Submitted by Renata Lopes (renatasil82@gmail.com) on 2016-07-14T12:16:03Z No. of bitstreams: 1 josefernandopereiramesquita.pdf: 385112 bytes, checksum: a5fa839a6e884999adc84c3ba76f4c42 (MD5) / Approved for entry into archive by Diamantino Mayra (mayra.diamantino@ufjf.edu.br) on 2016-07-19T14:53:42Z (GMT) No. of bitstreams: 1 josefernandopereiramesquita.pdf: 385112 bytes, checksum: a5fa839a6e884999adc84c3ba76f4c42 (MD5) / Made available in DSpace on 2016-07-19T14:53:42Z (GMT). No. of bitstreams: 1 josefernandopereiramesquita.pdf: 385112 bytes, checksum: a5fa839a6e884999adc84c3ba76f4c42 (MD5) Previous issue date: 2011-08-26 / Introdução: A doença renal crônica é uma síndrome clínica frequentemente associada à diversas comorbidades, sendo a doença cardiovascular sua principal causa de mortalidade e a aterosclerose uma condição presente na maioria dos pacientes. A disfunção sexual é complicação com alta prevalência nestes pacientes, tendo na disfunção erétil sua principal causa de queda de qualidade de vida, via comum dos processos ateroscleróticos. Objetivo: Avaliar a prevalência de disfunção erétil em pacientes portadores de doença renal crônica em tratamento conservador e correlacionar sua presença com fatores de risco cardiovascular e metabólico e avaliar se a doença renal crônica é fator de risco independente para disfunção erétil. Pacientes e Métodos: Avaliou-se 81 pacientes com idade média de 61,7+ 11,6 anos (extremos de 21 e 84 anos), acompanhados regularmente em ambulatório de nefrologia com caracterização da presença de comorbidades, hábitos e medicação em uso e aplicação do questionário específico (International Index of Erectile Function) para o diagnóstico clínico da presença de disfunção erétil. Realizou-se análise bivariada pelo teste do Qui-quadrado e regressão logística para análise do peso relativo das variáveis com significância estatística, sobre a variável desfecho. O nível de significância adotado foi menor ou igual a 0,05. Resultados: A prevalência de disfunção erétil foi de 76,5%. Pela análise multivariada, a presença de diabetes mellitus, seja como causa, seja como comorbidade foi considerada fator de risco para disfunção erétil (razão de chance - RC - 4,05 e intervalo de confiança de 95% - IC 95% - de 1,017 a 25,085), assim como menor tempo de conhecimento da condição de portador de doença renal crônica (tempo de doença menor que 60 meses com RC de 3,5 – IC 95% de 1,40 a 14,489). Conclusão: Concliu-se que a presença de disfunção erétil não apresentou relação estatística com a presença de comorbidades de risco cardiovascular, exceto para diabetes mellitus. Além disso, observou-se que o menor tempo de conhecimento da condição de portador de doença renal crônica foi condição de risco para a prevalência de disfunção erétil, talvez por condições clínico-metabólicas e inflamatórias comuns nesses pacientes. Entretanto, no presente estudo, não foi possível considerar a doença renal crônica como fator de risco independente para disfunção erétil. / Introduction: The chronic kidney disease (CKD) consists of a clinical syndrome consequential to a wide variety of illness wich, in direct or indirect ways, provokes imbalance of basics kidney’s functions. Frequently associated to many comorbidities , the CKD has as its major cause of mortality the cardiovascular illness. Furthermore, the aterosclerosis is normaly present in the majority of patients with functional kidney failure. Sexual dysfunction is a higly prevalent complication among these patients, and takes the erectile dysfunction (ED) as its main cause of falling quality of life, sharing the same course with the aterosclerotic process. Objective: The main goal of this study was to evaluate the prevalence of erectile dysfunction among patients with chronic kidney disease (phases III, IV and V) in conservative treatment , correlate it to cardiovascular and metabolic risk factors and analyze the CKD as a possible independent risk factor to ED or whether it correlates with the kind of comorbidity established. Methods: Eighty one patients, ranging from 21 to 84 years (mean 61.7 +/- 11.6 years), were randomly analyzed and followed-up through the ambulatory service of PrevenRim from IMEPEN Foundation with application of the questionnaire “Sexual Health Inventory for Men – SHIM (IIEF/5)” for clinical diagnosis of erectile dysfunction, after all patients gave informed consent. Statistical analysis were exploratory and descriptive; bivariate were done using the Chi-Square test and logistic regression was used to characterize the relative weight of different variables. Level of significance adopted was lesser or equal to 0,05 (p < 0,05). Results: Our data points towards a prevalence of 76.5% of erectile dysfunction among this group of patients, increasing with the age of these individuals and the phase of the disease, without reaching, however, a value for statistical significance. The presence of Diabetes mellitus (DM), whether being the cause or an associated comorbidity, was considered to be a risk factor for ED, with a substantial statistical meaning. Moreover, the time of knowing condition to be a carrier of CKD was, in this research, considered to be a risk factor for ED, when the patient has a short period of this knowledge, with statistical significance. Conclusions: The present study was able to demonstrate that the ED didn’t show any statistical relation with the major part of the comorbidities stablished, wich were considered to be of great importance in cardiovascular risk, except for DM. Also, we observed that the time of knowing condition to be a carrier of CKD, maybe for clinical-metabolic and inflamatory reasons in common among these patients, interfered in the prevalence of the ED in this group. However, considering the achievements of this research, none can be said about CKD being an independent risk factor for ED.

