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Biomedical subjects

Nasser Mikhail

Publications and source records attributed to Nasser Mikhail.

At least 19 recordsLinked to original sources
PubMed2006

Does testosterone have a role in erectile function?

PURPOSE: Despite the well-established role of testosterone in enhancing libido, its exact contribution to erections in men remains unclear. The main objectives of this review are to clarify the role of testosterone in erectile function and evaluate its therapeutic value in men with erectile dysfunction (ED). METHODS: Review of the relevant literature (English, French, and Spanish) from 1939 to June 2005 was conducted using data sources from MEDLINE, endocrinology text books, and hand searching of cross-references from original articles and reviews. Clinical trials, animal studies, case reports, reviews, and guidelines of major associations were included. RESULTS: Animal and preliminary human studies suggest that testosterone may facilitate erection by acting as vasodilator of the penile arterioles and cavernous sinusoids. Following castration, most, but not all, men had partial or complete loss of erection. Hypogonadism is not a common finding in ED, occurring in about 5% of cases, and in general, there is lack of association between serum testosterone levels, when present in normal or moderately low levels, and erectile function. Most trials using testosterone for treatment of ED in hypogonadal men suffer from methodological problems and report inconsistent results, but overall, suggest that testosterone may be superior to placebo. Erectile function is more likely to improve with testosterone therapy in patients with severe degrees of hypogonadism. Testosterone treatment may ameliorate the response to the phosphodiesterase 5 (PDE5) inhibitors in hypogonadal men and men with low-normal serum testosterone. Repeated measurement of morning serum total testosterone is a fairly accurate and easy method to evaluate androgenecity, but measurement of free or bioavailable testosterone is recommended in conditions that alter the levels of sex-hormone-binding globulin (SHBG), such as in the elderly and in obesity. CONCLUSIONS: Available data suggest that in most men circulating levels of testosterone, well below the normal range, are essential for normal erection and that higher levels of serum testosterone may not have major impact on erectile function. Screening for hypogonadism in all men with ED is necessary to identify cases of severe hypogonadism and some cases of mild to moderate hypogonadism, who may benefit from testosterone treatment.

3',5'-Cyclic-GMP Phosphodiesterases↗
PubMed2006

Exenatide: a novel approach for treatment of type 2 diabetes.

Exenatide (synthetic exendin-4) is the analog of glucagon-like peptide 1 (GLP-1), the major physiologic incretin. The latter is an intestinal hormone that enhances glucose-induced insulin secretion after meals. In addition, GLP-1 stimulates insulin synthesis, inhibits glucagon secretion, delays gastric emptying, and may promote satiety. These glucoregulatory actions help control plasma glucose in the postprandial period. However, in diabetes, the GLP-1 response to nutrient intake is impaired, leading to exacerbation of postprandial hyperglycemia. Exenatide was recently approved as adjunctive therapy in diabetic patients failing sulfonylureas and/or metformin. In clinical trials lasting 30 weeks, exenatide therapy was associated with moderate reduction in mean hemoglobin A1c (HbA1c) levels of approximately 0.8%, and an average weight loss of approximately 2 kg compared with baseline. Hypoglycemia was generally mild and occurred more commonly when exenatide was used in conjunction with sulfonylureas. The requirement of subcutaneous injections twice a day, and the frequent occurrence of nausea and vomiting, represent the main limitations of exenatide. Nevertheless, this agent may be a useful add-on therapy in obese diabetic patients with suboptimal control as a result of continuing weight gain and/or severe postprandial hyperglycemia. The introduction of GLP-1-based antidiabetic drugs is a novel and promising strategy to treat diabetes.

Adamantane↗
PubMed2005

Management of erectile dysfunction by the primary care physician.

Erectile dysfunction is common and closely associated with age and risk factors for cardiovascular disease. The oral selective inhibitors of phosphodiesterase type 5 (PDE5) have become the treatments of choice, owing to their convenience, general safety, and broad-spectrum effectiveness. For the same reasons, they have greatly simplified the workup. Thus, the general practitioner has gradually replaced the urologist for the initial management of erectile dysfunction and the proper evaluation of cardiac status before starting treatment with the PDE5 inhibitors. The following review provides a practical approach for the management of erectile dysfunction in primary care.

Cardiovascular Agents↗
PubMed2004

Use of alternative medicine among Hispanics.

OBJECTIVES: To determine the prevalence and patterns of use of alternative medicine among urban Hispanics. DESIGN: A cross-sectional survey. SETTINGS/LOCATION: Churches located in the northern part of Los Angeles and outpatients and inpatients in a county hospital in southern California. SUBJECTS: 179 Hispanic subjects. OUTCOME MEASURES: The following issues related to alternative medicine were evaluated: frequency and reasons for its use; perceived efficacy; safety; costs; sources of information; overall satisfaction; and subject-physician interaction with respect to alternative medicine. RESULTS: Sixty-three percent (63%) of respondents reported using or had used one or more types of alternative medicine. The majority of users were women (75%, 95% confidence interval [CI], 66%-83%). The most commonly reported alternative therapies were herbs (57%, 95% CI 47%-66%), prayer (43%, 95% CI 34%-53%), and dietary supplements (21%, 95% CI 14-30%). Compared to nonusers, users of alternative medicine had significantly lower yearly income, less proficiency in English language, and lower educational level. The main indications for using alternative medicine were pain (61.4%, 95% CI 51%-71%), lack of energy (38.6%, 95% CI 29%-49%), and overweight (22.8%, 95% CI 16%-33%). Only 5.2% of subjects (95% CI 2%-12%) believed that herbs are more effective than medications prescribed by physician. A majority of users (61%, 95% CI 50%-68%) had more confidence in their physicians than in their alternative medicine provider. Forty-five percent (45%) of users (95% CI 34%-56%) believed prescribed medication was safer than alternative medicine, whereas only 7% (95% CI 3%-15%) believed the reverse. Adverse effects related to herbs and dietary supplements were reported by 11 users. The majority of participants (78.9%, 95% CI 69-87%) did not speak to their physicians about alternative therapy. The mean score of overall satisfaction with conventional medicine was significantly higher than with alternative medicine. CONCLUSIONS: Despite the common use of alternative medicine among Hispanics, the majority of users believe that conventional medicine is superior to alternative medicine. There is a significant gap in communication between physicians and patients with respect to alternative medicine.

Adult↗