Erectile Dysfunction after Conservative Treatment of Sacral Fractures in Males without Injury to the Urinary System

Zeitschrift für Orthopädie und Unfallchirurgie ◽

10.1055/a-1611-0165 ◽

2021 ◽

Author(s):

Alkan Bayrak ◽

Altug Duramaz

Keyword(s):

Erectile Dysfunction ◽

Conservative Treatment ◽

Marital Status ◽

Functional Outcomes ◽

Sacral Fracture ◽

Urethral Injury ◽

Trauma Mechanism ◽

Fracture Types

Abstract Background This study aimed to determine the incidence of erectile dysfunction (ED) reported by patients, and to define the prognostic relationship between ED and conservatively treated sacral fracture without urethral injury. Methods Patients aged between 20 – 50 years who were sexually active and had no known sexual dysfunction prior to the trauma were included in the study. Seventy-seven patients (47 married, 30 single) treated conservatively for sacral fracture between April 2012 and February 2017 were retrospectively screened. Patients were compared in terms of age, marital status, body mass index (BMI), trauma mechanism, additional system injury, functional outcomes, and complications. Functional outcomes were assessed using the International Index of Erectile Function (IIEF-5) and the Majeed pelvic fracture functional assessment scale (MPS). Results No statistically significant difference was observed between fracture types with respect to age, BMI, follow-up, marital status, trauma mechanism, and accompanying injury. The incidence of ED was 27.3% for those that received conservative treatment after sacrum fracture. The mean score of IIEF-5 was 18.6 ± 6.6 and MPS was 77.2 ± 13.2. There was no significant relationship between the injury type of the patients and the IIEF-5 and MPS scores (p = 0.593 and p = 0.907, respectively). The lowest IIEF-5 score was found in Denis type 2 fractures (p = 0.020). Conclusion The frequency of ED was higher in Denis type 2 sacrum fractures. Sexual function should be questioned in the follow-up, especially in those fracture types.

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Management of Pelvic Fracture Urethral Injury- 147 Cases

KYAMC Journal ◽

10.3329/kyamcj.v10i4.45715 ◽

2020 ◽

Vol 10 (4) ◽

pp. 179-183

Author(s):

Hafiz Al Asad ◽

Nahid Rahman Zico ◽

AKM Shahadat Hossain ◽

Zulfia Zinat Chowhury ◽

Md Mostafizur Rahman ◽

...

Keyword(s):

Erectile Dysfunction ◽

Pelvic Fracture ◽

Urethral Catheter ◽

Urethral Injury ◽

College Hospital ◽

Medical College ◽

History Of ◽

Anastomotic Urethroplasty

Background: Dhaka Medical College Hospital is the highest referral center for PFUI. As anstomotic urethroplasty is a challenging surgery and most of the surgeons refer these type of injuries to our center, we performed this study to evaluate the outcome of our cases. Objective: This study aims to find the outcome and complications of perineal end to end anastomotic urethroplasty in the management of posterior urethral injury resulting from pelvic fracture. Materials and Methods: We performed 147 perineal bulbo-prostatic anastomotic urethroplasty for PFUIs from January, 2013 to May, 2019. Mean age was 37 years with majority between 21 to 50 years (>85%). Nine patients had history of failed anastomotic urethroplasty. After surgical intervention patients were discharged with a supra-pubic catheter (SPC) and per urethral catheter in situ. On 22nd POD urethral catheter was removed and SPC on the next day if patient can void normally. 1st and 2nd follow up done on of 3rd and 6th month respectively following surgery. If patient voided well and Qmax>15ml/ sec; repair was defined as successful. Results: Success rate of anastomotic urethroplasty for PFUI was 93.87%. Total 9 procedures were failed including 2 urethro-cutaneous fistula and needed re-do anastomosis. Erectile dysfunction (ED) was present in 18 patients before operation and after surgery 12 more patients developed ED and total number was 30 during first follow up, which reduced to 24 during second follow-up. Two patient developed incontinence which improved in subsequent follow-up. Conclusion: Anastomotic urethroplasty remains the gold standard in the management of PFUI. Erectile dysfunction is the main issue to be concerned and need special attention. KYAMC Journal Vol. 10, No.-4, January 2020, Page 179-183

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Conservative Treatment Versus Repair Deltoid in SER Type IV Equivalent Ankle Fracture

