BACKGROUND AND OBJECTIVES: Priapism is one of the complications of sickle cell disease characterized by a persistent and painful erection, which can lead to erectile dysfunction and sexual impotence. The objective of this study was to understand how men with sickle cell disease and priapism access emergency care. METHODS: A qualitative study conducted in a reference healthcare unit to people with sickle cell disease in the second largest city in Bahia. Seven adult men with sickle cell disease who had experienced priapism participated in the study. The data were collected by semi-structured interview and thematic story designs and submitted to content analysis. RESULTS: Priapism is seen as a lack of genital health. Participants use strategies to manage it at home to avoid embarrassment, which ends up in cocooning. Access to emergency services is motivated by persistent and relentless pain; and limited by the fear of priapism being mistaken for sexual deviance, lack of knowledge about the complication as a urologic emergency and financial shortfall, which confers a worse prognosis about erectile function. Men are embarrassed and discriminated by healthcare and support professionals, which discourages them from accessing these services in the future. CONCLUSION: This study emphasizes the importance of early diagnosis of sickle cell disease, the orientation of family members Access of men with sickle cell disease and priapism in emergency services Acesso de homens com doença falciforme e priapismo nos serviços de emergência

Objective: To evaluate epidemiological aspects of priapism in patients with sickle cell disease, and these aspects impact on adult sexual function. Methods: This was a cross-sectional study including individuals with sickle cell disease who were evaluated at a reference center for sickle cell. Participants completed a structured questionnaire about their sociodemographic characteristics and priapism events. Sexual function was assessed using validated two instruments, the Erection Hardness Score and one about the sex life satisfaction. Results: Sixty-four individuals with median aged of 12 (7 to 28) years were interviewed. The prevalence of priapism was 35.9% (23/64). The earliest priapism episode occurred at 2 years of age and the latest at 42 years. The statistical projection was that 71.1% of individuals of the study would have at least one episode of priapism throughout life. Patients with episodes of priapism (10/23) had significantly worse erectile function Erection Hardness Score of 2 [1-3]; p=0.01 and were less satisfied with sexual life 3 [3-5]; p=0.02. Conclusion: Priapism is usually present in childhood, and severe episodes are associated with cavernous damage, impairment in the quality of the erection, and lower sexual satisfaction.

Objectives: Develop and validate a new and simplified score for evaluating the lower urinary tract symptoms in men. Materials and methods: We modified the existing visual prostate symptom score, including changes in the images, sequence, and new alternatives, resulting in a new visual score (LUTS visual score-LUTS-V). For the validation of the new tool, we used the International Prostatic Symptom Score as the gold-standard and the new LUTS-V to 306 men. The total IPSS score and the total LUTS-V score of each subject were evaluated to determine the agreement between the two instruments. ROC curve was used to evaluate the diagnostic accuracy and best cut-off of LUTS-V. Sensitivity, specificity, and diagnostic odds ratios were used to describe the diagnostic properties. Results: The mean age of the participants was 59 [52-87] years. There was a significant correlation between LUTS-V and IPSS. (r=0.72 (p <0.0001). The Bland-Altman analyzes demonstrate good agreement between the two questionnaires (bias=5.6%). LUTS-V demonstrated excellent diagnostic accuracy in detecting the most serious cases with an area under the ROC curve of 83% [78-87%] 95% CI. p <0.001). LUTS-V >4 was the best threshold, with a sensitivity of 74% and specificity of 78%. Conclusions: LUTS-V is a simple, self-administered tool with a significant discriminatory power to identify subjects with moderate to severe LUTS and may represent a useful instrument for the diagnosis and follow-up of men with urinary symptoms.

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The available literature does not provide any questionnaire to evaluate sexual function after male to female (MtF) gender reassignment surgery (GRS). The assessment of sexual function in these patients is routinely performed by using tools designed for biological women, such as Female Sexual Function Index (FSFI). Such a limit leads to a suboptimal evaluation, especially in domains like lubrication and dyspareunia. Moreover, FSFI scores in MtF patients often are similar to those observed in nontranssexual women with sexual dysfunction. We aim at developing validate new questionnaire, the operated Male to Female Sexual Function Index (oMtFSFI) in order to assess sexual function in patients who underwent MtF GRS. METHODS: A panel of experts in gender dysphoria defined salient content areas to be explored. Ten MtF patients were administered the questionnaire in order to check its face validity. Their suggestions helped the expert revising the initial version. The revised oMtFSFI questionnaire presents 18 items and was applied in the present study. oMtFSFI with FSFI, Back Depression Inventory II and SF-36 questionnaires were web-based administered to 125 operated MtF patients, recruited during follow-up visits in 7 italian centres and to 80 women who provided self-ratings. The MtF participants completed oMtFSFI twice, three to four weeks apart. RESULTS: 65 MtF and 57 women completed the study. The two groups did not differ in their age (mean 38.5 SD 9.3 versus 37.7 SD 11.5 years old) or in their present vs not sexual activity in the last month (p[0.18). MtFs underwent GRS up to 19 years before (mean 5.1). Principal component analysis performed on the self-ratings provided by MtFs yielded a 3-domain structure (accounting for the 68.7% of the total variance): Sexual Dissatisfaction, Sexual Pain and Genital self-image. The same structure emerged when data from the whole group were analysed. For MtFs, Cronbach Alphas ranged from 0.64 to 0.93 for the three domains. After controlling for age and years from surgery, clear convergent associations with FSFI scales were found for Sexual Dissatisfaction and Sexual Pain but not for Genital Self-image; BDI did not account for additional variance. CONCLUSIONS: These results support the reliability and psychometric validity of the oMtFSFI in the assessment of key dimensions of transsexual women sexual function. Further studies are needed to develop a diagnostic cutoff scores for a potential classification of operated MtF's sexual dysfunction.

