published_or_final_version / Psychiatry / Master / Master of Research in Medicine

published_or_final_version / Nursing Studies / Master / Master of Nursing in Advanced Practice

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Thesis (J.C.L.)--Catholic University of America, 1985. / Typescript. This is an electronic reproduction of TREN, #029-0001. Includes bibliographical references (leaves 127-134).

Thesis (J.C.L.)--Catholic University of America, 1985. / Typescript. Includes bibliographical references (leaves 127-134).

CoordenaÃÃo de AperfeiÃoamento de NÃvel Superior / Erectile dysfunction is a worldwide public health issue and, in spite of advances brougth by the utilization of type-5 phosphodiesterase inhibitors, there is still much interest in new treatment alternatives, especially when derived from natural products. Some investigators observed the pro-erectile effects of an alkaloidal-rich fraction from Aspidosperma ulei Markgr., named F3-5. In this study, it was evaluated the degree of relaxation induced by F3-5 on rabbit corpus cavernosum, as well as possible Pharmacological mechanisms involved, in vitro. Several experimental assays were performed, utilizing the methods of cascade tissue superfusion and isolated tissue bath. WÃth strips ot corpus cavernosum pre-contracted with phenilephrine (5ÂM), dose-response curves of relaxation for F3-5 papaverine and DMSO were produced. were There were also assays fo, evaluation of the effects of L-NAME, 7-NI, 000, propranolol, atropine, sildenafil and F3-5 on the relaxations mediated by sodium litroprusside, acetylcholine, isoproterenol, sildenafil and F3-S. With depolarized preparations of corpus cavernosum, in a calcium-free, potassium-rich (60 mM) medium, the effects of F3-S and DMSO on the contractions induced by the progressive increase in Ca2+ concentration (1 - 300 mM) were observed. F3-5 was capable of inducing complete relaxation of rabbit corpus cavernosum with magnitude similar to that of papaverine for all doses tested, except 3 mg, when Ãt presented a significantly higher relaxation. Superfusions of L-NAME, 7-NI and ODQ did not significantly inhibit the relaxatÃons provoked by F3-5, suggesting that it acts independently of the nitrergià pathway. Propranolol and atropine also did not significantly interfere with relaxations mediated by F3-5 indicating that B-adrenergic or rnuscarinic receptors also might not be involved. F3-5 did not significantly amplify the relaxations promoted by sodium nitroprusside or acetylcholine, as opposed to sildenafil, suggesting that it does not act through inhibition of type-5 ohosphodiesterase. Finally, in cavernous tissue pre-incubated with F3-5, the minimum dose of Ca2+ necessary for muscular contraction was thirty times superior to that utilizedon the tissue without previous treatment, or treated with OMSO. This inhibition of the contractions of corpus cavernosum mediated by Ca2+ suggests, therefore, that F3-S can act through blockade of voltage-dependent calcium channels. / A disfunÃÃo erÃtil à um problema mundial de saÃde pÃblica e, apesar dos avanÃos trazidos pela utilizaÃÃo dos inibidores da fosfodiesterase tipo-5, ainda hà muito interesse em novas alternativas de tratamento, especialmente quando derivadas de produtos naturais. Alguns pesquisadores observaram os efeitos prÃ-erÃteis de uma fraÃÃo rica em alcalÃides de Aspidosperma ulei Markgr., denominada F3-5. Neste estudo, foi avaliado o grau de relaxamento induzido por F3-5 no corpo cavernoso de coelho, bem como possÃveis mecanismos farmacolÃgicos envolvidos, in vitro. Foram realizados diversos ensaios experimentais, utilizando-se os mÃtodos de superfusÃo de tecido em cascata e de banho isolado de tecido. Com tiras de corpo cavernoso prÃ-contraÃdas com fenilefrina (5 μM), foram produzidas curvas de dose-resposta de relaxamento para F3-5, papaverina e DMSO. TambÃm foram realizados ensaios para avaliaÃÃo dos efeitos de L-NAME, 7-NI, ODQ, propranolol, atropina, sildenafil e F3-5 sobre os relaxamentos mediados por nitroprussiato de sÃdio, acetilcolina, isoproterenol, sildenafil e F3-5. Com preparaÃÃes de corpo cavernoso despolarizadas, em um meio livre de cÃlcio e rico em potÃssio (60 mM), os efeitos de F3-5 e DMSO sobre as contraÃÃes induzidas pelo aumento progressivo na concentraÃÃo de Ca2+ (1 â 300 mM) foram observados. F3-5 foi capaz de induzir o relaxamento completo do corpo cavernoso de coelho, com magnitude similar à da papaverina para todas as doses testadas, exceto 3 mg, quando apresentou relaxamento significantemente maior. As superfusÃes de L-NAME, 7-NI e ODQ nÃo inibiram significantemente os relaxamentos provocados por F3-5, sugerindo que este age independentemente da via nitrÃrgica. Propranolol e atropina tambÃm nÃo interferiram significantemente com os relaxamentos mediados por F3-5, indicando que receptores β-adrenÃrgicos ou muscarÃnicos tambÃm nÃo devem estar envolvidos. F3-5 nÃo amplificou significantemente os relaxamentos promovidos por nitroprussiato de sÃdio ou acetilcolina, ao contrÃrio de sildenafil, sugerindo que nÃo age por inibiÃÃo da fosfodiesterase tipo-5. Finalmente, em tecido cavernoso prÃ-incubado com F3-5, a dose mÃnima de Ca2+ necessÃria para contraÃÃo muscular foi trinta vezes superior Ãquela utilizada em tecido sem tratamento prÃvio ou tratado com DMSO. Esta inibiÃÃo das contraÃÃes de corpo cavernoso mediadas pelo Ca2+ sugere, portanto, que F3-5 pode atuar atravÃs do bloqueio de canais de cÃlcio voltagem-dependente.