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00004 ◽

2018 ◽

Vol 3 (2) ◽

pp. 2473011418S0000

Author(s):

Chamnanni Rungprai

Keyword(s):

Conservative Treatment ◽

Functional Outcomes ◽

Ankle Fracture ◽

Deltoid Ligament ◽

Medial Side ◽

Type Iv ◽

Sf 36 ◽

Fibular Fixation ◽

Return To Activity

Category: Trauma Introduction/Purpose: There remains a controversy to repair deltoid ligament in SER type IV equivalence of acute ankle fracture. Some surgeons prefer conservative treatment with casting while others prefer to repair deltoid ligament after distal fibular fixation. However, there is a little evidence to report comparative outcomes between the two methods. There remains a controversy to repair deltoid ligament in SER type IV equivalence of acute ankle fracture. Some surgeons prefer conservative treatment with casting while others prefer to repair deltoid ligament after distal fibular fixation. However, there is a little evidence to report comparative outcomes between the two methods. The purpose of this study was to report clinical and functional outcomes including complications between the two methods. Methods: A prospective, randomized collected data of 41 consecutive patients who were diagnosed with SER type IV equivalence acute ankle fracture and underwent either conservative treatment (20 patients) or deltoid repair (21 patients) between 2015 and 2017. A minimum follow up to be included in the study was 6 months (mean, 13.2 months; range, 6 to 30 months). The primary outcome was visual analogue scale (VAS), Short Form-36 (SF-36); physical and mental component scores, and FAAM; ADL and Sport. Pre- and post-operative SF-36, FAAM, and pain (Visual Analog Scale) were obtained and compared between the two groups using independent t-test. The secondary outcomes were time to return to activity of daily living, sports, work, and complications. Results: There were 41 patients (30 male and 11 female) with mean age of 29.7 years (range, 18-70 years) and mean BMI of 26.7 kg/m2 (range, 18.3-33.6 kg/m2). Both methods demonstrated significant improvement of post-operative functional outcomes (FAAM, SF-36, and VAS (p < 0.05 all)) compared to pre-operative period; however, there was no significant different between the two groups. Functional outcomes between casting and deltoid repair groups were time to return to activity of daily living (10.4 vs 11.7 weeks), works (12.1 vs 12.9 weeks), sport (25.9 vs 23.7 weeks), weight bearing medial clear space (2.9 vs 3.9 mm), and complications included medial side ankle pain (57 vs 15%) and painful scar (0 vs 15%) for cast and deltoid repair respectively. Conclusion: Both casting and deltoid repair were demonstrated significant improvement in terms of functional outcomes as measured with the FAAM, SF-36, and VAS in patients with SER IV equivalent ankle fracture. Although there was no significant difference of functional outcome in short term of follow-up, deltoid repair group was better in term of medial side ankle pain and lesser medial clear space widening.

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Abstract P213: Marital status and Risk of type 2 Diabetes in the Health Professionals Follow-up Study

Circulation ◽

10.1161/circ.125.suppl_10.ap213 ◽

2012 ◽

Vol 125 (suppl_10) ◽

Author(s):

Marilyn C Cornelis ◽

Maria Glymour ◽

Ichiro Kawachi ◽

Stephanie E Chiuve ◽

Shun-Chiao Chang ◽

...

Keyword(s):

