Social environmental impact of COVID-19 and erectile dysfunction: an explorative review

BACKGROUND

To date, no attempt has been made to collate literature on the relationship between the social environmental impact of COVID-19 and erectile dysfunction. The aim of this explorative review was to assess and compare the prevalence of erectile dysfunction (ED) in male healthcare workers and males during the COVID-19 pandemic.

METHODS

A systematic review of major databases from inception to February 2021 was conducted. Prevalence data were extracted, and a random-effects meta-analysis was undertaken.

OUTCOMES

The pooled prevalence of ED amongst healthcare workers working in COVID-19 specific environments, and non-healthcare during the COVID-19 pandemic.

RESULTS

Of 52 initial studies, six were included for the final analysis. The pooled prevalence of ED in healthcare workers working in a COVID-19 environment was 63.6% (95% CI 20.3-92.3%), and in non-healthcare workers during the COVID-19 pandemic was 31.9% (95% CI 19.5-47.6%).

CONCLUSION

The prevalence of ED in healthcare workers working in COVID-19 environments was higher than representative samples and is of concern. Sexual health (and by extension, overall health), should be a priority when considering ways to care for this population. Considering the social environmental impact of COVID-19 on sexual health and in particular on ED, it is important to provide adequate psychological support systems and to promote quality of life with particular attention to sexual health.

Experiences of Trans and Non-Binary Patients during Medical Transitioning and Associations with the Patient-Physician Relationship in Austria

Background

Trans and non-binary (TNB) patients confront various issues in the healthcare system and with healthcare workers (HCWs) tasked with navigating complex systems to achieve optimal outcomes. The most time intensive and intimate contact TNB patients have is typically with physicians making the physician-patient relationship instrumental. This study aimed to explore the experiences of patient-physician relationship in TNB patients in Austria in order to identify caveats for future interventions.

Methods

We conducted an exploratory cross-sectional study using an online questionnaire consisting of 86 items including the Patient-Doctor Relationship Questionnaire 9 (PDRQ-9) distributed between June and October 2020 through various organizations working with TNB people. Austrian residents older than 18 who self-identified as TNB and were undergoing or finished medical transitioning were included. Descriptive statistics and linear regression models were applied.

Results

From a total of 91 participants, 58.3% identified as trans, 70.3% were assigned female at birth, and 87.7% were on hormone replacement therapy. Most (58.1%) perceived physicians as the most problematic HCWs, and 60.5% reported having never or rarely been taken seriously in healthcare settings. Linear regression model showed that PDRQ-9 score was associated with a diagnosis of a mental illness (beta=3.88, 95%CI 0.24 - 7.51), quality of life (beta=0.66, 95%CI 0.43 - 0.90), never being taken seriously (beta=11.69, 95%CI 2.91 - 20.47) and being misgendered (beta=-7.64, 95%CI -14.88 - -0.41) by HCWs.

Conclusions

TNB patients in Austria reported negative experiences in the healthcare system, mostly with physicians that often did not take their gender identity seriously or used inappropriate language. Future interventions should focus on increasing transgender care competencies across various components of medical education.

Strategies to challenge discrimination and foster inclusivity for LGBT+Q+ youth in workplaces: a qualitative exploratory study in six European countries

Background

Lesbian, gay, bisexual, trans and queer (LGBT+Q+) youth are highly vulnerable to work-based discrimination, which correlates with poor social, physical and mental health. The European Union funded WE-Project aims to empower LGBT+Q+ youth in Europe through work-based educational interventions. The first leg focused on exploring barriers and facilitators to workplace equality in Austria, Croatia, Serbia, Slovakia, Spain and the United Kingdom, gathering experiences of LGBT+Q+ youth and stakeholders.

Methods

Self-identifying LGBT+Q+ 15-26 year-olds were recruited via social media and diverse organisations for semi-structured interviews, while stakeholders from various institutions were invited to participate in focus group discussions based on standardised interview and discussion guidelines. Transcriptions were coded, categorised and thematically analysed, revealing five themes: societal discrimination influencing work-life, experiences of workplace discrimination, barriers to resolve discrimination, facilitators to overcome discrimination and creation of inclusive strategies.

