Utilization of the Intestinal Tract as a Delivery System for Urogenital Probiotics Clinical study comparing probiotic Lactobacillus GR-1 and RC-14 with metronidazole vaginal gel to treat symptomatic bacterial vaginosis. Managing menopause. Effect of nonoxynol-9 gel on urogenital gonorrhea and chlamydial infection: a randomized controlled trial. Complementary and alternative medicine in gastroenterology: the good, the bad, and the ugly. Effect of a probiotic food as an adjuvant to triple therapy for eradication of Helicobacter pylori infection in children. Probiotics and prebiotics in gastrointestinal disorders World Allergy Organization-McMaster University Guidelines for Allergic Disease Prevention (GLAD-P): Probiotics Assessing the evidence for the use of chiropractic manipulation in paediatric health conditions: A systematic review. Prophylactic Probiotics to Prevent Death and Nosocomial Infection in Preterm Infants Lactobacillus rhamnosus GR-1 and L. reuteri RC-14 to prevent or cure bacterial vaginosis among women with HIV. Efficacy of low-dose intravaginal estriol on urogenital aging in postmenopausal women Oral use of Lactobacillus rhamnosus GR-1 and L. fermentum RC-14 significantly alters vaginal flora: randomized, placebo-controlled trial in 64 healthy women. [Influence of probiotics and fibre on the incidence of bacterial infections following major abdominal surgery - results of a prospective trial]. Probiotics enhance the clearance of human papillomavirus-related cervical lesions: a prospective controlled pilot study Oral probiotic and prevention of Pseudomonas aeruginosa infections: a randomized, double-blind, placebo-controlled pilot study in intensive care unit patients Effects of intravaginal estriol and pelvic floor rehabilitation on urogenital aging in postmenopausal women Comparison between oral antibiotics and probiotics as bowel preparation for elective colon cancer surgery to prevent infection: prospective randomized trial. Systematic Reviews: Synthesis of Best Evidence for Clinical Decisions Different effects of probiotic species/strains on infections in preschool children: A double-blind, randomized, controlled study. Effect of Intravenous Hydrocortisone on Preventing Postoperative Sore Throat Followed by Laryngeal Mask Airway Use in patients Undergoing Urogenital Surgeries. Commentary on the Cochrane Review of acupuncture and assisted conception. The politics of probiotics: probiotics, necrotizing enterocolitis and the ethics of neonatal research
Orally consumed viable bacteria with proposed beneficial health effects , the so-called probiotics , are increasingly used to treat disorders of the gastrointestinal tract . It has been recently suggested that specifically selected lactobacilli could have a therapeutic role in female urogenital tract infections . It has been also suggested that some of these bacteria could be not intravaginally instilled , but also orally delivered . The authors investigate the ability of lactobacilli isolated from the vagina to survive gastrointestinal tract transit , and establish a link between the rate of intestinal survival and vaginal colonization Bacterial vaginosis ( BV ) is particularly common in black women , and in Nigeria it is often caused by Mycoplasma , as well as Atopobium , Prevotella and Gardnerella sp. Antimicrobial metronidazole oral therapy is poorly effective in eradicating the condition and restoring the Lactobacillus microbiota in the vagina . In this study , 40 women diagnosed with BV by discharge , fishy odor , sialidase positive test and Nugent Gram stain scoring , were r and omized to receive either two dried capsules containing Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14 each night for 5 days , or 0.75 % metronidazole gel , applied vaginally twice a day ( in the morning and evening ) . Follow-up at day 6 , 15 and 30 showed cure of BV in significantly more probiotic treated subjects ( 16 , 17 and 18/20 , respectively ) compared to metronidazole treatment ( 9 , 9 and 11/20 : P=0.016 at day 6 , P=0.002 at day 15 and P=0.056 at day 30 ) . This is the first report of an effective ( 90 % ) cure of BV using probiotic lactobacilli . Given the correlation between BV and HIV , and the high risk of the latter in Nigeria , intravaginal use of lactobacilli could provide women with a