Orientador: Gilberto De Nucci / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-22T19:42:28Z (GMT). No. of bitstreams: 1 SantosFilho_HiltonOliveirados_D.pdf: 1622141 bytes, checksum: 5f817cf4a04ee643bdf7e261e5861691 (MD5) Previous issue date: 2013 / Resumo: Carbonato de Lodenafila é um novo tipo de inibidor de fosfodiesterase 5 (PDE5) utilizado no tratamento da disfunção erétil. O presente estudo foi realizado para avaliar a segurança, tolerabilidade e farmacocinética do carbonato de lodenafila após a administração de doses orais únicas ascendentes (de 1 a 100 mg) a voluntários saudáveis do sexo masculino (n = 33). O estudo foi um estudo clínico fase I, aberto, de escalonamento de dose, utilizando a administração de doses orais únicas de carbonato de lodenafila. Carbonato de Lodenafila foi administrado sequencialmente escalonado em doses únicas de 1 mg a 100 mg com um período sem uso do medicamento (washout) de pelo menos 1 semana, entre cada dose. A progressão para a próxima dose foi permitida se após a avaliação dos exames clínicos, laboratoriais e Monitorização Ambulatorial da Pressão Arterial (MAPA), não demonstrassem alterações e eventos adversos sem relevância clínica. As amostras de sangue foram coletadas na pré-dose e em intervalos determinados e 24 horas após a administração. As amostras de plasma para a mensuração de carbonato lodenafila e lodenafila foram analisadas por cromatografia líquida acoplada à espectrometria de massa. Não foram observados eventos adversos graves, e nenhum dos voluntários abandonou o estudo devido à intolerância. As medições do MAPA, exames clínicos e laboratoriais e ECG não revelaram alterações significativas mesmo em doses mais elevadas. Carbonato Lodenafila não foi detectado em qualquer amostra, indicando que ele atua como um pró-droga. Os parâmetros farmacocinéticos médios de lodenafila para tmax e t1 / 2 foram 1,6 (± 0,4) horas e 3,3 (± 1,1) horas, respectivamente. Este estudo demonstrou que o carbonato de lodenafila é bem tolerado e apresentou um bom perfil de segurança em voluntários saudáveis do sexo masculino / Abstract: Lodenafil carbonate is a new phosphodiesterase type 5 (PDE5) inhibitor used in treatment of erectile dysfunction. The present study was conducted to evaluate the safety, tolerability, and pharmacokinetics of lodenafil carbonate after administering ascending (1 to 100 mg) single oral doses to healthy male volunteers (n=33). The study was an open-label, dose-escalation, phase I clinical trial involving the administration of single oral doses of lodenafil carbonate. Lodenafil carbonate was administered sequentially, escalating in single doses of 1 mg to 100 mg with a washout period of at least 1 week between each dose. The progression to the next dose was allowed after clinical and laboratory exams, Ambulatory Monitoring of Arterial Pressure (AMAP) without relevant clinical modifications and adverse events without clinical relevancy. Blood samples were collected at pre-dose, determined intervals and 24h postdosing. Plasma samples for measurement of lodenafil carbonate and lodenafil were analyzed by liquid chromatography coupled to tandem mass spectrometry. No serious adverse events were observed, and none of the subjects discontinued the study due to intolerance. The AMAP measurements, clinical and laboratory exams and ECG revealed no significant changes even at higher doses. Lodenafil carbonate was not detected in any samples, indicating that it acts as a pro-drug. The mean lodenafil pharmacokinetic parameters for tmax and t1/2 were 1.6 (±0.4) hr and 3.3 (±1.1) hr, respectively. This study demonstrated that lodenafil carbonate was well tolerated and showed a good safety profile in healthy male volunteers / Doutorado / Clinica Medica / Doutor em Clínica Médica

