Evaluation of a therapeutic vaccine for the prevention of recurrent urinary tract infections versus prophylactic treatment with antibiotics

INTRODUCTION AND HYPOTHESIS: Urinary tract infections (UTIs) are considered the most common bacterial infections, especially in women. The objective of this study was to evaluate the use of the sublingual bacterial vaccine Uromune® in order to prevent recurrent UTIs (RUTIs). METHODS: This study was conceived as a multicenter observational study. The clinical history of 319 women who presented at least 2 episodes of UTI in the last 6 months or 3 in 12 months was reviewed. Data related to treatment and clinical evolution were recorded and analyzed. A total of 159 patients received prophylactic treatment with Uromune® for a period of 3 months (group A) and 160 with sulfamethoxazole/trimethoprim 200/40 mg/day for a period of 6 months (group B). Uromune® contained an inactivated bacterial cell suspension of selected strains of Escherichia coli, Klebsiella pneumoniae, Proteus vulgaris, and Enterococcus faecalis. RESULTS: Patients in group A experienced a highly significant reduction in the number of infections compared to patients in group B. In the first 3 months, the mean number of infections was 0.36 versus 1.60 (P < 0.0001), respectively. A significant reduction was also observed after 9 and 15 months (P < 0.0001). The numbers of patients who did not have any UTI at 3, 9, and 15 months were 101, 90, and 55 in group A versus 9, 4, and 0 in group B (P < 0.0001). CONCLUSIONS: The results obtained in this study favor the use of this bacterial-based therapeutic vaccine as an effective strategy to reduce frequency, duration, severity, and costs of RUTIs

Improvements in the Effectiveness of Early Detection in Colorectal Cancer with Open-Label Randomised Study

Introduction: The general objective of this research is to improve the quality of colorectal cancer screening (CRC) by assessing, as an indicator of effectiveness, the ability of colonoscopy to detect more advanced adenomas in the exposed group than in the control group. Material and Methods: The present work is designed as an open-label randomized study on cancer screening, using two groups based on their exposure to the protocol: an exposed to intervention group (EIG, 167), and a control group (CG, 167), without the intervention of the protocol and by 1:1 matching. Results: In 167 patients in the GEI, 449 polyps are visualized and 274 are adenomas (80.58%), of which 100 (36.49%) are advanced adenomas. In the CG (n = 174), there are 321 polyps and 152 adenomas (82.60%). The variables significantly associated by logistic regression to the detection of adenomas are the male sex with an OR of 2.52. The variable time to withdrawal, ≥9 min, is significant at 99% confidence (p = 0.002/OR 34.67) and the fractional dose is significant at 99% (p = 0.009, OR 7.81). Conclusion: Based on the observations made, our study suggests that the intervention in collaboration between primary care and hospital care is effective from a preventive point of view and achieves the objective of effectiveness and quality of the PCCR

Urinary tract infections in women with stress urinary incontinence treated with transobturator suburethral tape and benefit gained from the sublingual polibacterial vaccine

Introduction and objectives: Stress urinary incontinence (SUI) and recurrent urinary tract infections (RUTIs) are highly prevalent diseases. Our purpose was to investigate the relationship between RUTIs and surgical correction of SUI with transobturator suburethral tape (TOT) and to describe the benefit gained from a sublingual polibacterial preparation on RUTIs developed after TOT. Materials and methods: A retrospective study was performed on 420 women who underwent TOT surgery due to SUI between April 2003 and October 2011. Group A: patients without urinary tract infections (UTIs) before TOT ( n = 294). Group B: patients with UTIs before TOT ( n = 126). Variables: age, personal history, number of UTIs/month prior to and after surgery, appearance of urgent urinary incontinence (UUI) with or without UTIs, response to International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF) and Short Form 36 (SF-36) questionnaires. Results: Group A: 85% dry; 5% UUI; 4% de novo UTIs with good response to antibiotics over 6 days. No RUTIs during the follow-up period, 2% with sporadic UTIs. Group B: 47.61% RUTIs; 52.39% sporadic UTIs; greater incidence of diabetes mellitus ( p < 0.0025) and smoking ( p < 0.0031) than group A. After TOT: 79.36% dry; 10% RUTIs. After treatment with antibiotics for 6 days and bacterial preparation for 3 months, 82% of patients did not have a UTI anymore. Postoperative cystourethrogram revealed 38% of nondiagnosed cystoceles before TOT. No patient had a postvoiding volume greater than 100 cm 3 after TOT. Improvement of ICIQ-SF ( p < 0.001) and SF-36 ( p < 0.0004) in both groups. Conclusion: After eliminating bias associated with the tape, the technique and the surgeon’s skills, SUI correction may decrease the number of UTIs and improve the quality of life. UTIs disappeared in 82% of patients with RUTIs after TOT

Estudio de las deleciones de los genes GSTM1 y GSTT1 y del polimorfismo Ile105Val del gen GSTP1 en pacientes con enfermedad ósea de Paget

Fundamento: La enfermedad ósea de Paget (EOP) es un trastorno focal del hueso con aumento el número, tamaño y actividad de los osteoclastos. Algunos datos epidemiológicos apoyan la teoría de su relación con agentes ambientales tóxicos o infecciosos. Su interacción con algunas alteraciones genéticas predisponentes conducirían a la EOP. Las glutatión-S-transferasas (GST) intervienen en la metabolización de toxinas, al catalizar el ataque nucleofílico del sustrato fisiológico, glutatión reducido o GSH (g-Glu-Cys-Gly) sobre el centro electrófilo de un gran número de estructuras tóxicas. Estudiamos si la variabilidad de los genes GSTM1, GSTP1 y GSTT1 se relaciona con el riesgo a desarrollar EOP.Pacientes y métodos: Analizamos a 148 pacientes diagnosticados de EOP y a 207 individuos controles pareados en sexo y edad sin antecedentes de alteraciones óseas. Con DNA genómico obtenido de sangre periférica se estudió la presencia-ausencia de deleción en los genes GSTM1 y GSTT1, mediante PCR multiplex. El estudio del polimorfismo Ile105Val del gen GSTP1 se llevó a cabo mediante PCR y posterior digestión con la enzima de restricción BsmaI. Se analizó la distribución de genotipos mediante el test chi-cuadrado de Pearson. Cuando se encontraron diferencias estadísticamente significativas, realizamos una regresión logística multivariante para conocer el riesgo que puede generar la presencia de un determinado genotipo. Utilizamos el programa SPSS 21.0. Se consideraron diferencias estadísticamente significativas aquéllas con valores de p<0,05. Resultados: Encontramos diferencias en la distribución de la presencia-ausencia de deleción en el gen GSTM1; no ser portador de la deleción o serlo en heterocigosis en el gen GSTM1 confiere un menor riesgo a desarrollar EOP (OR=0,56, IC 95%: 0,36-0,87; p=0,011). En el estudio de los genes GSTT1 y GSTP1 no hubo diferencias significativas. Conclusión: La actividad detoxificadora disminuye cuando se heredan las dos copias delecionadas del gen GSTM1 al disminuir la actividad enzimática; se ha asociado con una mayor susceptibilidad para algunos tumores, hepatopatía alcohólica y otros problemas inflamatorios. No conocemos descripción de su asociación con la EOP. En los individuos portadores del gen GSTM1 delecionado en homocigosis se observa con más frecuencia EOP. Este hecho podría explicar los hallazgos epidemiológicos que asocian la EOP a la exposición a determinados agentes ambientales