Urologija, Nefrologija, Seksologija
Nitrofurantoinas nėra pats efektyviausias gydymo pasirinkimas, kai gydoma vyresnio amžiaus moterų šlapimo takų infekcija, rašoma Kanados medikų asociacijos žurnale CMAJ. Mokslininkai palygino nitrofurantoino ir kitų populiarių antibiotikų ciprofloksacino ir norfloksicino efektyvumą. Tyrime dalyvavo 9223 vyresnio amžiaus moterys su sutrikusia inkstų funkcija ir 182634 su normalia inkstų funkcija. Plačiau...
Nitrofurantoin Not Best Choice for UTIs in Older Women
(HealthDay News) -- Nitrofurantoin may not be the most effective option for treatment of urinary tract infections in older women, according to a new study published online April 27 in CMAJ, the journal of the Canadian Medical Association.
The research was led by Amit Garg, M.D., Ph.D., a nephrologist at Western University in London, Canada. His team compared the benefits of nitrofurantoin to the effectiveness of other commonly used antibiotics such as ciprofloxacin and norfloxicin. The study involved 9,223 older women with impaired kidney function and 182,634 women with normal kidney function.
The researchers found that nitrofurantoin was less successful than other drugs in treating urinary tract infections among all of the women in the study -- not just those with reduced kidney function. What's more, the results of the study suggest that use of nitrofurantoin for urinary tract infections among older women may boost the odds the patient will require a second round of treatment with another antibiotic or a trip to the hospital, the researchers said.
"In our setting, nitrofurantoin was the most commonly prescribed antibiotic for a urinary tract infection in older women irrespective of their kidney function," Garg said in a journal news release. "These patients had more treatment failures with nitrofurantoin compared with other antibiotics such as ciprofloxacin," he added. "However, this was evident regardless of a patient's level of kidney function."
Prancūzijos mokslininkai, ištyrę 1062 jaunesnius nei 70 metų amžiaus operuotus asmenis nustatė, kad sedacija prieš operaciją lorazepamu ne tik nesumažina pacientų psichologinio streso, bet ir prailgina intubacijos laiką. Plačiau...
(HealthDay News) -- A new study questions the need for giving a sedative to surgical patients before anesthesia is administered. The report was published in the March 3 issue of the Journal of the American Medical Association.
A team led by Axel Maurice-Szamburski, M.D., of the Hopital de la Timone Adulte in Marseille, France, randomly assigned 1,062 adults younger than 70 who were having elective surgery to receive either lorazepam, an inactive placebo, or no medication before anesthesia.
The researchers found that lorazepam did not improve overall patient satisfaction, compared with no medication or a placebo. Even among the most anxious patients, the investigators found no significant differences in patient satisfaction between the groups. Moreover, it took longer for patients receiving the sedative to have their breathing tube removed after surgery compared with those who weren't given any sedative and those given a placebo. In addition, the rate of early mental alertness after surgery was lower in those who received the sedative (51 percent), compared with those who didn't receive a sedative (71 percent) and those given a placebo (64 percent). Also, on the day after surgery, the number of patients who said they did not remember the time period around their procedure was higher in the lorazepam group than in the other groups.
"Compared with placebo, lorazepam did reduce patient anxiety upon arrival to the operating room. Because there was no overall benefit from preoperative anxiety treatment, it is possible that anxiety arising upon arrival to the operating room does not influence overall patient satisfaction," the authors write.
Naujo tyrimo duomenimis, prostatos vėžio stebėjimo taktika nėra taikoma taip jau dažnai, kaip rekomenduojama, ir taikomas gydymas, kuris nėra būtinas, rašoma žurnale JAMA Oncology. Tyrimo autoriai teigia, kad prostatos vėžiu sergantys pacientai gydomi per dažnai ir per dažnai jiems taikoma radioterapija. Plačiau...
(HealthDay News) -- New research suggests that a wait-and-watch approach for prostate cancer isn't being used often enough, and that more men are being treated than may be necessary. The study appears online Feb. 19 in JAMA Oncology.
Additionally, the researchers expressed concern about the numbers of men being treated with radiation therapy, regardless of their tumor specifics. "Too many men are being treated for prostate cancer, and too many are being treated with radiation therapy," study lead author Karim Chamie, M.D., an assistant professor of urology at the University of California in Los Angeles, told HealthDay.