Orientador: Adriano Fregonesi / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-21T11:47:22Z (GMT). No. of bitstreams: 1 Reis_AnaLuizadosSantos_M.pdf: 1727145 bytes, checksum: d91bdd4c86eb8ff295f83d18058091f5 (MD5) Previous issue date: 2012 / Resumo: Introdução: A disfunção erétil (DE) afeta cerca da metade da população masculina adulta com idade superior a 40 anos no Brasil e no mundo. Relacionam-se ao envelhecimento e a doenças como diabetes, problemas cardiovasculares e prostáticos. Para quantificar e avaliar a resposta a tratamento para DE existem questionários específicos, a maioria desenvolvido e validado na língua inglesa. Entre esses instrumentos destacam-se o Índice Internacional de Função Erétil (IIEF) e o Quality of Erection Questionnaire (QEQ). Além dos instrumentos específicos para avaliar a sexualidade masculina, é importante considerar o impacto da DE e seus tratamentos na qualidade de vida geral desses indivíduos. Questionário de Qualidade de Vida Rand 36 (RAND) é um instrumento sensível e reprodutível na detecção de alterações da QV. Além da tradução, são necessárias adaptação cultural e validação de instrumentos desenvolvidos em inglês, para adequá-los à cultura brasileira e garantir propriedades psicométricas similares a versão no idioma original. Objetivos: Traduzir, adaptar culturalmente e validar instrumento QEQ para homens brasileiros e comparar seus escores com os do IIEF e os do RAND 36-Item Health Survey. Pacientes e Métodos: A versão em inglês do QEQ foi submetida a tradução, retro-tradução e adaptação cultural, assim obtivemos a versão em português do QEQ. O QEQ, IIEF e RAND foram respondidos por 192 homens com diferentes gravidades de DE, incluindo homens sem DE. A confiabilidade do QEQ em português foi estabelecida através de teste e re-teste (coeficiente de correlação intraclasses), análise de consistência interna (alfa de Cronbach) e habilidade de diferenciação entre homens sem queixa de DE daqueles com diferentes graus de acometimento de DE estabelecido pela pontuação do IIEF - domínio função erétil. A relação DE e QV foi avaliada através da comparação dos escores do QEQ e RAND e IIEF e RAND. Resultados: A versão em Português do QEQ apresentou excelentes propriedades psicométricas, com consistência interna de 0,93 e r=0,82. Observou-se alta correlação entre os escores do QEQ e IIEF, tanto escores totais como domínios. As moderadas correlações entre o QEQ e o RAND 36-Item Health Survey demonstraram validade discriminante. Conclusão: A versão em português do QEQ pode ser utilizada na avaliação de homens brasileiros e apresenta capacidade de distinção entre a classificação da gravidade de DE proposta pelo IIEF. Entre QEQ e RAND foi demonstrada validade discriminante. Entre as diferentes gravidades de DE mensurados pelo IIEF nossos dados não demonstraram alteração na qualidade de vida mensurada pelo RAND. Acreditamos que isso se deva a atuação de mecanismos psíquicos que minimizam o impacto da DE na qualidade de vida / Abstract: Introduction: Erectile Dysfunction (ED) affects about a half of Brazilian adult above 40 years and worldwide male population. Relates to the aging and diseases like diabetes, cardiovascular and prostate problems. To assess and quantify the treatment response for ED exists specific tools, most of them developed and validated for English speakers. Between these questionnaires highlights to International Index of Erectile Function (IIEF) and Quality of Erection Questionnaire (QEQ). Beside those specific male sexuality tools, its important to consider the ED impact and its treatment in general quality of life (QoL). The Rand 36-Itens Health Survey is a useful and reproducible tool to assess quality of life and its modifications. To use English developed questionnaires inside Brazilian culture are necessary translation, cross-cultural adaptation and validation of these to ensure their psychometric properties. Aim: Proceed QEQ translation, cross-cultural adaptation and validation to use in Brazilian men and compare their scores with IIEF and RAND 36-Item Health Survey. Subjects and Methods: The QEQ English version was translated, re-translated and adapted to Brazilian culture, so we obtained the QEQ Portuguese version. QEQ, IIEF and Rand 36-Item Health Survey was applied in 192 men with different degrees of ED, including no ED men. Reliability of QEQ in Portuguese was established by test and re-test (Intraclass correlation coefficient), Internal consistency (Cronbach's alpha) and ability of the QEQ scores to differentiate between without ED men and ED severity groups in agreement with IIEF - erectile function domain. The relation between ED and QoL was assessed by comparison of QEQ e RAND scores and IIEF and RAND scores. Results: The Portuguese version of QEQ presents excellent