Postgraduate medicine
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Postgraduate medicine · Nov 2010
ReviewHypogonadism, erectile dysfunction, and type 2 diabetes mellitus: what the clinician needs to know.
Testosterone levels and erectile function are known to decline as men age, leading to hypogonadism and erectile dysfunction (ED). Men with type 2 diabetes mellitus (T2DM) have a particularly high prevalence of hypogonadism and ED. This population also has an increased risk for cardiovascular diseases, as well as exposure to other metabolic and cardiovascular risk factors, such as obesity. ⋯ Hypogonadism is generally suspected when morning levels for total testosterone are < 300 ng/dL and clinical signs and symptoms typically associated with androgen deficiency are present. While hypogonadism and ED have emerged as predictors of cardiovascular disease and may respond to the lifestyle changes commonly recommended for patients with diabetes and the metabolic syndrome, the literature on whether treatment with testosterone supplementation affects outcomes beyond well-being and sexual function is still emerging. Primary care providers should be aware of this dysmetabolic cluster affecting their male patients and its importance, and, given the common occurrence of hypogonadism, ED, and T2DM, diagnosis of 1 of these conditions should elicit inquiry into the other 2 conditions.
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Cardiopulmonary exercise testing (CPX) is a relatively old technology, but has sustained relevance for many primary care clinical scenarios in which it is, ironically, rarely considered. Advancing computer technology has made CPX easier to administer and interpret at a time when our aging population is more prone to comorbidities and higher prevalence of nonspecific symptoms of exercise intolerance and dyspnea, for which CPX is particularly useful diagnostically and prognostically. ⋯ When used properly, CPX enables the physician to assess fitness and uncover cardiopulmonary issues at earlier phases of work-up, which would therefore be especially useful for primary care physicians. In this article, we provide an overview of CPX principles and testing logistics, as well as some of the clinical contexts in which it can enhance patient care.
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Vaginitis is one of the most common ambulatory problems to occur in women. It is a disorder responsible for > 10% of visits made to providers of women's health care. Although vaginal infections are the most common cause, other considerations include cervicitis, a normal vaginal discharge, foreign-body vaginitis, contact vaginitis, atrophic vaginitis, and desquamative inflammatory vaginitis. ⋯ Candida vaginitis is generally treated with either the vaginal administration of an imidazole or triazole antifungal agent or the prescription of oral fluconazole. Oral nitroimidazole agents, metronidazole or tinidazole, are the only effective treatments for trichomoniasis in the United States. Bacterial vaginosis, which has been linked to important gynecologic and pregnancy complications, can be treated with an available oral or topical agent containing either a nitroimidazole or clindamycin.