Bad Poetry and Other Short Stories is a collection of social, political, and religious commentary. The last three stories are also commentary from a non-fiction perspective.

Introdução e objetivos: A ejaculação precoce é uma forma de disfunção sexual presente em 25,8% dos homens brasileiros. O objetivo do presente estudo é avaliar se a associação de tadalafila, um inibidor da fosfodiesterase-5 e fluoxetina, um inibidor da recaptação da serotonina em uma apresentação de liberação lenta, ambos tomados uma vez por semana, pode prolongar o tempo de latência da ejaculação em homens com ejaculação precoce. Pacientes e Métodos: Sessenta pacientes com ejaculação precoce e sem disfunção erétil foram avaliados. A idade média foi 45,5 anos de idade (desvio padrão +/- 9,6). O tempo médio de ejaculação antes do início do tratamento era 51,3 segundos (desvio padrão +/- 23 segundos) e não foi estatisticamente significativo entre os grupos (p=0,805). Foram distribuídos de forma aleatória e duplo-cega em 4 grupos, conforme a medicação recebida: (1) fluoxetina 90 mg e placebo, (2) tadalafila 20 mg e fluoxetina 90 mg, (3) tadalafila 20 mg e placebo, e (4) placebo com placebo. Antes de iniciar qualquer medicamento, os pacientes anotaram o tempo de latência para ejaculação com um mesmo cronômetro uma vez por semana, durante 3 semanas. À partir do início do uso dos medicamentos, os pacientes cronometraram o tempo em nove ocasiões, uma vez por semana. Foi usado fluoxetina 90 mg ou placebo semanalmente e tadalafila 20 mg ou placebo em um intervalo de até 36 horas da presumida relação sexual com parceira heterossexual regular. Os pacientes foram prospectivamente seguidos a cada 3 semanas durante 12 semanas. Resultados: A comparação dos grupos com análise de variância (ANOVA) unidirecional demonstrou diferença estatisticamente significativa no tempo de ejaculação após tratamento (p<0,001). O maior aumento em relação ao tempo basal foi observado no grupo que associou tadalafila 20 mg com fluoxetina 90 mg semanalmente (p<0,001). Reações adversas foram observadas, tendo sido toleradas e equivalentes entre os grupos usando princípio ativo. Conclusão: Tadalafila 20 mg utilizada em um período de 36 horas de atividade sexual associado com fluoxetina 90 mg de liberação lenta usada semanalmente, significativamente aumentou o tempo de latência de ejaculação em homens com ejaculação precoce, quando comparados com cada droga usada isoladamente, beneficiando esses pacientes sem a necessidade do uso diário de medicamentos. / Introduction and Objectives: Premature ejaculation is a sexual disorder present in 25.8% of brazilian men. The aim of the present study is to evaluate if the association of tadalafil, a phosphodiesterase-5 inhibitor and fluoxetine, a selective serotonin reuptake inhibitor in a slow release presentation, both taken once a week, can prolong the intravaginal ejaculatory latency time (IELT) in men with premature ejaculation. Methods: Sixty patients with premature ejaculation and no erectile dysfunction were enrolled in the protocol. Mean age was 45.5 years (range 24 - 64 years, standard deviation +/- 9.6). They were randomly assigned in a double-blind manner into 4 groups to use the medications: (1) fluoxetine 90 mg and placebo, (2) tadalafil 20 mg and fluoxetine 90 mg, (3) tadalafil 20 mg and placebo, and (4) two different placebo capsules. Before starting any medication, each individual timed the IELT with a given stopwatch in 