psychometric properties, with internal consistency of 0,93 and r=0,82. We observed high correlations between QEQ and IIEF scores, in total and domains. Between QEQ and RAND 36-Item Health Survey the correlations are moderate, as a result of discriminant validity. Conclusion: The QEQ Portuguese version may be used to assess Brazilian men and is capable to differentiate severity class of ED proposed by IIEF. Between QEQ and RAND our data shows discriminant validity. Between different ED severity groups, measured by IIEF, our data did not show significant difference in QoL. We believe that this data are due to psychological mechanisms that minimize impacts of ED on other aspects of life / Mestrado / Fisiopatologia Cirúrgica / Mestra em Ciências

Orientador: Gilberto De Nucci / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-21T17:28:54Z (GMT). No. of bitstreams: 1 Carvalho_FernandaDelGrossiFerraz_D.pdf: 7417050 bytes, checksum: 077ba1139ebaf6a1ae4c5f1056628f58 (MD5) Previous issue date: 2012 / Resumo: A disfunção erétil (ED) é definida como a incapacidade de alcançar ou manter ereção peniana adequada para a relação sexual satisfatória. O diabetes mellitus (DM) é uma condição associada a inúmeros distúrbios sistêmicos que podem contribuir direta ou indiretamente para o desenvolvimento de ED, como aterosclerose de grandes vasos, doença arterial microvascular, neuropatia autonômica, dislipidemia, hipertensão arterial e disfunção endotelial. ...Observação: O resumo, na íntegra, poderá ser visualizado no texto completo da tese digital / Abstract: Erectile dysfunction (ED) is defined as the inability to achieve or maintain penile erection sufficient to permit satisfactory sexual intercourse. Diabetes mellitus (DM) is a condition associated with numerous systemic disorders that may contribute directly or indirectly to the development of ED, such as large vessel atherosclerosis, arterial microvascular disease, autonomic neuropathy, dyslipidemia, hypertension and endothelial dysfunction. ...Note: The complete abstract is available with the full electronic document / Doutorado / Farmacologia / Doutora em Farmacologia

Orientador: Gilberto de Nucci / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-07T12:13:37Z (GMT). No. of bitstreams: 1 Baracat_JulianaSignori_D.pdf: 5461737 bytes, checksum: 0ff83b88634432535b68af4042a52fff (MD5) Previous issue date: 2006 / Doutorado / Farmacologia / Doutor em Ciências Médicas

Orientadores: Fabíola Taufic Mónica Iglesias, Edson Antunes / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-29T00:02:26Z (GMT). No. of bitstreams: 1 Fernandes_CamilaStefaniEstancial_M.pdf: 2289746 bytes, checksum: e67d3948b14883b515cd7e008bc69850 (MD5) Previous issue date: 2015 / Resumo: Duas classes de medicamentos denominadas estimuladores e ativadores da GCs foram desenvolvidas para uso terapêutico em situações patológicas, onde há menor biodisponibilidade NO ou tolerância farmacológica. A principal diferença entre os moduladores da GCs é que os ativadores atuam de maneira mais eficaz mesmo quando a enzima encontra-se no estado oxidado. O presente trabalho foi dividido em duas etapas, a saber: 1) caracterização farmacológica do ativador BAY 60-2770 em corpo cavernoso (CC) de coelho e 2) avaliação do efeito do ativador BAY 60-2770 e estimulador BAY 41-2272 da GCs em CC isolado de ratos espontaneamente hipertensos (SHR) e normotensos (WKY). O BAY 60-2770 promoveu relaxamento concentração dependente em corpo cavernoso de coelho (pEC50: 7,584 ± 0,1923), sendo este efeito potencializado na presença dos inibidores da GCs ODQ (10 µM; pEC50: 8,170 ± 0,1365) e da fosfodiesterase tipo 5 (PDE5), tadalafil (100 ?M; pEC50: 8,381 ± 0,1334). A contração induzida por estimulação elétrica foi reduzida em aproximadamente 50% na presença de BAY 60-2770, sendo este efeito potencializado na presença de ODQ. Em relação ao relaxamento induzido pela estimulação elétrica, o ODQ e BAY 60-2770 aboliu e aumentou, respectivamente o relaxamento. A co-incubação de BAY 60-2770 com ODQ não alterou o relaxamento em comparação com o ODQ sozinho. Curiosamente, quando BAY 60-2770 foi incubado 20 min antes da adição de ODQ, os relaxamentos induzidos por estimulação elétrica foram parcialmente restaurados quando comparado com o ODQ sozinho. Em relação à