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International Urology and Nephrology Oct 2017Erectile dysfunction (ED) is a major care problem worldwide. Tadalafil and sildenafil are the two most common phosphodiesterase 5 inhibitors used to treat ED. This... (Comparative Study)
Comparative Study Meta-Analysis Review
AIMS
Erectile dysfunction (ED) is a major care problem worldwide. Tadalafil and sildenafil are the two most common phosphodiesterase 5 inhibitors used to treat ED. This systematic review and meta-analysis were conducted to directly compare tadalafil with sildenafil for the treatment of ED.
METHODS
We designed a strategy for searching the PubMed, Embase, EBSCO, Web of Science and Cochrane library databases; the reference lists of the retrieved studies were also investigated. A literature review was performed to identify all published randomized or non-randomized controlled trials that compared tadalafil with sildenafil for the treatment of ED and to assess the quality of the studies. Two investigators independently and blindly screened the studies for inclusion. The meta-analysis was performed using RevMan 5.0.
RESULTS
A total of 16 trials that compared tadalafil with sildenafil for the treatment of ED were included in the meta-analysis. In the meta-analysis, tadalafil and sildenafil appeared to have similar efficacies and overall adverse event rates. However, compared with sildenafil, tadalafil significantly improved psychological outcomes. Furthermore, the patients and their partners preferred tadalafil over sildenafil, and no significant difference was found in the adherence and persistence rates between tadalafil and sildenafil. Additionally, the myalgia and back pain rates were higher and the flushing rate was lower with tadalafil than with sildenafil.
CONCLUSION
Tadalafil shares a similar efficacy and safety with sildenafil and significantly improves patients' sexual confidence. Furthermore, patients and their partners prefer tadalafil to sildenafil. Hence, tadalafil may be a better choice for ED treatment.
Topics: Back Pain; Controlled Clinical Trials as Topic; Erectile Dysfunction; Flushing; Humans; Male; Myalgia; Patient Preference; Phosphodiesterase 5 Inhibitors; Self Efficacy; Sildenafil Citrate; Tadalafil
PubMed: 28741090
DOI: 10.1007/s11255-017-1644-5 -
Journal of the American Academy of... Jun 2019Rosacea has been reported less frequently among individuals with skin of color than in those with white skin, but rosacea is not a rare disease in this population. In... (Comparative Study)
Comparative Study Review
Rosacea has been reported less frequently among individuals with skin of color than in those with white skin, but rosacea is not a rare disease in this population. In fact, rosacea might be underreported and underdiagnosed in populations with skin of color because of the difficulty of discerning erythema and telangiectasia in dark skin. The susceptibility of persons with highly pigmented skin to dermatologic conditions like rosacea, whose triggers include sun exposure, is probably underestimated. Many people with skin of color who have rosacea might experience delayed diagnosis, leading to inappropriate or inadequate treatment; greater morbidity; and uncontrolled, progressive disease with disfiguring manifestations, including phymatous rosacea. In this article, we review the epidemiology of rosacea in skin of color and highlight variations in the clinical presentation of rosacea across the diverse spectrum of patient populations affected. We present strategies to aid in the timely diagnosis and effective treatment of rosacea in patients with skin of color, with an aim of promoting increased awareness of rosacea in these patients and reducing disparities in the management of their disease.
Topics: Acne Vulgaris; Delayed Diagnosis; Dermatitis; Diagnosis, Differential; Erythema; Flushing; Global Health; Healthcare Disparities; Humans; Medical History Taking; Prevalence; Racial Groups; Rosacea; Skin Pigmentation; Symptom Assessment; Telangiectasis
PubMed: 30240779
DOI: 10.1016/j.jaad.2018.08.049 -
Journal of Ayub Medical College,... 2022Childhood masturbations (CM) is stimulation of genital by pre-adolescent children with accompanying symptoms including sweating, tachycardia, blushing, muscle...
Childhood masturbations (CM) is stimulation of genital by pre-adolescent children with accompanying symptoms including sweating, tachycardia, blushing, muscle contraction and increase rate of breathing. We are presenting case series of three patients, who presented with history of vague symptoms and ultimately diagnosed and managed as case of CM. A 2 years old girl presented with history of to and fro movements. A 3 years old girl presented with history of rubbing of inner thighs and 3 years old boy presented with history of holding and rubbing genitalia with forward bending and symptoms of increase breathing, flushing and sweating. Video recording was available with two patients, which helped in making final diagnosis. Parents were counselled and patients referred for behavioural therapy. Conclusion: In young child CM should be considered in differential diagnosis whenever history is not fully suggestive of seizures.