3 different days, and likewise weekly during the treatment period. Mean IELT before starting treatment was 51.3 seconds (sd: +/- 23 seconds), and was not different between groups (p=0.805). They took fluoxetine 90 mg or placebo once a week, and tadalafil 20 mg or placebo in a 36-hour frame of intended sexual intercourse with a regular heterosexual partner. Patients were prospectively followed every 3 weeks during a 12-week interval. Results: Comparison between groups with oneway ANOVA demonstrated a statistically significant difference in post-treatment IELT (p<0.001). The greatest increase in time from baseline IELT was observed in patients in the tadalafil plus fluoxetine group (p<0.001). Side effects were observed and tolerated, being equivalent in groups using active drugs. Conclusion: Tadalafil 20 mg taken in a 36-hour window for sexual intercourse associated with fluoxetine 90 mg in a slow release form taken weekly, significantly increased the intravaginal ejaculatory latency time from baseline in men with premature ejaculation, when compared to either drug taken solely, benefiting patients without the need to be medicated on a daily basis.

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

Introduction: Erectile dysfunction, the persistent inability to achieve and maintain an erection sufficient to permit satisfactory sexual performance, is a common problem. Aim: To determine the prevalence of erectile dysfunction among men attending a primary health care clinic in Kwazulu-Natal and to determine the association between erectile dysfunction and age, smoking, economic status and co-morbid conditions. Method: An analytic, quantitative, cross-sectional study was conducted on a group of men attending the Primary Health Care clinic at Addington Hospital. The information was obtained using a structured questionnaire (IIEF15) which had already being validated. The questionnaire was self administered at the time of attending the clinic. Statistical analyses using Pearson Chi square, Mann Whitney and Kruskal-Wallis tests determined the statistical significance of the results. Results: A total of 1300 randomly selected men participated in the study of which 803 were eligible for analysis. The overall prevalence rate for erectile dysfunction was 64.9% (621) with 14.6% (117) having mild erectile dysfunction, 19.9% (160) moderate erectile dysfunction and 30.4% (244) severe erectile dysfunction. There was a strong association between erectile dysfunction and age, economic status and co-morbid conditions. (p<0.01) Discussion: The prevalence of erectile dysfunction in the urban primary health clinic was high. The results indicate that the condition is a common problem and that primary care physicians need to become aware of the condition. The awareness will result in improved assessment and offer of appropriate treatment that will only enhance the quality of life of patients. Furthermore, the strong association of erectile dysfunction with co-morbid conditions will serve as a predictor for undiagnosed medical conditions which would have otherwise not being detected. Conclusion: The prevalence of erectile dysfunction in a primary health centre was high and there is a statistically significant association with co-morbid conditions. Further epidemiological studies in the general population focussing on the incidence of erectile dysfunction are recommended. / Thesis (M.Med.)-University of KwaZulu-Natal, Durban, 2009.