RESUMEN
ABSTRACT The primary goal in the management strategy of a patient with ED would be to determine its etiology and cure it when possible, and not just to treat the symptoms alone. One of the new therapeutic strategies is the use of low intensity extracorporeal shockwave (LISW) therapy. The mechanism of shockwave therapy is not completely clear. It is suggested that LISW induces neovascularization and improvement of cavernosal arterial flow which can lead to an improvement of erectile function by releasing NO, VEGF and PCNA. Materials and Methods: 31 patients between February and June 2013 with mild to severe ED and non-Phosphodiesterase 5 inhibitors responders were enrolled. Patients underwent four weekly treatment sessions. During each session 3600 shocks at 0.09mJ/ mm2 were given, 900 shocks at each anatomical area (right and left corpus cavernosum, right and left crus). Improvement of the erectile function was evaluated using the International Index of Erectile Function (IIEF-EF), the Sexual Encounter Profile (SEP) diaries (SEP-Questions 2 and 3) and Global Assessment Questions (GAQ-Q1 and GAQ-Q2). Results: At 3-month follow-up IIEF-EF scores improved from 16.54±6.35 at baseline to 21.03±6.38. Patients answering ‘yes’ to the SEP-Q2 elevated from 61% to 89% and from 32% to 62% in the SEP-Q3. A statistically significant improvement was reported to the Global Assessment Questions (GAQ-Q1 and GAQ-Q2). Conclusion: In conclusion, we can affirm that LISW is a confirmed therapeutic approach to erectile dysfunction that definitely needs more long-term trials to be clarified and further verified.
Asunto(s)
Anciano , Humanos , Masculino , Persona de Mediana Edad , Disfunción Eréctil/terapia , Litotricia/métodos , Estudios de Seguimiento , Neovascularización Fisiológica , Óxido Nítrico Sintasa/análisis , Satisfacción del Paciente , Erección Peniana/fisiología , Antígeno Nuclear de Célula en Proliferación/análisis , Reproducibilidad de los Resultados , Autoinforme , Índice de Severidad de la Enfermedad , Factores de Tiempo , Resultado del Tratamiento , Factor A de Crecimiento Endotelial Vascular/análisisRESUMEN
Introduction: The insomnia represents a symptom that accompanies several psychiatricdisorders. It is described as a characteristic of the depressive episode, which increases in 40 times the risk to develop a depression. Objective: To establish statistic correlation between the magnitude of the observed insomnia to the moment of the diagnosis of depression and the answer to the antidepressant treatment in the following 3 months of therapy. Methodology: Secondary evaluation of clinical rehearsal randomizado in adult women treated with monitored pharmacotherapy. Sleep global score (PGS), social - demographical and clinical variables were compared, and among them they forward the ones that not in the 3 months of treatment according to blind evaluation with the Hamilton Depression Scale ( HRSD). Results: Sample of 175 women which are in an average age of 37,5 years (IQ 95 percent: 36,4 - 38,5). More than the half married. Most of them were house wives. Two thirds have had episodes of depression at least once. HRDS average of 19,0 (18,8 - 20,3). PGS basal average of 3,0 (d.s.: 1,94). PGS average after the 3 months 0,8 (0,6 - 1,0). Significant statistic correlation was found between the basal PGS and the patients recovery (quotient: 0.4106831; p = 0.015). Besides an improvement of 1,2 in the risk of not getting well to the 3 months of treatment (p = 0.05), for each point of PGS. Conclusions: The insomnia corresponds to a pathological entity which can modulate or moderate the apparition of some psychiatric pathologies and constitutes a recovery predictor in the antidepressant treatment, in the third month of treatment.
Introducción: El insomino constituye un síntoma acompañante en diferentes trastornos psiquiátricos. Describiéndose como un marcador de episodio depresivo, que incrementa en 40 veces el riesgo a desarrollar depresión. Objetivo: Establecer correlación estadística entre la magnitud del insomnio observado al momento del diagnóstico de depresión y la respuesta al tratamiento antidepresivo a los 3 meses de terapia. Metodología: Evaluación secundaria de ensayo clínico randomizado en mujeres adultas tratadas con farmacoterapia monitorizada. Se compararon variables de puntaje global de sueño (PGS), sociodemográficas y clínicas entre las que remitieron y las que no a los 3 meses de tratamiento según evaluación ciega con la Escala de Depresión de Hamilton (HRSD). Resultados: Muestra de 175 mujeres con edad promedio de 37,5 años (CI 95 por ciento: 36,4 - 38,5). Más de la mitad casadas. La mayoría dueña de casa. Dos tercios con episodio previo de depresión. HRDS promedio 19,0 (18,8 - 20,3). PGS basal promedio 3,0 (d.s.: 1,94). PGS promedio a los 3 meses 0,8 (0,6 - 1,0). Se encontró correlación estadísticamente significativa entre el PGS basal y la recuperación de las pacientes (coef: 0.4106831; p = 0,015). Además de un incremento de 1,2 en el riesgo de no recuperarse a los 3 meses de tratamiento (p = 0,05), por cada punto del PGS. Conclusiones: El insomnio corresponde a una entidad patológica que pudiera modular o moderar la aparición de algunas patologías psiquiátricas y constituye un predictor de recuperabilidad en el tratamiento antidepresivo, ya a los 3 meses de tratamiento.