Validation of the International Index of Erectile Function (IIFE) for Use in Brazil

Background

The International Index of Erectile Function has been proposed as a method for assessing sexual function assisting the diagnosis and classification of erectile dysfunction. However, IIEF was not validated for the Portuguese language.

Objective

Validate the International Index of Erectile Function in patients with cardiopulmonary and metabolic diseases.

Methods

The sample consisted of 108 participants of to Cardiopulmonary and Metabolic program Rehabilitation (CPMR) in southern Brazil. The clarity assessment of the instrument was performed using a scale ranging from zero to 10. The construct validity was carried out by confirmatory factor analysis (KMO = 0.85; Barllet p < 0.001), internal consistency by Cronbach''s alpha and reproducibility and interrater reliability via the test retest method.

Results

The items were considered very clear with averages superior to 9. The internal consistency resulted in 0.89. The majority of items related correctly with their domains, with exception of three questions from sexual satisfaction domain, and one from erectile function. All items showed excellent stability of measure and substantial to almost perfect agreement.

Conclusion

The present study showed that the IIEF is valid and reliable for use in participants of a cardiopulmonary and metabolic rehabilitation program.     

N5,N10-亚甲四氢叶酸还原酶基因多态性及血浆同型半胱氨酸水平与心肌梗死的关系

研究N^5,N^10-亚甲四氢叶酸还原酶基因多态性及血浆同型半胱氨酸水平与心肌梗死的关系。运用多聚酶链反应-限制片长多态性技术检测178例心肌梗死患者及178例正常人N^5,N^10-亚甲四氢叶酸还原酶基因多态性，用高效液相色谱仪和荧光检测仪测定血浆总同型半胱氨酸水平。结果发现，N^5,N^10-亚甲四氢叶酸还原酶有3种基因型，即纯合子突变型（TT），杂合子突变型（TC）及正常型（CC），心肌梗死组TT型频率为35.4%，TC型频率为53.8%。CC型频率为10.8%。T等位基因频率为62.3%。C等位基因频率为37.7%，正常组中TT型频率为20.1%。TC型频率为55.8%。CC型频率为24.1%。T等位基因频率为32.1%,C等位基因频率为67.9%，且心梗死组TT高于正常组。正常人群中TT基因型者血浆总同型半胱氨酸水平明显高明于（TC CC）基因型者，心肌梗死患者血浆总同型半胱氨酸水平显著高于正常组，多因素分析显示，N^5,N^10-亚甲四氢叶酸还原酶基因突变型TT可能是心肌梗死发病一个危险因素，结论提示，N^5,N^10-亚甲四氢叶酸还原酶TT基因型突变可能升高个体血浆总同型半胱氨酸水平，N^5,N^10-亚甲四氢叶酸还原酶基因可能是心肌梗死的易感基因之一，N^5,N^10-亚甲四氢叶酸还原酶基因突变型TT及高同型半胱氨酸血症可能是心肌梗死发病的一个危险因素。     

Elevated Resistive Index in the Hepatic Artery as a Predictor of Fulminant Hepatic Failure in Patients with Acute Viral Hepatitis: A Prospective Study Using Doppler Ultrasound

To assess the sensitivity and specificity of the resistive index of the hepatic artery, which is related to the vascular resistance of the artery, for the prediction of fulminant hepatic failure, we performed Doppler ultrasonography examinations on the hepatic arteries of 72 patients with acute viral hepatitis (25 of whom developed fulminant hepatic failure and 47 of whom recovered without developing fulminant hepatic failure) as well as the hepatic arteries of age- and sex-matched controls. The mean resistive index of the hepatic arteries in patients who developed fulminant hepatic failure was significantly larger than that of patients who recovered without developing fulminant hepatic failure (P < 0.01). When a resistive index cutoff level of 0.74 was used, an 84% sensitivity and a 94% specificity were obtained for the prediction of fulminant hepatic failure. An elevated resistive index of the hepatic artery may be useful for predicting the patient's clinical outcome and determining the need for a liver transplantation in patients with acute viral hepatitis.     