In the new study, the researchers aimed to figure out why many men don't choose the wait-and-watch option. The investigators tracked 37,621 men in the United States who were diagnosed with prostate cancer between 2004 and 2007. The researchers followed the men, who were all at least 65 when diagnosed, through 2009. Only 10 percent of those diagnosed chose to forgo treatment, at least temporarily, the investigators found. Almost 58 percent of the men chose radiation therapy, while 19 percent had their prostate removed.
Sandip Prasad, M.D., an assistant professor of urology at the Medical University of South Carolina in Charleston, who co-wrote a commentary in the same issue of the journal, didn't go as far as to say that radiation is overused. Still, he told HealthDay: "We believe treatment -- radiation or surgery -- shouldn't be 90 percent of what's being done."
Kuomet pirmame nėštumo trimestre moterys yra veikiamos ftalatų, jų gimsiantys berniukai turi didesnę riziką nevaisingumui išsivystyti, rašoma žurnale Human Reproduction. Veikiant dietilheksylftalatams dažniau gimstama su ženkliai trumpesniu anogenitaliniu tarpu, kas susiję su nevaisingumu ir mažu spermos kiekiu. Plačiau...
(HealthDay News) -- When expectant mothers are exposed to phthalates during the first trimester, their male offspring may have a greater risk of infertility later in life, a new study suggests. The report was published online Feb. 18 in Human Reproduction.
Boys exposed to the chemical diethylhexyl phthalate (DEHP) may be born with a significantly shorter anogenital distance than those not exposed to these chemicals. A shorter anogenital distance has been linked to infertility and low sperm count, the researchers explained. "We saw these changes even though moms' exposure to DEHP has dropped 50 percent in the past 10 years," lead researcher Shanna Swan, Ph.D., a professor of preventive medicine and obstetrics, gynecology, and reproductive medicine at the Icahn School of Medicine at Mount Sinai in New York City, toldHealthDay. "Therefore, we have not found a safe level of phthalate exposure for pregnant women," she contended.
For the study, Swan's team collected data on 753 pregnant women and their infants. Specifically, the researchers found that exposure in the womb to three types of DEHP was associated with a significantly shorter anogenital distance in boys, but not in girls.
In a statement, the American Chemistry Council (ACC) stressed that the study only examined one type of phthalate, not all versions of the chemical. And it said that phthalates are "one of the most widely studied family of chemicals in use today." The ACC added that DEHP "is known to break down into its metabolites within minutes after it enters the body. Information collected by the U.S. Centers for Disease Control and Prevention over the last 10 years indicates that, despite the fact that phthalates are used in many products, exposure from all sources combined is extremely low -- much lower than the levels established as safe by scientists at regulatory agencies."
Likopenai, kurių gausu pamidoruose, aitriuosiuose pipiruose, mažina inkstų ląstelinės karcinomos riziką, rašoma žurnale Cancer. Nustatyta, kad gausesnis likopenų vartojimas susijęs su 39 procentais mažesne vėžio rizika. Tyrime dalyvavo 240 pomenstruacinio amžiaus moterų. Plačiau...
(HealthDay News) -- For postmenopausal women, lycopene intake seems to be inversely associated with the risk of renal cell carcinoma (RCC), according to a study published in the Feb. 15 issue of Cancer.
Won Jin Ho, M.D., from Case Western Reserve University in Cleveland, and colleagues examined the correlation between antioxidant micronutrients and the risk of RCC. Data were included for 96,196 postmenopausal women enrolled in the Women's Health Initiative between 1993 and 1998 who were followed through July 2013. A baseline food frequency questionnaire was used to estimate dietary micronutrient intake, and an interview-based inventory procedure was used to collect data on supplement use. Follow-up surveys were used to ascertain RCC cases.
The researchers identified 240 women with RCC during follow-up. There was an inverse correlation for lycopene intake with RCC risk (P = 0.015); the highest versus the lowest intake was associated with a 39 percent lower risk of RCC (hazard ratio, 0.61). There were no other correlations for micronutrients with RCC risk.
"The current results suggest that further investigation into the correlation between lycopene intake and the risk of RCC is warranted," the authors write.
Nustatyta, kad besikartojantys inkstų akmenys gali būti susiję su didesniu kalcio sankaupų atsidėjimu kraujagyslių sienelėse, rašoma žurnale Clinical Journal of the American Society of Nephrology. Asmenims, kuriems dažnai recidyvuoja akmenligė, būtina atkreipti dėmesį į kaulų tankį, kuris sumažėja, hiperlipidemiją ir didesnę aterosklerozės riziką. Plačiau...
