Introduction The presence of erectile dysfunction (ED) could be a warning of vascular disease in different arterial territories. Aim The aim of this study was to investigate the association between ED and the presence of atherosclerosis in 2 different vascular beds: carotid and lower limbs. Methods A total of 614 volunteers between 45 and 74 years of age (mean age 61.0 years) were randomly selected from the general population. ED was assessed using the International Index of Erectile Function (IIEF-5). Ankle-brachial index (ABI) measurement and carotid atherosclerosis were evaluated by echo-Doppler. Main Outcome Measures Mean carotid intima-media thickness (IMT), prevalence of carotid plaques, mean ABI, and prevalence of ABI < 0.9 were the main outcome measures. Results ED was present in 373 subjects (59.7%). Mean carotid IMT was significantly higher in men with ED (0.762 ± 0.151 mm vs 0.718 ± 0.114 mm, P < .001). Also the global prevalence of carotid plaques was more frequent in men with ED (63.8% vs 44.8%, P < .001), even after adjusting by age, cardiovascular risk factors, and ongoing treatment (P = .039). Both the IMT and the prevalence of carotid plaques increased significantly with ED severity (P trend .004 and <.001, respectively). There were no significant differences between groups neither in mean ABI nor in the prevalence of subjects with ABI < 0.9. However, there was a trend to a lower ABI and a higher prevalence of ABI < 0.9 with increasing ED severity. Conclusion In the general population, the presence of ED identifies subjects with higher atherosclerosis burden in carotid arteries but not in the lower extremities.
Background and importance The paradigm of patients with immune mediated autoimmune diseases has changed with the introduction of biological medicines. The correct use of these drugs is necessary to guarantee their effectiveness. Aim and objectives To analyse adherence in immune mediated diseases patients treated with selective immunosuppressive drugs (adalimumab or etanercept) and to establish a link with patient characteristics and treatment duration. Material and methods A retrospective study in a third level hospital was conducted in patients receiving treatment with adalimumab or etanercept from January to December 2018. Adherence was measured via the medication possession ratio (MPR) over 1 year. Variables recorded were sex, age, pathology, previously taken biological drug treatments, treatment duration in days and number of auto-injectors. Statistical analysis of the data was made with SPSS. Results The sample population was 146 patients, 55.5% (81) men, mean age 53.58±12.47 years, and 55.5% were treated with adalimumab, 39.7% with etanercept and 3.9% with the biosimilar etanercept. Medium treatment duration was 5.07 ±3.09 years. The main pathologies and frequency were: rheumatoid arthritis in 32.2% (47) of patients, spondyloarthropathy in 18.5% (27), psoriatic arthritis in 17.8% (26), psoriasis in 13.7% (20), Crohn's disease in 11% (16), ulcerative colitis in 4.8% (7) and other pathologies in 2.1% (3). Regarding adherence, the overall rate was 89.3%. For each patient group, adherence was 86.24% in patients with rheumatoid arthritis, 89.36% in patients with spondyloarthropathy, 94.5% in patients with psoriatic arthritis, 84.11% in patients with psoriasis, 94.63% in patients with Crohn's disease, 93.01% in patients with ulcerative colitis, 84.38% in patients with Verneuil's disease and 84.11% in patients with systemic lupus erythematosus. In total, 78.1% (114) of all patients were adherent (MPR !80%). We did not observe statistically relevant associations between any of variables except for lower adherence to treatment and longer treatment duration (p=0.038). Conclusion and relevance Patients had good adherence to selective immunosuppressant treatments according to the MPR method. Sex, pathology or drug type were not related to absence of adherence. However, lack of adherence was observed the longer treatment lasted, which implies that it would be useful to have closer pharmacotherapeutic monitoring of this kind to reinforce adherence in patients.
BackgroundPain is a frequent symptom with many types of cancer. In 80–85% of patients with metastatic prostate cancer (MPC), the cancer spreads to the bone, which causes pain, pathologic fractures or spinal cord compression.PurposeTo develop a pharmaceutical care programme and to analyse the prevalence of pain in patients with MPC who attended the outpatient area of the hospital pharmacy.Material and methodsA literature search in several databases was conducted (Pubmed, Medline and Google Scholar) for a review of pain in patients with MPC. We also consulted the websites of the National Cancer Institute and other cancer organisations. The Wisconsin Brief Pain Questionnaire was selected for characterising the types and degree of pain that patients experienced. A diary to be distributed to patients to record their pain in terms of degree, duration and analgesic treatment, and an educational pamphlet about oncologic pain that included advice on how to deal with the pain and better understand its symptomatology, were developed. Follow-up of patients with MPC who began receiving treatment with abiraterone or enzalutamide from the hospital pharmacy from January to July 2016 was performed. They completed a questionnaire designed to evaluate the type of pain they were experiencing at their initial visit and at subsequent visits. They were given the diary and an informational pamphlet.ResultsThe programme began with 38 patients, of whom 56% presented with bone metastases. From the questionnaires they completed at each visit, it was observed that 35% reported pain. The most common analgesic treatment used was NSAIDs (36%) or NSAIDs plus opioids (29%). The materials patients received improved characterisation of their pain and served as a psychological support, basically through understanding that pain was a frequent symptom of their illness and one that could be treated more effectively.ConclusionA high prevalence of pain in patients with MPC was identified which indicates that analgesic treatment is often inadequate. Creating pharmaceutical care programmes may contribute to better pain evaluation and treatment, and better support for patients.References and/or acknowledgementsThe author would like to thank the pharmacists who supported this study.No conflict of interest
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