The Effect of Tamsulosin Treatment on Erectile Functions in Patients with Lower Urinary Tract Symptoms (LUTS) due to Benign Prostate Hyperplasia: Correlation between Improvement of LUTS and Erectile Function

Objectives: To evaluate the impact of tamsulosin treatment on erectile function in patients with lower urinary tract symptoms (LUTS). Methods: Seventy‐five patients with LUTS received tamsulosin 0.2 mg once daily for 3 months. Subjective efficacy was assessed by International Prostatic Symptom Score (IPSS) for LUTS and International Index for Erectile Function 5 (IIEF5) for erectile dysfunction (ED). Objective efficacy was assessed by prostate volume and urine flow rate. All measurements were performed at baseline and month 3. On the basis of IPSS ratio (month 3/baseline), the patients were classified into good responders (≤0.75) and poor responders (>0.75). Good responders to ED were defined as the patients who improved IIEF5 score 3 or more. Results: Seventy‐four subjects completed the study. IPSS score showed significant improvement, but IIEF5 score showed no significant change. Forty‐three patients (58%) were classified into good responders to LUTS. The baseline score of IIEF5 in the good responders was significantly higher than that in the poor responders. Negative correlation was recognized between IPSS ratio and baseline score of IIEF5. Nine patients (13%) were able to classify into good responders to ED, who had significantly smaller prostate volume and showed significantly lower IPSS ratio. Conclusions: The tamsulosin therapy for LUTS patients showed a significant improvement of LUTS, but no significant change of erectile functions. The better response to LUTS was seen in the milder ED patient. Tamsulosin therapy may be effective not only on LUTS but also on ED in the patients who have small prostate.     

Evaluation of Left Ventricular Function and its Relationship With Multidimensional Grading System (BODE Index) in Patients With COPD

Cardiovascular disease (CVD) is one of the main causes of morbidity and mortality in chronic obstructive pulmonary disease (COPD) patients however data regarding left ventricle (LV) function in COPD is limited. We, in this study, aimed to evaluate the LV systolic function and its relation to BODE index in COPD patients with the utility of two-dimensional speckle tracking echocardiography (2D-STE). The study involved 125 COPD patients and 30 control subjects. All patients underwent 2D-echocardiography, pulmonary function tests and -minute walk tests. The patients were divided into four quartiles according to BODE index score. COPD patients had lower mitral annulus systolic velocity (Sm), average global longitudinal strain (GLS), average global longitudinal strain rate systolic (GLSRs), average GLSR early diastolic (GLSRe), average GLSR late diastolic (GLSRa), tricuspid annular plane systolic excursion (TAPSE) and peak systolic myocardial velocity (Sm-RV) (p < 0.001, p < 0.001, p < 0.001, p < 0.001, p < 0.001, p < 0.001 and p = 0.002 respectively) than control subjects. There were significant differences between BODE index quartiles in terms of Sm, average GLS and average GLSRs. Patients were divided into two groups according to median value of GLS (> –18.6 and ≤ –18.6). BODE index quartiles were found to be independent predictors of decreased GLS in multivariate logistic regression analysis (p = 0.030). Increased BODE index was associated with impaired LV mechanics in patients with COPD.     

Influence of Storage Time and Temperature on International Normalized Ratio (INR) Levels and Plasma Activities of Vitamin K Dependent Clotting Factors

We designed this study to assess the effect of storage time and temperature on the international normalized ratio (INR) levels and plasma activities of vitamin K-dependent, clotting factors. A total of 100 subjects, comprising 34 healthy controls, 33 patients with liver cirrhosis and 33 patients on long-term coumarin therapy were enrolled. After centrifugation of collected specimens, aliquots of plasma were stored at room temperature (20 ?22°C), refrigerated at 2-6°C and frozen at ?40°C. Determinations of INR and plasma activities of clotting factors II, VII, IX and X were performed immediately after sampling (0 time) and after 6, 12 and 24 h. We found no significant change of either INR levels or plasma activity of any of the studied clotting factors up-to 24 h at different studied temperatures ( p >0.05). Our data demonstrates that clinical specimens for determination of INR levels and plasma activities of factors II, VII, IX and X are acceptable for testing for up-to 24 h whatever may be the temperature of storage.     