Topics: Male; Female; Humans; Child; Adolescent; Child, Preschool; Masturbation; Seizures; Diagnosis, Differential; Behavior Therapy
PubMed: 36566414
DOI: 10.55519/JAMC-04-9186 -
Reviews in Endocrine & Metabolic... Sep 2016Cutaneous flushing is a common presenting complaint in endocrine disorders. The pathophysiology of flushing involves changes in cutaneous blood flow triggered by... (Review)
Review
Cutaneous flushing is a common presenting complaint in endocrine disorders. The pathophysiology of flushing involves changes in cutaneous blood flow triggered by multiple intrinsic factors that are either related to physiology or disease. Flushing can be divided into episodic or persistent causes. Episodic flushing is mediated by the release of endogenous vasoactive mediators or medications, while persistent flushing results in a fixed facial erythema with telangiectasia and cyanosis due to slow-flowing deoxygenated blood in large cutaneous blood vessels. The differential diagnosis of cutaneous flushing in neuroendocrine disorders is limited, yet encompasses a broad spectrum of benign and malignant entities, including carcinoid syndrome, pheochromocytoma, Cushing syndrome, medullary thyroid cancer, and pancreatic neuroendocrine tumors. In this review, we provide a concise and up-to-date discussion on the differential diagnosis and approach of flushing in neuroendocrinology.
Topics: Endocrine System Diseases; Flushing; Humans; Neuroendocrine Tumors
PubMed: 27873108
DOI: 10.1007/s11154-016-9394-8 -
Ugeskrift For Laeger Feb 2014Mesenteric traction syndrome (MTS) manifests in 58-87% of patients undergoing upper abdominal surgery and is characterised by a triad of hypotension, tachycardia, and... (Review)
Review
Mesenteric traction syndrome (MTS) manifests in 58-87% of patients undergoing upper abdominal surgery and is characterised by a triad of hypotension, tachycardia, and flushing. Prostacyclin is released from the gut mucosa following intestinal eventration and cyclooxygenase antagonists prevent the development of MTS. Also the use of remifentanil appears to increase the incidence of MTS and hypotension is aggravated by epidural analgesia. Yet, prostacyclin may be important for maintaining microcirculation within the splanchnic area and preserve its mucosal barrier.
Topics: Abdomen; Cyclooxygenase Inhibitors; Epoprostenol; Flushing; Humans; Hypotension; Intraoperative Complications; Splanchnic Circulation; Syndrome; Tachycardia
PubMed: 25350303
DOI: No ID Found -
International Journal of Clinical... Sep 2009To summarise the metabolic responses to niacin that can lead to flushing and to critically evaluate flushing mitigation research. (Review)
Review
AIMS
To summarise the metabolic responses to niacin that can lead to flushing and to critically evaluate flushing mitigation research.
METHODS AND RESULTS
This comprehensive review of the mechanism of action of niacin-induced flushing critically evaluates research regarding flushing mitigating formulations and agents. Niacin induces flushing through dermal Langerhans cells where the activation of G protein-coupled receptor 109A (GPR109A) increases arachidonic acid and prostaglandins, such as prostaglandin D(2) (PGD(2)) and prostaglandin E(2) (PGE(2)), subsequently activating prostaglandin D(2) receptor (DP(1)), prostaglandin E(2) receptor (EP(2)) and prostaglandin E receptor 4 (EP(4)) in capillaries and causing cutaneous vasodilatation. Controlling niacin absorption rates, inhibiting prostaglandin production, or blocking DP(1), EP(2) and EP(4) receptors can inhibit flushing. Niacin extended-release (NER) formulations have reduced flushing incidence, duration and severity relative to crystalline immediate-release niacin with similar lipid efficacy. Non-steroidal anti-inflammatory drugs (NSAIDs), notably aspirin given 30 min before NER at bedtime, further reduce flushing. An antagonist to the DP(1) receptor (laropiprant) combined with an ER niacin formulation can reduce flushing; however, significant residual flushing occurs with clinically-relevant dosages.
