Use Of Sildenafil Research Articles

Placental histopathology in early-onset fetal growth restriction with use of sildenafil, a secondary analysis of the Dutch STRIDER study.

ObjectivesPlacental pathology lesions are common in early-onset fetal growth restriction (eoFGR). Therapeutic interventions to improve eoFGR outcomes are needed. In the international STRIDER trials (Sildenafil Therapy In Dismal prognosis Early-onset intrauterine growth Restriction) sildenafil didn’t improve perinatal outcomes of eoFGR. We aimed to study the underlying placental pathology in the Dutch STRIDER trial and the effects of sildenafil on placental histopathology by describing the associations with sildenafil treatment, placental-dysfunction serum biomarkers and markers of oxidative stress. MethodsThe Dutch STRIDER trial was a randomized controlled trial of sildenafil versus placebo in 216 singleton pregnancies complicated by eoFGR, included between 20+0- and 29+6-weeks’ gestation. In 158 cases, placental histology was available. Lesions were classified independently by three perinatal pathologists blinded for clinical data, according to the international criteria of the Amsterdam Placental Workshop Group Consensus Statement. Blood samples taken at inclusion were analyzed for free thiols (FT), placental growth factor (PlGF) and soluble FMS-like tyrosine kinase-1 (sFlt-1, n=85). ResultsThe ‘big four’ placental lesions (maternal and fetal vascular malperfusion, and chronic or acute inflammatory lesions) were equally distributed in both groups. However, massive perivillous fibrin deposition (MPFD) and chronic histiocytic intervillositis (CHIV) were less common in the sildenafil-treated group compared to the placebo-treated group (p=0.026 and p=0.043). FT, PlGF and sFlt-1 at inclusion were not discriminative for placental lesions. ConclusionsSildenafil had no effect on common placental lesions. The lower incidence of MPFD and CHIV after sildenafil exposure merits more research on the interaction between sildenafil and the immune system.

Benefits of Tadalafil and Sildenafil on Mortality, Cardiovascular Disease, and Dementia

BackgroundErectile dysfunction and lower urinary tract symptoms, from benign prostatic hyperplasia and bladder neck obstructions, are prevalent in men and associated with an increased risk of cardiovascular diseases. Phosphodiesterase-5 (PDE-5) inhibitors, such as tadalafil and sildenafil, are used to treat erectile dysfunction and may also offer cardiovascular benefits due to their vasodilatory effects. This study evaluates the impact of these PDE-5 inhibitors on all-cause mortality, cardiovascular disease, and dementia in middle-aged men with erectile dysfunction and lower urinary tract symptoms over a 3 year follow-up period. MethodsThis longitudinal study analyzed data from 50 million US men using the TriNetX database. Men at least 40 years of age prescribed tadalafil or sildenafil after an erectile dysfunction diagnosis, or tadalafil after lower urinary tract symptom diagnoses, from 2004 to 2021 were included. Three-year outcomes assessed included all-cause mortality, cardiovascular disease, and dementia, comparing men on PDE-5 inhibitors to those not on these medications. Propensity matching was performed for demographics and eight pre-existing conditions. ResultsThe final cohort included 509,788 men with erectile dysfunction and 1,075,908 with lower urinary tract symptoms. Tadalafil and sildenafil were associated with significantly reduced risks of all-cause mortality (RR 0.66/0.76), myocardial infarction (0.73/0.83), stroke (0.66/0.78), venous thromboembolism (0.79/0.80), and dementia (0.68/0.75) in erectile dysfunction patients, with tadalafil showing more significant benefits. In lower urinary tract symptom patients, tadalafil was similarly associated with reduced mortality, cardiovascular disease, and dementia. ConclusionsIn conclusion, tadalafil and sildenafil use in erectile dysfunction patients reduced mortality, cardiovascular disease, and dementia risks, with tadalafil providing more benefits. Tadalafil also conferred similar benefits to patients with lower urinary tract symptoms.

