Role of interleukin 1ß and interleukin 10 variants on ocular toxoplasmosis in Brazilian individuals.

Introduction: Ocular toxoplasmosis (OT) is an intraocular inflammation caused by Toxoplasma gondii infection that affects the retina and choroid, giving rise to posterior uveitis. Genetic polymorphisms in cytokine genes may exert influence in the expression of these molecules and play a significant role in inflammatory responses and susceptibility to OT. The aim of this study was to evaluate the role of polymorphisms rs16944 (-511 C > T) of the interleukin (IL) 1ß gene and rs1800896 (-1082 G > A) of the IL10 gene on OT in Brazilian individuals with a serologic diagnosis of T. gondii and after conducting fundoscopic exams. Methods: Participants with a positive serology were classified into two distinct groups according to the presence (G1; n = 110) or absence (G2; n = 104) of OT. The control group (G3) consisted of individuals without the infection (n = 108). Results: It was observed that the C/C genotype of the IL1ß gene polymorphism was a protective factor for OT (p = 0.02, OR = 0.28, 95% CI 0.08-0.78 for G1 vs. G2; p = 0.03; OR = 0.29, 95% CI 0.09-0.82 for G1 vs. G3), according to the recessive inheritance model. Conclusions: The -511C.T polymorphisms of the IL1ß gene seems to play an important role in the pathogenesis of OT in Brazilian individuals.

Evaluation of Serological and Molecular Tests Used for the Identification of Toxoplasma gondii Infection in Patients Treated in an Ophthalmology Clinic of a Public Health Service in São Paulo State, Brazil.

Ocular toxoplasmosis is one of the most common complications caused by the infection with the parasite Toxoplasma gondii. The risk of developing eye lesions and impaired vision is considered higher in Brazil than other countries. The clinical diagnosis is difficult and the use of sensitive and specific laboratorial methods can aid to the correct diagnosis of this infection. We compared serological methods ELISA and ELFA, and molecular cPCR, Nested PCR and qPCR for the diagnosis of T. gondii infection in groups of patients clinically evaluated with ocular diseases non-toxoplasma related (G1 = 185) and with lesions caused by toxoplasmosis (G2 = 164) in an Ophthalmology clinic in Brazil. Results were compared by the Kappa index, and sensitivity (S), specificity (E), positive predictive value (PPV), and negative (NPV) were calculated. Serologic methods were in agreement with ELISA more sensitive and ELFA more specific to characterize the acute and chronic infections while molecular methods were discrepant where qPCR presented higher sensitivity, however, lower specificity when compared to cPCR and Nested PCR.

Educational program on sexual medicine for medical students: pilot project in Brazil.

BACKGROUND: Little is known about the factors that influence the graduation of medical students in relation to the preparation of their approach to sexual health care. Teaching hours for sexual education in undergraduate medical courses are frequently insufficient to prepare them for their roles to treat this complex issue. This study aimed to evaluate the delivery of sexual education to medical students by assessing their knowledge, attitudes, and self-confidence to treat patients. METHODS: A 1-day course was organized to tackle the main concerns of patients in respect to sexual health problems. The course was comprised of classes and time for students to discuss doubts with specialists. At the end of the course the knowledge of students on the subject and their confidence to care for patients with concerns on sexual issues were evaluated. RESULTS: Seventy-four medical students participated in the 1-day educational program on sexual medicine that included lectures about different topics and discussion. At the end of the course, students answered questionnaires about how the course had possibly improved their confidence regarding dealing with sexual issues. The analysis of the opinions of the students suggested an improvement in self-confidence with regard to discussing sexual behavior with patients. CONCLUSIONS: The results demonstrated a necessity to increase knowledge and stimulate positive attitudes of students about sexuality thereby improving their ability to treat patients with sexuality problems.

Efficacy and tolerability of lodenafil carbonate for oral therapy of erectile dysfunction: a phase III clinical trial.

