- StatPearls: Premature Ejaculation [BOOK]StatPearls Publishing: Treasure Island (FL)BOOK
- Ejaculation occurs when the semen gets released from the male reproductive system. The term premature ejaculation describes the phenomenon which occurs when ejaculation happens sooner than a man or his partner would like during sexual activity. About 30% of men are affected but possibly up to 75% in some reviews. Thus it is considered to be the most common sexual disorder in the male populatio…
Ejaculation occurs when the semen gets released from the male reproductive system. The term premature ejaculation describes the phenomenon which occurs when ejaculation happens sooner than a man or his partner would like during sexual activity. About 30% of men are affected but possibly up to 75% in some reviews. Thus it is considered to be the most common sexual disorder in the male population. Occasional premature ejaculation is not a cause for concern; however, for those individuals who meet diagnostic criteria, this condition can cause significant distress and impairment as the sexual activity may be less enjoyable, and relationships may suffer negative consequences. There are several different definitions of premature ejaculation. It has been defined simply as an inability to exert voluntary control over the ejaculatory reflex or as the condition where a man reaches orgasm and ejaculates before he desires to do so. Masters and Johnson defined it as "the inability of the male to control ejaculation sufficiently to satisfy his female partner in more than 50% of coital episodes provided that she is not anorgasmic" while Strassberg et al. defines it as "the condition where the male has little voluntary control over ejaculation and ejaculates within 2 minutes or less after intromission in at least 50% of coital attempts." The World Health Organization (WHO) describes premature ejaculation as "the inability to delay ejaculation sufficient to enjoy lovemaking, which is manifested by either an occurrence of ejaculation before or very soon after the beginning of intercourse or ejaculation occurring in the absence of sufficient erection to make intercourse possible." Some have suggested that any ejaculation which occurs less than 1 minute after vaginal penetration is automatically "premature" while others suggest that this intravaginal time should normally be at least 4 minutes long with anything less considered pathological. The DSM-5 defines premature ejaculation as follows: Ejaculation occurs during partnered sexual activity within approximately 1 minute following vaginal penetration and before the individual wishes it, during all or almost all sexual activity (75% to 100% of the time) Symptoms must persist for at minimum 6 months and cause clinically significant distress to the individual. The dysfunction is not explainable by a nonsexual mental disorder, medical conditions, the effects of a drug or medication, or severe relationship distress or other significant stressors. The severity of premature ejaculation ranges from mild to severe as follows: Mild (occurs within approximately 30 seconds to 1 minute of penetration). Moderate (occurs within approximately 15 to 30 seconds of penetration). Severe (occurs before sexual activity, at the start of sexual activity, or within approximately 15 seconds of penetration). Additional specifiers in regards to duration and context are as follows: Lifelong - (present since first sexual experience). Acquired - (developing after a period of relative normal sexual functioning). Generalized - (not limited to specific types of stimulation, situation, or partners). Situational - (limited to certain types of stimulation, situations, or partners). Approximately 30% of men ages 18 to 59 years old have problems with premature ejaculation; however, shame and embarrassment prevent many men from discussing this sensitive topic with their provider. As premature ejaculation has both psychological and biological origins, there are a variety of medications, therapeutic options, and sexual techniques available to delay ejaculation, which may improve sexual satisfaction and intimacy.
- StatPearls: Physiology, Ovulation, Basal Body Temperature [BOOK]StatPearls Publishing: Treasure Island (FL)BOOK
- Basal body temperature (BBT) is defined as the lowest natural, non-pathologic body temperature recorded after a period of rest. Women have used charting average basal body temperatures over the length of a menstrual period has been a tool to determine if ovulation has occurred or not. Basal body temperature measurements have been used for decades to help women optimize the timing of intercourse d…
Basal body temperature (BBT) is defined as the lowest natural, non-pathologic body temperature recorded after a period of rest. Women have used charting average basal body temperatures over the length of a menstrual period has been a tool to determine if ovulation has occurred or not. Basal body temperature measurements have been used for decades to help women optimize the timing of intercourse during a fertile window. This unique methodology was also prevalent before the invent of oral contraception pills, as it aided women in an attempt to avoid fertilization during a fertile period. Still to this day, women use this seemingly simple tool for planning purposes.
