Syed H. Tariq

A Model for Managing Delirious Older Inpatients

Although multiple models of care exist to prevent the development of delirium in hospitalized patients, models for the management of patients for whom delirium is unpreventable or who already have delirium on admission to the hospital are needed.

MRI and S‐MRCP findings in patients with suspected chronic pancreatitis: Correlation with endoscopic pancreatic function testing (ePFT)

To review magnetic resonance imaging (MRI) and secretin stimulated magnetic resonance cholangiopancreatography (S‐MRCP) findings of patients with suspected chronic pancreatitis and compare them with endoscopic pancreatic function testing (ePFT).

Sexuality and disease

Disease is commonly associated with sexual dysfunction in both men and women. In many cases, effective treatments are available that can improve libido, erectile dysfunction, and vaginal dryness. Sexual problems in older persons with disease often lead to anxiety, marital discord, and withdrawal. It is the responsibility of all health care professionals to inquire about sexuality in all patients, no matter what the patients age, and to be aware that frailty [79-81] is not, in itself, a barrier to sexuality. Health professionals need to give education, support, and counseling on sexuality for patients with disease.

Erectile dysfunction:: etiology and treatment in young and old patients

This study shows that endocrine and vascular etiologies of erectile dysfunction are more common in the older age group, whereas depression and marital discord are more common in the younger age group. There is considerable overlap between various factors pointing to the multifactorial nature of erectile dysfunction. Review of the treatment option chosen reveals that the invasive modalities were least common as compared with the popular vacuum tumescence device (although cumbersome) and testosterone replacement. Persons with low testosterone have an improved efficacy of sildenafil when hypogonadism is treated. Sildenafil with its ease of administration and high efficacy seems to be the logical first choice for most of the patients. If contraindications exist or treatment failures occur, other treatment options should be offered to patients.

Andropause: Is the Emperor Wearing Any Clothes?

The andropause is considered to occur in men over 50 years of age who have a cluster of symptoms compatible with testosterone deficiency and a low total, free or bioavailable testosterone [1,2]. Many of the symptoms of the andropause are similar to the symptoms seen in aging men. They also overlap with the symptoms seen in depressed individuals [3]. Some would extend this definition to include persons with symptoms and a borderline low testosterone level. Others have suggested that symptoms alone are sufficient, particularly if they respond to testosterone replacement. Unfortunately, this ignores the powerful placebo response seen in older persons with andropausal symptoms [4]. The counter argument to this is that placebos have a strong effect in depressed individuals, but that does not invalidate the use of antidepressants that may have no greater additional response than a placebo. Other names used for the andropause include androgen deficiency in aging males (ADAM), partial androgen deficiency in aging males (PADAM), the climacteric, male menopause, late-onset hypogonadism, and the viropause. Frailty is becoming a well accepted concept in older persons [5–8]. There is now increasing belief that testosterone deficiency in both men [9] and women [10] may play a role in its pathogenesis. As cytokine excess is considered another factor in the pathogenesis of frailty [11,12], and testosterone can inhibit cytokine production, this provides an additional mechanism in support of this concept [13,14]. This has increased the enthusiasm for perceiving that andropause may be a precursor of frailty and disability. Historically, the understanding of the symptoms of hypogonadism were developed from observing the effects of castration. The concept of altering male behavior began with the demigoddess, Semiramis of Assyria, who castrated males around her and spread to Egypt, Turkey, Russia, India and the Ming Dynasty of China [15]. The concept of hypogonadism as a disease process was first described in the Bible. In the nineteenth century BrownSequard treated himself with testicular extracts in an attempt to reverse the symptoms of aging. This was followed by a large number of rich old men throughout the world receiving testicular transplants from humans, monkeys or goats, in an attempt to be rejuvenated. Following the isolation of testosterone from bull testicles in the 1930s, Werner [16] characterized the male climacteric as a testosterone deficiency syndrome that responds to testosterone replacement therapy. The symptoms of the male climacteric included decreased libido, decreased potency, irritability, fatigue, depression, memory problems, sleep disturbances, numbness and tingling and hot flashes. This review will attempt to draw back the curtain obscuring the science behind the changes in testosterone with aging. It will try to remove the mythology that often clouds an important area of aging research. Unfortunately, as pointed out by others, it will conclude that there is insufficient information to provide unequivocal conclusions about the need to treat the andropause [17–19].

Dietary prescription in diabetes mellitus

No one specific diet is recommended by the ADA for the management of diabetes. The prescribed diet should be based on nutritional assessment, treatment goals, and desired outcome. The nutritional therapy should be individualized to meet the patients nutritional requirements. Glycemic control should be maintained by monitoring metabolic parameters, adjusting medication, and patient education.