Characteristics of patients with erectile dysfunction in a family physicianled erectile dysfunction clinic:Retrospective case series

Objectives:1.To examine the characteristics of patients with erectile dysfunction in a family physician led erectile dysfunction clinic;2.To review association of chronic disease spectrum and erectile dysfunction;3.To review initial treatment pattern and outcome.Design:Retrospective case series review.Subjects:All consecutive patients seen in a regional hospital family physician led erectile dysfunction clinic from April 2014 to March 2015.Main outcome measures:1.The severity of erectile dysfunction,based on International Index of Erectile Function(IIEF-5).2.The associated chronic comorbidities of patients.3.Treatment patterns and patient outcomes.Results:One hundred and eighty three patients presented with erectile dysfunction(ED)with mean age 58.7(range 23 to 82)years old were seen during the study period.One hundred and twenty seven patients(69.4%)had comorbidity of chronic diseases,including 50.8%had hypertension,38.8%had diabetes mellitus and 33.9%had hyperlipidaemia.Their mean body mass index was 25.2 kg/m2,the mean blood pressure was 137.3/79.5 mm Hg(1 mm Hg=0.133 kPa).According to IIEF-5 score,50.3%,30.6%and 18.6%had severe,moderate and mild erectile dysfunction respectively.The average duration of ED before seeking medical help was 3.9 years.Phosphodiesterase 5(PDE5)inhibitors were prescribed to 119 patients(65%),and 57.1%of them achieved good response.Twenty nine patients(15.8%)were referred to other specialty for further management,including 27.6%had contraindication for PDE5 inhibitor.Conclusion:High proportion of erectile dysfunction patients had comorbitiy of chronic dis-eases.57.1%of those patients receiving PDE5 inhibitors showed good response.

Overnight pulse oximetry for screening of obstructive sleep apnea in at-risk adult patients in the primary care setting:prospective case series

Objective:To estimate prevalence of OSA among at risk adult patients in primary care setting.To test the correlation and agreement between overnight pulse oximetry and polysomnography(PSG).To test the OSA screening performance of overnight pulse oximetry.Design and Setting:Prospective case series involving adult Chinese patients with risk fac-tors for OSA at a primary care clinic of Hong Kong.Methods:The prevalence and severity of OSA were established based on overnight pulse oximetry derived oxygen desaturation index(ODI).Screening performance of overnight pulse oxi-metry was compared directly with gold standard diagnostic test PSG.Results:Three hundred and five male and 229 female patients were recruited.Snoring(48.3%)was the top presenting symptom.Three hundred and twenty five patients(60.9%)were screened positive to have OSA.One hundred and nine patients had performed PSG,the ODI_4 and apnoea-hypopnea index(AHI)had Pearson correlation coefficient 0.71(P<0.001).Bland and Alt-man plot showed good agreement.Using designation criteria of ODI_4≥5 events/hr,the sensitivity and specificity for OSA diagnosis are 94.4%and 78.9%respectively.Conclusion:The prevalence of OSA is 60.9% among adult primary care population who are at risk for OSA.Overnight pulse oximetry shows good performance as a screening tool for the screening of OSA.

Screening of intraocular pressure before routine pupil dilation for retinal photography: Clinical case report

Introduction:Pharmacologic dilation of the pupil results in twice the sensitivity of detection of diabetic retinopathy compared with undilated retinal examination.The potential risk of acute angle-closure glaucoma after pupil dilation has been hypothesized to be higher in Asian patients with diabetes mellitus.Clinical case:A 61-year-old man with diabetes mellitus and hypertension was incidentally found to have elevated intraocular pressure(IOP)before routine retinal photography.He was asymptomatic and the visual acuity was 0.67 for both eyes.An ophthalmologist later found he had anatomical narrow-angle borderline glaucoma.Topical administration of pilocarpine and oral administration of acetazolamide were initiated,and laser iridotomy was later performed.IOP screening:Among 1736 diabetic and/or hypertensive patients who underwent IOP screen-ing,31 patients(1.8%)had IOP of any eye persistently higher than 21 mm Hg on at least two occa-sions.The mean(standard deviation)IOP of the right eye was 24.1(2.1)mm Hg,while that of the left eye was 24.6(2.5)mm Hg.Four patients(12.9%)were found to have glaucoma,and treatment was initiated by an ophthalmologist.Therefore further study should be conducted to evaluate the cost-effectiveness of IOP screening among this group of patients.

Epidemiological study of hypertensive retinopathy in the primary care setting: Retrospective cross-sectional review of retinal photographs

Objective:The objective is to estimate the prevalence and grading of hypertensive retinopa-thy in the primary care setting;examine the patient characteristics associated with hypertensive retinopathy;and examine the association of hypertensive retinopathy and other hypertension complications.Methods:This is a retrospective cross-sectional study.Subjects included adult hypertensive patients with available and gradable retinal photographs.Results:Two hundred fifty-six male hypertensive patients(34.3%)and 491 female hyper-tensive patients(65.7%)were included.The average duration of hypertension was 7.2 years,and 49.8%and 41.2%of patients were taking one or two antihypertensive medications respectively.Among 1491 qualified retinal photographs(744 right eye and 747 left eye),24.9%,62.6%,and 12.5%were classified as showing normal,mild,and moderate hypertensive retinopathy respec-tively.The three commonest retinal signs were generalized or focal arteriolar narrowing(650 cases,43.6%),hard exudates(168 cases,11.3%),and opacity(copper or silver wiring)of the arteriolar wall(166 cases,11.1%).Patients older than 61 years,having hypertension for more than 15 years,or taking three or more antihypertensive medications were significantly associated with hyperten-sive retinopathy(P<0.05).Conclusion:In a primary care clinic in Hong Kong,77.1%of hypertensive patients had hypertensive retinopathy.Advanced hypertensive retinopathy was the commonest target organ damage for hypertensive patients in a primary care clinic.