Evaluation of sexual functional status and consistency of scales in patients with hypogonadotropic hypogonadism before and after testosterone replacement therapy: a single-center experience

ABSTRACT Objective: This study aimed to investigate the frequency of sexual dysfunction and the effect of short-term testosterone replacement therapy on sexual functions in congenital hypogonadism patients. Furthermore, we sought to reveal the consistency of the self-report scales used for the diagnosis of sexual dysfunction and the relationship between biochemical parameters. Materials and methods: The study was conducted on 47 young male patients aged above 18 years who were diagnosed with hypogonadotropic hypogonadism. Short (IIEF-5) and long (IIEF-15) forms of the International Index of Erectile Function and Arizona Sexual Experiences Scale (ASEX) were applied before treatment under the supervision of a physician. The patients' blood pressure, height, and weight were measured, and their luteinizing hormone (LH), FSH, and total testosterone levels were recorded. Patients who started their treatments were called for a follow-up checkup after 6 months. Their blood pressure, height, and weight were measured by reapplying the ASEX, IIEF-5, and IIEF-15. In addition, their LH, FSH, and total testosterone levels in the biochemical tests were rerecorded. Results: In this study, the sexual dysfunction status of patients diagnosed with hypogonadotropic hypogonadism before and after treatment was evaluated using the ASEX, IIEF-15, and IIEF-5 scales. A decrease in sexual dysfunction was observed in all three scales after treatment compared with that before treatment. The IIEF-5 and IIEF-15 scales were found to be uncorrelated in terms of the pretreatment values but were correlated in terms of the post-treatment values. Although a correlation was observed between ASEX and IIEF-5 before treatment, no correlation was detected between ASEX and IIEF-15. After the treatment, ASEX was found to be correlated with both IIEF-5 and IIEF-15. The results of the scales indicated the correlation in all categories, except the pretreatment results of the IIEF-15 scale. Conclusion: The results of the current study demonstrated a significant improvement in the sexual function of hypogonadism patients undergoing short-term testosterone therapy. The ASEX, IIEF-5, and IIEF-15 scales used in the diagnosis and follow-up of sexual dysfunction were useful for evaluating sexual functions in hypogonadotropic hypogonadism patients.

Projection of new thresholds for hypertension to outpatient clinic patients and impact of risk factors: a cross-sectional study

ABSTRACT BACKGROUND: The 2017 American College of Cardiology (ACC)/American Heart Association (AHA) guidelines on hypertension management recommend new stage 1 hypertension thresholds (130-139/80-89 mmHg) for starting antihypertensive treatment. OBJECTIVE: To analyze the impact of the 2017 ACC/AHA guidelines on patients' diagnoses within daily practice, in comparison with management using the 2018 European hypertension guidelines, regarding the new thresholds. DESIGN AND SETTING: Cross-sectional study conducted in a hypertension outpatient clinic at a tertiary-level public hospital. METHODS: The diagnosis of hypertension was defined separately using each guideline. The participants were patients who were attending the hypertension clinic, who were evaluated using the thresholds of two guidelines, based on cardiovascular risk factors, including age, gender, smoking status, diabetes mellitus, dyslipidemia, obesity, osteoporosis, chronic renal failure and family history of hypertension. RESULTS: After adapting the guidelines to the blood pressure values of our sample, 74.5% (n = 277) of the patients were diagnosed as hypertensive according to the blood pressure classification of the European Society of Cardiology (ESC) guidelines published in 2018, while 91.1% (n = 339) of the patients were hypertensive according to the new 2017 ACC/AHA guidelines. Multivariate regression analysis revealed that the significant demographic and cardiovascular risk factors associated with hypertension, based on the 2018 European Society of Hypertension (ESH)/ESC guidelines, were age (odds ratio, OR: 1.027; 95% confidence interval, CI: 1.001-1.054; P = 0.042), obesity (OR: 4.534; 95% CI: 1.830-11.237; P = 0.001) and family history of hypertension (OR: 2.199; 95% CI: 1.252-3.862; P = 0.006). CONCLUSIONS: The factors associated with the definition of hypertension may vary through changing the threshold values.

Does the trait anxiety affect the dental fear?

