Managing uncomplicated recurrent urinary tract infections in reproductive aged women: a primary care approach.

PURPOSE: Uncomplicated, recurrent urinary tract infections (RUTIs) in heal-thy, premenopausal women are a common health complaint. This article discusses risk factors, diagnostic techniques, medical management, and referral information to help clinicians manage RUTIs in the primary care setting. DATA SOURCES: This article cites research articles, systematic reviews, and current guidelines. CONCLUSIONS: The majority of RUTIs in healthy premenopausal women can be managed by using individualized plans of care. Referrals are usually not useful nor cost effective. IMPLICATIONS FOR PRACTICE: This article discusses treatments based on increasing antimicrobial resistance and examines nonmicrobial options in RUTI prevention. This article serves as a foundation for guiding primary care providers in managing this common problem using current research and guidelines.

Effect of orange juice and beverage with phytosterols on cytokines and PAI-1 activity.

BACKGROUND & AIMS: Inflammation is pivotal in all phases of atherosclerosis. Dietary options which lower inflammatory biomarkers would be an attractive strategy to reduce risk from cardiovascular diseases and cancer. Indeed, fruit and vegetable intake or fruit juice consumption is associated with health and wellness. However, there is a paucity of data examining the effect of orange juice on biomarkers of inflammation in healthy volunteers. We have previously conducted the first placebo-controlled randomized studies examining the effect of sterol fortified orange juice or sterol fortified reduced calorie orange juice beverage supplementation (2 g sterols/day) compared to Placebo OJ or Placebo OJBev, and showed significant benefits on the lipid profile as well as significant reduction in hsCRP, the prototypic marker of inflammation and a cardiovascular risk marker. The aim of this study was to examine the effect of orange juice (OJ) or OJ beverage (Bev) alone and fortified with plant sterols (1g/240 ml juice or beverage twice a day) on pro-inflammatory cytokines and PAI-1, a marker of impaired fibrinolysis in healthy human volunteers. METHODS: In the first study, 72 healthy human volunteers received Placebo OJ or Sterol OJ and in the second study, 72 volunteers received OJBev or Sterol OJBev for 8 weeks and blood was drawn at baseline and following supplementation for 8 weeks. Biomarkers of Inflammation (IL-1b, IL-6, TNF, IL-8, IL-10) were assessed in serum using the BD Human Inflammatory Cytokine Cytometric Bead Array and PAI-1 activity was assessed in citrated plasma. RESULTS: OJ or OJBev alone failed to result in any significant effects on circulating cytokine levels or PAI-1 activity. There was a significant reduction in IL-1b with sterol fortified OJ (p < 0.05) compared to baseline. In addition, both sterol fortified OJ as well as sterol fortified OJBev resulted in significant reductions in serum IL-6 levels (p < 0.01). CONCLUSION: Thus, sterol fortified OJ and OJ Beverage are able to effectively lower biomarkers of inflammation in healthy human volunteers in addition to providing lipid profile benefits and may thus contribute to decreasing cardiovascular risk.

Simvastatin reduces circulating plasminogen activator inhibitor 1 activity in volunteers with the metabolic syndrome.

BACKGROUND: The Metabolic Syndrome (MS) confers an increased risk for diabetes and cardiovascular disease. We previously showed that simvastatin has concomitant benefits in reducing low-density lipoprotein (LDL)-cholesterol and inflammation in MS subjects. The levels of plasminogen activator inhibitor 1(PAI-1), soluble P-selectin (sP-selectin), and soluble CD40 ligand (sCD40L) play an important role in the development and progression of atherosclerosis. Their levels are increased in the MS. The current study was to investigate the effects of simvastatin on PAI-1, sP-selectin, and sCD40 ligand. METHODS: Fifty subjects with MS were randomized into either placebo or simvastatin (40 mg/day) group for 8 weeks. Blood samples were obtained at baseline and at the end of the study. PAI-1 activity and sP-selectin and sCD40L levels were measured by enzyme-linked immunosorbent assay (ELISA). RESULTS: There was no baseline difference in any of the parameters studied. Compared to baseline, simvastatin significantly reduced (P < 0.05) the circulating PAI-1 activity (24.3 +/- 5.2 IU/mL at baseline vs. 21.4 +/- 3.9 IU/mL after 8 weeks of treatment). Simvastatin did not alter (P < 0.05) the levels of sP-selectin (111.4 +/- 35.9 ng/mL at baseline vs. 118.5 +/- 71.2 ng/mL after 8 weeks) or sCD40L (2.0 +/- 1.6 ng/mL at baseline vs. 1.5 +/- 1.0 ng/mL after 8 weeks). CONCLUSION: Our data indicate that simvastatin therapy has significant effects on the fibrinolytic system in MS subjects as evidenced in a reduction in PAI-1 activity.