Effects of probiotic supplementation on glycaemic control and lipid profiles in gestational diabetes: A randomized, double-blind, placebo-controlled trial.

BACKGROUND: To our knowledge, data on the effects of probiotic supplementation on glycaemic control and lipid concentrations in patients with gestational diabetes mellitus (GDM) are scarce. AIM: The aim of the present study was to determine the effects of probiotic supplementation on glycaemic control and lipid profiles in GDM patients. METHODS: Sixty pregnant women with GDM, primigravida and aged 18-40years, were divided into two groups to receive either probiotic capsules (n=30) or a matching placebo (n=30) in this randomized double-blind, placebo-controlled trial. The patients in the probiotic group took a daily capsule that contained three viable freeze-dried strains: Lactobacillus acidophilus (2×10(9)CFU/g), L. casei (2×10(9)CFU/g) and Bifidobacterium bifidum (2×10(9)CFU/g) for 6weeks. The placebo group took capsules filled with cellulose for the same time period. Fasting blood samples were taken at the beginning and end of the study to quantify the relevant markers. RESULTS: After 6weeks of intervention, probiotic supplementation vs a placebo resulted in significant decreases in fasting plasma glucose (-9.2±9.2mg/dL vs +1.1±12.2mg/dL, P<0.001), serum insulin levels (-0.8±3.1µIU/mL vs +4.5±10.6µIU/mL, P=0.01), homoeostasis model assessment (HOMA) for insulin resistance (-0.4±0.9 vs +1.1±2.5, P=0.003) and HOMA for ß-cell function (+1.1±9.8 vs +18.0±42.5, P=0.03), and a significant increase in the quantitative insulin sensitivity check index (+0.007±0.01 vs -0.01±0.02, P=0.007). In addition, significant decreases in serum triglycerides (-1.6±59.4mg/dL vs +27.1±37.9mg/dL, P=0.03) and VLDL cholesterol concentrations (-0.3±11.9mg/dL vs +5.4±7.6mg/dL, P=0.03) were seen following supplementation with the probiotics compared with the placebo. However, no significant changes in other lipid profiles were seen with the intervention. CONCLUSION: Overall, the results of our study have demonstrated that taking probiotic supplements for 6weeks in patients with GDM had beneficial effects on glycaemic control, triglycerides and VLDL cholesterol concentrations, although there was no effect on other lipid profiles.

Atorvastatin improves the response to sildenafil in hypercholesterolemic men with erectile dysfunction not initially responsive to sildenafil.

Despite the initial enthusiasm, the significant number of patients in whom sildenafil is contraindicated or ineffective is a major challenge to all urologists. Our aim was to determine the safety and efficacy of adjunctive atorvastatin in restoring normal erectile function in hypercholesterolemic (low-density lipoprotein (LDL) cholesterol >120 mg per 100 ml) sildenafil nonresponders. The study comprised 131 men with ED not responding to sildenafil citrate. They were randomized either to 40 mg atorvastatin daily (n=66, group 1) or matching placebo (n=65, group 2) for 12 weeks while they were taking on-demand 100 mg sildenafil. Erectile function was subjectively assessed using the 5-item version of the International Index of Erectile Function (IIEF-5) questionnaire and response to the global efficacy question (GEQ). Serum biochemical and lipid profile (total cholesterol, triglycerides, LDL cholesterol and high-density lipoprotein cholesterol) analyses were performed at baseline and repeated at post-treatment weeks 6 and 12. Compared with the placebo group (59 patients, mean age+/-s.d. 61.9+/-6.1, mean years ED 3.9+/-1.8), the atorvastatin group (59 patients, mean age+/-s.d. 63.9+/-6.9, mean years ED 3.7+/-1.6) had significantly greater improvements in all IIEF-5 questions (P=0.01) and GEQ (P=0.001). Subgroup analyses did reveal trends in the atorvastatin group to indicate that a change in the IIEF-5 score is affected by age, severity of ED and baseline serum levels of LDL. Patients with moderate (r=0.28, P=0.01) and severe (r=0.20, P=0.01) ED had better positive response rates to adjunctive atorvastatin than patients with mild to moderate ED. None of the patients taking atorvastatin achieved a response of 5 to the IIEF-5 questions and none of the patients regained normal erectile function as defined by the IIEF-5 score >21. Subjects experienced a statistically significant but modest improvement in erectile function. Further investigation is needed to test the usefulness of long-term atorvastatin administration to restore erectile function in sildenafil nonresponders.

The correlation between semen parameters in processed and unprocessed semen with pregnancy rate in intrauterine insemination in the treatment of male factor infertility.

PURPOSE: Our aims were to determine the relation of semen parameters in processed and unprocessed semen samples with pregnancy rate in intrauterine insemination (IUI) in the treatment of male factor infertility. MATERIALS AND METHODS: In a quasi experimental study, 412 couples with male factor infertility were studied. To treat male factor infertility, 561 IUI cycles were done. RESULTS: Total pregnancy rate was 7.84% (44 in 561) per cycle. There was an inverse relationship between pregnancy rate and duration of infertility. Total sperm count after processing was higher in pregnant cycles than in non-pregnant ones (P <0.05). The mean total motile sperms after processing for pregnant and non-pregnant cycles was 72.2 +/- 78.8 and 53.2 +/- 54.3, respectively (P <0.05). CONCLUSION: IUI is a valuable method for the treatment of male factor infertility. The higher number of sperms, total motile sperms and IUI sessions, and lower duration of infertility, all have a positive relationship with pregnancy rate.

Extracorporeal shock wave lithotripsy of renal calculi during early pregnancy.

OBJECTIVE: To evaluate the safety of renal stone treatment by extracorporeal shock wave lithotripsy (ESWL) during pregnancy. PATIENTS AND METHODS: Data from 824 women of reproductive age who were treated by ESWL were analysed and the patients surveyed using a questionnaire about pregnancies, to which 636 (76%) responded. Of these patients, six had inadvertently undergone ESWL for renal stones during the first month of pregnancy. The stones were detected and located during ESWL using ultrasonography. RESULTS: The six patients gave birth to six children who had no detectable malformations or chromosomal anomalies. CONCLUSION: Although these results suggest that there were no adverse effects of ESWL during early pregnancy, a larger series should be assessed to confirm the safety and long-term effects of ultrasound-guided ESWL in the treatment of renal calculi during pregnancy. We do not advocate lithotripsy as a treatment for renal calculi in pregnancy, but inadvertent lithotripsy in a pregnant woman is not a cause for concern.

Accuracy of residual urine measurement in men: comparison between real-time ultrasonography and catheterization.

PURPOSE: The practical value of ultrasonography as a rapid means to determine accurately residual urine volume was assessed. MATERIALS AND METHODS: Transverse and sagittal bladder diameters, as well as areas from longitudinal and transverse images, were measured with real-time ultrasonography in 324 men immediately after voiding. Calculated bladder volumes using measured diameters and areas for each of 11 formulas in the literature were compared to the corresponding measured total residual urine volumes. RESULTS: The lower limit of ultrasonographic visualization of urine in the bladder was approximately 48 ml. No correlation existed between ultrasound calculated bladder volumes and measured residual urine for any of the 11 formulas. CONCLUSIONS: Ultrasonography cannot rapidly measure bladder volumes accurately to date. Catheterization remains the most accurate method of assessing post-void residuals but in many cases it may not be the best approach to patient care.