Conservative and medical treatments of non-sickle cell disease-related ischemic priapism: a systematic review by the EAU Sexual and Reproductive Health Panel.

Conservative and medical treatments are considered the first step in ischemic priapism (IP) management, although there is no clear evidence regarding their efficacy. We conducted a systematic review on behalf of the EAU Guidelines panel on Sexual and Reproductive health to analyse the available evidence on the efficacy and safety of conservative and medical treatment for non-sickle cell disease-related IP. Databases searched for relevant literature investigating efficacy and safety of conservative measures and medical treatment for IP included Medline, EMBASE, Cochrane Libraries and clinicaltrial.gov published up to September 2021. Overall, 41 retrospective, 3 prospective single-arm studies and 3 randomized controlled trials met the inclusion criteria. Intracavernous injection with sympathomimetic (ICIs) agents were the most frequently utilized treatment with efficacy ranging from 0 to 100% of cases. The combination of ICIs with corporeal aspiration with or without irrigation with saline was successful in 70 to 100% of cases. Oral treatment with ß2 receptor agonist (e.g., terbutaline) showed mild to moderate efficacy. Conservative methods including ice pack, exercise, cold enema and ejaculation depicted lower effectiveness in resolving priapism (1-55%). Longer time interval from the onset to the resolution of IP was associated with higher rate of erectile dysfunction at follow-up (30-70%), especially after 24 h.

Copper-induced Haemolytic Anaemia.

Acute copper toxicity is uncommon in Western countries and is often the result of accidental consumption or a suicide attempt. We report the case of a 65-year-old man presenting to the accident and emergency department after a suicide attempt with ingestion of Bordeaux mixture, ibuprofen, acetaminophen and bleach. Primary evaluation showed caustic oesophagitis, toxic hepatitis and acute renal injury, which were treated with supportive care. During admission, he developed a non-immune haemolytic anaemia associated with high levels of copper in urine and blood. Chelation treatment with penicillamine was started and evolution was favourable after 1 month of treatment. Copper poisoning can be lethal. Prompt diagnosis and treatment are key for a favourable prognosis. LEARNING POINTS: Acute copper intoxication is rare and early clinical suspicion and diagnosis are essential to reduce mortality.The diagnosis of copper poisoning should be based on clinical presentation and measurement of urine and blood copper levels in addition to serum ceruloplasmin levels.Treatment includes reduction of absorption, supportive measures, management of complications and chelation therapy.

Effects of a Mindfulness-Based Intervention for Teachers: a Study on Teacher and Student Outcomes.

Objectives: Teachers' stress can affect their occupational health and negatively impact classroom climate and students' well-being. This study aims to evaluate the proximal and distal effects of a mindfulness-based program, specially developed to promote teachers' social-emotional competencies (SEC), across teachers, classroom climates, and students' outcomes. Methods: The study followed a randomized trial design with two data collection points (pretest and posttest). Participants in the experimental group (EG) included 123 elementary school teachers, their 1503 students, and these students' parents (1494), while the control group (CG) comprised 105 elementary school teachers, their 947 students, and these students' parents (913). A mixed data collection strategy was used that included teachers' and students' (self-) report, observational ratings of teachers' classroom behaviors, and parents' reports on students. Results: After the intervention, EG teachers, compared to CG teachers, reported a significant increase in mindfulness and emotional regulation competencies, self-efficacy, and well-being and a decrease in burnout symptoms. Similarly, a significant improvement was found in EG teachers' classroom behaviors related to students' engagement. Additionally, significant improvements were also found in EG students' perceptions of the quality of their teachers' involvement in classroom relationships, self-reported effect, and social competencies perceived by their parents. Conclusions: These findings further the knowledge on the role played by mindfulness-based SEC interventions in reducing teachers' burnout symptoms and cultivating their SEC and well-being, in promoting a nurturing classroom climate and also in promoting the SEC and well-being of students. Supplementary Information: The online version contains supplementary material available at 10.1007/s12671-021-01635-3.

Mindfulness and relaxation: the effects of a program with university hospital workers / Mindfulness e relaxamento: efeitos de um programa com trabalhadores de um hospital universitário

Our study compared the effects of mindfulness and relaxation interventions on stress, quality of life, resilience, and mindfulness levels. A total of 29 workers, recruited at a university hospital in the northeastern region of Brazil and distributed in two groups: Mindfulness (89.5% female, age mean 37.5 ± 6.23 years old); and Relaxation (90.0% female, age mean 34.2 ± 8.66). After eight weeks of daily mindfulness or relaxation practices, both groups significantly reduced the perceived stress and stress at work, and increased their mindfulness and resilience levels, as well as the physical and psychological quality of life domains. Our results suggest that both interventions may be effective in the organizational environment, assisting in health promotion and increasing the ability of individuals to recover from an adversity (resilience).