Issue of recreational use of sildenafil

Introduction and purposeErectile dysfunction (ED) is defined as the inability to achieve and maintain an erection sufficient for satisfactory sexual intercourse. Sildenafil is one of the most popular medications used to treat ED, but in recent years, there has been a growing trend of recreational use of this drug, particularly among younger individuals, which can lead to numerous negative health consequences. The aim of this article is to provide an overview of the recreational use of sildenafil, especially among younger individuals.State of knowledgeSildenafil primarily affects the smooth muscle of the blood vessels in the corpora cavernosa, facilitating the achievement and maintenance of an erection. The most common side effects of sildenafil include headaches, dizziness, facial flushing, nausea, muscle pain, and nasal congestion. A relatively rare but potentially severe side effect of sildenafil is priapism. It is noted that those using sildenafil recreationally often have multiple sexual partners, as the drug helps them prolong sexual encounters. Studies show that sildenafil is used by groups that should have no problem achieving sexual satisfaction. The use of the drug in combination with alcohol and other substances is noticeable.ConclusionsRecreational use of sildenafil appears to be an increasingly common behavior among young men who do not have difficulties achieving or maintaining an erection. There are no studies yet that specifically examine the recreational use of sildenafil among women. It is necessary to conduct further research to better understand the prevalence of this phenomenon and to identify the factors that predispose individuals to engage in recreational use of sildenafil.

Sildenafil as Bridge Therapy for Inhaled Nitric Oxide in Preterm Neonates

OBJECTIVE Inhaled nitric oxide (iNO) is a mainstay of treatment for infants with persistent pulmonary ­hypertension. However, abrupt discontinuation of inhaled nitric oxide can result in rebound pulmonary ­hypertension. The objective of this analysis is to describe the use of sildenafil to facilitate the weaning from iNO in preterm neonates. METHODS This retrospective chart review identified all infants who were receiving iNO and subsequently received sildenafil between 2017 and 2021. Neonates were included if they met the following criteria: gestational age at birth less than 34 weeks, receiving iNO, and started on sildenafil with the indication to facilitate weaning or discontinuation of iNO. Patients were excluded if they had major congenital anomalies, including congenital heart disease or congenital diaphragmatic hernia. RESULTS We identified 7 neonates with a gestational age range of 22 5/7 weeks to 31 0/7 weeks and birth weight range of 545 to 910 g with previously failed attempts at iNO weaning. The most common starting dose for sildenafil was 0.125 mg/kg intravenously every 8 hours or 0.25 mg/kg enterally every 8 hours. Four infants were able to discontinue iNO within 48 hours of sildenafil initiation, 1 patient discontinued iNO within 5 days, and 1 patient within 10 days of sildenafil initiation. One patient experienced weaning failure from iNO despite initiation of sildenafil. No adverse events, such as hypotension or deaths, were reported in any of the 7 infants. CONCLUSIONS Sildenafil facilitated weaning off iNO in most preterm neonates evaluated without adverse side effects.

SILDENAFIL DECREASED TNF-α AND IL-6 LEVELS IN CD‐INDUCED ACUTE TOXICITY

Objective: This study aimed to evaluate the effects of sildenafil (SIL) on inflammation and histopathological changes in cadmium (Cd)-induced toxicity in female rats. Material and Method: Interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF- α) levels were measured to assess the degree of inflammation. Histopathological changes in the liver, lungs and kidneys were also assessed. Result and Discussion: SIL significantly reduced the cellular release of TNF-α and IL-6, which have been implicated in the pathogenesis of Cd-induced tissue damage. When SIL was administered alone, it showed histopathological effects similar to the control group. However, it was found that co-administration of SIL with Cd prevented portal vein dilation and central vein enlargement in the liver, prevented necrosis in kidney tissue, but did not affect the lung. Although SIL has variable protective effects on tissues, our results are in support of the idea that the use of SIL in tissue damage management can be investigated for its efficacy in modulating oxidative stress-induced proinflammatory cytokine activation in vivo and ultimately help prevent Cd-induced tissue damage. Our study has shown that SIL can reduce Cd-induced acute toxicity in rats. SIL may be use as a protective agent against toxicity of heavy metals.