(HealthDay News) -- Some people who develop recurring kidney stones may also have high levels of calcium deposits in their blood vessels, and that could explain their increased risk for cardiovascular disease, new research suggests. The findings were published online Jan. 29 in the Clinical Journal of the American Society of Nephrology.
Linda Shavit, M.D., a senior nephrologist at the Shaare Zedek Medical Center in Jerusalem, and colleagues utilized computed tomography scans to look for calcium deposits in the abdominal aorta. Of the 111 people in the study, 57 suffered recurring kidney stones that were comprised of calcium, and 54 did not have kidney stones. The authors found that those with recurring kidney stones made of calcium had higher calcium deposits in their abdominal aortas, but they also had less dense bones than those who did not have kidney stones.
"It's becoming clear that having kidney stones is a bit like having raised blood pressure, raised blood lipids, or diabetes in that it is another indicator of, or risk factor for, cardiovascular disease and its consequences," study coauthor Robert Unwin, M.D., of University College London, told HealthDay. Unwin is currently chief scientist with the AstraZeneca cardiovascular & metabolic diseases innovative medicines and early development science unit in Molndal, Sweden. The main message, Unwin said, "is to begin to take having kidney stones seriously in relation to cardiovascular disease risk, and to practice preventive monitoring and treatments, including diet and lifestyle."
An accompanying editorial, written by Eric Taylor, M.D., of the Maine Medical Center in Portland and Brigham and Women's Hospital in Boston, noted that it's too early to incorporate a history of kidney stones into screening guidelines for cardiovascular risk factors or osteoporosis.
Nauja gydymo strategija - bipolinė androgenų terapija, kuomet kaitaliojama maža ir didelė testosterono koncentracija, gali pagerinti prostatos vėžio jautrumą standartinei hormonų terapijai, teigiama žurnale Science Translational Medicine. Nedidelės apimties tyrime dalyvavo 16 vyrų, iš kurių septyniems išsivystė vėžio remisija, keturiems vėžys sumažėjo, vienam - išnyko. Plačiau...
(HealthDay News) -- A treatment strategy called bipolar androgen therapy -- where patients alternate between low and high levels of testosterone -- might make prostate tumors more responsive to standard hormonal therapy, according to a small study published in the Jan. 7 issue of Science Translational Medicine.
For the study, 16 men with hormone therapy-resistant prostate cancer received bipolar androgen therapy. Of these patients, seven had their cancer go into remission. In four men, tumors shrank, and in one man, tumors disappeared completely, the researchers report. If confirmed in several ongoing larger trials, "this could lead to a new treatment approach" for prostate cancers that have grown resistant to hormonal therapy, lead researcher Michael Schweizer, M.D., an assistant professor of oncology at the University of Washington School of Medicine in Seattle, told HealthDay. Overall, "50 percent of patients had declines in their prostate specific antigen and 50 percent had shrinkage of their cancer," Schweizer said.
Senior study author Samuel Denmeade, M.D., is co-director of the prostate cancer program at Johns Hopkins University in Baltimore. He told HealthDay that he believes the new approach has benefits beyond its effect on cancer cells -- restoring a man's testosterone levels also reduced the side effects of hormone therapy, which include mood swings and sexual dysfunction. And although testosterone levels alternated between high and low, the men seemed to tolerate the treatment well, he added.
Denmeade stressed that this treatment is not a cure, but a way to make men feel better and extend the time standard hormonal therapy remains effective. "Maybe men will live longer, but we don't know that yet," he said. Bipolar androgen therapy is probably not for "men who have not [yet] had any treatment for prostate cancer," he added. Moreover, the long-term effects or dangers of the therapy aren't yet known. Only longer, larger trials will help uncover any risks associated with the treatment.
Preliminarus genetinis tyrimas gali padėti identifikuoti, kuris transplantuotas inkstas gali būti atmestas. Atmetimo reakcijos pasitaiko 15-20 proc. pacientų, net jei jie gauna imunosupresinį gydymą. Plačiau...
Nedidelės apimties tyrimo išvadose teigiama, kad vaistas nuo impotencijos yohimbine gali padėti sergantiems antro tipo diabetu, kurie turi dalinę geno mutaciją, mažinančią insulino produkciją. Apie 40 procentų sergančių antro tipo diabetu turi šią geno mutaciją. Plačiau...