Results

Overall 56 LGBT+Q+ youth interviewees and 38 stakeholders from 6 European countries were recruited. Facilitators overcoming workplace discrimination and inclusive strategies towards work-based equality for LGBT+Q+ youth were varyingly emphasised and included: clear policies, open communication, staff involvement and inclusive infrastructure, LGBT+Q+ quotas as well as education on diversity in schools and increasing visibility, legal recognition of partnerships, implementing youth centres, and access to counselling.

Conclusions

Results indicate several strategies to consider when designing interventions challenging work-based discrimination of LGBT+Q+ youth. Participating countries differ in social acceptance and legal protections of LGBT+Q+ youth, but experiences and voiced issues are similar, necessitating relevant anti-discrimination interventions throughout Europe.

Amide proton transfer-weighted MRI in the clinical setting - correlation with dynamic susceptibility contrast perfusion in the post-treatment imaging of adult glioma patients at 3T

INTRODUCTION

We investigated the correlation between amide proton transfer-weighted magnetic resonance imaging (APTw MRI) and dynamic susceptibility contrast (DSC) perfusion in order to assess the potential of APTw MRI as an alternative to DSC in adult brain tumor (glioma) imaging.

METHODS

After Ethical Committee approval, forty adult patients, treated for histopathologically confirmed glioma (World Health Organization (WHO) grade II-IV), were prospectively imaged at 3 Tesla (3 T) with DSC perfusion and a commercially available three-dimensional (3D) APTw sequence. Two consultant neuroradiologists independently performed region of interest (ROI) measurements on relative cerebral blood volume (rCBV) and APTw maps, co-registered with anatomical images. The correlation APTw MRI-DSC perfusion was assessed using Spearman's rank-order test. Inter-observer agreement was evaluated by the intraclass correlation coefficient (ICC) and Bland-Altman (BA) plots.

RESULTS

A statistically significant moderately strong positive correlation was observed between maximum rCBV (rCBV_max) and maximum APTw (APTw_max) values (observer 1: r = 0.73; p < 0.01; observer 2: r = 0.62; p < 0.01). We found good inter-observer agreement for APTw_max (ICC = 0.82; 95% confidence interval (CI) 0.66-0.90), with somewhat broad outer 95% CI for the BA Limits of Agreement (LoA) (-1.6 to 1.9). ICC for APTw_max was higher than ICC for rCBV_max (ICC = 0.74; 95%; CI 0.50-0.86), but the difference was not statistically significant.

CONCLUSION

APTw_max values correlate positively with rCBV_max in patients treated for brain glioma. APTw imaging is a reproducible technique, with some observer dependence. Results need to be confirmed by a larger population analysis.

IMPLICATIONS FOR PRACTICE

APTw MRI can be a useful addition to glioma follow-up imaging and a potential alternative to DSC perfusion, especially in patients where contrast agent is contraindicated.

Associations between workplace characteristics and “outness” in LGBTIQ workers in Austria

Introduction

Lesbian, gay, bisexual, transgender, intersex, and queer (LGBTIQ) individuals are often subjected to negative attitudes at the workplace, which may lead to non-disclosure of their sexual and/or gender identities. We aimed to determine the prevalence of workplace disclosure of sexual or gender identity (i.e. “outness”; being “out”) and to examine its associations with workplace characteristics in LGBTIQ workers in Austria.

Methods

Sociodemographic, work- and wellbeing-related data were gathered using an online questionnaire between February and June 2017. From the initial 1268 respondents, 1054 (83%) provided complete data and were included in the analysis.

Results

Participants were mostly 26-35 years old (39.1%), educated (43.9% tertiary level), urban (53.8%), cisgender gay men (40.0%) with a full-time employment (63.9%). Overall, 51.7% were “out” at the workplace. Being bisexual (OR = 0.46, 95%CI 0.27-0.81), having anti-discrimination guidelines (OR = 0.53, 95%CI 0.32-0.90), living alone (OR = 0.50, 95%CI 0.32-0.79 and in shared households (OR = 0.49, 95%CI 0.25-0.96) were associated with lesser likelihood of being “out” at work. Furthermore, being “out” at work was associated with middle age (36-45-year-olds; OR = 1.74, 95%CI 1.07-2.85), duration of employment &gt;10 years (OR = 2.03, 95%CI 1.08-3.81), LGBT friendly work environment (OR 1.61, 95%CI 1.36-1.91), anti-discrimination policies enacted (OR = 2.02, 95%CI 1.23-3.32), and work council protections (OR = 1.56, 95%CI 1.04-2.36).

