Prevalence of erectile dysfunction (ED) severity based on the International Index of Erectile Function (IIEF) short version score (No ED >21; Mild ED 17–21, Mild-moderate ED 12–16, Moderate ED 8–11, severe ED <8) at baseline (phase 1) and follow-up assessment (phase 2) in the whole study population and after excluding subjects who reported no sexual activity.

<p>Prevalence of erectile dysfunction (ED) severity based on the International Index of Erectile Function (IIEF) short version score (No ED >21; Mild ED 17–21, Mild-moderate ED 12–16, Moderate ED 8–11, severe ED <8) at baseline (phase 1) and follow-up assessment (phase 2) in the whole study population and after excluding subjects who reported no sexual activity.</p

Sexual Dysfunction in Type 2 Diabetes at Diagnosis: Progression over Time and Drug and Non-Drug Correlated Factors

<div><p>Aims</p><p>To present the longitudinal data of the SUBITO-DE study, a prospective survey involving male patients with new or recently diagnosed type 2 diabetes mellitus (T2DM) (<24 months).</p><p>Materials and Methods</p><p>Sexual function was assessed in male patients with T2DM at baseline (phase 1) and after a mean follow-up of 18 months (phase 2). Standard metabolic parameters and sexual and depressive symptoms were evaluated.</p><p>Results</p><p>Six of the 499 enrolled patients died of different causes during phase 1. Of the 493 surviving men invited to participate in phase 2, 450 (mean age 59.0±9.0 years) (90.2%) accepted and 43 (8.2%) were lost to follow-up. As compared to baseline, the proportion of the men who reported improvement in erectile dysfunction (ED) at follow-up was nearly double that of the men who reported worsening of ED (22.6% vs. 12.8%). The increase in frequency of sexual activity the men reported at follow-up assessment indicates that many never treated before baseline were taking an ED drug during the study period (106 subjects). Phosphodiesterase type 5 inhibitors (PDE5i) were the ED drugs most commonly taken at both baseline and follow-up. An overall improvement over baseline values was observed in metabolic targets for T2DM and depressive symptoms. Conversely, no change in lifestyle behaviors was recorded during the study.</p><p>Conclusions</p><p>Sexual dysfunction is a major concern in men with T2DM. The SUBITO-DE study demonstrates that, when combined with adequate counseling and tailored PDE5i therapy, an integrated approach to achieving metabolic targets in men with T2DM can improve sexual function as well as depressive symptoms.</p></div

Descriptive characteristics of the study population.

<p>Descriptive characteristics of the study population.</p

The safety and efficacy of Avanafil, a new 2^nd generation PDE5i: comprehensive review and meta-analysis

<p><b><i>Introduction</i>:</b> The discontinuation rate with phosphodiesterase type 5 inhibitors (PDE5i) remains very high. Recently, a new PDE5ì, avanafil, has become available worldwide.</p> <p><b><i>Areas covered</i>:</b> All placebo-controlled randomized clinical trials (RCTs) on the effect of avanafil in patients with ED were reviewed and meta-analyzed. So far, 5 different RCTs on avanafil have been published, including 1379 and 605 patients in active and placebo groups, respectively. Avanafil was up to 3-fold superior to placebo in determining successful sexual intercourse. Although head-to-head comparative studies are still lacking, re-analyses of available data, showed that avanafil had comparable efficacy, but lower incidence of drug-related side effects, compared to first-generation PDE5is.</p> <p><b><i>Expert opinion</i>:</b> Avanafil specific and peculiar pharmacological profile, addresses several problems that have been documented with first-generation PDE5is. Avanafil should theoretically guarantee a low dropout incidence by ensuring a natural profile of action and a low incidence of side effects. Longer studies and head-to-heard trials are advisable to clarify these issues.</p

Hyponatremia Improvement Is Associated with a Reduced Risk of Mortality: Evidence from a Meta-Analysis

<div><p>Background</p><p>Hyponatremia is the most common electrolyte disorder and it is associated with increased morbidity and mortality. However, there is no clear demonstration that the improvement of serum sodium concentration ([Na⁺]) counteracts the increased risk of mortality associated with hyponatremia. Thus, we performed a meta-analysis that included the published studies that addressed the effect of hyponatremia improvement on mortality.</p><p>Methods and Findings</p><p>A Medline, Embase and Cochrane search was performed to retrieve all English-language studies of human subjects published up to June 30^th 2014, using the following words: “hyponatremia”, “hyponatraemia”, “mortality”, “morbidity” and “sodium”. Fifteen studies satisfied inclusion criteria encompassing a total of 13,816 patients. The identification of relevant abstracts, the selection of studies and the subsequent data extraction were performed independently by two of the authors, and conflicts resolved by a third investigator. Across all fifteen studies, any improvement of hyponatremia was associated with a reduced risk of overall mortality (OR=0.57[0.40-0.81]). The association was even stronger when only those studies (n=8) reporting a threshold for serum [Na⁺] improvement to >130 mmol/L were considered (OR=0.51[0.31-0.86]). The reduced mortality rate persisted at follow-up (OR=0.55[0.36-0.84] at 12 months). Meta-regression analyses showed that the reduced mortality associated with hyponatremia improvement was more evident in older subjects and in those with lower serum [Na⁺] at enrollment.</p><p>Conclusions</p><p>This meta-analysis documents for the first time that improvement in serum [Na⁺] in hyponatremic patients is associated with a reduction of overall mortality.</p></div

Odds ratio for overall mortality rate in patients from studies in which a threshold for serum [Na⁺] improvement >130 mmol/L was reported.

<p>Odds ratio for overall mortality rate in patients from studies in which a threshold for serum [Na⁺] improvement >130 mmol/L was reported.</p

Observational studies included in the meta-analysis.

<p>* = threshold for serum [Na⁺] improvement <u>></u>130 mmol/L.</p><p>HN: hyponatremia; HF: heart failure; SCLC: small cell lung cancer; APE: acute pulmonary embolism; MI; myocardial infarction.</p><p>Observational studies included in the meta-analysis.</p

Studies that met inclusion criteria but did not provide data for meta-analysis.

<p>Studies that met inclusion criteria but did not provide data for meta-analysis.</p

Trial flow diagram.

<p>Trial flow diagram.</p

The metabolic role of prolactin: systematic review, meta-analysis and preclinical considerations

Hyperprolactinemia has been proven to induce hypogonadism and metabolic derangements in both genders, while the consequences of prolactin (PRL) deficiency have been poorly investigated. To systematically review and analyze data from clinical studies focusing on the metabolic consequences of abnormally high prolactin levels (HPRL) and low prolactin levels (LPRL). In addition, data from preclinical studies about underlying pathophysiological mechanisms were summarized and discussed. PRL contributes to providing the correct amount of energy to support the mother and the fetus/offspring during pregnancy and lactation, but it also has a homeostatic role. Pathological PRL elevation beyond these physiological conditions, but also its reduction, impairs metabolism and body composition in both genders, increasing the risk of diabetes and cardiovascular events. Hence, hypoprolactinemia should be avoided as much as possible during treatment with dopamine agonists for prolactinomas. Patients with hypoprolactinemia, because of endogenous or iatrogenic conditions, deserve, as those with hyperprolactinemia, careful metabolic assessment.</p