INTRODUCTION: This is a phase III, prospective, randomized, double-blind, placebo-controlled clinical trial on lodenafil carbonate (LC), a novel phosphodiesterase 5 inhibitor developed in Brazil. AIM: Expanding information on LC efficacy and safety. MAIN OUTCOME MEASURES: International Index of Erectile Function (IIEF) erectile domain, positive answers to the sexual encounter profile (SEP)-2 and SEP-3 questions and incidence of adverse events (AEs). METHODS: A total of 350 men with erectile dysfunction (ED) of all degrees were randomized to placebo, LC 40 mg or LC 80 mg and followed for 4 weeks. They completed the IIEF and answered the SEP questions 2 and 3 after each intercourse without and with the use of LC. RESULTS: IIEF Erectile Domain scores without and with the use of medication were the following (mean [M] +/- standard deviation [SD]): placebo = 13.9 +/- 5.2 and 14.8 +/- 7.8; LC 40 mg = 13.6 +/- 5.3 and 18.6 +/- 8.0; LC 80 mg = 13.4 +/- 4.9 and 20.6 +/- 7.7 (analysis of variance [ANOVA] P < 0.01). Positive answers to SEP-2 without and with the use of medication were the following (M +/- SD): placebo = 55.3 +/- 43.2% and 52.1 +/- 41.4%; LC 40 mg = 46.4 +/- 44.3% and 63.5 +/- 42.0%; LC 80 mg = 50.2 +/- 40.9% and 80.8 +/- 32.3% (ANOVA P < 0.01). Positive answers to SEP-3 were the following: placebo = 20.2 +/- 32.3% and 29.7 +/- 38.1%; LC 40 mg = 19.6 +/- 34.3% and 50.8 +/- 44.4%; LC 80 mg = 20.8 +/- 33.2% and 66.0 +/- 39.3% (ANOVA P < 0.01). The patients with at least one AE were placebo = 28.7%, LC 40 mg = 40.9%, and LC 80 mg = 49.5%. AEs whose incidence was significantly higher with LC than with placebo included rhinitis, headache, flushing, visual disorder, and dizziness. CONCLUSIONS: LC showed a satisfactory efficacy-safety profile for oral therapy of ED.

Implants, mechanical devices, and vascular surgery for erectile dysfunction.

INTRODUCTION: The field of erectile dysfunction (ED) is evolving and there is a need for state-of-the-art information in the area of treatment. Aim. To develop an evidence-based, state-of-the-art consensus report on the treatment of erectile dysfunction by implants, mechanical devices, and vascular surgery. METHODS: To provide state-of-the-art knowledge concerning treatment of erectile dysfunction by implant, mechanical device, and vascular surgery, representing the opinions of 7 experts from 5 countries developed in a consensus process over a 2-year period. MAIN OUTCOME MEASURE: Expert opinion was based on the grading of evidence-based medical literature, widespread internal committee discussion, public presentation, and debate. RESULTS: The inflatable penile prosthesis (IPP) is indicated for the treatment of organic erectile dysfunction after failure or rejection of other treatment options. Comparisons between the IPP and other forms of ED therapy generally reveal a higher satisfaction rate in men with ED who chose the prosthesis. Organic ED responds well to vacuum erection device (VED) therapy, especially among men with a suboptimal response to intracavernosal pharmacotherapy. After radical prostatectomy, VED therapy combined with phosphodiesterase type 5 therapy improved sexual satisfaction in patients dissatisfied with VED alone. Penile revascularization surgery seems most successful in young men with absence of venous leakage and isolated stenosis of the internal pudendal artery following perineal or pelvic trauma. Currently, surgery to limit venous leakage is not recommended. CONCLUSIONS: It is important for the future of the field that patients be made aware of all treatment options for erectile dysfunction in order to make an informed decision. The treating physician should be aware of the patient's medical and sexual history in helping to guide the decision. More research is needed in the area of revascularization surgery, in particular, venous outflow surgery.

Comparative cross-over study of sildenafil and apomorphine for treating erectile dysfunction.