Conclusions

Approximately half of participants reported being “out” at work. An LGBTIQ-friendly work environment, presence of work council protections and of enacted anti-discrimination policies were linked with higher workplace outness. Instating discrimination protections might facilitate “outness” and therefore visibility of LGBTIQ workers, leading to better health outcomes and productivity.

Unexpected abundance and long-term relative stability of the brown alga Cystoseira amentacea, hitherto regarded as a threatened species, in the north-western Mediterranean Sea

Cystoseira amentacea is a Mediterranean endemic alga thriving on very shallow rocky substrates. It has been considered as a threatened species, having experienced a steady decline and is therefore protected by international conventions. The historical distribution of the species has been assessed along the French Mediterranean coast, on the basis of 467 articles and herbarium vouchers. We have produced an accurate map of its current distribution and abundance along 1832 km of coastline, through in situ surveys. C. amentacea was observed along 1125 km of shoreline, including 33% of almost continuous or continuous belt. In most of its range, there is no evidence of loss, except in 4 areas of Provence, French Riviera and Corsica. A significant relation was found between the absence or low abundance of C. amentacea and the vicinity of ports and large sewage outfalls. The status of conservation of the species should therefore be reassessed.

Is lymphocytic thyroiditis a unique type or merely a type of Hashimoto's thyroiditis?

AIM

Objective of the study was to clarify the role of apoptosis in the pathogenesis of lymphocytic thyroiditis (LT) and the existence of difference between Hashimoto's thyroiditis (HT) and LT.

METHODS

We evaluated levels of antithyroglobulin and antithyroperoxidase antibodies, the apoptosis by in situ Cell Death Detection-TUNEL and the expression of Bcl2 and Bax by immunohistochemistry in thyroid tissues from 16 patient with HT, 10 with LT and 10 with euthyroid goiter-EG (control group).

RESULTS

It was found that apoptosis of thyrocytes in HT (mean 3.05%, SD 1.29%) and LT (mean 2.70%, SD 1.17%) was statistically significantly higher than EG (mean 0.56%, SD 0.23%), but the difference in the percentage of thyrocytes between HT and LT was not statistically significant. In HT the percentage of apoptotic infiltrating lymphocytes (mean 0.59%, SD 0.23%) was smaller than in EG (mean 2.26%, SD 1.42%), but it showed no significant difference in comparison to LT. The expression of Bax in infiltrating lymphocytes in HT (mean 0.72%, SD 0.34%) was statistically significantly higher than LT (mean 0.11%, SD 0.06%). The level of thyroglobulin was lower in HT compared to LT (P<0.01) and compared to EG (P<0.01). The level of antithyroglobulin/antithyroperoxidase antibodies was higher in HT compared to LT (P<0.01) and compared to EG (P<0.01). There was no statistically significant difference in the level of thyroglobulin and level of antibodies between LT and EG.

CONCLUSION

These results suppose that apoptosis represents one of significant mechanisms in the pathogenesis of both HT and LT and that LT probably differs from HT.

Effects of Bleaching Agents on Human Enamel Light Reflectance

In dental bleaching, the micromorphological alterations of hard tissues have been well investigated, but little is known about the optical changes involved. The results of the current study showed that enamel, irrespective of maturation, is subjected to a shift in reflectance towards blue within the color space and enhanced reflection. This effect was demonstrated in different bleaching agent concentrations and protocols.

Fractures of the capitellum: a new method of fixation using a maxillofacial plate

Isolated capitellar fractures are rare, intraarticular fractures requiring an aggressive management regimen. Several treatment options have been described for the Type 1 fracture. A new technique of direct anatomic reduction and fixation of the fracture using a maxillofacial plate is reported. Advantages of this new technique are highlighted, and results with its use in treating patients of all ages are described.

