Prospective comparison of tadalafil 5 mg, dapoxetine 30 mg, and the combination of both in the treatment of premature ejaculation.

Objective: To compare the efficacy of tadalafil alone, dapoxetine alone, and tadalafil with dapoxetine as a combination therapy for the treatment of premature ejaculation. Patients and Methods: Eligible patients attended our andrology clinic with premature ejaculation were randomly allocated into three groups: group A (92 participants) received on-demand tadalafil, 5 mg; group B (91 participants) were given on-demand dapoxetine, 30 mg; and group C (89 participants) received on-demand combination of tadalafil, 5 mg, and dapoxetine, 30 mg. We assessed the changes in the intravaginal ejaculatory latency time (IELT) and the satisfaction scores 1, 2, and 3 months after treatment. Results: Highly statistically significant improvements were found in the mean IELT and satisfaction scores 1, 2, and 3 months post-treatment in all groups (P = <0.001). Post hoc analysis suggested this improvement was more pronounced in group C (P < 0.001). Conclusion: Both tadalafil and dapoxetine are effective in the treatment of patients with premature ejaculation, but the combination of both drugs gives better results.

Psychotropic Medication Prescribing for Youth at a Regional Autism Center.

Objectives: The Seattle Children's Autism Center (SCAC) serves youth throughout Washington state (WA). The authors examined (1) whether the ethnicity and race of patients seen at the SCAC aligned with the demographics reported in the WA census, and (2) whether psychotropic medication prescriptions were associated with patient factors, including age, sex, ethnicity, race, insurance, visit number, and diagnoses. Methods: The authors extracted demographic and prescription data from electronic medical records for all patients (3-21 years) seen at the SCAC in 2018 for psychiatric medication evaluation in the context of autism spectrum disorder (ASD) and/or other related neurodevelopmental disorder (n = 1112), and used binary logistic regression to ascertain the effects of patient factors on psychotropic prescriptions. Results: The SCAC study sample appeared to align well with the WA census. Older age and higher visit number were among the most significant factors associated with psychotropic prescriptions. Psychotropic prescriptions increased with age, across all categories, except attention-deficit/hyperactivity disorder medications. There were no sex differences in prescribing rates. There were differences in prescribing rates by ethnicity and race. There were also increased prescription rates among those with Medicaid insurance. Conclusion: These demographic differences in prescribing for youth with ASD provide more specificity than prior studies about sex, ethnic, racial, and insurance-related differences, and can serve as an impetus to examine the reasons for variance.

Role of Fused Three-Dimensional Time-of-Flight Magnetic Resonance Angiography and 3-Dimensional T2-Weighted Imaging Sequences in Neurovascular Compression.

BACKGROUND: To evaluate role of fused 3-dimensional time-of-flight magnetic resonance angiography (3D-TOF-MRA) and 3-dimensional constructive interference in steady state (3D-CISS) in neurovascular compression in trigeminal neuralgia (TN) and hemifacial spasm (HFS). MATERIAL AND METHODS: A prospective study was conducted on 30 patients (mean age 47.20 ± 11.69 years), 17 (56.7%) male and 13 (43.3%) female, with TN and HFS. 3D-TOF-MRA and 3D-CISS sequences of the cerebellopontine angle were performed, as well as postprocessing with fusion of the images. Two independent readers assessed the degree of neurovascular conflict. The images were evaluated for site, signal, and degree of nerve compression and the offending vessel. The kappa test for interobserver agreement was done. RESULTS: The interobserver agreement of both readers was excellent for degree of compression (k = 0.70, 95% confidence interval [CI] 0.49-0.92, r = 0.856, P = 0.001), excellent for the side affected (k = 1.0, 95% CI = 1.0-1.0, r = 1.000, P = 0.001), excellent for the offending vessel (k = 0.85, 95% CI = 0.66-1.0, P = < 0.001), and excellent for the position of the offending vessel (k = 0.685, 95% CI = 0.489-0.882, r = 0.863, P ≤ 0.001). There was no significant correlation between the degree of compression and signal intensity. CONCLUSIONS: Fused 3D-TOF-MRA and 3D-CISS images are a reliable, noninvasive tool for the evaluation of offending vessel and degree of affection in patients with neurovascular compression. MRA-CISS can be used for evaluation and treatment planning of neurovascular compression in TN and HFS.

Indicators of Quality of Clinical Care for Type 2 Diabetes Patients in Primary Health Care Centers in Qatar: A Retrospective Analysis.