Este estudo comparou os efeitos de intervenções baseadas em mindfulness e em relaxamento sobre níveis de estresse, qualidade de vida e resiliência. Participaram do estudo 29 trabalhadores de um hospital universitário do nordeste do Brasil, distribuídos em dois grupos: Mindfulness (89,5% mulheres, média de idade 37,5 ± 6,23); e Relaxamento (90,0% mulheres, média de idade 34,2 ± 8,66). Após oito semanas de práticas diárias dessas internveções, ambos os grupos reduziram significativamente o estresse percebido e aumentaram os níveis de mindfulness, de resiliência e os domínios físico e psicológico da qualidade de vida. Nossos resultados sugerem que elas podem ser eficazes no ambiente organizacional, auxiliando na promoção da saúde e aumentando a capacidade dos indivíduos de se recuperarem da adversidade (resiliência).

A fully human anti-BMP6 antibody reduces the need for erythropoietin in rodent models of the anemia of chronic disease.

Recombinant erythropoietin (EPO) and iron substitution are a standard of care for treatment of anemias associated with chronic inflammation, including anemia of chronic kidney disease. A black box warning for EPO therapy and concerns about negative side effects related to high-dose iron supplementation as well as the significant proportion of patients becoming EPO resistant over time explains the medical need to define novel strategies to ameliorate anemia of chronic disease (ACD). As hepcidin is central to the iron-restrictive phenotype in ACD, therapeutic approaches targeting hepcidin were recently developed. We herein report the therapeutic effects of a fully human anti-BMP6 antibody (KY1070) either as monotherapy or in combination with Darbepoetin alfa on iron metabolism and anemia resolution in 2 different, well-established, and clinically relevant rodent models of ACD. In addition to counteracting hepcidin-driven iron limitation for erythropoiesis, we found that the combination of KY1070 and recombinant human EPO improved the erythroid response compared with either monotherapy in a qualitative and quantitative manner. Consequently, the combination of KY1070 and Darbepoetin alfa resulted in an EPO-sparing effect. Moreover, we found that suppression of hepcidin via KY1070 modulates ferroportin expression on erythroid precursor cells, thereby lowering potentially toxic-free intracellular iron levels and by accelerating erythroid output as reflected by increased maturation of erythrocyte progenitors. In summary, we conclude that treatment of ACD, as a highly complex disease, becomes more effective by a multifactorial therapeutic approach upon mobilization of endogenous iron deposits and stimulation of erythropoiesis.

Multimodal therapeutic approach of vaginismus: an innovative approach through trigger point infiltration and pulsed radiofrequency of the pudendal nerve / Terapêutica multimodal do vaginismo: abordagem inovadora por meio de infiltração de pontos gatilho e radiofrequência pulsada do nervo pudendo

Abstract Vaginismus is a poorly understood disorder, characterized by an involuntary muscular spasm of the pelvic floor muscles and outer third of the vagina during intercourse attempt, which results in aversion to penetration. It is reported to affect 1-7% of women worldwide. With this report the authors aim to describe the case of a young patient with vaginismus in whom techniques usually from the chronic pain domain were used as part of her multimodal therapeutic regimen.

Resumo O vaginismo é uma doença pouco compreendida que se caracteriza por uma contração muscular involuntária dos músculos do pavimento pélvico e do terço externo da vagina durante as tentativas de intercurso sexual, o que resulta em aversão à penetração. Estima-se que possa afetar entre 1%-7% da população feminina mundial. Com este relato os autores pretendem apresentar o caso de uma paciente jovem com vaginismo na qual foram usadas técnicas habitualmente do domínio da medicina da dor crônica como parte do seu esquema terapêutico multimodal.

[Multimodal therapeutic approach of vaginismus: an innovative approach through trigger point infiltration and pulsed radiofrequency of the pudendal nerve]. / Terapêutica multimodal do vaginismo: abordagem inovadora por meio de infiltração de pontos gatilho e radiofrequência pulsada do nervo pudendo.

Vaginismus is a poorly understood disorder, characterized by an involuntary muscular spasm of the pelvic floor muscles and outer third of the vagina during intercourse attempt, which results in aversion to penetration. It is reported to affect 1-7% of women worldwide. With this report the authors aim to describe the case of a young patient with vaginismus in whom techniques usually from the chronic pain domain were used as part of her multimodal therapeutic regimen.