Marital Status ◽

Health Professionals ◽

Dietary Factors ◽

Time Dependent ◽

Never Married ◽

Follow Up Study ◽

Increased Risk ◽

Married Men

Married individuals may enjoy better physical and mental health than their unmarried counterparts. Previous work has suggested that never entering marriage or marital termination by death or divorce increases risk of premature mortality and cardiovascular disease, with more pronounced effects among men. Few studies to date have investigated the role of marital status in the development of type 2 diabetes (T2D). We tested the hypothesis that men who are not married have increased risk of incident T2D in the Health Professionals Follow-up Study, an on-going cohort of men. A total of 41,379 men ages 40 to 75 without diabetes at baseline in 1986 were followed until 2008. T2D, marital status and covariates were assessed by questionnaires biennially. New cases of T2D were confirmed by a supplementary questionnaire validated by medical record review. Cox proportional hazards models estimated the effect of time-dependent measures of marital status on incident T2D. Potential confounders and components of the causal pathway were included as time-dependent covariates. During 22 years of follow-up (801,850 person-years), we documented 2952 incident cases of T2D. Strongest associations were evident for widowed men, while associations among men who were either never married or divorced/separated were less consistent. Compared to married men, RRs (95% CIs) of developing T2D for divorced/separated, widowed and never married men were 1.09 (0.94–1.27), 1.29 (1.06–1.57), and 1.17 (0.91–1.52), respectively, after adjusting for age, family history of diabetes and ethnicity. The RR of T2D associated with widowhood was attenuated after adjusting for lifestyle and dietary factors [RR: 1.21 (1.00–1.48)] and no longer significant when further adjusting for BMI [RR: 1.16 (0.95–1.41)]. The opposite trend was observed for divorced/separated men: when adjusting for lifestyle and dietary factors [RR: 1.12 (0.96–1.30)] as well as BMI [1.14 (0.98–1.32)] the RR of T2D increased slightly. Among men who were never married, diet and lifestyle did not alter RR of T2D [1.17 (0.91–1.52)], however, after further adjusting for BMI there was a notable enhanced RR of T2D [1.23 (0.95–1.60)]. When allowing for a 2-year lag period between marital status and disease, RRs of T2D for widowers were augmented and when further adjusting for BMI remained borderline significant [RR: 1.24 (1.00–1.55)]. In conclusion, being widowed is associated with an increased risk of T2D in men and this may be mediated, in part, through unfavorable changes in lifestyle, diet and adiposity. Together with prior work, our findings suggest that widowhood has important implications for metabolic functioning and greater attention to the cardiometabolic health of this population is warranted.

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Type 2 diabetes: basic clinical and laboratory parameters and risk of cardiovascular death

Russian Journal of Cardiology ◽

10.15829/1560-4071-2020-3822 ◽

2020 ◽

Vol 25 (4) ◽

pp. 3822

Author(s):

O D Rymar ◽

L V Shcherbakova ◽

A O Shchetinina ◽

S V Mustafina ◽

Y I Ragino ◽

...

Keyword(s):

Physical Activity ◽

Blood Pressure ◽

Type 2 Diabetes ◽

Marital Status ◽

Cardiovascular Death ◽

Initial Examination ◽

Laboratory Parameters ◽

Duration Of Diabetes

Aim. To evaluate the basic clinical and laboratory parameters and their relationship with the 14-year risk of cardiovascular death in individuals with type 2 diabetes (T2D).Material and methods. A prospective case-control study of a sample of Novosibirsk residents with T2D was performed. An initial examination was conducted as part of the HAPIEE project in 2003-2005. The follow-up period lasted until 2017 and amounted to 13,7±0,7 years. The case group consisted of 145 people (mean age — 62,0±5,7 years) with recorded cardiovascular death. Control group — 272 people (mean age — 57,9±6,6 years) without recorded death as of December 31, 2017. Persons with a history of non-fatal myocardial infarction and/or stroke at the initial examination were excluded. Blood pressure (BP), biochemical, anthropometric and socio-demographic data were determined. Logistic regression models were used to analyze the association of clinical and laboratory parameters with the risk of cardiovascular death.Results. T2D subjects with recorded cardiovascular death at the initial examination had a longer duration of the disease, higher fasting plasma glucose (FPG) and anthropometric parameters (body mass index (BMI), waist circumference (WC) (in women)), systolic blood pressure (SBP) and diastolic blood pressure (DBP). In individuals of both sexes, the risk of cardiovascular death increased 2,2 times with WC >95 cm, 2,3 times with an increased WC/HC ratio, 2,2 times with a BMI ≥30 kg/m2, 1,9 times with physical activity <3 hours/week, 2 times for smokers and those with a single marital status, 3,5 times for hypertensive people, 2 times with FPG ≥7,5 mmol/L and longer duration of diabetes.Conclusion. Fourteen-year follow-up revealed that individuals with T2D have associations of cardiovascular death with both conventional risk factors such as hypertension, abdominal obesity, low level of physical activity, smoking, single marital status, and diabetes-related ones — FPG and the duration of diabetes.

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Vitamin D Supplementation and Serum Levels of Magne-sium and Selenium in Type 2 Diabetes Mellitus Patients: Gender Dimorphic Changes

International Journal for Vitamin and Nutrition Research ◽

10.1024/0300-9831/a000190 ◽

2014 ◽

Vol 84 (1-2) ◽

pp. 27-34 ◽

Cited By ~ 7

Author(s):

Nasser M. Al-Daghri ◽

Khalid M. Alkharfy ◽

Nasiruddin Khan ◽

Hanan A. Alfawaz ◽

Abdulrahman S. Al-Ajlan ◽

...

