ABSTRACT
PURPOSE OF REVIEW: To evaluate the role of Ureaplasma urealyticum as a genital pathogen in women's health. Three aspects were analyzed: (1) preterm delivery (PTD); (2) female infertility; and (3) lower genital tract pathology including pelvic inflammatory disease (PID), cervicitis, and genital discomfort (discharge, burning). RECENT FINDINGS: A systematic review was performed. Searching PUBMED and EMBASE for published articles from January 2003 to September 2017 using the key word "Ureaplasma urealyticum" yielded 1835 manuscripts. These were further screened using defined inclusion criteria: (1) original peer-reviewed observational studies; (2) English language; (3) U. urealyticum was specifically isolated; (4) present "cases"/"exposed" and "controls"/"unexposed" to enable calculating an association between U. urealyticum and the outcome studied. Altogether, 32 studies were included that underwent quality scoring based on methodology, sample size, study population, and method of identification of U. urealyticum. The association of U. urealyticum and PTD was inconsistent between the studies. Eight of the ten prospective studies failed to show an association between U. urealyticum and PTD, yet four of the six case control studies found a positive association. Regarding female infertility and genital discomfort, five of the six studies for each of these topics failed to find an association. Only two studies met the inclusion criteria for cervicitis with conflicting conclusions. Unfortunately, none of the studies met the inclusion criteria for PID. It seems that U. urealyticum has a limited role as a pathogen in female infertility, cervicitis, PID, and genital discomfort. The role as a pathogen in PTD is unclear and future studies are needed to address this issue.
ABSTRACT
BACKGROUND: Concerns about an inhibitory effect of proton pump inhibitors (PPIs) on clopidogrel metabolism have been raised. Because the pharmacological effect of clopidogrel is dependent on genetically determined activity of the hepatic cytochrome P450 isoenzymes system, it is important to examine the interaction between different PPIs and high on-treatment platelet reactivity (HPR) after controlling for genetic variability. The aim of the study was to assess the effect of 2 PPIs and a histamine-2 (H2) receptor-blocker on platelet reactivity in a crossover trial where each patient was alternately treated with each drug. HYPOTHESIS: Omeprazole reduces HPR more than other PPI or H2 blockers. METHODS: Patients treated with aspirin and clopidogrel for at least 1 month were assigned to 3 consecutive 1-month treatment periods during which they were treated with each of the 3 study medications twice daily: omeprazole 20 mg, famotidine 40 mg, and pantoprazole 20 mg. At the end of each treatment phase, platelet function was evaluated with the Verify Now system using 2 cutoff values (>208 P2Y12 reaction units [PRUs] and >230 PRUs) for the definition of HPR. RESULTS: Patients with HPR were older than those without HPR (62 ± 10 vs 55 ± 8 years, respectively, P = 0.03). HPR was more prevalent during omeprazole therapy compared to famotidine or pantoprazole (48%, 33%, and 31%, respectively, for the 208 PRU cutoff, P= 0.04; and 37%, 17%, and 23%, respectively, for the 230 PRU cutoff, P= 0.003). CONCLUSIONS: After eliminating the effects of interindividual variability in clopidogrel metabolism, omeprazole therapy was associated with substantially more HPR than famotidine or pantoprazole.