الفهرس 
Aim of the workOnly 14 pages are availabe for public view
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Abstract
Erectile dysfunction (ED) is characterized as the inability to
achieve or maintain an erection to complete sexual intercourse or
another chosen sexual activity sufficiently. It is known that ED is
more widespread in patients with type 2 diabetes mellitus and
metabolic syndrome. In a pathophysiological cascade responsible for
endothelial dysfunction plays a role an impaired vascular nitric oxide
(NO) synthesis and impaired vasodilatation through increased
inflammation and oxidative stress.
Erectile dysfunction (ED) and cardiovascular diseases have the
same risk factors as hypertension, diabetes mellitus,
hypercholesterolemia and smoking. The severity of erectile
dysfunction correlates with the cardiovascular risk of patients and
represents the early symptom of generalized atherosclerosis. ED can
also be considered as a marker of early subclinical coronary artery
damage and thus as an independent predictor of future cardiovascular
events.
NO bioavailability may be decreased by suppressed endothelial
nitric oxide synthase (eNOS) expression and/or activity or by
increased NO scavenging, for example, by superoxide formed during
increased oxidative stress. Oxidative stress is a key pathogenic factor
in the development of diabetic complications. During chronic
hyperglycemia, advanced glycation end products (AGEs) are formed.
AGEs bind covalently to the vascular collagen leading to thickening
of the vascular wall, decreased elasticity, endothelial dysfunction and
atherosclerosis.
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ROS are involved in many mechanisms of initiation or
maintenance of functional and structural damage to cells and the entire
organism. Increased oxidative stress and expression of inflammatory
markers are seen in patients with diabetic ED.
Endoglin, which is a 180 kDa homodimeric integral membrane
glycoprotein, is involved in the regulation of endothelial function,
serving as a receptor for the transforming growth factor-beta
superfamily involved in the atherosclerotic processes. A soluble form
of endoglin (S-endoglin), formed by the cleavage of the extracellular
domain of the entire endoglin molecule, has been also suggested as a
marker of endothelial dysfunction. S-endoglin was found to be
increased in the serum of patients with type 2 DM and positively
correlated with the severity of diabetic vascular changes.
The current study aimed to investigate the relation between
Erectile dysfunction in smokers and non smokers and endothelial
dysfunction marker, endoglin. It is a prospective randomized study
was conducted on 60 men suffering from Erectile dysfunction and
attended to the Andrology Clinic in Menoufia University Hospital
after obtaining consent from each patient.
The studied patients were classified into three groups as
follows:
group I: consisting of smoker men suffering from Erectile
dysfunction, group II: consisting of non-smoker men suffering from
Erectile dysfunction and group III: consisting of apparently healthy
volunteers’ men without Erectile dysfunction matched age and sex.
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The studied subjects were divided into three groups:
group I: Consisting of 30 smoker men suffering from erectile
dysfunction.
group II: Consisting of 30 non-smoker men suffering from
erectile dysfunction.
group III: Consisting of 30 apparently healthy age matched
non smoker volunteers.
Ethical consideration: The Ethical Committee of the Faculty
of Medicine, University Hospital, approved the study (record number:
122020DERMA). A written informed consent was obtained from each
participant after simple and clear explanation of the research
objectives.
Inclusion Criteria: men suffering from erectile dysfunction,
smokers and non-smokers.
Exclusion criteria: patients with a clear psychogenic ED,
testosterone deficiency, acute inflammatory diseases, renal or hepatic
insufficiency were excluded from the study.
All Patients and controls were subjected to the following:
The medical history includes the patient’s name, age, and
smoking index.
Sexual history and severity of ED as determined by the IIEF-5
questionnaire The IIEF-5 questionnaire was completed by patients and
participants. The IIEF-5 questionnaire has a maximum score of 25
points.
The following score is used to describe erectile function:
Normal function (21-25 points), mild erectile dysfunction (16-20
Summary
79
points), moderate erectile dysfunction (11-15 points), and severe
erectile dysfunction (11-15 points) are the four categories of erectile
dysfunction (less than 10 points).
Full clinical examination: General examination and local
genital examination to exclude mechanical causes of erectile
dysfunction as pyronie‘s disease and signs of hypoandrogenism.
Biochemical parameters: serum glucose, triacylglycerids,
glycated hemoglobin (HbA1c), and serum Endoglin (ng/ml)
The current findings can be summarized as follows:
Age, history of disease, sexual history, BMI, presence of metabolic
syndrome, Systolic and diastolic blood pressure, triglyceride and
Hg A1C, Endoglin level were significantly higher in cases (Smoker
ED patient& Non smoker ED patient) than control group.
There was non-significant difference between cases and control
groups regarding waist circumference.
There was a significantly higher endoglin level in ED patients
than the control group (groups I and II). The levels of endoglin and
ILEF had a negative relationship . Smokers had greater serum
endoglin levels than non smokers . The level of endoglin and the
smoking index had a negative relationship . The amount of serum
endoglin was found to have a significant positive connection with
BMI, waist circumference, and systolic and diastolic blood pressure.