CONCLUSIONS
Niacin is an attractive option for treating dyslipidemic patients, and tolerance to niacin-induced flushing develops rapidly. Healthcare professionals should particularly address flushing during niacin dose titration.
Topics: Arachidonic Acid; Delayed-Action Preparations; Dyslipidemias; Flushing; Humans; Hypolipidemic Agents; Niacin; Patient Education as Topic; Prostaglandin Antagonists; Prostaglandins; Receptors, Immunologic; Receptors, Prostaglandin; Vasoconstriction; Vasodilation
PubMed: 19691622
DOI: 10.1111/j.1742-1241.2009.02099.x -
AWWA Water Science 2021A one-day water sampling and flushing study was conducted for three schools in Maricopa County that experienced prolonged building inactivity due to the COVID-19...
UNLABELLED
A one-day water sampling and flushing study was conducted for three schools in Maricopa County that experienced prolonged building inactivity due to the COVID-19 pandemic: an elementary school, middle school, and high school. Grab samples were taken at hand washing sinks, water fountains, and hose bibbs before and after flushing. Samples were analyzed for free chlorine, UVA254, copper, lead, total trihalomethanes, pH, conductivity, temperature, and species. All three schools experienced an increase in free chlorine post-flush. Copper concentrations were higher for first draw samples than post-flush samples for all schools. Conductivity, temperature, and pH did not see a major change after flushing. UVA254 values decreased after flushing. Bromoform species saw a 20% increase after flushing at the elementary school. spp. did not decrease post-flush at the elementary school. Overall, flushing changed the water quality at the schools. However, equipment flushing may be necessary to fully remediate spp.
ARTICLE IMPACT STATEMENT
Prolonged closure of buildings causes water quality issues such as lack of disinfectant and . Flushing can restore water quality.
PubMed: 34901766
DOI: 10.1002/aws2.1239 -
Clinical Medicine & Research Jun 2018Flushing is the subjective sensation of warmth accompanied by visible cutaneous erythema occurring throughout the body with a predilection for the face, neck, pinnae,... (Review)
Review
Flushing is the subjective sensation of warmth accompanied by visible cutaneous erythema occurring throughout the body with a predilection for the face, neck, pinnae, and upper trunk where the skin is thinnest and cutaneous vessels are superficially located and in greatest numbers. Flushing can be present in either a wet or dry form depending upon whether neural-mediated mechanisms are involved. Activation of the sympathetic nervous system results in wet flushing, accompanied by diaphoresis, due to concomitant stimulation of eccrine sweat glands. Wet flushing is caused by certain medications, panic disorder and paroxysmal extreme pain disorder (PEPD). Vasodilator mediated flushing due to the formation and release of a variety of biogenic amines, neuropeptides and phospholipid mediators such as histamine, serotonin and prostaglandins, respectively, typically presents as dry flushing where sweating is characteristically absent. Flushing occurring with neuroendocrine tumors accompanied by gastrointestinal symptoms is generally of the dry flushing variant, which may be an important clinical clue to the differential diagnosis. A number of primary diseases of the gastrointestinal tract cause flushing, and conversely extra-intestinal conditions are associated with flushing and gastrointestinal symptoms. Gastrointestinal findings vary and include one or more of the following non-specific symptoms such as abdominal pain, nausea, vomiting, diarrhea or constipation. The purpose of this review is to provide a focused comprehensive discussion on the presentation, pathophysiology, diagnostic evaluation and management of those diseases that arise from the gastrointestinal tract or other site that may cause gastrointestinal symptoms secondarily accompanied by flushing. This review is divided into two parts given the scope of conditions that cause flushing and affect the gastrointestinal tract: Part 1 covers neuroendocrine tumors (carcinoid, pheochromocytomas, vasoactive intestinal polypeptide, medullary carcinoma of the thyroid), polyneuropathy, organomegaly, endocrinopathy, monoclonal protein, skin changes (POEMS), and conditions involving mast cells and basophils; while Part 2 covers dumping syndrome, mesenteric traction syndrome, rosacea, hyperthyroidism and thyroid storm, anaphylaxis, panic disorders, paroxysmal extreme pain disorder, and food, alcohol and medications.
