Prevalence of androgen deficiency in chronic spinal cord injury patients suffering from erectile dysfunction.

STUDY DESIGN: Retrospective cross-sectional study. OBJECTIVES: To estimate the prevalence of biochemical androgen deficiency in Iranian spinal cord injured men suffering from erectile dysfunction (ED) and to determine factors related to this problem. SETTING: An andrology clinic of a teaching hospital in Tehran. METHODS: Men, 18 years of age and older, with chronic (>2 years) spinal cord injury (SCI) suffering from ED were recruited. Demographic data, hormonal and lipid levels, injury variables and drug history were obtained from the medical records. The relationships between biochemical androgen deficiency (unequivocally low serum testosterone levels) and patient characteristics, injury variables and laboratory data were determined. RESULTS: Out of 319 patients, 32.6% had total testosterone deficiency and 29.1% had biochemical androgen deficiency. Of those with biochemical androgen deficiency, 93.5 and 85.7% had luteinizing hormone (LH) and follicle stimulating hormone (FSH) within or below the normal ranges, respectively. Opioid use, triglyceride (TG) and total cholesterol (TC) were associated with biochemical androgen deficiency. Significant correlations between total testosterone level and sex hormone binding globulin (r=0.3, P<0.001), LH (r=0.2, P=0.02), TC (r=-0.1, P=0.04) and TG (r=-0.3, P<0.001) were found. CONCLUSION: A substantial proportion of our patients with chronic SCI and ED had biochemical androgen deficiency. Opioid use, TG and TC levels were associated with biochemical androgen deficiency in our studied population. Standard screening of androgen deficiency and testosterone replacement therapy are recommended in men with chronic SCI suffering from ED. SPONSORSHIP: Tehran University of Medical Sciences.

Development of a practical tool for assessing the severity of acute otitis media.

BACKGROUND: Watchful waiting management of nonsevere acute otitis media (AOM) can reduce the use of antibiotics, but it requires a reliable means of assessing clinical severity. OBJECTIVE: We present the development of a pocket AOM card with which the clinician can rapidly assess total AOM severity. DESIGN/METHODS: The components of the pocket card consisted of a faces scale, to assess parent perception of severity, and a standard set of tympanic membrane photographs, with which the pediatrician can grade the severity of tympanic membrane inflammation. The components of the pocket card were tested for validity, reliability and responsiveness with the use of data from parents, pediatricians and pediatric otolaryngologists. STATISTICS: Instruments were assessed for concurrent correlation, sequence validity and reliability against previously published questionnaires with the use of Spearman correlation. Responsiveness was calculated with the use of enrollment, day 12 and day 30 data from a randomized clinical trial. RESULTS: The components of the pocket AOM card demonstrated excellent sequence validity, concurrent correlation and reliability (r = 0.58-0.99). Total AOM card severity, consisting of the sum of the 2 scales, demonstrated better responsiveness to change than any of the scales taken individually. CONCLUSIONS: The AOM card combines a parent assessment of symptoms and the clinician assessment of the tympanic membrane to provide an assessment of total AOM severity that can be used to facilitate shared decision making between parent and clinician. The combined score of the AOM card was more responsive to change than any of the instruments used alone. The AOM card provides a useful tool for teaching and research.

Bullous myringitis: a case-control study.

Prior studies have shown that bullous myringitis (BM) accounts for <10% of acute otitis media (AOM) cases, and that the distribution of viral and bacterial pathogens in BM is similar to that in AOM without BM, except for a relative increase in the proportion of Streptococcus pneumoniae in BM. We studied 518 cases of AOM in children aged 6 months to 12 years. Using tele-otoscopy to assist the diagnosis, we identified 41 cases (7.9%) with BM. Children who had AOM with BM were older than AOM patients without BM (median age: 4.3 years vs 18 months). We compared 41 cases of AOM with BM to 41 control cases of age-, race-, and gender-matched AOM patients without BM. When compared with this matched control group, children with BM had more severe symptoms at the time of diagnosis and were more likely to have bulging of the tympanic membrane in the quadrants that were not obscured by the bulla. Children with AOM and BM may require aggressive pain management. Although parents and clinicians may agree that a watchful waiting approach is appropriate for older children with mild AOM, children experiencing painful AOM with BM may not be successful candidates for a watchful-waiting approach, because parents may resist postponement of antibiotic therapy in children who are more symptomatic.