Sildenafil: two decades of benefits or risks?

Sildenafil is a selective inhibitor of cyclic guanosine monophosphate (cGMP)-specific phosphodiesterase type 5 (PDE-5). A patent was registered for this drug in 1990, which expired in 2010. Since expiration, the drug has been marketed under various trade names or as generic drugs. Numerous clinical trials have been conducted addressing the effectiveness of the drug for erectile dysfunction (ED) and its safety regarding the presence or absence of specific comorbidities. After over 20 years in the market, we need to ask: has the scientific community reached a general consensus as to the overall efficacy and safety of the drug? Can we firmly state that the benefits of the drug outweigh its risks? This review suggests that sildenafil is an effective and easily manageable treatment for erectile dysfunction, both in the absence and in the presence of comorbidities. After two decades of the emergence of sildenafil as a drug of choice for the treatment of ED (and the numerous studies and clinical trials undertaken during this time span), it is now possible to state that the benefits of the drug do outweigh the risks, and represent an significant improvement in the quality of life in men with ED.

Efeitos da suplementação de fibras solúveis sobre as células do sistema imune após exercício exaustivo em ratos treinados / Effects of soluble fibers supplementation on immune system cells after exhausting exercise in trained rats

A intensidade, volume, modalidade de exercício, assim como o nível de aptidão e fatores nutricionais podem alterar a reposta imunológica. O objetivo deste estudo foi avaliar o efeito da suplementação crônica de farelo de aveia (fonte de fibras solúveis) sobre as células do sistema imunológico em ratos treinados, frente a um teste de exaustão. Foram utilizados ratos Wistar, ± dois meses, peso ± 200g, divididos em três grupos (n = 9, cada um): 1) controle sedentário (C); 2) treinado oito semanas submetido ao teste de exaustão (EX); e 3) treinado oito semanas submetido ao teste de exaustão com suplementação de 30 por cento de farelo de aveia (EXA). O treinamento consistiu de 60 minutos de natação diários, cinco dias por semana durante oito semanas. As análises realizadas foram: contagem total de leucócitos, linfócitos dos linfonodos mesentéricos, macrófagos peritoneais e capacidade fagocitária de macrófagos peritoneais. Aplicou-se o teste estatístico ANOVA two way, seguido do post hoc de Tukey com p < 0,05. O grupo EX apresentou leucocitose quando comparado com o controle, o que não ocorreu no grupo EXA, porém, na comparação entre os grupos exercitados EXA, mostrou menor leucocitose em relação a EX. Não houve alteração significativa nos linfócitos teciduais em nenhum dos grupos exercitados. Tanto o número de macrófagos peritoneais como a capacidade fagocitária desta célula foram maiores nos grupos exercitados. Porém, no grupo suplementado a capacidade fagocitária foi maior em relação ao grupo exaustão sem farelo de aveia. A suplementação de fibras solúveis demonstrou resultados benéficos com relação às alterações imunológicas induzidas pelo exercício extenuante, além de aumentar a capacidade fagocitária de macrófagos peritoniais em ratos treinados durante oito semanas submetidos ao teste de exaustão.

Exercise modality, volume, intensity, as well as physical fitness and nutritional factors may modulate the immune response. The purpose of this investigation was to verify the effects of chronic oat bran supplementation on immune cells in trained rats submitted to an extenuating test. Wistar rats (two months old), +200g weight, divided into three groups (n = 9, per group) were used: 1) a sedentary control (C) 2) trained for eight weeks submitted to an exhaustion test (EX), and 3) trained for eight weeks submitted to an exhaustion test with 30 percent oat bran supplementation (EXA). Training consisted of 60 daily minutes of swimming, five days a week, during eight weeks. The analyses conducted were: total leukocytes, lymphocytes from lymph nodes, peritoneal macrophages and peritoneal macrophages phagocytic capacity. Statistical analyses were done by the two-way ANOVA test, followed by Tukey's post hoc test (p < 0.05). EX group presented leukocytosis when compared to control; however, EXA group did not. In exercised group, comparison with EXA has shown lower leukocytosis in relation to EX. No significant alteration was observed for tissue lymphocytes in any of the exercised groups. The number of peritoneal macrophages as well as phagocytic capacity of this cell was higher in exercised groups. In oat bran supplemented group the phagocytic capacity was higher as compared to exhaustion group without oat bran. Soluble fibers supplementation has shown benefic results with regard to immune alterations induced by exhaustive exercise, and increased peritoneal macrophages phagocytic capacity in rats trained for eight weeks submitted to an exhaustion test.