- StatPearls: Obesity Surgery Pre-Op Assessment And Preparation [BOOK]StatPearls Publishing: Treasure Island (FL)BOOK
- Obesity in the United States (US) has become synonymous with heart disease, diabetes, and early death. Research supports the link between obesity and adverse health outcomes. Obesity is one of the most challenging public health issues not only in the USA but globally. According to the Centers for Disease Control and Prevention (CDC), there are 93 million obese adults in the US, representing 39…
Obesity in the United States (US) has become synonymous with heart disease, diabetes, and early death. Research supports the link between obesity and adverse health outcomes. Obesity is one of the most challenging public health issues not only in the USA but globally. According to the Centers for Disease Control and Prevention (CDC), there are 93 million obese adults in the US, representing 39.8% of the adult population. Obesity is a major risk factor for the development of diabetes, heart disease, and is a leading cause of preventable death. Estimates are that the medical cost of obesity ascends to 147 billion dollars per year. There is no medical treatment for obesity that works consistently or in a predictive manner. To date, bariatric surgery is the only known treatment for obesity. Bariatric surgery has gained particular importance due to its success in reversing the abnormal metabolic profile; after bariatric surgery, there is a marked improvement in the management of diabetes, hypertension, sleep apnea, arthritis, and the metabolic syndrome. This surgical approach to obesity has been significantly more successful at sustained weight loss in morbidly obese patients compared to diet and medical interventions. Also, there is significant improvement in overall mortality associated with bariatric surgery. However, obese patients have several comorbidities that increase the risk of any surgery; thus, prior to surgery, a preoperative workup is highly recommended. This activity describes the preoperative preparation and workup of an obese patient undergoing bariatric surgery and the role of an interprofessional team evaluation during the peri-operative period.
- StatPearls: Arterial Gas Embolism [BOOK]StatPearls Publishing: Treasure Island (FL)BOOK
- Arterial gas embolism is a rare, life-threatening entity, which requires prompt recognition and early intervention. The air in the arterial circulation can lead to ischemia of various organ systems (i.e., brain, spinal cord, heart, kidneys, spleen, and GI tract)). As a result, the complications arising from arterial gas embolism can be devastating. The clinical features can be an initial asymptom…
Arterial gas embolism is a rare, life-threatening entity, which requires prompt recognition and early intervention. The air in the arterial circulation can lead to ischemia of various organ systems (i.e., brain, spinal cord, heart, kidneys, spleen, and GI tract)). As a result, the complications arising from arterial gas embolism can be devastating. The clinical features can be an initial asymptomatic period to nonspecific signs and symptoms to complete cardiovascular collapse. However, there are many precautions and techniques medical professionals can undertake to prevent this lethal condition.
- StatPearls: Body Image Distortion [BOOK]StatPearls Publishing: Treasure Island (FL)BOOK
- Body image is the subjective picture of individuals of their own body, irrespective of how their body actually looks. Body image is a complex construct comprising thoughts, feelings, evaluations, and behaviors related to one’s body. Body image misperception is common in the general population and is also a core component of several serious diseases, including body dysmorphic disorder, an…
Body image is the subjective picture of individuals of their own body, irrespective of how their body actually looks. Body image is a complex construct comprising thoughts, feelings, evaluations, and behaviors related to one’s body. Body image misperception is common in the general population and is also a core component of several serious diseases, including body dysmorphic disorder, anorexia nervosa, and bulimia nervosa. Distortions in body image are unpleasant and can have tragic results. Poor body image can affect physical and psychological health and can influence self-esteem, mood, competence, social functioning, and occupational functioning. The understanding of the neurotypical distortions in healthy cognition and perceptual distortions in clinical conditions is essential to address body image concerns and enable suffering individuals to lead more contented and productive lives. In this activity, we outline the role of body image in psychological and physical functioning and describe features of various body image-related conditions and disorders. Historical Perspective Early in the 1900s, there were considerable efforts by neurologists to understand unusual forms of body perception reported by patients with brain injury, or phantom limb experience in amputees. The early concepts of body image indeed were rooted in neuropathology. Head, in 1920, first defined body image as a unity of past experiences created in the cerebral sensory cortex. Schilder, who was a neurologist, proposed a biopsychosocial approach to body image, highlighting the need to examine its neurological, psychological, and sociocultural components. Newell noted that body image is dynamic and changes with age, mood, or even clothing. Krueger suggested that body image is the representation of identity derived from both external and internal body experiences. Definition What is body image, and why is it important? Body image is one of the components of personal identity. Body image is the figure that one has on their anthropometric measurements, contours, and shape of the body; and also the feelings correlated to these factors that affect the satisfaction with the body or specific parts of the body. Indeed, body image represents how we think, feel, perceive, and