Male Andropause : A Myth or Reality

Male andropause, male climacteric or viropause is a condition in which men suffer from complex symptomatology due to low androgen level with aging. After the age of 40 years testosterone level starts declining and andropause corresponds to the age at which a pathogenic threshold is reached. This review summarizes the etiology, consequences, screening, diagnosis, monitoring of androgen deficiency in aging male (ADAM). The pros and cons of testosterone replacement therapy (TRT) in elderly male have been discussed. Currently oral, transdermal, transbuccal, intramuscular, and subcutaneous implants are available for clinical use. The choice is made by physicians based on therapeutic indication and patient preferences.Key Words: Andropause, Aging male, Testosterone replacement therapy     

Hospitalisations due to interpersonal violence: a population-based study in Western Australia

OBJECTIVE: To quantify the impact on the Western Australian health care system of hospitalisations due to interpersonal violence, and to identify risk factors for a repeat hospital admission for interpersonal violence. DESIGN AND SETTING: A population-based, retrospective study of interpersonal violence in WA using linked data (1990--2004) from the Western Australian Mortality Database, the Hospital Morbidity Data System and the Mental Health Information System. MAIN OUTCOME MEASURES: Number of hospitalisations and associated length of stay; risk factors for repeat hospitalisation. RESULTS: Over the period 1990--2004, there were 36,934 hospital admissions due to interpersonal violence, with 11,507 of these hospitalisations due to a subsequent episode of interpersonal violence. The average length of stay was 2.6 days (SD, 4.9 days). People who were more likely to be readmitted for interpersonal violence included women (adjusted hazard ratio [AHR], 1.31; 95% CI, 1.23-1.39), Indigenous people (AHR, 1.37; 95% CI, 1.28-1.46) and patients with a mental illness (AHR, 1.46; 95% CI, 1.37-1.54). People with more affluent backgrounds tended to have a lower risk of being readmitted than people in the most disadvantaged socioeconomic group. CONCLUSION: Greater priority should be directed towards the primary prevention of violence. Groups at high risk, such as women, Indigenous people and those with a mental illness, should be targeted for special attention.     

Pseudo-Bernard-Soulier syndrome: thrombocytopenia caused by autoantibody to platelet glycoprotein Ib

The Bernard-Soulier syndrome is an inherited bleeding disorder that is due to a deficiency in platelet glycoprotein Ib. Bernard-Soulier platelets fail to agglutinate in response to ristocetin despite normal levels of factor VIII:von Willebrand factor. We report a patient who developed severe refractory thrombocytopenia postsurgically while receiving procainamide therapy. Thrombocytopenia was immune mediated since the patient's platelets bore high levels of antiplatelet antibody. Radioimmunoprecipitation studies demonstrated that the autoantibodies had specificity for platelet glycoproteins Ib and V as well as platelet HLA. The patient's plasma as well as purified immunoglobulin G completely inhibited the ristocetin-induced aggregation of normal platelets but did not inhibit adenosine diphosphate-induced aggregation. The laboratory studies revealed that this patient suffered from antibody-mediated thrombocytopenia with unusual characteristics that we have called pseudo-Bernard-Soulier syndrome.     

A comparative study to screen dementia and APOE genotypes in an ageing East African population

Previous studies have established cross-cultural methods to screen for ageing- related dementia and susceptibility genes, in particular Alzheimer's disease (AD) among the Canadian Cree, African Americans and Yoruba in Nigeria. We determined whether the Community Screening Interview for Dementia (CSID), translated into Kikuyu, a major language of Kenya, could be used to evaluate dementia of the Alzheimer type. Using two sets of coefficients of cognitive and informant scores, two discriminant function (DF) scores were calculated for each of 100 elderly (>65 years) Nyeri Kenyans. When the cut-off points were selected for 100% sensitivities, the specificities of the DF scores were remarkably similar (93.75%) in the Kenyan sample. We propose the adapted CSID can be utilised to detect dementia among East Africans. We also show that apolipoprotein E epsilon 4 allele frequencies were high (approximately 30%) and not different between normal subjects and those with probable AD. There was no evidence to suggest years of education or vascular factors were associated with dementia status.     

Anti-Klebsiella K30 phospholipid antibodies in systemic lupus erythematosus: Antigen cross-reactions and idiotypic sharing with antibodies to DNA andKlebsiella K30 polysaccharide

Patients with systemic lupus erythematosus were examined for the presence of serum antibodies reactive with phospholipids (PL) extracted from the membranes ofKlebsiella K30 (K30PL). Affinity-purified anti-K30PL antibodies were tested for their ability to cross-react with other PL antigens or DNA and for the presence of idiotypic markers known to be associated with anti-DNA antibodies or antibodies toKlebsiella K30 polysaccharide (K30p). Affinity-purified antibodies to K30PL, phosphatidylserine (PS), or phosphatidylinositol (PL) uniformly cross-reacted with each other. Analysis of the PL preparations by thin-layer chromatography and reversed-phase high-performance liquid chromatography (HPLC) showed the presence of several components. Lupus sera reacted with one component mainly in the HPLC-fractionated K30PL preparation, although this component appeared to be present in the other PL preparations. Direct-binding and inhibition studies showed that affinity-purified antibodies to the K30PL extract, PS, or PI reacted poorly with DNA. However, the anti-K30PL antibodies possessed a prominent anti-DNA idiotypic marker (AM Id) in 60% of the patients and an anti-K30p idiotypic marker (SP Id) in 94% of the patients. The results thus show that anti-K30PL antibodies are idiotypically related to anti-DNA and anti-K30p antibody subpopulations, although they do not share the same antigen-binding characteristics.