Current status of intracavernosal injection therapy in erectile dysfunction

INTRODUCTION

Erectile dysfunction (ED) is defined as the inability to attain and/or maintain a penile erection. The first introduction of intracavernosal injection (ICI) for the treatment of erectile failure was in 1982 by Virag who reported the positive effects of papaverine on erectile tissue, followed by Brindley concurrently conducting research on ICI therapy with alpha-blockade. ICI remains a viable option for the treatment of ED, even after FDA approval of phosphodiesterase type 5 inhibitors in 1998. The American Urological Association (AUA) and the European Association of Urology (EAU) both recommend ICI as a second-line therapy for the treatment of ED. We herein provide an overview of the current state of ICI therapy for the treatment of ED.

AREAS COVERED

We performed a literature review from 1977-2022, using PubMed and the current AUA and EAU guidelines to discuss the current state of ICI for the treatment of ED.

EXPERT OPINION

Although other oral agents are considered first line for the treatment of ED, the current guidelines and literature demonstrate that ICI is a safe and effective option for patients; however, careful patient selection and counseling should be performed to maximize the effectiveness and safety of this ED treatment.

Psychiatric comorbidities of Incarceration in a Patient with Gender Dysphoria: A Case Report

Introduction

Mental health remains key comorbidity in the transgender population. There are more grave consequences on mental health if there is long-term incarceration history of a transgender person. 21% of transgender women are incarcerated in their lifetime, compared to <3% of the US general population. Incarcerated, transgender women are typically at risk for verbal, physical, and sexual assault that has been cross-sectionally linked to poor mental health in transgender patients. Childhood traumas and Adverse childhood experiences like sexual abuse may attribute to gender dysphoria as well as the externalizing and internalizing behaviors of the child in later part of life.

Objectives

Better understand Gender Dysphoria and Incarceration.

Methods

A case report and review of the literature.

Results

X is a 56-year-old transgender female, admitted for Major Depressive disorder with Psychotic features, and substance abuse disorder. She was disoriented to person place, or time, believing she was at the “Federal Penitentiary.” She was also selectively mute and socially isolative as well as unable to perform ADL’s. She has an extensive legal history, which started in 1985 when she burglarized a pharmacy store for estrogen. Patient was started on Sertraline, Mirtazapine, and Risperidone. She was still socially withdrawn but was soon oriented to person place, and time and was able to complete her daily tasks.

Conclusions

In this poster we discuss the challenges of managing an acute patient with extensive legal and substance abuse history, while also addressing the features of gender identity disorder and highlighting the difficult path of both the patient and physician in managing these challenges.

Disclosure

No significant relationships.

Comparative PBT screening using (Q)SAR tools within REACH legislation

Small to medium sized enterprises (SMEs) in the EU are facing challenges due to the introduction of new legislation designed to protect consumers and the environment, REACH (Registration, Evaluation, Authorisation and Restriction of CHemicals). There can be high costs associated with implementing REACH because data on mammalian toxicity, environmental toxicity and environmental fate properties is required and if this data is obtained experimentally the cost is significant. These costs can be reduced if reliable quantitative structure-activity relationships ((Q)SAR) models are instead used to obtain the required information. In this paper we investigate how easily freely available (Q)SAR models can be applied for persistent, bioaccumulative and toxic (PBT) screening of 17 chemicals of interest to SMEs. In this study the PBT predictions obtained from the more user-friendly PBT Profiler and the Danish(Q)SAR database for the chemicals were compared with the results taken directly from the EPI Suite software. It was found that these widely used (Q)SAR databases might have some errors and examples are provided. It was concluded that extra care must be taken when considering the use of these databases for PBT screening. In addition, to increase the likelihood of a correct prediction, data estimates from various (Q)SAR models relevant to the PBT endpoints must be compared.