RESUMEN
Diabetes is a predisposing factor for urinary tract and genital infections in both women and men. Sodium-glucose cotransporter-2 (SGLT2) inhibitors constitute a novel therapeutic class indicated for type 2 diabetes (T2D) patients, and are already on the market in a few countries in Europe. They decrease glycaemia mainly by enhancing glucose excretion in urine by reducing renal glucose reabsorption via the action of SGLT2 in the kidneys. In general, they are well tolerated, but their mode of action results in specific side effects as well as an increased risk of genital (vulvovaginitis and balanitis) and urinary tract infections, for which T2D patients are already at high risk, reported within the first 6 months of treatment. Usually these infectious events are successfully treated with standard therapies, but diabetologists are not accustomed to dealing with them. The aim of this review is to describe the different types of lower urinary tract and genital infections, and the treatment strategies currently available for patients with diabetes.
Asunto(s)
Diabetes Mellitus Tipo 2 , Infecciones del Sistema Genital , Infecciones Urinarias , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/epidemiología , Femenino , Humanos , Masculino , Infecciones del Sistema Genital/complicaciones , Infecciones del Sistema Genital/epidemiología , Infecciones Urinarias/complicaciones , Infecciones Urinarias/epidemiologíaRESUMEN
ETHNOPHARMACOLOGICAL RELEVANCE: Based on ethnobotanical data obtained from Nigerien and Senegalese traditional healers, two Euphorbiaceae plants, Sebastiania chamaelea and Chrozophora senegalensis, traditionally used to treat malaria, were selected for further investigations. MATERIALS AND METHODS: Plant extracts were prepared with different solvents and tested both in vitro on several strains of Plasmodium falciparum, and in vivo to evaluate their antiplasmodial properties and isolate their active principles. RESULTS: With IC50 values around 6.5µg/ml and no significant cytotoxicity (>50µg/ml), the whole plant aqueous extract from S. chamaelea showed the best in vitro results. In vitro potentiation assays showed strong synergistic activity of S. chamaelea extract with the antiplasmodial drug chloroquine on the chloroquine-resistant P. falciparum strain W2-Indochina. In other respects, the aqueous crude extract of C. senegalensis leaves showed the most significant antiplasmodial activity in vitro (IC50 values less than 2µg/ml). We also demonstrated the prophylactic activity of C. senegalensis in vivo in a murine malaria model. Bioassay-guided fractionation of aqueous extracts of these plants enabled the isolation and identification of ellagic acid (EA, 1) as the main compound responsible for their antiplasmodial activity. Together with EA, other derivatives belonging to different chemical groups were isolated but showed moderate antimalarial activity: gallic acid (2), brevifolin carboxylic acid (3), protocatechuic acid (4), corillagin (5), rutin (6) and 3,4,8,9,10-pentahydroxy-dibenzo(b,d)pyran-6-one (7). The structures were determined by the usual spectroscopic methods and by comparison with published data. Furthermore, we report here the quantification of compound 1 (EA) by RP-HPLC in the dried extracts of these plants, reported for the first time in both these species, and possessing the highest in vitro antiplasmodial activity with IC50 values from 180 to 330nm. CONCLUSIONS: These in vitro and in vivo results support the traditional use in Africa of crude extracts of both S. chamaelea and C. senegalensis as an antimalarial treatment and prove the significant antiplasmodial property of EA.
Asunto(s)
Antimaláricos/uso terapéutico , Euphorbiaceae/química , Malaria/tratamiento farmacológico , Medicinas Tradicionales Africanas , Extractos Vegetales/uso terapéutico , Plasmodium/efectos de los fármacos , Animales , Antimaláricos/aislamiento & purificación , Antimaláricos/toxicidad , Supervivencia Celular/efectos de los fármacos , Ácido Elágico/aislamiento & purificación , Femenino , Células Endoteliales de la Vena Umbilical Humana , Humanos , Malaria/parasitología , Malaria Falciparum/tratamiento farmacológico , Malaria Falciparum/parasitología , Ratones , Niger , Pruebas de Sensibilidad Parasitaria , Extractos Vegetales/aislamiento & purificación , Extractos Vegetales/toxicidad , Plasmodium falciparum/efectos de los fármacos , SenegalRESUMEN
To determine the risk factors for EDin men treated by prostate brachytherapy (PB) for localized prostate cancer and to propose a model to predict post-implant erectile function. Out of a series of 270 sexually active men treated by PB, 241 (89%) (mean age=66 years (range, 43-80)) accepted to participate in a mail-based study on erectile function. The risk factors for erectile dysfunction were determined by regression analysis and a predictive model was proposed. The performance of the model was determined in this population and subsequently verified in a population of 50 men treated by PB in another treatment center. The risk factors for ED after PB were age, the pre-implant IIEF score and prostate volume. In the studied population, the final model to predict a post-treatment IIEF-5 score, using these factors, had a sensitivity of 69% and a specificity of 68% associated to an area under the ROC curve (AUC) of 0.75. The same performance was obtained in another treatment center. Age, pre-implant IIEF-5 score and prostate volume may be used to predict post-implant erectile function in patients treated by PB.
Asunto(s)
Braquiterapia/efectos adversos , Disfunción Eréctil/etiología , Neoplasias de la Próstata/radioterapia , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Disfunción Eréctil/epidemiología , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Modelos Biológicos , Erección Peniana , Próstata/patología , Neoplasias de la Próstata/patología , Neoplasias de la Próstata/fisiopatología , Factores de Riesgo , Sensibilidad y Especificidad , Encuestas y CuestionariosRESUMEN
Lactobacillus urinary tract infection (UTI) seems exceptionally reported. Nevertheless, with the introduction of a chromogenic medium UriSelect 4, eight cases of UTI in old women (mean of 81.2 years) mediated by Lactobacillus delbrueckii identified by DNA sequencing were reported between 2007 and 2009.