Safety assessment of sildenafil use in neonates: a real-world data analysis based on the FDA adverse event reporting system (FAERS)

ABSTRACT Background The safety of neonatal sildenafil use remains uncertain. This study aimed to investigate adverse events (AEs) associated with sildenafil use in neonates. Research design and methods We collected data on AEs associated with sildenafil use in neonates from the US Food and Drug Administration Adverse Event Reporting System database, spanning from its inception of the database in 2004 to 2023. Disproportionality measures were employed to analyze the correlation between AEs and sildenafil. Results Sildenafil was identified as the primary suspect drug in 75 AE reports, involving 214 AEs. Three system organ classes, namely, eye disorders, hepatobiliary disorders, and vascular disorders were associated with sildenafil use. Six preferred terms, namely, flushing, retinopathy of prematurity, hyperbilirubinemia, pulmonary hemorrhage, hypotension, and diarrhea were associated with sildenafil use. Notably, hyperbilirubinemia and pulmonary hemorrhage were previously unreported AEs associated with sildenafil use. Conclusion The results highlight the ongoing uncertainty surrounding the safety of neonatal sildenafil use and provide vital support for risk monitoring and identification in neonates receiving sildenafil. Additionally, the study underscores the need for continuous safety surveillance in neonates treated with sildenafil and suggests further exploration of the precise causal relationships between AEs and sildenafil.

Retrospective study of preterm infants exposed to inhaled nitric oxide in Kaiser Permanente Southern California: morbidity, mortality and follow-up.

Describe characteristics of preterm infants exposed to inhaled nitric oxide (iNO) in Kaiser Permanente Southern California. Case review of preterm infants <34-weeks exposed to iNO during 2010-2020 including respiratory and echocardiographic status, NICU course, and 12-month follow-up. 270 infants, 2.63% of births<34 weeks, (median, range: 26.1, 225/7-336/7 weeks gestation) were exposed to iNO. Median FiO2 at iNO initiation was 1.0 (IQR 0.94-1.0). Pulmonary hypertension (PH) was not associated with risk-adjusted 2 h oxygenation response or improved survival. Mortality to NICU discharge was 37.4%. Median cost of iNO was $7,695/patient. Discharged survivors experienced frequent rehospitalization (34.9%), use of supplemental oxygen, sildenafil, diuretics, bronchodilators, and steroids. Four infants had persistent PH. Five infants died after NICU discharge. Preterm infants receiving iNO have high mortality and 1st year morbidity. As currently used, iNO may be an indicator of respiratory diseaseseverity rather than mediator of improved outcomes.

One mechanism of sudden sensorineural hearing loss after sildenafil and sexual activity

Objectives A case of sudden sensorineural hearing loss following use of sildenafil was examined in detail over a period of three days from first report to recovery. Design Case study. The subject presented with sudden sensorineural hearing loss and diplacusis a day after onset. Testing involved detailed interview, standard audiometry, detailed inter-octave audiometry, and measurement of detailed psychophysical frequency tuning curves during a two day recovery period. Study Sample One male aged in his thirties with otherwise normal hearing. Results Although standard audiometry was within normal limits, detailed inter-octave audiometry and psychophysical frequency tuning curves were consistent with a punctate unilateral intra-cochlear lesion that resolved over a period of three days. Conclusions This is the first report of such a frequency-specific audiometric shift and diplacusis after sildenafil, and is not consistent with previous reports of direct ototoxic pharmacological effects. We propose that the lesion was most likely caused by a cochlear bleed, and may have been due to physical exertion rather than a direct pharmaceutical effect. The study highlights the important role of additional diagnostic testing that can be easily achieved in a clinical setting with minimal equipment

(092) SEXUAL EXPERIENCES IN AN EXPLORATORY, PHASE 2B, RANDOMIZED, DOUBLE-BLIND, PLACEBO-CONTROLLED CLINICAL TRIAL OF SILDENAFIL, 3.6% CREAM FOR THE TREATMENT OF FEMALE SEXUAL AROUSAL DISORDER