behave regarding our bodies. Body image is a multidimensional concept. The complexity of body image can be appreciated by looking at its components. These components apply to people with healthy and unhealthy perceptions of their bodies and include: Cognitive: thoughts and beliefs about the body. Perceptual: how people perceive the size and shape of their body and body parts. Affective: feelings about the body. Behavioral: the actions that people perform to check on, tend to, alter, or conceal their body. Related but different terms are often used interchangeably in the literature concerning the state of consciousness in which there is an altered body image perception, including body image distortion, body image misperception, body image disturbance, negative body image, altered body image, and body dissatisfaction. The problem of variable terms is intensified by the fact that some studies focus on psychiatric or medical patients, some deal with nonpatients, and others deal with both groups. Body image distortion is a multidimensional symptom, comprising various components of body image. Components that most widely accepted are the cognitive, the perceptive, and the affective. The cognitive component is from thoughts and beliefs concerning body shape and appearance, and the mental representation of the body. The perceptive component involves the identification and estimation of the body, and it indicates the accuracy of the individuals' evaluation of their body size, shape, and weight compared to their actual proportions. Finally, the affective component includes feelings that individuals develop towards their body and satisfaction or dissatisfaction of individuals about their body. Thereupon, body image disturbance can manifest as disturbance of percept (i.e., distortion) and concept (i.e., body dissatisfaction). Perceptual disturbance involves the failure to evaluate the size of one’s body accurately. Body dissatisfaction includes attitudinal or affective perception of one’s body and negative feelings and cognitions. Body image disturbances are thought to also manifest on a behavioral level, such as body avoidance, body checking, or dieting. Negative body image characteristically demonstrates a dissatisfaction of body or body parts, preoccupation with appearance, and engaging in behaviors such as frequent mirror checking, self-weighing, or avoidance of public situations. Negative body image often gets measured as body dissatisfaction. Body dissatisfaction is attributable to a discrepancy between the perception of body image and its idealized image. Body Image Development There are some debates as to when body image development begins. Price believes that primitive sense of body image originates in the uterus with spontaneous movements of the fetus and corresponding feedback from sensory and proprioceptive input. Body image is a learned phenomenon from experiences during both pre-natal and post-natal development in which cross-cortical connections and mirror neurons play prominent roles. Complex interactions between neurophysiological, socio-cultural, and cognitive factors contribute to body image development and maintenance. Different factors such as gender, fashion, peer groups, educational and familial influences, evolving socialization, and physical alterations (hair growth, acne, breast development, menstruation) put children into unknown territory with vulnerable body images. Primary socialization takes place early in life, and a sense of self-recognition is assumed to develop by the age of two. Children in the toddler years become aware of their gender. They also discover social norms, such as competitiveness and athleticism for men (strong legs, muscles, large arms), and beauty or smallness for females (glossy hair, perfect skin, tiny waist, no hips). When children become aware of their body appearance, they attempt to manipulate their parents to receive admiration and approval. This need for approval grows upon starting school, exhibiting a need for social acceptance. Cash assumes body image as a learned behavior. Smolak proposes that children mainly focus on appearance in the context of the toys they play with, such as Barbie dolls. As children grow and socialize, they begin comparing themselves with other children, especially concerning appearance (e.g., little children desire to be bigger). By the age of 6, body shape becomes increasingly prominent consideration (especially muscle and weight). Smolak reported that among school children aged 6 to 12 years old, 40–50% demonstrated dissatisfaction with some part of their body size or shape. Adolescence indicates the transition from childhood to adulthood and is associated with physical and social changes. Adolescence is a critical period in body image development. Body image in adolescents is also under the influence of parents. The parent-adolescent relationship has a significant impact on the development of adolescents’ body dissatisfaction. Parents send sociocultural or critical messages and messages about body appearance ideals to their children. When Individuals feel secure regarding their relationships, they are more satisfied with their body and less likely to think in ways that they have to adhere to appearance ideals to receive others’ acceptance. Researches have shown that adolescents with better parent-adolescent relationships are less likely to experience body dissatisfaction. Although in younger children, the influence of families on body image development is more significant than friends, the role of parents decreases as children get older and peer responses become more important than families. Body image in people aged 14 to 27 is greatly affected by their peers. A critical event or series of events such as teasing and rejection may lead to body image misperception. Studies have found that the more frequent being teased about body size and weight while growing up, the more likely to experience body image distortion and body dissatisfaction during adulthood.
