Background and purpose: Several adverse effects were reported for oral sildenafil. In this research after formulation of sildenafil topical gel, the effect of gel was compared with sildenafil tablet in a double-blind placebo-controled clinical trial. Materials and methods: After choosing the solvent system, several formulations were prepared and the most suitable gel was chosen for clinical trial. The study was a controlled randomized (block-random sampling), double blind, prospective, placebo-controlled trial. 94 patients, with clinically diagnosed erectile dysfunction were recruited. This includes men with ED of organic, psychogenic, and mixed causes. Patients were divided into two categories of age under and over 50. Six blocks were considered for including patients based on the nature of ED and age. All of the patients with ED from July 2003 to May 2004 diagnosed by one urologist were included in the study. The cases received 1% topical gel of sildenafil and placebo tablet, and the control group received sildenafil tablet (100 mg) and gel base (without drug) as placebo. The tablets were taken one hour before sexual action and the topical gel was used in 0.5g (approximately) on the glans of penis and were massaged for 5min, before the sexual activity. Results: In the case group that topical gel of sildenafil was administered, 5 patients (12.5%) had complete erection, 5 patients had moderate erection and erection was not observed in 30 (75%) of them. In control group, that sildenafil tablet was administered, these results were 28 (70%), 6 (15%) and 6 (15%) respectively. The onset of erection in case group (in-patients with complete erection) was 7.4 ± 3.6 min, but this time was 37.8 ± 14.9 min in control group. Four cases of mild headache were observed in-patients who administered topical gel of sildenafil. This was pain treated before 4 min. Two cases of severe headache were observed in-patients who were administered sildenafil tablet. The disorder on visual function was observed in one patient in control group. One case of severe dyspepsia was observed in this group too. Conclusion: Sildenafil delivery using transdermal formulation can be enhanced by several synthetic or natural percutaneous absorption enhancers, and appears to be a promising approach for the treatment of erectile dysfunction.  

Context :Post-operative cognitive dysfunction (POCD) and postoperative delirium (POD) are common complications following major surgery, particularly in older adults. Emerging evidence suggests that olfactory dysfunction may significantly predispose individuals to these cognitive disturbances, potentially serving as an early marker for post-surgical cognitive decline. However, the relationship between olfactory impairment and post-operative cognitive outcomes remains underexplored. Objectives :The present systematic review aims to synthesize current evidence on the impact of olfactory dysfunction on POCD and POD. Evidence Acquisition :The review adhered to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. A comprehensive search of PubMed, Scopus, and the Web of Science (WOS) was conducted from inception until December 2024. Studies on patients undergoing major operations that involved verified olfactory and cognitive examinations and yielded quantitative data were included. Exclusion criteria encompassed research focusing on non-surgical groups, non-original studies, and studies lacking postoperative cognitive assessments. Results :From an initial 389 articles, seven studies met the inclusion criteria, comprising 1,038 participants. These studies, conducted between 2004 and 2022, included patients undergoing major surgeries such as cardiac, abdominal, and neurosurgery. Various olfactory tests [e.g., sniffin’ sticks, brief smell identification test (BSIT)] and cognitive assessments [e.g., mini-mental state examination (MMSE), clock drawing test (CDT)] were used. The findings across studies were heterogeneous but suggested a potential link between olfactory dysfunction and both POCD and POD. Specifically, several studies indicated that impaired olfactory function was associated with an increased risk of delirium (OR = 1.90; 95% CI = 1.17 - 3.09) and cognitive decline post-surgery. Some studies identified olfactory impairment as an independent predictor of worse cognitive outcomes, particularly among frail or elderly populations. Conclusions :The evidence reviewed supports the hypothesis that olfactory dysfunction may be a preoperative marker for POCD, particularly delirium and delayed neurocognitive recovery (dNCR). Based on the obtained results, olfactory testing could be a useful preoperative screening tool, especially in populations at risk for cognitive decline.