Impotence Drug Might Counter Common Gene Mutation in Type 2 Diabetes: Study
(HealthDay News) -- In a small study, Swedish researchers found that the impotence drug yohimbine might help people with type 2 diabetes who have a particular gene mutation that lowers their insulin production.
Among 50 men and women with type 2 diabetes partially caused by a mutation in a gene called alpha(2A)-AR, those treated with yohimbine showed improved insulin production and lower blood sugar levels, compared with those receiving a placebo.
"If a diabetic patient carries the risk mutation, he or she is more sensitive to stress hormones such as adrenaline," said lead researcher Dr. Anders Rosengren, head of the translational diabetes research group at Lund University Diabetes Center in Malmo.
About 40 percent of patients with type 2 diabetes carry this mutation. "It is not that patients are more stressed, but that adrenaline suppresses insulin secretion," he added.
Rosengren explained how the drug overcomes the effects of the mutation: "It is like driving a car with the brakes constantly on. If you add yohimbine, you release the brake and the car -- the insulin-producing cells -- can go at normal speed. The cells secrete adequate amounts of insulin in response to sugar."
Yohimbine isn't without side effects, however, Rosengren said. In the study, some patients experienced anxiety, stress and high blood pressure. His group is trying to find a way to reduce these side effects while preserving the benefits of the drug.
One expert also noted that targeting a single gene may not help many patients with diabetes.
Close to 300 genes play a role in diabetes, according to Dr. Joel Zonszein, director of the Clinical Diabetes Center at Montefiore Medical Center in New York City.
"Only a few have this mutation alone," Zonszein said. "In real life, we are not able to treat most patients with diabetes with a genetic therapy."
Zonszein said that there are many medications available to lower blood sugar, and combined with diet, exercise and weight loss, they are effective in treating type 2 diabetes.
Rosengren also noted that type 2 diabetes is primarily a lifestyle disease.
In other words, lifestyle factors trigger the disease, but the severity and susceptibility is influenced by genetic mutations, he said.
Rosengren added that even though two patients might have the same gene mutation, their condition won't be identical. "That is because several different risk genes and, importantly, lifestyle factors interact to shape the disease process in the individual patient," he said.
Lifestyle changes -- such as diet, exercise and weight loss -- will always be a cornerstone in type 2 diabetes management, Rosengren said.
However, this study shows that it may be possible in the future to block the negative effects of gene mutations, he said. "These findings open up a potential avenue to more personalized treatment using a combination of lifestyle modification and more targeted drugs," Rosengren said.
The report was published Oct. 8 in the journal Science Translational Medicine.
Visit the American Diabetes Association for more on this blood sugar disease.
SOURCES: Anders Rosengren, M.D., Ph.D., head translational diabetes research group, Lund University Diabetes Center, Malmo, Sweden; Joel Zonszein, M.D., director, Clinical Diabetes Center, Montefiore Medical Center, New York City; Oct. 8, 2014, Science Translational Medicine
Last Updated: Oct 9, 2014
Amerikos gydytojų kolegija (American College of Physicians) pateikė klinikines rekomendacijas moterų šlapimo nelaikymo nechirurginiam gydymui. Pagrindinės gydymo kryptys - dubens raumenų stiprinimas, farmakologinis gydymas ir svorio korekcija. Plačiau...
(HealthDay News) -- The American College of Physicians (ACP) has presented evidence and provided clinical recommendations for the nonsurgical management of urinary incontinence (UI) in women. The clinical practice guideline has been published in the Sept. 16 issue of the Annals of Internal Medicine.
Amir Qaseem, M.D., Ph.D., of the ACP in Philadelphia, and colleagues reviewed literature from 1990 through December 2013 to grade evidence and recommendations for the nonsurgical management of UI in women.
The researchers found evidence to support six strong recommendations for the management of UI in women. For stress UI, first-line treatment with pelvic floor muscle training (high-quality evidence) is recommended. Systemic pharmacologic therapy is not recommended for stress UI (low-quality evidence). For urgency UI, bladder training (moderate-quality evidence) is recommended; pharmacologic treatment is advised if bladder training fails (high-quality evidence). For mixed UI, pelvic floor muscle training (moderate-quality evidence) is recommended. For obese women with UI, weight loss and exercise (moderate-quality evidence) are recommended.
"Urinary incontinence is a common and important health care problem in women that is underreported and underdiagnosed," the authors write.
Several authors disclosed financial ties to pharmaceutical and biomedical companies