segunda etapa do trabalho, o relaxamento induzido pelos moduladores da GCs, BAY 60-2770 e BAY 41-2272 não diferiram em CC de ratos SHR comparados ao seu respectivo controle, porém, estes dados não corroboram com a quantificação de GMPc, no qual evidenciamos aumento dos seus níveis em CC de ratos SHR sendo estes níveis ainda maiores quando na presença de ODQ em comparação ao CC de WKY. Observamos também que o relaxamento induzido pela acetilcolina (ACh) encontrou-se reduzido em CC dos animais hipertensos, entretanto, a adição de BAY 60-2770 ou BAY 41-2272 restaurou este relaxamento. Não foi encontrada diferença na expressão das subunidades ?1 e ?1 da GCs em ratos SHR e WKY, porém quando analisamos a expressão da PDE-5, verificamos maior expressão em CC de ratos SHR. O BAY 60-2770 foi capaz de elevar a pressão intracavernosa em CC de ratos normotensos em todas as frequências estudadas, porém esta elevação somente foi significativa na frequência de 16 Hz. Considerando que 1) BAY 60-2770 induziu relaxamento em CC de coelho e de rato hipertenso de maneira mais potente que o estimulador BAY 41-2272, 2) a adição de ODQ potencializou o relaxamento do BAY 60-2770, mas não do BAY 41-2272 em CC de ambas espécies, 3) o aumento dos níveis de GMPc foi maior em CC de ratos SHR após estímulo com BAY 60-2770, mas não com BAY 41-2272 pode-se concluir que em situações patológicas onde há oxidação da GCs e/ou menor biodisponilidade de NO, os ativadores da GCs seriam mais vantajosos que os estimuladores ou inibidores da PDE5 para o tratamento da disfunção erétil / Abstract: Two classes of drugs referred to as stimulators and sGC activators have been developed for therapeutic use in pathological situations where there is less NO bioavailability and pharmacological tolerance. The main difference between the sGC activators modulators is that they act more effectively even when the enzyme is in the oxidized state. This study was divided into two stages: 1) pharmacological characterization of BAY 60-2770 activator in corpus cavernosum (CC) of rabbit and 2) evaluation of the effect of BAY 60-2770 BAY 41-2272 activator and stimulator of GCs isolated from spontaneously hypertensive rats (SHR) and normotensive (WKY). The BAY 60-2770 induced concentration-dependent relaxation in rabbit corpus cavernosum (pEC 50: 7.584 ± 0.1923), and this increased effect in the presence of GCs ODQ inhibitors (10 ?M; pEC 50: 8.170 ± 0.1365) and the phosphodiesterase type 5 (PDE5), tadalafil (100 ?m; pEC50: 8.381 ± 0.1334). The contraction induced by electric stimulation was reduced by approximately 50% in the presence of BAY 60-2770, and this increased effect in the presence of ODQ. In relation to the relaxation induced by electrical stimulation, ODQ and BAY 60-2770 abolished and increased, respectively the relaxation. Co-incubation with BAY 60-2770 with ODQ did not change compared to the relaxation with only ODQ. Curiously, when BAY 60-2770 was incubated 20 minutes before addition of ODQ, the relaxation induced by electric stimulation was partially restored when compared with only ODQ. In the second part, relaxation induced by modulators of GCs, BAY 60-2770 and BAY 41-2272 did not differ in SHR CC compared to their respective control, however, these data do not corroborate the quantification of cGMP, in which we observed an increase in their levels in SHR rats and these levels even higher in the presence of ODQ in comparing the CC of WKY. We also observed a reduction of the relaxation induced by acetylcholine (ACh) in CC of hypertensive animals, however, the addition of BAY 60-2770 or BAY 41-2272 restored this relaxation. There was no difference in the expression of ?1 and ?1 subunits of sGC in SHR and WKY rats, but when we analyzed the expression of PDE-5, we found greater expression in SHR. The BAY 60-2770 was able to raise up the intracavernous pressure in the normotensive rats in all studied frequencies, but this increase was only significant in the frequency of 16 Hz. Considering 1) BAY 60-2770 induced relaxation in rabbit and hypertensive rat so that the most potent stimulator BAY 41-2272, 2) addition of ODQ potentiated relaxation of BAY 60-2770, but not in BAY 41-2272 in CC of both, 3) increased levels cGMP was greater in SHR rats after stimulation with BAY 60-2770, but not in BAY 41-2272 so can be concluded that in pathologic situations where there is oxidation of GCs and / or low bioavailability of NO, would activators of sGC more advantageous than PDE5 inhibitors or stimulators for the treatment of erectile dysfunction / Mestrado / Farmacologia / Mestra em Farmacologia