Resting Heart Rate as an Important Predictor of Mortality and Morbidity in Ambulatory Patients With Heart Failure: A Systematic Review and Meta-Analysis

BackgroundResting heart rate is a risk factor of adverse heart failure outcomes; however, studies have shown controversial results. This meta-analysis evaluates the association of resting heart rate with mortality and hospitalization and identifies factors influencing its effect.Methods and ResultsWe systematically searched electronic databases in February 2019 for studies published in 2005 or before that evaluated the resting heart rate as a primary predictor or covariate of multivariable models of mortality and/or hospitalization in adult ambulatory patients with heart failure. Random effects inverse variance meta-analyses were performed to calculate pooled hazard ratios. The Grading of Recommendations, Assessment, Development and Evaluation approach was used to assess evidence quality. Sixty-two studies on 163,445 patients proved eligible. Median population heart rate was 74 bpm (interquartile range 72–76 bpm). A 10-bpm increase was significantly associated with increased risk of all-cause mortality (hazard ratio 1.10, 95% confidence interval 1.08–1.13, high quality). Overall, subgroup analyses related to patient characteristics showed no changes to the effect estimate; however, there was a strongly positive interaction with age showing increasing risk of all-cause mortality per 10 bpm increase in heart rate.ConclusionsHigh-quality evidence demonstrates increasing resting heart rate is a significant predictor of all-cause mortality in ambulatory patients with heart failure on optimal medical therapy, with consistent effect across most patient factors and an increased risk trending with older age.     

Determinants of Exhaled Nitric Oxide Levels (FeNO) in Childhood Atopic Asthma: Evidence for Neonatal Respiratory Distress as a Factor Associated With Low FeNO Levels

Background. In allergic asthmatic children exhaled nitric oxide (FeNO) levels are related to eosinophilic inflammation by correlation analysis. Whether FeNO can be modified by factors potentially influencing the natural history of asthma in early life is not known. Objective. To evaluate the frequency of anamnestic factors influencing the natural history of asthma and to identify potential determinants for elevated or low FeNO levels by multivariate analysis. Methods. One hundred seventy-one children with mild-moderate asthma were stratified according to their FeNO levels into three groups: low (<20 ppb), mid (20–40 ppb), and high (>40 ppb). The frequency of nine anamnestic factors together with indices of allergic sensitization (total and allergen-specific immunoglobulin E [IgE], blood eosinophil counts) and of airflow limitation (forced expiratory volume in one second [FEV₁]% predicted) were evaluated. Results. Among factors related to the patient history, neonatal respiratory distress was reported only in children with low FeNO levels, whereas this factor was never reported in children with mid-to-high FeNO levels (p = .008). As compared with low FeNO group, mid and high FeNO groups showed higher eosinophil counts and a tendency to have lower FEV₁ values. By multivariate analysis, four factors (eosinophils >300 cells/mm³, cat-specific IgE, house dust mites [HDM]-specific IgE, FEV₁ ≤86% predicted) turned out to be significantly associated with mid-high FeNO levels and two factors (eosinophils >600 cells/mm³, total IgE >355 kU/L) with high FeNO levels. Conclusions. Besides confirming the well-known tight association between blood eosinophilia and/or allergic sensitization and FeNO, these data provide new evidence for neonatal respiratory distress as potential factor associated with low FeNO levels in childhood atopic asthma.     

Diastolic Dysfunction in Individuals With Human Immunodeficiency Virus Infection: Literature Review,Rationale and Design of the Characterizing Heart Function on Antiretroviral Therapy (CHART) Study

Antiretroviral therapy (ART) has been associated with a shift in the epidemiology of human immunodeficiency virus (HIV)–associated cardiomyopathy from a phenotype of primarily left ventricular (LV) systolic dysfunction to LV diastolic dysfunction (DD). Patients with HIV receiving ART have higher rates of DD compared with age-matched control subjects and develop DD at a younger age. However, little is known about the natural history and pathogenesis of DD in virally suppressed HIV-infected patients. Current evidence suggests that immune processes modulate the risk for cardiac involvement in HIV-infected persons. Ongoing inflammation appears to have myocardial effects, and accelerated myocardial fibrosis appears to be a key mediator of HIV-induced DD. The Characterizing Heart Function on Antiretroviral Therapy (CHART) study aims to systematically investigate determinants, mechanisms, and consequences of DD in HIV-infected patients. We will compare ART-treated virally suppressed HIV-infected individuals with and without DD and HIV? individuals with DD regarding (1) systemic inflammation, myocardial stress, and subclinical myocardial necrosis as indicated by circulating biomarkers; (2) immune system activation as indicated by cell surface receptors; (3) myocardial fibrosis according to cardiac magnetic resonance examination; (4) markers of fibrosis and remodeling, oxidative stress, and hypercoagulability; (5) left atrial function according to echocardiographic examination; (6) myocardial stress and subclinical necrosis as indicated by circulating biomarkers; (7) proteomic and metabolic profiles; and (8) phenotype signatures derived from clinical, biomarker, and imaging data.     

