ABSTRACT
In this review, we discuss the treatment options for male hypogonadism and the associated benefits and potential short- and long-term risks. The choice for treatment may depend on the cause of hypogonadism and the desire for maintaining or improving fertility. We also highlight surgical management of male hypogonadism. Comprehensive searching strategy through Well-known medical databases [MIDLINE/ PubMed, and Embase] searching articles that published in English language up to December 2017, and discussing the surgical management of male hypogonadism. Malehypogonadism is identified by the presence of symptoms or signs of male hypogonadism and consistent serum testosterone levels that are below the normally accepted adult male range. Once the medical diagnosis is confirmed, the primary goal of treatment is testosterone substitution to accomplish serum testosterone levels that remain in the mid-adult range and the symptoms and signs of hypogonadism are eliminated. Recent developments led to numerous delivery systems for testosterone. For patients with primary hypogonadism testosterone therapy is the approach of choice. The patient needs to be completely informed about expected benefits and side-effects of the treatment option. The option of the preparation should be a joint decision by a notified patient and the doctor
ABSTRACT
Background: Patients with severe traumatic brain injury [TBI] are at high risk for airway obstruction and hypoxia at the accident scene, and routine prehospital endotracheal intubation has been widely advocated. Aim of the Study: to evaluate and compare the outcome and mortality rates of trauma patients undergoing Prehospital Tracheal Intubationversus those undergoing Emergency Department Intubation
Methods: A literature search was carried out on MEDLINE [including MEDLINE in-process], CINAHL, Embase and the Cochrane Library [from 1990 to October 2017]. Databases using "Prehospital Tracheal Intubation", "Emergency Department Intubation ", "Adults? trauma", and "mortality" as a MeSH heading and as text word. High yield journals were also had searched
Results: Eleven studies enrolling 17317 patients were included, out of which 4545 underwent PTI while 12772 underwent EDI. Median mortality rate in patients undergoing pre-hospital intubation was 52.12% [7.8-90.16%], compared to 27.98% [6.25-41.56%] in patients undergoing intubation in the emergency department. The overall quality of evidence was very low. Six of the eleven studies found a significantly higher mortality rate after pre-hospital intubation whilst five found no significant differences
Conclusion: Study outcome suggests that EDI was superior to PHI. Nevertheless, prehospital intubation was a marker for more severely ill patients who would have had higher mortality thus, the suggestion of the association between pre-hospital intubation and a higher mortality rate does not essentially oppose the importance of the intervention, but rather a need for further investigation of the possible causes for this finding