Abstract Introduction Quantifying the change in the mean number of satisfactory sexual experiences (SSEs) is an efficacy endpoint recommended by the US Food and Drug Administration in studies of treatments for female sexual dysfunctions (FSD), including female sexual arousal disorder (FSAD). Objective Post-hoc analysis of sexual experiences in a study of Sildenafil Cream, 3.6% for treatment of FSAD Methods Phase 2b, exploratory, randomized, placebo-controlled, double-blind study of Sildenafil Cream, 3.6% among premenopausal women with FSAD (NCT04948151). Following a baseline, single-blind, placebo, run-in period, participants were randomized and used investigational product (IP) at home for 12 weeks. Between monthly, in-clinic assessments, participants answered questions in an electronic diary (eDiary), within 24-hours of each sexual experience. Sexual experiences were categorized as “Partnered” versus “By Myself” and “Satisfactory” versus “Not Satisfactory”. eDiary question 11 (Q11) asked “Were conditions appropriate for satisfactory sexual activity (enough time, no distractions, etc.)?”. Changes from baseline in the mean number of SSEs was a secondary efficacy endpoint. The Orgasm domain (questions 22-24) of the Sexual Function Questionnaire (SFQ28) was an exploratory efficacy endpoint. Un-partnered women and women with sexual partners who did not sign informed consent were enrolled in the study, but in these cases (n=15), IP was only used in solo sexual experiences. Results Sildenafil Cream users had more sexual experiences and more un-partnered sexual experiences during the double-blind treatment period compared to Placebo Cream users. Sildenafil Cream users were significantly more likely to engage in sexual experiences even when conditions were not appropriate for a satisfactory experience. Although, the change from baseline in the mean number of SSEs at week 12 decreased during solo, un-partnered sexual experiences for both product groups (-0.12±0.27 for Sildenafil versus -0.04±0.32 for Placebo, p=0.85), during the double-blind treatment period, Sildenafil Cream users reported significantly higher proportions of SSEs during un-partnered sexual experiences (197/261, 75.5%) compared to Placebo users (116/187, 62.0%) (p=0.002). Despite Sildenafil Cream users engaging in a sexual experience more frequently when conditions were not appropriate, the proportion of SSEs during these events when Q11=“No” were not different between active (17/59, 28.8%) versus placebo (8/25, 32.0%) users (p=0.77). Finally, un-partnered women and women with un-enrolled sexual partners, who by definition had only solo sexual experiences, had an increase from baseline in their SFQ Orgasm at week 12 with Sildenafil use (2.58±1.13) versus Placebo users in this subset, who had decreases in this score (-0.34±1.13) (p=0.13). Conclusions These data support that Sildenafil Cream 3.6% enhanced solo, un-partnered sexual experiences, which represented approximately 1 in 5 events in this FSAD treatment study. Disclosure Yes, this is sponsored by industry/sponsor: Dare Bioscience and Strategic Science and Technologies LLC Clarification: Industry initiated, executed and funded study Any of the authors act as a consultant, employee or shareholder of an industry for: Dare Bioscience and Strategic Science and Technologies LLC.

Social Perceptions of Masculinity and Sexual Esteem Are Impacted by Viagra Use, Testosterone, and Sexual Performance.

Sexual behaviors play a role in the social construction of masculinity. Moreover, this stereotype has been capitalized upon by pharmaceutical companies, as well as those that sell products not approved by the U.S. Food and Drug Administration, for purposes of marketing sexual medicines. Stereotypical notions of masculinity, however, also emphasize the importance of self-reliance, which may cause some to look unfavorably upon the use of sexual medicine. Consistent with this notion, a male target was viewed as more masculine when his female partner consistently reached orgasm, unless he had no history of erectile dysfunction (ED), but was taking Viagra anyway (Experiment 1; N = 522). In addition, when his partner consistently reached orgasm, ratings of his sexual esteem were also lower if he used Viagra than if he did not, but only if he had no history of ED. In Experiment 2 (N = 711), although there was no effect of a male target's use of testosterone, social perception of his masculinity and sexual esteem increased as his "natural" levels of testosterone increased. In addition, exploratory analysis revealed that if the male target had low (but not normal or high) "natural" levels of testosterone, ratings of his masculinity were higher if his female partner consistently had an orgasm, which suggests that female orgasm served to "rescue" masculinity. Because expectations about drugs drive their use, it is important to address preconceived notions about the use of sexual medicines for purposes of enhancing masculinity and sexual esteem, as the social perception of their use is much more complex.

Tailoring of Bilosomal Nanogel for Augmenting the Off-Label Use of Sildenafil Citrate in Pediatric Pulmonary Hypertension.

