nonhome discharge should be considered during perioperative decision-making.

Hematuria, both microscopic and gross, is a commonly encountered urologic condition. The prevalence of microscopic hematuria (MH) ranges from 2.4% to 31.1%, with variation based on age, gender, and known risk factors such as tobacco use. In 2012, the American Urological Association revised their guidelines for evaluation of asymptomatic MH, redefining MH as ≥3 red blood DNA Damage DNA Repair Library per high-powered field from a single urine specimen. Before these revisions, prior guidelines stated that a diagnosis of MH required two positive urinalyses collected at different time points.
Although less stringent MH guidelines may help diagnose more cases of urologic malignancies, these revisions may also result in a significant increase in overall hematuria consultations. For instance, at the Atlanta Veterans Affairs Medical Center (AVAMC), 24% of new consults are for hematuria, the majority of which are related to MH (unpublished data). For patients receiving care at the Veterans Health Administration (VHA), any potential increases to specialty care clinical access is important to address given recent concerns regarding veterans\’ impaired healthcare access.
To address this increased clinical activity and to help ensure prompt urologic evaluation for veterans with hematuria, we implemented a program utilizing telephone appointments as an alternative method to conventional clinic visits for hematuria consults. These efforts are particularly timely and congruent with other recent endeavors by the VHA, such as the VA Choice program, subsidized transportation, and establishment of patient portals (myHealthEVet) to reduce barriers to medical care and access for veterans. Among urology patients within the VHA, telemedicine programs can save veterans both time and money.

The authors appreciate the editorial comment. The intent of our study was to evaluate the feasibility and acceptability of establishing a tele-urology clinic for the initial evaluation of hematuria using a simple, widely used form of communication, the telephone. The study showed high levels of acceptance and satisfaction with telephone clinics. Additionally, patients noted tele-urology to be an efficient, convenient modality for the initial evaluation of hematuria.

Intraoperative floppy iris syndrome (IFIS) was first described by Chang and Campbell as a complication encountered during cataract surgery. It is characterized by a triad of flaccid and billowing iris, a propensity for iris prolapse toward the incisions, and progressive intraoperative pupil constriction. Furthermore, it may lead to postoperative complications including lost lens or lens fragments, retinal detachment, and endophthalmitis. Many studies have reported its association with α-adrenergic receptor antagonists, a class of drugs commonly prescribed for benign prostate hyperplasia (BPH). There are three types of α-adrenergic receptors: type α, type α, and type α. Tamsulosin targets specifically the α-adrenergic receptors, which are found in the lower urinary tract and the eye; therefore, it is well known for its association with IFIS, although such association has been equivocal with other non-subtype specific α-adrenergic receptor antagonists. The reported incidence of IFIS is 40.4%-100% in patients exposed to tamsulosin and 0-66.7% in patients exposed to other α-adrenergic receptor antagonists. Additionally, tamsulosin increases the risk of post-cataract surgery complications by 2.3 times. It has been found that IFIS may still occur despite discontinuing α-adrenergic receptor antagonists years prior to the surgery. A study has also reported the occurrence of IFIS after only 2 days of tamsulosin. This suggests that cessation of the drug does not reverse the effect and the prescribing physicians should inform the patients of this complication preemptively.