Detection of Subclinical Atherosclerosis in Peripheral Arterial Beds With B-Mode Ultrasound: A Proposal for Guiding the Decision for Medical Intervention and an Artifact-Corrected Volumetric Scoring Index

ObjectivesTo assess subclinical atherosclerotic cardiovascular disease (ASCVD) using B-mode ultrasound, with special emphasis on the incremental value of performing imaging in multiple peripheral arteries, and to compare imaging findings with traditional risk factors for medical intervention eligibility.MethodsData from 2 asymptomatic cohorts from India with unknown ASCVD risk factors were compared to 2 cohorts from North America with known ASCVD risk factors. Carotid and iliofemoral arteries of the Indian cohorts were examined with automated ultrasound in a high-pace environment by non-experts. A simplified metric of atherosclerotic disease burden (FUster-Narula or FUN Score) was developed from 3D imaging data by summing intima-media volume (IMV) over 5-cm arterial segments. Effectiveness of ASCVD prevention guidelines to direct therapy was compared to results from direct imaging.ResultsOf the 941 (mean age 44.27 ± 13.76 years, 34% female) enrollees from India, 224 (24%) demonstrated plaques in at least 1 of the 4 arterial sites examined; 107 (11%) had plaques in only the carotids, 70 (7%) in both the carotids and iliofemoral arteries, and 47 (5%) had plaques in only the iliofemoral arteries. Older age and male sex were associated with the presence of plaque, but association with systolic blood pressure was not observed.Data from 2 North American clinics (n = 481, mean age 59.68 ± 11.95 years, 39% female) showed that 203 subjects (42%) had carotid plaque; 82% of whom would not have qualified for lipid-lowering therapy under the Adult Treatment Panel (ATP) III Guidelines. Using the recently published ATP IV Guidelines, 33% of the individuals with carotid plaque would also have failed to qualify for treatment.ConclusionsB-mode ultrasound examination of bilateral iliofemoral arteries provided an incremental yield in identifying subclinical atherosclerotic disease compared to carotid evaluation alone. Ultrasound examination allowed improved identification of individuals who could be targeted for prophylactic medical intervention compared to ATP III and ATP IV Guidelines.     

Usefulness of Doppler Echocardiographic Left Ventricular Diastolic Function and Peak Exercise Oxygen Consumption to Predict Cardiovascular Outcomes in Patients With Systolic Heart Failure (from HF-ACTION)

Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training (HF-ACTION) was a multicenter, randomized controlled trial designed to examine the safety and efficacy of aerobic exercise training versus usual care in 2,331 patients with systolic heart failure (HF). In HF-ACTION patients with rest transthoracic echocardiographic measurements, the predictive value of 8 Doppler echocardiographic measurements-left ventricular (LV) diastolic dimension, mass, systolic (ejection fraction) and diastolic (mitral valve peak early diastolic/peak late diastolic [E/A] ratio, peak mitral valve early diastolic velocity/tissue Doppler peak early diastolic myocardial velocity [E/E'] ratio, and deceleration time) function, left atrial dimension, and mitral regurgitation severity-was examined for a primary end point of all-cause death or hospitalization and a secondary end point of cardiovascular disease death or HF hospitalization. Also compared was the prognostic value of echocardiographic variables versus peak oxygen consumption (Vo(2)). Mitral valve E/A and E/E' ratios were more powerful independent predictors of clinical end points than the LV ejection fraction but less powerful than peak Vo(2). In multivariate analyses for predicting the primary end point, adding E/A ratio to a basic demographic and clinical model increased the C-index from 0.61 to 0.62, compared with 0.64 after adding peak Vo(2). For the secondary end point, 6 echocardiographic variables, but not the LV ejection fraction or left atrial dimension, provided independent predictive power over the basic model. The addition of E/E' or E/A to the basic model increased the C-index from 0.70 to 0.72 and 0.73, respectively (all p values <0.0001). Simultaneously adding E/A ratio and peak Vo(2) to the basic model increased the C-index to 0.75 (p <0.0005). No echocardiographic variable was significantly related to the change from baseline to 3 months in exercise peak Vo(2). In conclusion, the addition of echocardiographic LV diastolic function variables improves the prognostic value of a basic demographic and clinical model for cardiovascular disease outcomes.