Pediatric pulmonary hypertension is a serious syndrome with significant morbidity and mortality. Sildenafil is widely used off-label in pediatric patients with pulmonary arterial hypertension. In this study, bile salt-stabilized nanovesicles (bilosomes) were screened for their efficacy to enhance the transdermal delivery of the phosphodiesterase type 5 inhibitor, sildenafil citrate, in an attempt to augment its therapeutic efficacy in pediatric pulmonary hypertension. A response surface methodology was implemented for fabricating and optimizing a bilosomal formulation of sildenafil (SDF-BS). The optimized SDF-BS formulation was characterized in terms of its entrapment efficiency (EE), zeta potential, vesicle size, and in vitro release profile. The optimized formula was then loaded onto hydroxypropyl methyl cellulose (HPMC) hydrogel and assessed for skin permeation, in vivo pharmacokinetics, and pharmacodynamic studies. The optimized SDF-BS showed the following characteristic features; EE of 88.7 ± 1.1%, vesicle size of 185.0 + 9.2 nm, zeta potential of -20.4 ± 1.1 mV, and efficiently sustained SDF release for 12 h. Skin permeation study revealed a remarkable improvement in SDF penetration from bilosomal gel compared to plain SDF gel. In addition, pharmacokinetic results revealed that encapsulating SDF within bilosomal vesicles significantly enhanced its systemic bioavailability (∼3 folds), compared to SDF oral suspension. In addition, pharmacodynamic investigation revealed that, compared to plain SDF gel or oral drug suspension, SDF-BS gel applied topically triggered a significant elevation (p < 0.05) in cGMP serum levels, underscoring the superior therapeutic efficacy of SDF-BS gel. Conclusively, bilosomes can be viewed as a promising nanocarrier for transdermal delivery of SDF that would grant higher therapeutic efficiency while alleviating the limitations encountered with SDF oral administration.

Effect of lazaroid U-74389G and Sildenafil, alone or in combination, on pulmonary function during ischamia-reperfusion injury of myocardium: An exploratory study

Background: This experimental study was designed to evaluate the effects of the pharmaceutical substances U-74389G (Lazaroid) and Sildenafil, administered separately or in combination, during anaesthesia in relation to pulmonary function, in a myocardial ischaemia-reperfusion procedure. Methods: We sought to determine the effect of sildenafil and lazaroid U-74389G maleate, alone or in combination, on systemic and pulmonary tissue inflammation and oxidative stress in a pig model of myocardial ischaemia-reperfusion injury. A total of 56 pigs were divided into seven groups according to the use of sildenafil, lazaroid, or their combination, and the time of administration (prior to the induction of myocardial ischaemia or after reperfusion). Results: Both sildenafil and lazaroid U-74389G maleate, administered either 10 minutes before the induction of myocardial ischaemia or immediately after the start of reperfusion, resulted in a significant effect on several markers of systemic inflammation (p&lt;0.05). In addition, a significant reduction in lung tissue expression of tumour necrosis factor-alpha (TNF-a) (p&lt;0.05) was observed with sildenafil, lazaroid U-74389G maleate, and their combination, when administered either before the induction of myocardial ischaemia or after the induction of reperfusion. However, no effect on tissue oxidative stress was demonstrated. Conclusion: Sildenafil, lazaroid U-74389G maleate, and their combination led to a significant amelioration of both systemic and pulmonary tissue-specific inflammatory responses. Notably, they did not exert any significant effect against tissue oxidative stress in this model. Human mechanistic studies are required to confirm these observations.

(PM-17) THE ROLE OF PHOSPHODIESTERASE-5 INHIBITORS IN THE TREATMENT OF COMPLEX PENILE WOUNDS: A CASE REPORT AND LITERATURE REVIEW

Abstract Introduction/Objective Phosphodiesterase-5 inhibitors (PDE5i) are traditionally employed for the management of erectile dysfunction and lower urinary tract symptoms. However, their role in the healing of complex penile wounds remains scarcely discussed. This study aims to describe the case of a 27-year-old man who suffered from penile strangulation, treated with sildenafil. Additionally, a literature review concerning the use of PDE5i for the treatment of complex penile injuries will be conducted. Methods A 27-year-old man presented to the emergency room after a self-induced penile strangulation using a ring placed at the base of the penis. Extensive necrosis of the corpus cavernosum was identified through magnetic resonance imaging. Considering the psychosocial implications of penile amputation, organ preservation was chosen, and conservative treatment with sildenafil and daily local dressings was initiated. Thirty days after admission, Doppler ultrasound revealed symmetrical corpus cavernosum with normal echogenicity and usual blood flow patterns. Subsequently, the patient underwent superficial necrotic tissue debridement followed by partial skin grafting in a second stage, leading to hospital discharge after 55 days of hospitalization. Results PDE5 inhibitors enhance nitric oxide bioavailability, promoting vasodilation and improved tissue oxygenation, thereby facilitating various phases of the healing process. Evidence indicates their benefit in microvascular perfusion in skin and soft tissues. Reports suggest satisfactory outcomes of topical PDE5i application in radiation-induced lesions, implying their role in epidermal cell expansion, reduction of inflammatory infiltrates, enhanced vascularization, and decreased collagen deposition. Conclusion This study presents a successful case of sildenafil use in treatment of a complex penile wound, shedding light on an unconventional application of PDE5i. Financing No conflict.