- The Importance of Primary Reconstruction in the Treatment of Blast Related Hand Injuries During Childhood. [Journal Article]Z Orthop Unfall 2019ZO
- CONCLUSIONS: Blast related injuries of the hand during childhood are frequent and can cause different and complex defects. Besides prevention of these injuries, primary reconstruction of the affected hand is of outmost importance in preventing long-term consequences.
- A Mentorship Program for Academic Obstetrician Gynecologists that Improved Publication and Overall Confidence for Success. [Journal Article]Semin Reprod Med 2019SR
- This article aims to evaluate the impact of a mentorship program to enhance the training of clinical and research scientists in obstetrics and gynecology (OBGYN). A departmental course was developed for junior faculty and fellows based on their areas of interest. The research was IRB-approved. The curriculum consisted of monthly interactive workshops for an interdisciplinary group of trainees in …
This article aims to evaluate the impact of a mentorship program to enhance the training of clinical and research scientists in obstetrics and gynecology (OBGYN). A departmental course was developed for junior faculty and fellows based on their areas of interest. The research was IRB-approved. The curriculum consisted of monthly interactive workshops for an interdisciplinary group of trainees in OBGYN. Themes included research, education, and leadership in academic OBGYN. There was a strong emphasis on participatory exercises. Examples of curriculum topics included manuscript publication and review, grant writing, working with an IRB, promotion, and time management. Pre- and post-course questionnaires assessed participants' confidence in skills related to the course topics. Generalized linear models were used to assess changes in post-course response, using each question as the dependent variable and an indicator for post-course as the predictor variable. The control group was composed of junior faculty and fellows before the course was initiated. Outcome measures included the number and impact factor of published manuscripts. A Wilcoxon rank-sum test was used to assess outcome measures. Of the 118 attendees, 26 (22.0%) were junior faculty, 35 (29.66%) were clinical fellows, and 28 (23.7%) were research fellows, other research staff, or students. For each 3-year course series, an average of 20 participants completed the post-course surveys, of which 72% were clinical fellows, 22% were assistant professors, and 5% were instructors. The data revealed a statistically significant change in the participant's overall confidence in skills related to research, education, and leadership when comparing the cumulative results from the pre-to-post course surveys (p < 0.001). Specifically, participants noted improved confidence in their skills related to clinical and translation research (p < 0.001) and leadership and academic career advancement (p = 0.001). Additionally, junior faculty and clinical fellows who attended the course had a higher number of publications during the course period compared with controls (p = 0.003 and p = 0.008, respectively). This subspecialty-tailored, departmental training program was effective in increasing junior faculty and clinical fellows' confidence in skills related to career advancement and research and in the number of peer-reviewed publications.
- Surgical Outcomes after Abdominoperineal Resection with Sacrectomy and Soft Tissue Reconstruction: Lessons Learned. [Journal Article]J Reconstr Microsurg 2019JR
- CONCLUSIONS: The RAM flap was the workhorse flap for pelvic reconstruction following APRS in our cohort. Wound complications are common following APRS. High sacrectomy is associated with higher incidence of complications compared with low sacrectomy. Optimal surgical planning and patient counseling is fundamental to improve current surgical outcomes.
- An analysis of clinical efficacy of microsurgical resection of intradural neoplasm by unilateral approach with Caspar retractors. [Journal Article]Med Princ Pract 2019MP
- CONCLUSIONS: The microsurgical resection of intraspinal tumors with the aid of Caspar retractors has advantages of small trauma, less bleeding and faster recovery. It is a safe and efficacious method for treating small intraspinal tumors.
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- Do We Know the True Burden of Tick-Borne Encephalitis? A Cross-Sectional Study. [Journal Article]Neuroepidemiology 2019; :1-8N
- CONCLUSIONS: Our findings seem to confirm an underreporting of the cases of TBE and inadequate TBE surveillance in the Veneto, despite the clinical severity of the disease and the fact that it is mandatory to report all cases. The routine integration of different databases is crucial to the successful implementation and assessment of targeted prevention strategies and fundamental to public health decision-making on this issue.