Indirect assessment of low-intensity shockwave therapy's energy density and pulse frequency for erectile dysfunction: a systematic review, bayesian network meta-analysis and meta-regression.

Shockwaves are thought to activate regenerative and angiogenic pathways, providing a possible therapeutic benefit for patients with erectile dysfunction. This study aimed to analyze the effectiveness of low-intensity extracorporeal shockwave therapy energy density and pulse frequency. In May 2022, a systematic search of online databases was performed to identify randomized clinical trials related to low-intensity extracorporeal shockwave therapy in erectile dysfunction. Eligible articles compared low-intensity extracorporeal shockwave therapy to controls or sham procedures. A Bayesian framework with 200,000 Markov chains was performed. We included a total of 1272 patients from 18 studies. The energy flux density measured in joules included 0.09 mJ/mm2 (mean difference 3.2 IIEF [95% CrI 2.8, 3.6]), 0.15 mJ/mm2 (mean difference 4.9 IIEF [95% CrI 2.8, 7.2]) and 0.20 mJ/mm2 (mean difference 1.2 IIEF [95% CrI 0.11, 2.3]). Of these, 0.15 mJ/mm2 had the greatest ranking (SUCRA = 0.983) compared with placebo. When analyzed by pulse frequency, significant increases were found in 500 pulses/session (mean difference 2.5 IIEF [CrI 1.9, 3.2]), 1500 pulses/session (mean difference 4.6 IIEF [95% CrI 3.9, 5.4]) and > 3000 pulses/session (mean difference 3.1 IIEF [95% CrI 2.1, 4.2]). Of these, 1500 pulses/session had the highest SUCRA, at 0.996. Our network meta-analysis suggests that low-intensity extracorporeal shockwave therapy is an effective intervention for erectile dysfunction, as measured by increases in the IIEF-EF. Sessions featuring 1500 pulses and an energy flux density of 0.15 mJ/mm2 appear to be the most effective.

Relationship of age at menarche, coitarche and first gestation: A retrospective cohort analysis.

Introduction: Teenage pregnancy is defined as a pregnancy occurring between ages 10 and 19 (Loredo-Abdlá et al., 2017; Belitzky, 1985; Kaplanoglu et al., 2015), and is associated with increased morbidity and mortality for both mother and child. Several factors have been identified with increased risk of a teenage pregnancy, including incomplete sexual education awareness and increased exposure at a young age. In addition, an earlier onset of sexual intercourse, or coitarche, has been linked to a higher risk of teenage pregnancy. Early menarche, defined as first menstruation before the age of 12 has been previously identified as a risk factor for an earlier coitarche, possibly linking an early menarche with a higher incidence of teenage pregnancy. This study aims to compare and determine the relationship between the incidence of teenage pregnancy with early menarche and coitarche in a low income setting. Design Setting Participants Interventions Main Outcome Measures: A cross sectional review of electronic records of women admitted for delivery in a second level center in northeastern Mexico, being a low-income setting, where 814 teenage and 1474 adult mothers were included. Results: Primigravid teenagers had earlier menarche and coitarche than adult counterparts and opted for postpartum contraception more frequently. Linear regression analysis revealed significant unadjusted beta coefficients between age at first pregnancy and coitarche (0.839) and menarche (0.362). Menarche and coitarche had a significant linear regression association of 0.395. Conclusion: We found amongst primigravid patients that teenagers had earlier menarche and coitarche than adults, which in turn correlated to their age at their first pregnancy.