Socket wear in bilateral simultaneous total hip arthroplasty

A total of 51 patients with bilateral simultaneous Charnley total hip arthroplasties were studied for wear behavior. The mean observation time was 14.7 years. Fourteen hips had been revised during follow-up. The mean wear rate was 0.071 mm/y for left hips and 0.081 mm/y for right hips. There were considerable side differences for individual patients and little agreement between the wear measurements of left and right hips. Linear wear was increased in men, in patients with high body weight. Linear wear after hip arthroplasty is not side related.

Polyethylene wear and calcar osteolysis

We have examined retrospectively the correlation between linear wear of the polyethylene socket and calcar height loss (osteolysis) in 266 patients with 410 total hip arthroplasties who were followed up for a minimum of 10 years. A positive correlation existed between wear and osteolysis. The correlation was stronger in patients with osteoarthrosis. Simultaneous bilateral hip arthroplasty showed no difference in the relationship between polyethylene wear and calcar height loss when comparing the right and left hip. There was poor correlation between calcar height loss and wear in patients with rheumatoid arthritis. Our findings support the theory that femoral osteolysis in the total hip arthroplasty is related to the amount of liberated particles generated by the wear of components. The poor correlation found in cases with rheumatoid arthritis could be related to suppression of the immune response in these patients.

Migration and wear of long-term successful Charnley total hip replacements

We analysed in-vivo migration and wear over a long period of all-polyethylene acetabular cups which had not been affected by mechanical loosening. The selection criteria of regular radiological follow-up, good clinical outcome (Charnley score of 5 or 6), continued walking without crutches and no radiological signs of loosening of the acetabular cups were fulfilled by 25 Charnley total hip arthroplasties.

Mean migration, measured by the Nunn method, was 0.6 mm in the medial and 0.2 mm in the cranial direction. The mean yearly rate of wear was 0.05 mm and 0.04 mm, with six and two cups having no detectable wear, as measured by the Livermore and Charnley-Cupic methods, respectively. The maximal detected wear was 3.7 mm. There were no changes in the rate of wear with time. Computerised Ein Bild Röntgen Analyse (single-image radiological analysis) measurements of 20 hips indicated plastic deformation of the cups.

We conclude that long-term successful cups do not migrate and have a very low rate of wear which was not affected by ageing of the polyethylene. There was no evidence that polyethylene wear alone caused mechanical loosening of the cup but high rates of wear seem to have an adverse prognostic value in terms of the long-term survival of the prosthesis.

Migration and wear of long-term successful Charnley total hip replacements

We analysed in-vivo migration and wear over a long period of all-polyethylene acetabular cups which had not been affected by mechanical loosening. The selection criteria of regular radiological follow-up, good clinical outcome (Charnley score of 5 or 6), continued walking without crutches and no radiological signs of loosening of the acetabular cups were fulfilled by 25 Charnley total hip arthroplasties. Mean migration, measured by the Nunn method, was 0.6 mm in the medial and 0.2 mm in the cranial direction. The mean yearly rate of wear was 0.05 mm and 0.04 mm, with six and two cups having no detectable wear, as measured by the Livermore and Charnley-Cupic methods, respectively. The maximal detected wear was 3.7 mm. There were no changes in the rate of wear with time. Computerised Ein Bild Röntgen Analyse (single-image radiological analysis) measurements of 20 hips indicated plastic deformation of the cups. We conclude that long-term successful cups do not migrate and have a very low rate of wear which was not affected by ageing of the polyethylene. There was no evidence that polyethylene wear alone caused mechanical loosening of the cup but high rates of wear seem to have an adverse prognostic value in terms of the long-term survival of the prosthesis.

Prognosis of dislocation after total hip arthroplasty

One hundred sixty-one dislocations after cemented total hip arthroplasty, with a mean follow-up period of 8 years after dislocation, were reviewed with the aim of establishing the prognosis. There were 84% single and 16% recurrent dislocations. Closed reduction was successful in 81% of cases. Thirty-seven percent of dislocations were early (within 5 weeks), 36% occurred in patients who had had previous surgery, and in 47% there was nonunion of the trochanter. There was a two-way interaction between these factors, and all factors were significant for recurrent dislocation. Twenty-six (16%) recurrent dislocations required surgery. The most common causes of recurrent dislocation demonstrated at operation were component malposition (58%) and failure of the abductor mechanism (42%). In total, 96% of cases were successfully treated.