Topics: Abdominal Pain; Adrenal Gland Neoplasms; Basophils; Carcinoid Tumor; Carcinoma, Neuroendocrine; Constipation; Diarrhea; Flushing; Gastrointestinal Diseases; Humans; Leukocyte Disorders; Mastocytosis; Nausea; Neuroendocrine Tumors; POEMS Syndrome; Pancreatic Neoplasms; Pheochromocytoma; Thyroid Neoplasms; Vipoma; Vomiting
PubMed: 29650525
DOI: 10.3121/cmr.2017.1379a -
Effect of intermittent bladder flushing on recurrence rate in feline urethral obstruction: 72 cases.The Canadian Veterinary Journal = La... Dec 2022To evaluate the effect of intermittent bladder flushing on recurrent urethral obstruction (rUO) at 7 d and 30 d after discharge and the risk of bacteriuria as a result...
OBJECTIVE
To evaluate the effect of intermittent bladder flushing on recurrent urethral obstruction (rUO) at 7 d and 30 d after discharge and the risk of bacteriuria as a result of indwelling urethral catheterization.
ANIMALS
There were 72 cats with suspected obstructive feline idiopathic cystitis admitted to the hospital.
PROCEDURES
Cats were randomly assigned to either intermittent bladder flushing ( = 34) or no-flush (control) groups ( = 38). Bladder flushing was performed with 5 mL/kg of sterile 0.9% saline, q8h during indwelling urinary catheterization. Urine was tested for bacteriuria by a point-of-care test at the time of urinary catheterization and cystocentesis following catheter removal before discharge. Risk of rUO by groups and its association with other variables were evaluated.
RESULTS
The age (median: 3.0 years) in the flush group was younger ( = 0.01), and the length of hospitalization (> 24 hours) was longer ( < 0.01) than that of the control group. Overall rUO was 6.6% on Day 7 and 21.8% on Day 30 after discharge, but there was no significant difference between groups. A shorter duration of catheterization (< 24 hours) was associated with higher risk of rUO (odds ratio: 6.0). The incidence of catheter-related bacteriuria was 14.5% and was not significantly different between groups (13.8% and 15.2% in the flush and control, respectively).
CONCLUSION AND CLINICAL RELEVANCE
Intermittent bladder flushing during hospitalization appears safe but did not decrease the incidence of rUO. The incidence of bacteriuria following catheterization was not affected by intermittent bladder flushing.
Topics: Cats; Animals; Urinary Bladder; Bacteriuria; Urethral Obstruction; Urinary Catheterization; Urethra; Cat Diseases
PubMed: 36467381
DOI: No ID Found -
Medicina (Kaunas, Lithuania) Jul 2022Harlequin syndrome (HS) is a rare autonomic disorder. The causes and risk factors of the disease are not fully understood. Some cases of HS are associated with traumatic... (Review)
Review
Harlequin syndrome (HS) is a rare autonomic disorder. The causes and risk factors of the disease are not fully understood. Some cases of HS are associated with traumatic injuries, tumors, or vascular impairments of the head. Symptoms of HS can also occur in some autoimmune disorders, ophthalmic disorders, sleep disorders, and with certain organic lesions. In this context, a thorough review of the pathophysiology of HS in relation to neurological, ophthalmological, and dermatological conditions is necessary. In this mini-review, we aim to review the pathophysiological changes and underlying mechanisms in primary and secondary HS. Additionally, we discuss possible management approaches for patients with HS in light of the discussed pathological mechanisms. The main symptoms of HS that are correlated with autonomic nervous system impairments include sudden unilateral flushing of the face, neck, chest, and rarely arm, with concurrent contralateral anhidrosis. Despite reported co-occurring syndromes (such as cluster headaches), several studies have shown that HS could frequently overlap with other syndromes that are disruptive to the idiopathic nerve pathways. HS usually does not require any medical treatment. In some severe cases, symptomatic treatments could be needed. However, total symptomatic relief may not be achieved in many cases of HS. We therefore suggest an approach to comprehensive management of HS, which may lead to better long-term control of HS.
Topics: Autonomic Nervous System Diseases; Face; Flushing; Humans; Hypohidrosis; Primary Dysautonomias; Rare Diseases
PubMed: 35888657
DOI: 10.3390/medicina58070938