Objetivo: Descrever o perfil epidemiológico de casos de leishmaniose visceral notificados em Feira de Santana, Bahia, no período de 2001 a 2015. Método: Estudo ecológico, descritivo, que analisou os dados secundários dos casos notificados confirmados de Leishmaniose Visceral (LV) do Sistema de Informação de Agravos de Notificação (SINAN), entre 2001 e 2015. Resultados: Observou-se 229 casos totais de LV. Constatou-se a maior ocorrência dos casos na faixa etária entre 1 e 4 anos (21,8), gênero masculino (58,5%), cor/raça parda (69%,) e nível de escolaridade com concentração entre a 1ª e a 4ª séries do ensino fundamental incompletas ou 1 a 3 anos de estudo concluídos, com 27 casos (11,8%). Verificou-se que 114 casos (49,8%) ocorreram em zona de residência urbana. Houve cura em 171 (74,7%) dos casos e óbito em22 (9,6%). Conclusão: Feira de Santana é zona endêmica de transmissão intensa para Leishmaniose Visceral, doença esta que se encontra em relativa estabilidade no número de casos para os últimos seis anos do período analisado, mas com transição estabelecida para a zona urbana da cidade. É necessária uma revisão das políticas públicas para contenção do vetor e dos animais reservatórios do protozoário.AbstractObjective: To describe the epidemiologic profile of the Visceral Leishmaniasis cases notified in Feira de Santana, Bahia, from 2001 to 2015. Method: Descriptive and ecological study. Analysis of secondary data was made concerning the confirmed notified cases of Visceral Leishmaniasis (VL) from Brazilian Information System for Notifiable Diseases (SINAN) between 2001 and 2015. Results: 229 confirmed Visceral Leishmaniasis cases were observed. Greater incidence rates were found in the age-group from 1 to 4 years (21.8%), male gender (54.5%), brown skin (69%) and incomplete elementary education, with 27 cases (11.8%). 114 cases (49. 8%) took place in the urban zone. The cure was achieved in 171 cases (74.7%) whereas death occurred in 22 cases (9.6%). Conclusion: Feira de Santana is an endemic region of high transmission for Visceral Leishmaniasis, which has been in relative stability in the number of cases for the last six years of this analyzed period with an apparent rural-to-urban transition. A review of public policies is required to restrain the host animals and the fly vector of the protozoan parasite.

OBJECTIVETo validate a new simplified score for the assessment of men with LUTS (LUTS-V).METHODSWe made adjustments to the VPSS, resulting in a new simplified instrument (LUTS visual score – LUTS-V). In a pilot study, LUTS-V was administered to 50 men to identify interpretation issues. We used the International Prostate Symptom Score (IPSS) as the gold standard to validate the new tool in 306 men. The total IPSS and LUTS-V scores for each subject were evaluated and we used Bland-Altman analysis and Pearson’s correlation plot to assess the agreement between the scores. A ROC curve was utilized to determine the diagnostic accuracy of LUTS-V and its diagnostic properties were described in terms of sensitivity, specificity, positive and negative predictive values.RESULTSMedian age was 59 [52-67] years and, according to the IPSS, 26 (8.7%) patients had severe symptoms, while 99 (33%) had moderate symptoms, and 175 (58.3%) had mild symptoms. We found a positive correlation between the IPSS and LUTS-V (r = 0.72; p < 0.0001). Bland-Altman analysis showed good agreement between the two questionnaires. We found LUTS-V to have a diagnostic accuracy to detect more severe cases of 83% (95% CI: [78-87%]; p < 0.001), as estimated by the area under the ROC curve. The cut-off value of ≥ 4 points was the best threshold, with a sensitivity of 74% and a specificity of 78%, which resulted in a negative predictive value of 81% and a positive predictive value of 71% in this scenario. Median completion time was 0.51 [0.41-1.07] min for LUTS-V and 2.5 [2.2-3.4] min for the IPSS (p < 0.0001). In addition, 91.5% of patients completed the questionnaires with no help, while the other 8.5% were interviewed.CONCLUSIONLUTS-V is a simple, self-administered tool with a significant discriminating power to identify patients with moderate to severe symptoms.

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