Abstract The aims of the present study were to evaluate possible associations between trait anxiety, dental fear and the predictors of these interactions including demographic characteristics and dental history of patients applied to the dental care center in Ankara, Turkey. A sample of 607 participants (mean age: 21.02 ± 2.32) responded to a Turkish version of the Modified Dental Fear Survey (MDFS), the State–Trait Anxiety Inventory (STAI-T) and a questionnaire regarding previous negative dental experience. Multiple logistic regression analysis was used to identify the association between dental fear and the independent variables including trait anxiety, age groups, education level, dental visit frequency, experience and the source of dental knowledge. There was a trend for increasing in trait anxiety scores with greater levels of dental fear in a medium level of the dental fear group (OR = 1.055, 95%CI [1.025–1.086]; p < 0.001) and in a high level of the dental fear group (OR = 1.090 [1.057–1.124]; p < 0.001). Comparing to the low level of dental fear group; participants of medium dental fear level intended more likely to go to the dentist when they have a complaint instead of regularly going (odds ratio; OR = 3.177, 95%CI [1.304–7.741]; p = 0.011). Participants of high dental fear level tended to be less likely to have experienced no problem (OR = 0.476, 95%CI [0.284–0.795]; p = 0.005) than the low level of the dental fear group. We strongly indicate that higher dental fear scores have a predisposition of having high trait anxiety scores. Unpleasant dental experiences increased the risk for high dental fear levels. Patients with dental fear tended only to visit a dentist when necessary, avoiding regular visits.

Impact of predictors upon the reduction of lipid parameters in family medicine practice / Impacto de preditores da redução dos parâmetros de lipídios na prática da medicina de família

ABSTRACT CONTEXT AND OBJECTIVE: To evaluate predictors of changes in lipid parameters consisting of LDL-C (low-density lipoprotein cholesterol), TC (total cholesterol) and non-HDL-C (non-high density lipoprotein cholesterol) among primary care patients. DESIGN AND SETTING: Retrospective study conducted on family medicine patients. METHODS: Demographic features and other clinically relevant information were abstracted from medical records. The primary outcome was the difference in LDL-C level from initial testing to the index test. Secondary outcomes were the changes in TC and non-HDL-C levels between two measurements. RESULTS: Three hundred and eleven participants were included in the final secondary analysis. Multiple linear regression revealed that male patients (β = 4.97, P = 0.040), diabetes (β = 9.75, P = 0.003) and higher LDL-C levels at baseline (β = 0.35, P < 0.001) were positively associated with LDL variance, whereas longer time period (β = -0.15, P = 0.045) and familial hypercholesterolemia history (β = -7.56, P = 0.033) were negatively associated. Male patients (β = 8.45, P = 0.002), DM (β = 9.26, P = 0.011), higher TC levels at baseline (β = 0.35, P < 0.001) and taking statins (β = 7.31, P = 0.023) were positively associated with TC variance, whilst longer time period (β = -0.183, P = 0.031) and familial hypercholesterolemia (β = -10.70, P = 0.008) were negatively associated. CONCLUSION: In the present study, patients who were male, on statin treatment, diagnosed with diabetes and had higher baseline lipid values were more likely associated with better lipid outcomes at future testing.

RESUMO CONTEXTO E OBJETIVO: Avaliar preditores de alterações nos parâmetros lipídicos que consistem em LDL-C (colesterol de lipoproteína de baixa densidade), TC (colesterol total) e não HDL-C (não colesterol de lipoproteína de alta densidade) entre os pacientes de cuidados primários. TIPO DE ESTUDO E LOCAL: Estudo retrospectivo realizado em pacientes de medicina familiar. MÉTODOS: Aspectos demográficos e outras informações clinicamente relevantes foram extraídos dos prontuários médicos. O desfecho primário foi a diferença de nível de LDL-C entre os exames iniciais e o exame índice. Os desfechos secundários foram as mudanças dos níveis de TC e não HDL-C entre as duas medidas. RESULTADOS: Trezentos e onze participantes foram incluídos na análise secundária final. Regressão linear múltipla revelou que os pacientes do sexo masculino (β = 4,97, P = 0,040), diabetes (DM) (β = 9,75, P = 0,003) e níveis de LDL mais elevados no início do estudo (β = 0,35, P < 0,001) foram associados positivamente com variância LDL, enquanto longo período de tempo (β = -0,15, P = 0,045) e história hipercolesterolemia familiar (β = -7,56, P = 0,033) foram associados negativamente. Pacientes do sexo masculino (β = 8,45, P = 0,002), com DM (β = 9,26, P = 0,011), níveis elevados de CT na linha de base (β = 0,35, P < 0,001) e tomar estatinas (β = 7,31, P = 0,023) associaram-se positivamente com a variância TC, enquanto longo período de tempo (β = -0,183, P = 0,031), hipercolesterolemia familiar (β = -10,70, P = 0,008) foram associados negativamente. CONCLUSÕES: No presente estudo, os pacientes que eram do sexo masculino, em tratamento com estatinas, com diagnóstico de DM e que tinham valores lipídicos basais mais elevados foram mais provavelmente associados a melhores resultados de lipídios em testes futuros.