BACKGROUND: Despite the high prevalence of type 2 diabetes mellitus in Gulf countries, standards of diabetes care at the primary care level have not been widely studied. AIM: To compare the results of diabetes clinical indicators from the American Diabetes Association (ADA) 2017 guidelines to the reference benchmarks in the Behavioral Risk Factor Surveillance System. MATERIALS AND METHODS: A cross-sectional analysis of electronic medical records in 643 randomly selected adult patients with type 2 diabetes was undertaken. A checklist enabled the collection of sociodemographic, clinical, biochemical, and quality measurement data. Data were analyzed using Stata 9.0. The chi-squared test was used to compare two or more proportions. RESULTS: There were 643 patients (male = 60.3%; female = 39.7%), and the majority (71.7%) aged between 40 and 64 years. Common comorbidities were dyslipidemia (72.3%), hypertension (70%), obesity (50.1%), and preobesity (overweight) (37.9%). Over 15% were smokers. The most commonly prescribed diabetes medications were metformin (89.9%), dipeptidyl peptidase-4 inhibitors (61.1%), and sulfonylureas (49.3%). Only 35.5% (p < 0.0001) of patients met the reference glycated hemoglobin (HbA1c) cutoff level of 7.0%. The reference level for blood pressure control was met by 70.2% (p < 0.0001) and for low-density lipoprotein cholesterol, 73.8% (p < 0.0001). Albuminuria was present in 39.2%, and very low vitamin D level (<20 ng/ml) in 39.1%. Most patients had annual foot (89.6%, p < 0.0001) and eye (72.3%, p < 0.0001) examinations. Only 39.9% had referrals for dietary counseling, and there were lower rates of referrals and uptake for pneumococcal, influenza, and hepatitis B vaccines. Most (76.2%) did not have screening for depression. CONCLUSION: The majority of the results met the ADA standards, while glycemic control, dietary counseling, and screening for depression were poor in comparison to the standards. Continuing education for clinicians, patient education for self-management, and targeted weight management are recommended.

Preoperative multislice computed tomography evaluation of shoulder deformities in brachial plexus birth palsy patients undergoing tendon transfer.

BACKGROUND: Brachial plexus birth palsy (BPBP) refers to a birth related paralysis of the upper extremity. The current study was designed to evaluate the efficacy of computed tomography (CT) in the assessment of humeral head posterior subluxation and glenoid retroversion preoperatively and to evaluate whether or not bony deformity correlates with functional improvement (based on Modified Mallet Score) following tendon transfer in brachial plexus birth palsy patients. PATIENTS AND METHODS: This prospective study included 30 patients, 15 below 4 years and 15 above 4 years old, with a mean age 3.65 ±â€¯1.39 (range 2-8) years old. Thirteen patients were males (43.3%) and 17 were females (56.6%). The left side was affected in 13 patients (43.3%), while the right in 17 (56.7%). The Modified Mallet Score was used for clinical assessment of the shoulder function. A multislice CT scan with 3D reconstruction was used as a preoperative radiological assessment of the shoulder. An electromyography (EMG) of the muscles around the shoulder was performed. All patients were operated upon by anterior release of the internal rotators to improve the external rotation range of motion and by transfer of teres major and latissimus dorsi to improve the abduction motion through one anterior deltopectoral incision and a small posterosuperior incision. Postoperatively, the range of shoulder abduction and external rotation had been assessed after shoulder spica removal and till the end of follow up. RESULTS: Fourteen patients (46.7%) had a normal glenoid version angle (normal range from -12° to 2°) and normal range of articulation with the glenoid (42.3%-71.4%) and 16 patients (53.3%) had an abnormal glenoid version angle and abnormal range of articulation with the glenoid. According to the Modified Mallet Score, there was a statistically significant difference in the mean value of global abduction (P = 0.04), external rotation (P = 0.03), hand to mouth (P = 0.02), hand to neck (P = 0.03) and hand to spine (P = 0.02) between the pre- and post-operative assessment of all patients. There was a statistically significant difference in the mean value of postoperative Modified Mallet Score between the patients under the age of 4 years and those above the age of 4 years. There was no statistically significant difference between the patients with normal CT angles and those with abnormal CT angles. There was no statistically significant difference in the mean value of glenoid version angle and percentage of humeral head articulation between the patients below the age of 4 years and those above 4 years (P = 0.845). CONCLUSION: The study concluded that the glenoid version angle and humeral head articulation percentage do not negatively affect results of the tendon transfer around the shoulder in patients of upper brachial plexus birth palsy. LEVEL OF EVIDENCE: IV.

Efficacy and Safety of Intravenous Ketorolac versus Nalbuphine in Relieving Postoperative Pain after Tonsillectomy in Children.

BACKGROUND: Pain is a major postoperative complication worldwide, which in turn impairs normal body performance and increases postoperative morbidity, hospitalisation, and the susceptibility to infections which also lead to chronic pain development. AIM: The purpose of this study was to evaluate the efficacy of intravenous ketorolac versus nalbuphine as analgesia after adenotonsillectomy surgery to determine the optimal procedure for pain control and postoperative reduction of analgesic use. METHODS: A group of 100 pediatric patients undergoing tonsillectomy or adenotonsillectomy were assigned as follows to two equal groups: Group A: 50 patients received intravenous ketorolac 0.9 mg/Kg. Group B: 50 patients received intravenous nalbuphine 0.25 mg/Kg. RESULTS: FLACC (Face, Legs, Activity, Cry, Consolability) pain score was measured after recovery from anaesthesia (postoperative). There was a statistically significant difference concerning pain score between group 'A' and group 'B' as pain score in 'A' (ranging from 3.18 ± 0.87 to 4.68 ± 0.74) is lower compared to 'B' (ranging from 3.90 ± 0.76 to 5.54 ± 0.73) and probability value < 0.05 except at 90 & 120 min which was observed statistically insignificant. There was no serious postoperative complication detected in either group. CONCLUSION: It is concluded that intravenous ketorolac is more effective than intravenous nalbuphine in reducing pain intensity and postoperative analgesic requirements after adenotonsillectomy in children.