OBJECTIVE: To compare the effectiveness, safety and tolerability of sildenafil and apomorphine in Brazilian patients with erectile dysfunction (ED) of various causes. PATIENTS AND METHODS: In all, 108 patients (mean age 55 years, sd 11) and documented ED for > or =6 months were included in 12 centres in Brazil. The patients were initially followed for 2 weeks and then randomized to initial treatment with apomorphine or sildenafil, taken before sexual intercourse, no more than once a day. The initial dose (2 mg apomorphine and 50 mg sildenafil) could be adjusted (to 3 mg apomorphine, or to 25 or 100 mg for sildenafil) depending on the effectiveness and tolerability during the first 4 weeks of treatment. The patients were re-evaluated after 8 weeks on treatment and, after a wash-out period of 2 weeks (no treatment), received the other study drug (other than that received in the first phase), and then had the same procedures as in the first phase. RESULTS: In all, 97 patients were evaluated for therapeutic effectiveness, the overall effectiveness being assessed using two questions; sildenafil had a significantly higher proportion of affirmative answers for both (P < 0.001). Likewise, the estimates for the mean (sd) proportion of successful sexual intercourse, of 83.3 (4.7)% vs 40.3 (4.7)% and the total ED Inventory of Treatment Satisfaction score, of 86.7 (2.9) vs 56.9 (2.9) (P < 0.001) were higher for sildenafil. At the end of the study, 93.8% of the patients randomized to initial therapy with apomorphine declared a preference for sildenafil, and 81.3% of those initially treated with sildenafil declared a preference for that drug. The two drugs were well tolerated, and the main adverse events for apomorphine were nausea, vomiting, headache, taste perversion and dizziness; for sildenafil they were headache, flushing or vasodilatation, abdominal pain or dyspepsia and nasal congestion. CONCLUSIONS: Sildenafil is more effective than apomorphine for treating ED, in the domains of erectile function, satisfaction with sexual intercourse and overall satisfaction, and was the drug preferred by most of the patients.

O uso de doxazosina para tratamento de pacientes hipertensos portadores de hiperplasia prostática benigna / Doxazosin for treatment of hypertensive patients with benign prostatic hyperplasia

Introdução: A coexistência de hiperplasia prostática benigna (HPB) e hipertensão arterial sistêmica (HAS) ocorre em quase 25 dos homens com idade superior a 60 anos. O tratamento farmacológico da HPB com bloqueadores a-1-adrenérgicos pode ser benéfico para ambas as patologias. Este estudo multicêntrico teve por objetivo primário avaliar a eficácia e segurança de doxazosina sobre os sintomas prostáticos em pacientes hipertensos portadores de HPB. O objetivo secundário foi a avaliação de seus efeitos sobre a pressão arterial. Pacientes e métodos: Após um período de duas semanas de tratamento com placebo, 82 pacientes portadores de HAS sem tratamento farmacológico (pressão arterial [PA] diastólica 95-110 mmHg) e com Escore Internacional de Sintomas Prostáticos (I-PSS) ³ 12 foram tratados por 10 semanas com doses tituladas de doxazosina, que foi depois mantida por mais 4 semanas (dose otimizada). Pacientes que não apresentassem controle da PA (PA diastólica < 90 mmHg) com a máxima dose titulada de doxazosina deveriam receber amlodipino 5mg/dia. Os parâmetros primários de eficácia foram as mudanças no I-PSS. Os parâmetros secundários foram as variações da PA diastólica e sistólica na posição sentada e da freqüência cardíaca (FC), medida pelo pulso radial. A segurança foi avaliada pela incidência de eventos adversos e de hipotensão postural. Resultados: O I-PSS diminuiu, significativamente, de 20,3 ± 4,7 para 7,4 ± 5,4 (p<0,001), após 14 semanas de tratamento (redução média de 36,5 ). Houve redução significativa (P<0,001) da PA sistólica (de 155,0 ± 14,3 para 129,9 ± 14,3 mmHg) e diastólica (de 100,4 ± 4,5 para 81,5 ± 8,2 mmHg). Também houve diminuição da FC ao final do estudo (de 76,0 ± 8,8 para 72,8 ± 7,7 p=0,03). Apenas três pacientes receberam amlodipino. Eventos adversos relacionados ao medicamento foram registrados em 16 pacientes (19,5), mas nenhum deles foi grave ou levou à interrupção do tratamento. Não ocorreu aumento da incidência de hipotensão postural durante o estudo. Conclusão: A doxazosina, titulada de acordo com o protocolo deste estudo, é eficaz e segura para o tratamento de pacientes hipertensos com HPB sintomática, reduzindo os sintomas prostáticos e os níveis de PA.

Experiência de 10 anos com a prótese peniana de Small-Carrion / 10 years' experience with penile Small-Carrion's prosthesis

A implantaçäo de um dispositivo protético no interior do pênis é um meio eficaz e benéfico de tratamento da impotência sexual. Na maioria dos pacientes, os fatores que motivam a busca de uma prótese säo a auto-satisfaçäo e a esperança de novamente serem capazes de gratificar sua parceira sexual. Apresenta-se a experiência com a prótese de Small-Carrion, que proporcionou resultados estéticos e funcionais superiores à maioria dos implantes de silicone habitualmente utilizados