Intracerebral Haemorrhage after Illicit Use of Sildenafil: A Case Report

Sildenafil(viagra) has become one of the top selling over the counter product for the treatment of male erectile dysfunction.(1) We report a case of 34year male patient admitted in our ICU with history of severe headache followed by sudden loss of consciousness after ingestion of two tablets of sildenafil(50mg) land up intracerebral bleed and died. There are many cases in the literature reporting intracerebral or subarachnoid haemorrhage associated with use of sildenafil while sexual contact.

Association of sildenafil use with age-related macular degeneration: a retrospective cohort study

ObjectiveDespite significant advances in clinical care and understanding of the underlying pathophysiology, age-related macular degeneration (AMD)—a major cause of global blindness—lacks effective treatment to prevent the irreversible degeneration of photoreceptors...

Effects of combination of tramadol and sildenafil citrate (Viagra) on hepatic and renal function parameters in Male Albino Rats

Erectile dysfunction, premature ejaculation and pleasure seeking have increased the use of sildenafil citrate, tramadol and their combination by youths who believe these drugs could positively impact their sexual life. Sildenafil citrate and tramadol are metabolized in the liver, and their by-products excreted through the kidneys, making these organs possible targets for toxicity. Aim: This study evaluates the effects of combination of tramadol and sildenafil citrate on hepatic and renal function parameters in male albino rats. Methodology: A total of forty-nine (49) male albino rats weighing between 150 to 180g were used for the study. Sildenafil citrate and tramadol were administered to the rats by means of oral gavage for 28 days. The liver enzymes alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were determined using the Reitman-Frankel method. Alkaline phosphatase (ALP) was determined using the Colorimetric endpoint method. Total protein (TP) was determined using the biuret method. Albumin (ALB) was determined using the bromocresol green method. Sodium (Na+), potassium (K+) and chloride (CL-) were determined using ion selective electrode (ISE) method. Bicarbonate (HCO3-) was determined using titrimetric method. Urea was determined using Urease bertholet method. Creatinine was determined using Jaffe-Slot method. Results: There were no significant differences (P&gt;.05) in the liver enzymes ALT, AST and ALP in all the treatment groups compared to the negative control. Total protein (TP) and albumin (ALB) also showed no significant differences (P&gt;.05) in the groups, compared to the negative control. there were no significant differences (P&gt;.05) in the electrolyte levels in the treatment groups, compared to the negative control. Urea and creatinine levels were also not significantly different (P&gt;.05) in the treatment groups, compared to the negative control. Conclusion: Administration of sildenafil citrate singularly and in combination with tramadol, at recommended and double doses for 28 days, did not impact the liver and was also non-toxic to the kidneys.

Use of sildenafil for the treatment of neonatal persistent pulmonary hypertension

Introduction: Persistent pulmonary hypertension of the newborn is a neonatal respiratory and vascular pathology with a high mortality rate. Furthermore, its prevalence is 1 to 2 per 1000 live births, accounting for 8%-10% of neonatal deaths. The therapeutic approach involves supporting pulmonary recruitment and pharmacological vasodilation, most notably sildenafil. Methodology: The study is a narrative review of the literature that was carried out from the PUBMED database using the keywords “Persistent Pulmonary Hypertension of the Newborn” and “Sildenafil”, with the time filter in the last 30 years (1994- 2023). Discussion: Physiologically, during fetal life, the lungs remain filled with fluids, but immediately after birth, pulmonary vascular resistance decreases drastically, allowing alveolar oxygen tension and ventilation to be possible. However, in the pathogenesis of neonatal persistent pulmonary hypertension, there is an increase in pulmonary vascular resistance and remodeling of the vascular structure after birth, which potentiate this exaggerated vasoconstriction. Therefore, the standard exam for investigating the pathology is echocardiography. Sildenafil is a drug used to treat neonatal persistent pulmonary hypertension, as it enhances better blood flow and better delivery of oxygen to tissues, through its physiopharmacology aimed at vasodilation secondary to inhibition of phosphodiesterase-5. Conclusion: Neonatal persistent pulmonary hypertension is still one of the main neonatal pathologies with high morbidity and mortality in the neonatal population, due to the complexity of presentations and the variation in therapeutic responses to pharmacotherapy.

