The association between Parkinson's disease and Sexual dysfunction: Clinical correlation and therapeutic implications.

Sexual function which comprises of desire, arousal, orgasm and satisfaction and pain, involves coordinated physiologic responses from multiple different pathways. Sexual dysfunction (SD) occurs when these domains of the sexual response cycle are affected. SD is a common but under-recognized non-motor feature in Parkinson's disease (PD), a common age-related neurodegenerative disorder. SD significantly affects the quality of life of PD patients and their partners. Advanced age, gender, hormone deficiency, neuropsychiatric and medical comorbidities contribute to SD in PD. Possible potential pathological mechanisms include vasculogenic, endocrinologic, neurogenic and psychogenic factors. Various therapeutic interventions, both pharmacological and non-pharmacological modalities have been suggested to improve SD in PD. However, erectile dysfunction (ED) is the only SD with evidence-based treatment available. Non-pharmacological therapies are also offering promising evidence in the improvement of SD. A multidisciplinary approach in the assessment, investigation, and treatment is needed to address the real life complex issues (gender and comorbidities, neurobiological, vasoactive, hormonal as well as psychosocial aspects). Future clinical studies with validated and standardized methods in assessing SD as well as experimental models will be necessary for better insight into the pathophysiology. This would facilitate appropriate therapy and improve sexual rehabilitation in PD patients.

Remote Prescription During Pandemic: Challenges and Solutions.

The current COVID-19 pandemic has created an awareness and at the same time provides an impetus to transform digitalisation of healthcare delivery. Remote prescription is one key component of telemedicine, but it is the easiest and already practised in most places during the current pandemic even without the framework of virtual medicine in place. However, remote prescription, with its antecedent problems cannot be properly and safely executed in isolation. To ensure patients' safety and health outcomes, specific guidelines will need to be developed to cater for specific medical conditions to address individual drug prescriptions and concerns. There is a need for a robust governance to ensure that patient's safety is the foremost priority, and provisions should be made for requirements of remote prescription in the different medical subspecialities. The pandemic provides an enormous opportunity for stakeholders and policymakers to come together to create a seamless and user friendly and yet innovative healthcare ecosystem to transform clinical healthcare delivery with patient safety as the core driver in the implementation.