Population-based study of erectile dysfunction and polypharmacy

Study Type – Symptom prevalence (population cohort) Level of Evidence 1b What's known on the subject? and What does the study add? It is known that medical conditions such as diabetes, high blood pressure, high cholesterol, smoking and prescribed medications cause erectile dysfunction (ED). This has been studied at the molecular level and reported in population studies. The present study shows that, after accounting for known medical problems, there is a dose–response relationship, in which worsening degrees of ED are seen when a greater number of medications are taken, regardless if they are prescribed or over the counter. The study can help primary care doctors and urologists to make a differential diagnosis of ED and it can also help improve patient's erectile function by tailoring and curtailing current medication use to maximize therapeutic benefit but minimize ED side effects in men, thus improving health‐related quality of life.

OBJECTIVE

• ? To study the association between erectile dysfunction (ED) and polypharmacy use in a large, ethnically and racially diverse cohort of men enrolled in the California Men's Health Study (CMHS).

PATIENTS AND METHODS

• ? Men from the Kaiser Permanente Southern California (KPSC) health plan, enrolled in the CMHS in 2002, had an age range of 45–69 years. ED and comorbidities of these subjects were identified by questionnaire responses.
• ? The number of drugs taken was determined from the year before enrollment through electronic pharmacy records and questionnaire responses.

RESULTS

• ? Among the 37 712 (KPSC) subjects, 10 717 (29%) reported moderate or severe ED.
• ? Across all age groups, ED was more prevalent as the number of medications increased.
• ? In men taking 0–2, 3–5,6–9 and ≥10 medications, the percentage of men reporting moderate ED was 15.9, 19.7, 25.5 and 30.9%, respectively (P < 0.001).
• ? With adjustment for age, race, smoking, diabetes, hypertension, hyperlipidaemia, peripheral vascular disease, coronary artery disease and body mass index, men taking >10 drugs were more likely to have ED (odds ratio = 2.32, 95% confidence interval 2.14–2.52) with evidence of a dose–response relationship.

CONCLUSION

• ? These data suggest that the number of medications a man takes is associated with worse ED, even after comorbidities have been taken into account.

     

Validation of some pathophysiological mechanisms of the CKD progression theory and outcome prediction in IgA nephropathy

Background: The "remnant kidney" chronic kidney disease (CKD) progression theory based on hemodynamic, proteinuric and inflammatory mechanisms consequent to nephron loss has not been confirmed in a human disease. The aim of this study was to evaluate whether some of these mechanisms are present in IgA nephropathy (IgAN) and predict functional outcome. Methods: In 132 IgAN patients (68 untreated, 64 angiotensin-converting enzyme inhibitor [ACEi]-treated) fractional excretion of IgG (FEIgG) and alpha1-microglobulin, proteinuria/day and beta-NAG excretion were divided by percentage of nonglobally sclerotic glomeruli ("surviving glomeruli" [SG]) to assess the effective glomerular loss and tubular load of proteins in surviving nephrons. Proteinuric markers were compared between 4 SG groups: group 1: <=50%; group 2: >50% and <80%; group 3: >=80% and <100%; and group 4: 100%. The outcome prediction (estimated glomerular filtration rate [eGFR] improvement and stability, progression) was assessed comparing low- and high-risk groups for each marker. Results: Proteinuric markers showed increasing values in parallel with reduction of percentages of SG (p<0.0001). FEIgG/SG, 40-fold higher in patients with SG <=50% vs. SG=100% (0.00040 ± 0.00039 vs. 0.00001 ± 0.00002, p<0.0001), was the most powerful outcome predictor: in ACEi-untreated patients, FEIgG/SG less or greater than 0.00010 predicted eGFR improvement and stability (88% vs. 12%, p<0.0001) and end-stage renal disease (ESRD) + eGFR reduction >=50% (2% vs. 87.5%, p<0.0001); ACEi treatment reduced ESRD+eGFR reduction >=50%: 36% vs. 87.5% (p=0.002). In patients with FEIgG/SG <0.00010 the eGFR increase is significantly higher in ACEi-treated for >=70 months versus ACEi-untreated with follow up >=70 months (+35% ± 23% vs. +13% ± 8%, p=0.004). Conclusions: In IgAN, progressive nephron loss is associated with an increase of proteinuric markers of glomerular and tubular damage. FEIgG/SG is the best outcome predictor. These data represent the first validation in a human disease of some pathophysiological mechanisms of CKD progression theory.     

