Marked testosterone deficiency-related symptoms may be associated to higher metabolic risk in men with low testosterone levels.

INTRODUCTION: Testosterone deficiency syndrome (TDS) is usually suspected on the basis of signs/symptoms. However, some men with low testosterone levels (low T) are asymptomatic or present mild, unnoticed symptoms. Would they have the same cardiovascular risk as symptomatic men? AIMS: This study aims to assess the relationship between presence/severity of low T-related symptoms and the likelihood of metabolic syndrome (MetS). METHODS: Data were taken from a multicenter, cross-sectional study conducted in Spain among men visiting men's healthcare offices aged ≥45 with low T (total T <8 nmol/L or <12 nmol/L and calculated free T <250 nmol/L). Only subjects whose MetS components and symptoms had been assessed were selected. Data available included anthropometrics, toxic habits, comorbidities, and total testosterone (TT) levels. MAIN OUTCOME MEASURES: MetS was defined using the harmonized definition. Erectile dysfunction was classified using the International Index of Erectile Function questionnaire. The Ageing Male Symptoms (AMS) scale assessed symptoms. Symptom severity was classified as "none/mild" and "moderate/severe." Bivariate and multivariate logistic regression analyses were performed to calculate the effect of moderate/severe symptoms on the odds ratio (OR) for MetS. RESULTS: Mean age (SD) was 61.2 (8.1) years. Erectile dysfunction (ED), AMS, and MetS prevalence were 97.4%, 94.9%, and 69.6%. Prevalence of MetS was higher in men with moderate/severe symptoms vs. men with no/mild ones (75.3% vs. 57.9%, P < 0.001). Age and prevalence of TT <8 nmol/L, moderate/severe ED, and obesity were significantly higher in men with moderate/severe symptoms. Multivariate analysis showed that besides obesity and moderate/severe ED, moderate/severe symptoms increased the likelihood of MetS. This effect disappeared in men with severe ED and in the nonobese. Three symptoms showed relationship with MetS after adjusting for all confounding factors. CONCLUSION: Severity of TDS symptoms may indicate higher cardiovascular risk in men with low T.

Metabolic syndrome in men with low testosterone levels: relationship with cardiovascular risk factors and comorbidities and with erectile dysfunction.

INTRODUCTION: Testosterone deficiency and metabolic syndrome (MetS) are strongly associated. Patients consulting for sexual dysfunction may have testosterone deficiency, providing a valuable opportunity to assess MetS. The identification of variables predicting MetS is of great importance. AIMS: To identify cardiovascular comorbidities and risk factors, including erectile dysfunction (ED), associated with MetS in men aged≥45 with total testosterone (TT)<8 nmol/L (or <12 nmol/L when calculated free testosterone was <50 pmol/L) and to gain further insight into the relationship between both conditions. METHODS: Data were collected from a multicenter, cross-sectional, observational study conducted in Spain among men visiting men's health-care offices with a confirmed diagnosis of testosterone deficiency. Subjects with data for MetS assessment were included in this analysis. Other data available were anthropometrics, toxic habits, cardiovascular comorbidities, ED diagnosis, and TT values. MAIN OUTCOME MEASURES: The MetS harmonized definition was used. Waist circumference threshold was 94 cm. ED was diagnosed and classified using the International Index of Erectile Function-5 (IIEF-5) questionnaire. Bivariate and multivariate logistic regression analyses were performed to calculate odds ratios (ORs) for MetS. RESULTS: Mean age was 61.2±8.1 years. Prevalences of ED and MetS were 97.6% and 69%, respectively, both increasing with age. Bivariate analysis showed that moderate or severe ED, obesity, and peripheral vascular disease (PVD) were the variables associated with the greatest odds of MetS (OR=2.672 and 2.514, respectively), followed by alcohol intake (OR=1.911). Tobacco use, ag,e and testosterone deficiency severity had a minimal effect that disappeared on multivariate analysis. Elevated triglycerides and HDL-cholesterol were MetS risk factors associated with a lower TT level. CONCLUSION: The high prevalence of MetS among men with testosterone deficiency highlights the opportunity to assess cardiovascular health in patients consulting for sexual dysfunction. Moderate to severe ED, obesity, PVD, and alcohol intake significantly increase the likelihood of MetS.

Further psychometric validation of the sexual life quality questionnaire for men with erectile dysfunction and their partners on a modified Spanish language version.

INTRODUCTION: Although erectile dysfunction (ED) is known to hamper quality of life (QoL) of afflicted men and their partners, there are few validated instruments for assessing the couple's sexual QoL. The Sexual Life Quality of Life Questionnaire (SLQQ) was developed in the United States for this purpose, and so it has been used in clinical studies. Yet, the original description did not address some important psychometric properties included in the Food and Drug Administration 2006 guidance for patient-reported outcome instruments. AIMS: The aims of this study were to validate a Spanish language version of the modified SLQQ (mSLQQ), and to evaluate on it those psychometric properties lacking in the seminal description, namely discriminant validity and test-retest stability. METHODS: Psychometric validation of the translated SLQQ was conducted on 164 ED patients and their sexual partners, and 60 age-matched non-dysfunctional couples. At baseline, all subjects completed the mSLQQ QoL and the 12-item Short-Form Health Survey questionnaires, and the men the International Index of Erectile Function. Two weeks later, ED patients abstaining from any ED medication and their partners repeated the mSLQQ QoL (104 valid couples). Oral medication for ED was then prescribed. Four weeks thereafter, they completed the QoL and treatment satisfaction scales of the SLQQ. MAIN OUTCOME MEASURES: The mSLQQ QoL scores of men and women at different times for psychometric analyses. Results. Cronbach alpha coefficients indicated good internal consistency. Large differences between control and ED couples, and close association with ED severity demonstrated discriminant and convergent validity, respectively. High intra-class correlation coefficients and similar mean scores at first and second visits substantiated test-retest stability. Significant increases after treatment with robust effect size demonstrated sensitivity to change in both patients and partners. CONCLUSIONS: This adaptation of the SLQQ shows psychometric properties comparable to the original description. The additional properties demonstrated here fully validate the mSLQQ as a tool for evaluating sexual QoL in ED patients and their partners.

Susceptibility of Mexican brucella isolates to moxifloxacin, ciprofloxacin and other antimicrobials used in the treatment of human brucellosis.

Brucellosis is a disease of domestic and wild animals that is transmitted to humans and exists worldwide. We assessed the in vitro activity of moxifloxacin, ciprofloxacin, tetracycline, doxicycline, rifampin, streptomycin and trimethoprim-sulfamethoxazole (TMP/SMX) against 97 Brucella strains isolated from clinical samples, animals and dairy products in Mexico. Fluoroquinolones showed an antibacterial activity similar to that of tetracyclines (MIC(90) 0.5). Other drugs commonly used against brucellosis were less active, such as rifampin (MIC(90) 2.0 microg/ml) and streptomycin (MIC(90) 4.0 microg/ml). TMP/SMX showed the poorest activity (MIC(90) 8.0 microg/ml). Fluoroquinolones, either first-generation or the newer 8-methoxi derivatives, might be useful in the therapy of brucellosis, which remains to be assessed in clinical trials.