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.

How might recharge change under projected climate change in western US?

Although groundwater is a major resource of water in the western US, little research has been done on the impacts of climate change on groundwater storage and recharge in the West. Here we assess the impact of projected changes in climate on groundwater recharge in the near (2021-2050) and far (2071-2100) future across the western US. Recharge is expected to decrease slightly (highly certain) in the West (-1.6%) and Southwest (-2.9%) regions in the near future and decrease considerably (highly certain) in the South region (-10.6%) in the far future. The Northern Rockies region is expected to get more recharge (highly certain) in both the near (+5.0%) and far (+9.0%) future. In general, southern portions of the western US are expected to get less recharge in the future and northern portions will get more. This study also shows that climate change interacts with land surface properties to affect the amount of recharge that occurs in the future.

Aspergillus endocarditis: rare but serious Aspergillus ball obstructing the pulmonary artery.

Aspergillus endocarditis is considered a rare complication in cardiac surgery, which is usually fatal due to unclear clinical manifestations. We present two cases with early and late post-operative Aspergillus endocarditis. Early diagnosis, more investigation for appropriate antifungal agents and their dosage, and early and aggressive surgical treatment may decrease fatality.