Items for developing revised classification criteria in systemic sclerosis: Results of a consensus exercise

Objective

Classification criteria for systemic sclerosis (SSc; scleroderma) are being updated. Our objective was to select a set of items potentially useful for the classification of SSc using consensus procedures, including the Delphi and nominal group techniques (NGT).

Methods

Items were identified through 2 independent consensus exercises performed by the Scleroderma Clinical Trials Consortium and the European League Against Rheumatism Scleroderma Trials and Research Group. The first‐round items from both exercises were collated and redundancies were removed, leaving 168 items. A 3‐round Delphi exercise was performed using a 1–9 scale (where 1 = completely inappropriate and 9 = completely appropriate) and a consensus meeting using NGT was conducted. During the last Delphi round, the items were ranked on a 1–10 scale.

Results

In round 1, 106 experts rated the 168 items. Those with a median score of <4 were removed, resulting in a list of 102 items. In round 2, the items were again rated for appropriateness and subjected to a consensus meeting using NGT by European and North American SSc experts (n = 16), resulting in 23 items. In round 3, SSc experts (n = 26) then individually scored each of the 23 items in a last Delphi round using an appropriateness score ( 1 - 9 ) and ranking their 10 most appropriate items for the classification of SSc. Presence of skin thickening, SSc‐specific autoantibodies, abnormal nailfold capillary pattern, and Raynaud's phenomenon ranked highest in the final list that also included items indicating internal organ involvement.

Conclusion

The Delphi exercise and NGT resulted in a set of 23 items for the classification of SSc that will be assessed for their discriminative properties in a prospective study.     

Correlations of clinical and laboratory measures of balance in older men and women

Objective

It is known that impaired balance is associated with falls in older adults; however, there is no accepted gold standard on how balance should be measured. Few studies have examined measures of postural sway and clinical balance concurrently in large samples of community‐dwelling older adults. We examined the associations among 4 types of measures of laboratory‐ and clinic‐based balance in a large population‐based cohort of older adults.

Methods

We evaluated balance measures in the Maintenance of Balance, Independent Living, Intellect and Zest in the Elderly Boston Study (276 men and 489 women ages 64–97 years). The measures included laboratory‐based anteroposterior (AP) path length and mean sway speed, mediolateral (ML) mean sway and root mean square, and area of ellipse postural sway; the Short Physical Performance Battery (SPPB); the Berg Balance Scale; and the one‐leg stand test. Spearman's rank correlation coefficients were assessed among the balance measures.

Results

The area of ellipse sway was highly correlated with the ML sway measures (r = >0.91, P < 0.0001) and sway speed was highly correlated with AP sway (r = 0.97, P < 0.0001). The Berg Balance Scale was highly correlated with the SPPB (r = 0.74, P < 0.001) and the one‐leg stand test (r = 0.82, P < 0.001). Correlations between the laboratory‐ and clinic‐based balance measures were low but statistically significant (?0.29 ≤ r ≤ ?0.16, P < 0.0001).

Conclusion

Clinic‐based balance measures, and laboratory‐based measures comparing area of ellipse with ML sways or sway speed with AP sway, are highly correlated. There is less correlation between the clinic‐ and laboratory‐based measures. Since both laboratory‐ and clinic‐based measures inform balance in older adults, but are not highly correlated with each other, future work should investigate the differences.

     

Radiological features of Paget disease of bone associated with VCP myopathy

Objective  

Mutations in the Valosin-containing protein (VCP) gene cause a unique disorder characterized by classic Paget disease of bone (PDB), inclusion body myopathy, and frontotemporal dementia (IBMPFD). Our objective was to analyze the radiographic features of PDB associated with VCP mutations since there is a dearth of literature on the PDB component of VCP disease.