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Vitamin D ◽

Type 2 Diabetes Mellitus ◽

Serum Levels ◽

Vitamin D Supplementation ◽

Serum Selenium ◽

Dependent Manner

The aim of our study was to evaluate the effects of vitamin D supplementation on circulating levels of magnesium and selenium in patients with type 2 diabetes mellitus (T2DM). A total of 126 adult Saudi patients (55 men and 71 women, mean age 53.6 ± 10.7 years) with controlled T2DM were randomly recruited for the study. All subjects were given vitamin D3 tablets (2000 IU/day) for six months. Follow-up mean concentrations of serum 25-hydroxyvitamin D [25-(OH) vitamin D] significantly increased in both men (34.1 ± 12.4 to 57.8 ± 17.0 nmol/L) and women (35.7 ± 13.5 to 60.1 ± 18.5 nmol/L, p < 0.001), while levels of parathyroid hormone (PTH) decreased significantly in both men (1.6 ± 0.17 to 0.96 ± 0.10 pmol/L, p = 0.003) and women (1.6 ± 0.17 to 1.0 ± 0.14 pmol/L, p = 0.02). In addition, there was a significant increase in serum levels of selenium and magnesium in men and women (p-values < 0.001 and 0.04, respectively) after follow-up. In women, a significant correlation was observed between delta change (variables at six months-variable at baseline) of serum magnesium versus high-density lipoprotein (HDL)-cholesterol (r = 0.36, p = 0.006) and fasting glucose (r = - 0.33, p = 0.01). In men, there was a significant correlation between serum selenium and triglycerides (r = 0.32, p = 0.04). Vitamin D supplementation improves serum concentrations of magnesium and selenium in a gender-dependent manner, which in turn could affect several cardiometabolic parameters such as glucose and lipids.

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C-reactive protein as a marker of progression of carotid atherosclerosis in subjects with type 2 diabetes mellitus

VASA ◽

10.1024/0301-1526/a000614 ◽

2017 ◽

Vol 46 (3) ◽

pp. 187-192 ◽

Cited By ~ 7

Author(s):

Aleš Pleskovič ◽

Marija Šantl Letonja ◽

Andreja Cokan Vujkovac ◽

Jovana Nikolajević Starčević ◽

Katarina Gazdikova ◽

...

Keyword(s):

Diabetes Mellitus ◽

Carotid Atherosclerosis ◽

Inflammatory Marker ◽

Progression Rate ◽

C Reactive Protein ◽

Reactive Protein ◽

Hs Crp ◽

Unstable Plaques

Abstract. Background: This prospective study was designed to evaluate the effect of inflammatory markers on the presence and progression of subclinical markers of carotid atherosclerosis in a 3.8-year follow-up period in patients with type 2 diabetes mellitus (T2DM). Patients and methods: A total of 595 subjects with T2DM were enrolled. Subclinical markers of carotid atherosclerosis (carotid intima media thickness (CIMT), plaque thickness, and plaques presence) were assessed with ultrasound at the time of recruitment and again after 3.8 years. Subjects with T2DM were divided into 2 groups according to the plasma high sensitive C-reactive protein (hs-CRP) levels (subjects with hs-CRP ≥ 2 mg/L and subjects with hs-CRP below 2 mg/L). Results: Subjects with T2DM and hs-CRP levels ≥ 2 mg/L had higher CIMT in comparison with subjects with T2DM and hs-CRP levels below 2 mg/L, and higher incidence of plaques/unstable plaques in comparison with subjects with T2DM and hs-CRP levels below 2 mg/L. Multivariate logistic regression analysis found the association between the HDL cholesterol level and presence of plaques, whereas the inflammatory marker hs-CRP was not associated with subclinical markers of progression of carotid atherosclerosis. Multiple linear regression analysis found the association between the hs-CRP levels and either CIMT progression rate or a change in the number of sites with plaques in a 3.8-year follow-up. Conclusions: We demonstrated an association between the inflammatory marker hs-CRP and either CIMT or incidence of plaques/unstable plaques at the time of recruitment in Caucasians with T2DM. Moreover, we found the association between hs-CRP levels and either CIMT progression rate or a change in the number of sites with plaques in a 3.8-year follow-up in subjects with T2DM.

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