Effects of Chronic Migraine on Male Sexual Health.

OBJECTIVE: To investigate the clinical implication of the sexual functions of male patients diagnosed with chronic migraine (CM) compared with the healthy population. STUDY DESIGN: Observational study. PLACE AND DURATION OF STUDY: Departments of Urology and Neurology, Hitit University Hospital, Turkey, from August 2019 to August 2020. METHODOLOGY: A total of 179 patients (92 subjects diagnosed with CM and 87 control healthy volunteers) were included in this study. Demographic descriptive data including age, height, weight, and body mass index (BMI) of all patients were recorded. A 5-question version of the international index of erectile function questionnaire (IIEF-5) was applied to evaluate their sexual functions. Furthermore, a migraine identification test was performed for CM patients for the diagnosis of migraine in accordance with the International Headache Society's (IHS) definition of chronic migraine. Visual analog scale (VAS) scores between 0-10 points were recorded for the qualitative assessment of migraine pain. RESULTS: The IIEF-5 scores of CM patients [16 (11 - 21)] were lower compared to the control patients [21 (19 - 23), p <0.001)]. A negative correlation was found between the VAS scores and IIEF-5 scores of CM patients (rho -0.582, p <0.001). In the regression analysis, it was found that a 1-unit increase in the VAS score led to a 1.5 point decrease in the IIEF-5 score (p <0.001). CONCLUSION: Migraine pain in male patients with CM adversely affected erectile functions. A more detailed investigation of the pathophysiological mechanisms may be helpful in the treatment of ED. KEY WORDS: Erectile dysfunction, Chronic migraine, IIEF-5, Erectile functions.

Which patient should start empirical antibiotic treatment in urinary tract infection in emergency departments?

OBJECTIVES: This study aims to determine the factors that would lead the doctors in EDs to a more the accurate diagnosis of urinary tract infection (UTI) and the correct initiation of empirical antibiotherapy in the emergency room and reduce the use of unnecessary antibiotherapy. METHODS: This study is a prospective observational study from a single-center, investigating patients with an age of 18 years and older who presented to the emergency department (ED) with the symptoms of UTI between January and May 2018. The guiding parameters to establish a UTI diagnosis and start an empirical antibiotherapy were investigated between the negative (Group 1) and positive (>103 colonies) (Group 2) groups, as a result of urine culture in terms of urine culture. RESULTS: Our study included a total of 108 patients (59 women and 49 men). The average age was 47.11 ± 14.97. Age and gender were similar among the groups and not a discriminating factor in the diagnosis of UTI. High Charlson Comorbidity Index score, history of chronic kidney failure and cerebrovascular disease, leukocyte esterase, nitrite positivity, and leukocyte cluster presence were higher in Group 2. We suggest that these parameters might be predictive values to detect bacterial growth in urine culture. Empirical antibiotherapy was started in 48.4% of the patients in Group 1 and 95.7% of the patients in Group 2. CONCLUSIONS: In EDs, admission complaints of the patients and physical examination findings do not always result in the diagnosis of UTI. Our study showed that UTI diagnosis could be made more accurately using leukocyte esterase, nitrite positivity, the presence of leukocyte clusters, and the Charlson Comorbidity Index score. We also suggest that regional antibiotic resistance should be considered before starting empirical antibiotherapy.