Persistent pulmonary hypertension of the newborn infant (PPHN) due to premature closure of the ductus arteriosus (DA)

Abstract Objectives To describe the course of an infant with persistent pulmonary hypertension of the newborn (PPHN) secondary to premature closure of the ductus arteriosus (DA), a very rare phenomenon which can lead to adverse clinical outcomes. Case presentation A term infant was diagnosed with severe PPHN with echocardiographic features noted at 6 h after birth which included supra-systemic pulmonary pressures, severe isolated right ventricle (RV) hypertrophy, poor RV dysfunction and no ductal flow in the context of a structurally normal heart. There was maternal use of low-dose aspirin in pregnancy due to preeclampsia. There is a known association between use of prostaglandin synthase inhibitors such as aspirin with ductal closure leading to increased RV pressure. Treatment was commenced with positive pressure ventilation, inhaled nitric oxide (iNO) and milrinone. There was a limited response to iNO necessitating increasing the concentration of milrinone with a marked improvement in oxygenation. Following commencement of sildenafil, inhaled nitric oxide was gradually weaned and stopped in the third week and the infant extubated. The infant was discharged home on oral sildenafil at four weeks of age with no respiratory or feeding support. Echocardiographic features of raised right sided pressures persisted, but with reduced RV hypertrophy and septal flattening and improved RV function. Oral sildenafil was subsequently weaned and stopped at four months of age. Conclusions A severe form of PPHN due to premature closure of the DA requires early discussion with the cardiologist. The use of milrinone and sildenafil can lead to a favourable outcome.

Prophylactic sildenafil to prevent bronchopulmonary dysplasia: A systematic review and meta-analysis.

Bronchopulmonary dysplasia (BPD) persists as one of the foremost factors contributing to mortality and morbidity in extremely preterm infants. The effectiveness of administering sildenafil early on to prevent BPD remains uncertain. The aim of this study was to investigate the efficacy and safety of prophylactically administered sildenafil during the early life stages of preterm infants to prevent mortality and BPD. MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature, and Ichushi were searched. Published randomized controlled trials (RCTs), non-RCTs, interrupted time series, cohort studies, case-control studies, and controlled before-and-after studies were included. Two reviewers independently screened the title, abstract, and full text, extracted data, assessed the risk of bias, and evaluated the certainty of evidence (CoE) following the Grading of Recommendations Assessment and Development and Evaluation approach. The random-effects model was used for a meta-analysis of RCTs. This review included three RCTs (162 infants). There were no significant differences between theprophylactic sildenafil and placebo groups in mortality (risk ratio [RR]: 1.32; 95% confidence interval [CI]: 0.16-10.75; very low CoE), BPD (RR: 1.20; 95% CI: 0.79-1.83; very low CoE), and all other outcome assessed (all with very low CoE). The sample sizes were less than the optimal sizes for all outcomes assessed, indicating the need for further trials. The prophylactic use of sildenafil in individuals at risk of BPD did not indicate any advantageous effects in terms of mortality, BPD, and other outcomes, or increased side effects.

Factors associated with sexual quality of life among men living with HIV.

This study aims to assess the prevalence of sexual difficulties and identify factors associated with the Sexual Quality of Life (SQoL) among people living with HIV (PLWHA). The study included 107 heterosexual men and 474 men who have sex with men (MSM) from five countries. Participants self-reported variables related to physical and mental health, as well as HIV-related parameters. Erectile or ejaculation difficulty, as well as low sexual desire, were investigated. SQoL was measured using the PROQOL-SexLife questionnaire. Most of participants reported low sexual desire, predominantly among MSM. Among MSM, living with a partner and healthcare satisfaction were associated with SQoL scores in POP dimension, while consistent condom use, cardiovascular complications, and being single were associated with SQoL scores in STI dimension. Viagra use, anti-cholesterol treatment, and living with a partner were associated with SQoL scores in DIS dimension. Among heterosexual men, employment and African origin were associated with SQoL scores in the POP dimension. Alcohol consumption was associated with SQoL scores in STI dimension. This study underscores the importance of non-clinical determinants when assessing SQoL among PLWHA, emphasizing psychological factors and the perceived quality of healthcare. Tailored interventions should incorporate these findings to enhance overall SQoL outcomes.