Study Type – Therapy (population cohort) Level of Evidence 2a What's known on the subject? and What does the study add? Clomiphene citrate (CC) has previously been documented to be efficacious in the treatment of hypogonadism. However little is known about the long term efficacy and safety of CC. Our study demonstrates that CC is efficacious after 3 years of therapy. Testosterone levels and bone mineral density measurement improved significantly and were sustained over this prolonged period. Subjective improvements were also demonstrated. No adverse events were reported. OBJECTIVE To assess the efficacy and safety of long‐term clomiphene citrate (CC) therapy in symptomatic patients with hypogonadism (HG). PATIENTS AND METHODS Serum T, oestradiol and luteinizing hormone (LH) were measured in patients who were treated with CC for over 12 months. Additionally, bone densitometry (BD) results were collected for all patients. Demographic, comorbidity, treatment and Androgen Deficiency in Aging Men (ADAM) score data were also recorded. Comparison was made between baseline and post‐treatment variables, and multivariable analysis was conducted to define predictors of successful response to CC. The main outcome measures were predictors of response and long‐term results with long‐term CC therapy in hypogonadal patients. RESULTS The 46 patients (mean age 44 years) had baseline serum testosterone (T) levels of 228 ng/dL. Follow‐up T levels were 612 ng/dL at 1 year, 562 ng/dL at 2 years, and 582 ng/dL at 3 years (P < 0.001). Mean femoral neck and lumbar spine BD scores improved significantly. ADAM scores (and responses) fell from a baseline of 7 to a nadir of 3 after 1 year. No adverse events were reported by any patients. CONCLUSIONS Clomiphene citrate is an effective long‐term therapy for HG in appropriate patients. The drug raises T levels substantially in addition to improving other manifestations of HG such as osteopenia/osteoporosis and ADAM symptoms.
Introduction As a vascular test, dynamic infusion cavernosometry (DIC) has lost popularity, and in the urologic community, penile duplex Doppler ultrasound (DUS) has become the sole test to investigate a vascular etiology of erectile dysfunction. Vasoactive agent redosing has been shown to increase the accuracy of DUS. Aim To define the erectile hemodynamics in men with previously diagnosed venous leak on DUS. Methods Prospective data were collected on patients who (i) had been given a diagnosis of venous leak based on an outside DUS; (ii) elected to undergo a repeat DUS; and (iii) when the repeat DUS suggested venous leak, underwent DIC. Main Outcome Measures DUS: peak systolic velocity and end-diastolic velocity. DIC: flow to maintain. Results 292 patients were included. Mean ± standard deviation age was 44 ± 26 years. On repeat DUS, 19% (56/292) had completely normal hemodynamics and 7% (20/292) had arterial insufficiency only without venous leak. DIC revealed normal hemodynamics in 13% (38/292), while in 58% (152/292) of patients, the venous leak diagnosis was confirmed. Overall, 47% (137/292) of patients who had been given a diagnosis of venous leak had completely normal hemodynamics, and in only 43% (126/292), the venous leak diagnosis was confirmed upon repeat vascular testing. On multivariable analysis, younger age (<45 years), failure to obtain an adequate erection during the original DUS, and having <2 vascular risk factors were predictive of a false diagnosis of venous leak. Conclusions Penile DUS has a propensity to inaccurately assign a diagnosis of venous leak. Great care should be taken when performing DUS especially in younger men without a significant vascular risk factor history, and the failure to obtain a good erection should make the clinician cautious in assigning a diagnosis of venous leak. Furthermore, there still exists a role for cavernosometry, which appears to have a greater accuracy at diagnosing venous leak.
Despite an extensive body of research showing the negative consequences of weight stigma, healthcare providers (HCPs) continue to marginalize fat 1 patients through negative attitudes, stereotypical beliefs, and discriminatory actions (Daníelsdóttir et al., 2010;Phelan et al., 2015). Weight stigma is present through all stages of medical training, where derogatory comments about fat patients abound (see Flint, 2015). It is therefore imperative to combat weight stigma early in medical education. Reviews of weight stigma reduction research have shown that existing interventions are ineffective, or, at best, only minimally effective (Alberga et al., 2016;Lee et al., 2014).There is a clear need for new approaches in this field. Fat studies is an interdisciplinary field of scholarship that may offer new insights for intervening in weight stigma, guided by three tenets: first, the oppression of fat people exists on a structural level; second, fat bodies are part of the natural diversity of body sizes; and third, any knowledge produced about fat people should include fat people
OBJETIVO: Verificar a ocorrência de sinais e sintomas da disfunção do sistema nervoso autônomo em indivíduos com disfonia comportamental e compará-la com resultados obtidos por indivíduos sem queixa vocal. MÉTODOS: Participaram 128 indivíduos adultos, com idades entre 14 e 74 anos, que foram divididos em dois grupos: disfonia comportamental (61 sujeitos) e sem queixa vocal (67 sujeitos). Foi aplicado o Protocolo de Disfunção Autônoma contendo 46 questões, sendo 22 relacionadas ao sistema nervoso autônomo e sem relação direta com a voz, 16 relacionadas tanto ao sistema nervoso autônomo quanto à voz, seis questões não-relevantes e duas questões de confiabilidade. RESULTADOS: Nas questões relacionadas à voz, como pigarros constantes, necessidade de engolir frequentemente, cansaço ao falar e dor de garganta, houve maior ocorrência de alterações neurovegetativas no grupo com disfonia comportamental. Nas questões sem relação direta com a voz, os indivíduos disfônicos apresentaram maior ocorrência de três dos 22 sintomas: gases, zumbido e engole ar enquanto fala. Os dois grupos apresentaram resultados semelhantes nas questões consideradas não relevantes ao sistema nervoso autônomo. As questões de confiabilidade necessitaram de reformulação. CONCLUSÃO: Indivíduos com disfonia comportamental apresentam maior ocorrência de sintomas neurovegetativos, principalmente daqueles que possuem relação direta com a voz. Tais resultados indicam maior labilidade do sistema nervoso autônomo nesses indivíduos.
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