Antigen/antibody content of circulating immune complexes in HIV-infected patients

Dual infection with HIV and hepatitis B virus (HBV) is not an uncommon feature. Immunity impairment due to HIV infection can be the cause of a higher rate of HBV replication with less intensive liver damage and less effective immune response to HBV. Many HIV-infected patients have an elevated level of circulating immune complexes (CIC) in serum, throughout all stages of illness evolution. The aim of our study was to estimate p24 and HBsAg content of CIC in dually infected patients, and the prevalence of major classes of complexed antibodies (IgM and IgG). We examined 146 samples of sera from 105 HIV positive patients of the Institute for Infectious and Tropical Diseases during 1992 and 1993. On those sera we performed p24Ag and HbsAg detection, with and without prior dissociation of CIC, we determined serum level of CIC and immunoglobulin classes IgM and IgG level in sera and in polyethilenglycol (PEG) precipitates of sera. Acid dissociation of immune complexes revealed a high proportion of HIV antigen positive sera in all stages of HIV disease progression. HbsAg in serum of HIV positive patients was also found coupled in immune complexes much more frequently than in the HIV negative control group. In many instances both antigens were simultaneously found coupled in CIC. Immune complexes detected have been shown to contain both IgM and IgG immunoglobulins, while IgM antibodies were associated to immune complexes in higher proportion than IgG, compared to total serum immunoglobulins.

Total knee arthroplasty after patellectomy

We compared the outcome of total knee arthroplasty in 19 patients who had had previous patellectomy with the results in a matched series of arthroplasties performed on knees in which the patella was intact. The mean follow-up was 63 months (21 to 114). In the study group, the outcome was poor in five patients. There was instability in the coronal plane in three patients and persistent pain in four. Three supracondylar fractures occurred. The overall complication rate was 36%. In the control group, pain was relieved in every case and there were no complications. Total knee arthroplasty has a higher complication rate and inferior results if the knee has undergone prior patellectomy.

Total knee arthroplasty after patellectomy

We compared the outcome of total knee arthroplasty in 19 patients who had had previous patellectomy with the results in a matched series of arthroplasties performed on knees in which the patella was intact. The mean follow-up was 63 months (21 to 114). In the study group, the outcome was poor in five patients. There was instability in the coronal plane in three patients and persistent pain in four. Three supracondylar fractures occurred. The overall complication rate was 36%. In the control group, pain was relieved in every case and there were no complications. Total knee arthroplasty has a higher complication rate and inferior results if the knee has undergone prior patellectomy.

Frog virus 3 morphogenesis: effect of temperature and metabolic inhibitors

The different stages of frog virus 3 (FV 3) morphogenesis have been investigated in chick embryo fibroblasts infected at an optimal temperature for virus growth (29 degrees C). The metabolic requirements for morphogenesis were determined by adding inhibitors of macromolecular synthesis at different periods in the virus growth cycle. The effect of a non-permissive temperature for FV 3 replication (37 degrees C) was also studied in shift up experiments. The following results were obtained: (I) when DNA replication was inhibited, neither immature nor mature virus particles appeared; (2) continuous protein synthesis was required for every stage of virus morphogenesis. However, the assembly of virions into paracrystalline arrays seemed to be a passive phenomenon. (3) Continuous mRNA transcription was not necessary for assembly of capsid constituents, although most of these capsids appeared empty; there was also a striking increase in the number of aberrant virus structures. (4) If infected cells were shifted to a non-permissive temperature, virus maturation was completely inhibited.

[New data on the structure and the budding of FV3 (frog virus 3) (author's transl)]

The freeze-etching technique when applied to FV3 suspensions revealed the perfectly icosahedral structure of the viral nucleocapsids. This allowed a fine substructure suggesting the existence of numerous subunits of small dimensions to be detected at their surface. Observations of the replicas of infected cells obtained by freeze-etching revealed modifications of the external face of the cytoplasmic membrane occurring at the level of the budding viral particles; in these zones parallel stripes appeared, whose elementary structure is constant (13,5 nm). Observations of the infected cells with the scanning microscope enabled the spreading of the budding process on all the cells of a same culture to be studied. By counting the number of budding particles per mum2, it was possible to demonstrate the heterogeneity of the budding process at the surface of the cells.