No abstract

Frailty assessment has been identified as critical approach in chronic respiratory diseases with substantial impact in the health status and functionality in later life. Aging modifies the immune response leading to a chronic pro-inflammatory state and increased susceptibility to airway infections. Since epigenetic changes, airway epithelium dysfunction and inflammatory cytokine activity seem to be more pronounced in the immunosenescence, elderly asthmatics are at higher risk of poor clinical outcomes. Therefore, we hypothesize that frailty would be associated with the degree of asthma control in elderly patients with moderate to severe asthma. The aims of this study are to investigate association between frailty and asthma control in patients over 60 years old to estimate the prevalence of frailty in this study population. We plan to conduct a cross-sectional study with at least 120 patients above 60 years old with diagnostic of moderate to severe asthma according to Global Initiative for Asthma (GINA) guidelines, treated at a referral outpatient clinic. We defined asthma control by the six-domain Asthma Control Questionnaire (ACQ-6) and frailty phenotype in accordance with Fried scale and visual scale of frailty (VS-Frailty). We hope to analyze the multidimensional relationships between frailty and asthma and contribute to innovative therapeutic plans in geriatric asthma.

Objectives: Develop and validate a new and simplified score for evaluating the lower urinary tract symptoms in men. Materials and methods: We modified the existing visual prostate symptom score, including changes in the images, sequence, and new alternatives, resulting in a new visual score (LUTS visual score-LUTS-V). For the validation of the new tool, we used the International Prostatic Symptom Score as the gold-standard and the new LUTS-V to 306 men. The total IPSS score and the total LUTS-V score of each subject were evaluated to determine the agreement between the two instruments. ROC curve was used to evaluate the diagnostic accuracy and best cut-off of LUTS-V. Sensitivity, specificity, and diagnostic odds ratios were used to describe the diagnostic properties. Results: The mean age of the participants was 59 [52-87] years. There was a significant correlation between LUTS-V and IPSS. (r=0.72 (p <0.0001). The Bland-Altman analyzes demonstrate good agreement between the two questionnaires (bias=5.6%). LUTS-V demonstrated excellent diagnostic accuracy in detecting the most serious cases with an area under the ROC curve of 83% [78-87%] 95% CI. p <0.001). LUTS-V >4 was the best threshold, with a sensitivity of 74% and specificity of 78%. Conclusions: LUTS-V is a simple, self-administered tool with a significant discriminatory power to identify subjects with moderate to severe LUTS and may represent a useful instrument for the diagnosis and follow-up of men with urinary symptoms.

No abstract

INTRODUCTION AND OBJECTIVE: In normal physiologic conditions, the hypothalamic-pituitary-gonadal (HPG) axis is expected to increase luteinizing hormone (LH) levels, as testosterone (T) levels tend to decline. This phenomenon could theoretically prevent the establishment of testosterone deficiency (TD), which contradicts the understanding that T levels have a steady decline during the normal aging process. The present study aimed to investigate the prevalence of compensated hypogonadism (CH) in a cohort of middle-aged men and to search for predictors of an adequate compensatory response.METHODS: We analyzed a prospectively maintained database of patients seeking treatment at a general urology clinic. We included patients seen from August 2020 to October 2021in the present analysis. Sociodemographics, comorbidity profile, and metabolic syndrome parameters were routinely assessed. Obesity was defined as waist circumference >102 cm. Early morning blood samples were collected, and a complete hormonal blood panel was measured. TD was defined as TT levels <300 ng/dL. CH was defined as TT< 300 ng/dL and LH > 9.4 mUI/mL. We used a multivariable model to identify independent predictors of CH, which included age, metabolic syndrome components, and lab results.RESULTS: 577 consecutive patients were included in the analysis. The median age was 59 years [IQR 49-68 years]. The median baseline TT was 478 ng/dl . In our sample, 41% had diabetes, 44% had hypertension, and 33% had metabolic syndrome. The prevalence of TD in our sample was 15.5%. Out of 84.5% of men with normal T levels, 6.8% had CH. Compared to eugonadal men, those with CH were more than 20 years older (median age 56.0 vs. 76.0). Median waist circumference was 97.0 cm, 94.0 cm, and 107 cm for men with normal T, CH, and TD, respectively (p<0.001). On multivariable analysis, obesity was the only TD predictor ). On the prediction model of CH among men with normal T levels, age per year) and obesity (OR[0.14, 95% CI 0.03 to 0.62) remained significant.CONCLUSIONS: In our patient population, increasing age and absence of obesity were predictors of CH. For individuals with WC<102, age appears not to impact T levels significantly as LH levels tend to maintain androgen production. Such findings might partially explain the absence of increased TD prevalence in normal-weight populations found in previous published epidemiological studies.