京都大学 / 新制・課程博士 / 博士(医学) / 甲第23075号 / 医博第4702号 / 新制||医||1049(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 川上 浩司, 教授 近藤 尚己, 教授 小川 修 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

Introduction: According to the literature, low serum testosterone levels are associated with diabetes mellitus. Minimal data exist for its prevalence or predictors in South Africa. Erectile dysfunction is a common condition in diabetic patients. The prevalence and predictors in our patient population is unknown. Methods: An observational, cross-sectional study was performed in 150 consecutive male diabetic patients over the age of 50 years in the Diabetic clinic of Steve Biko Academic Hospital. These patients were evaluated for diabetes control and complications, the presence of erectile dysfunction and for hypogonadism symptoms. Morning serum testosterone levels were done. Subjects with low testosterone levels were compared to those with normal levels. Results: The mean age of the patients was 62 years (standard deviation (SD) 7.87), 91.3% had type 2 diabetes, and 84.7% were on insulin. The mean duration of diabetes was 15 years (SD 8.65). The mean body mass index was 30.7 (SD 5.37), the mean waist circumference was 112.4cm (SD 16.42), the median creatinine was 96μmol/L (interquartile range (IQR) 79-133) and the median HbA1C was 7.85% (IQR 6.80-9.30). Ischaemic heart disease was previously diagnosed in 40.7% of patients. Some degree of erectile dysfunction was reported in 95.3% of the patients with 51.3% reporting serious dysfunction. The prevalence of androgen deficiency symptoms was 94.7%. Fifty percent of the men had low total testosterone levels; 40.7% had low modified calculated bioavailable testosterone levels, and in 27.3% both were low. With multivariate logistic regression the significant factors associated with low total testosterone were waist circumference and known cardiovascular disease. For a low modified calculated bioavailable testosterone level significant variables were age, diabetes duration and body mass index and for an outcome defined as both the above the significant factors were diabetes duration, body mass index, and known cardiovascular disease. With multivariate logistic regression the significant factors associated with erectile dysfunction were age, body mass index, peripheral neuropathy score, and diuretic therapy. The prevalence of symptoms of androgen deficiency was very high with 94.7% of all patients reporting a significant amount of symptoms on the Androgen Deficiency in Adult Males (ADAM) questionnaire. If only the total serum testosterone level was evaluated instead of the modified calculated bioavailable testosterone, the sensitivity was 69%, the specificity was 63%, with a poor positive predictive value of only 56%. The negative predictive value was better at 75%. Differences in quality of life scores were only seen for some erectile dysfunction subgroups but not for low testosterone levels. Conclusion: This study confirms the high prevalence of low testosterone levels and of erectile dysfunction in diabetic male patients in a tertiary setting, and argues in favour of universal screening of this population group. Multiple predictors of low testosterone levels and of erectile dysfunction were identified. The ADAM questionnaire was not useful in identifying subjects with a low testosterone level. Total testosterone testing alone performed poorly in comparison with modified calculated bioavailable testosterone and is not the recommended test of choice. Erectile dysfunction negatively affected the quality of life. / Dissertation (MSc)--University of Pretoria, 2014. / gm2015 / Clinical Epidemiology / MSc / Unrestricted

Bakgrund: Prostata är en körtel som befinner sig under mäns urinblåsa och omger urinröret. Prostatacancer är den vanligaste cancerform i Sverige bland män. En vanlig behandling är radikal prostatektomi vilket innebär avlägsnade av prostatakörtel. En av biverkningar vid denna behandling är erektil dysfunktion som påverkar över hälften av män efter ingreppet. Mäns sexualitet är intimt kopplad till det sociala sammanhanget och kan påverkas av både fysiologiska och psykosociala faktorer. Syfte: Att beskriva mäns upplevelse av sexualitet efter radikal prostatektomi. Metod: Det valdes meta-etnografi som analysmetod för att besvara metasyntesens syfte. För datainsamling användes PubMed, CINAHL och PsykINFO.Kvaliteten av artiklarna bedömdes enligt Joanna Briggs granskningsmall. Metasyntesens resultat grundas på 15 vetenskapliga artiklar. Resultat: Resultatet utgörs av tre huvudkategorier som framkom under analysen av artiklarna: Första huvudkategori är Upplevelsen av det sexuella livet, vilken inkluderar underkategorin Brist på stöd och underkategorin Begränsningar för sexuell aktivitet. Den andra huvudkategorin är Påverkan på psykosocialt välbefinnande och upplevda känslor som följs av underkategorin Livsövergångar och förändringar, påverkan på livskvalitet och underkategorin Omdefiniering av sexualitet. Den tredje huvudkategori är Förändrad identitet som följs av underkategorin Förlorad av självförtroende, maskulinitet och manlighet. Slutsats: Män upplevde negativa förändringar i sina sexuella skript, påverkade av traditionella maskulinitetsnormer. Av den anledningen är det av stor betydelse att denna patientgrupp får adekvat stöd efter operationen och sexuell rådgivning i syfte att främja sexuell hälsa, sexualitet och att minimera negativa biverkningar på livskvalitet och mäns uppfattning av maskulinitet samt manlighet. Klinisk tillämpbarhet: Denna studie kan bidra till en ökad insikt, kunskap och förståelse om män som har genomgått radikal prostatektomi. Vilket vidare kan hjälpa barnmorskor att hantera bemötandet av dessa patienter. Förbättrad insikt och förståelse för problematiken kan främja högkvalitativ personcentrerad vård, minska sjukhusvistelse och öka patienternas tillit för hälso- och sjukvården. / Background: The prostate is a gland located under the male bladder and surrounding the urethra. Prostate cancer is the most common form of cancer in Sweden among men. A common treatment is radical prostatectomy, which means removal of the prostate gland. One of the side effects of this treatment is erectile dysfunction, which affects over half of men after the procedure. Men's sexuality is intimately linked to the social context and can be influenced by both physiological and psychosocial factors Aim: To describe men's experience of sexuality after radical prostatectomy. Method: Meta-ethnography was chosen as the analysis method to answer the purpose of the meta-synthesis. PubMed, CINAHL and PsykINFO were used for data collection. The quality of the articles was assessed according to the Joanna Briggs review template. The results of the meta-synthesis are based on 15 scientific articles. Results: The result consists of three main categories that emerged during the analysis of the articles: The first main category is the experience of sexual life, which includes the subcategory Lack of support and the subcategory Restrictions on sexual activity. The second main category is Impact on psychosocial well-being and perceived emotions followed by the sub-category Life transitions and changes, impact on quality of life and the sub-category Redefining sexuality. The third main category is Changed Identity which is followed by the sub-category Loss of Confidence, Masculinity and Masculinity. Conclusion: Men experienced negative changes in their sexual scripts, influenced by traditional masculinity norms. For that reason, it is of great importance that this patient group receives adequate support after the operation and sexual counseling in order to promote sexual health, sexuality and to minimize negative side effects on quality of life and men's perception of masculinity and masculinity. Clinical applicability: This study may contribute to an increased insight, knowledge and understanding of men who have undergone radical prostatectomy. Which can further help midwives manage the treatment of these patients. Improved insight and understanding of the problem can promote high-quality person-centred care, reduce hospital stays and increase patients' trust in health care.

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