self-use therapy , similar to over-the-counter anti-yeast medication , for treatment of urogenital infections OBJECTIVE To provide up date d guidelines for health care providers on the management of menopause in asymptomatic healthy women as well as in women presenting with vasomotor or urogenital symptoms and on considerations related to cardiovascular disease , breast cancer , urogynaecology , and sexuality . OUTCOMES Lifestyle interventions , prescription medications , and complementary and alternative therapies are presented according to their efficacy in the treatment of menopausal symptoms . Counselling and therapeutic strategies for sexuality concerns in the peri- and postmenopausal years are review ed . Approaches to the identification and evaluation of women at high risk of osteoporosis , along with options for prevention and treatment , are presented in the companion osteoporosis guideline . EVIDENCE Published literature was retrieved through search es of PubMed and The Cochrane Library in August and September 2012 with the use of appropriate controlled vocabulary ( e.g. , hormone therapy , menopause , cardiovascular diseases , and sexual function ) and key words ( e.g. , hormone therapy , perimenopause , heart disease , and sexuality ) . Results were restricted to clinical practice guidelines , systematic review s , r and omized control trials/controlled clinical trials , and observational studies . Results were limited to publication date s of 2009 onwards and to material in English or French . Search es were up date d on a regular basis and incorporated in the guideline until January 5 , 2013 . Grey ( unpublished ) literature was identified through search ing the websites of health technology assessment and health technology assessment -related agencies , national and international medical specialty societies , and clinical practice guideline collection CONTEXT Nonoxynol-9 has been suggested as a vaginal microbicide to protect against common sexually transmitted infections . OBJECTIVE To compare nonoxynol-9 gel and condom use ( gel group ) vs condom use alone ( condom group ) for the prevention of male-to-female transmission of urogenital gonococcal and chlamydial infection . DESIGN AND SETTING R and omized controlled trial conducted at 10 community clinics and 10 pharmacies in Yaoundé , Cameroon , between October 1998 and September 2000 , with 6 months of follow-up . PARTICIPANTS High-risk population of 1251 women ( excluding sex workers ) being treated for or who had symptoms of sexually transmitted infections . Three were excluded from the gel group ( 0.5 % ) and 7 from the condom group ( 1 % ) because of no follow-up data . INTERVENTIONS Nonoxynol-9 gel ( 100 mg ) and condoms or condoms only . MAIN OUTCOME MEASURE A positive test result for gonococcal or chlamydial infection by the ligase chain reaction assay ; secondary outcome measure was a positive test result for human immunodeficiency virus ( HIV ) . RESULTS The rate ratio ( RR ) for new urogenital infections was 1.2 for the gel group vs condom group ( 95 % confidence interval [ CI ] , 0.9 - 1.6 ; P = .21 ) . The gel group had 116 diagnosed gonococcal infections , chlamydial infections , or both for a rate of 43.6 per 100 person-years , and the condom group had 100 infections for a rate of 36.6 per 100 person-years . The RR for gonococcal infection in the gel group vs the condom group was 1.5 ( 95 % CI , 1.0 - 2.3 ) and for chlamydial infection was 1.0 ( 95 % CI , 0.7 - 1.4 ) . There were 5 new cases of HIV infections in the gel group and 4 in the condom group . Three women in each group became pregnant during the study . CONCLUSION Nonoxynol-9 gel did not protect against urogenital gonococcal or chlamydial infection A large proportion of the American population avails itself of a variety of complementary and alternative medicine ( CAM ) interventions . Allopathic practitioners often dismiss CAM because of distrust or a belief that there is no sound scientific evidence that has established its utility . However , although not widely appreciated , there are thous and s of r and omized controlled trials ( RCTs ) that have addressed the efficacy of CAM . We review ed the RCTs of herbal and other natural products , acupuncture , and homeopathy as examples of typical CAM modalities , focusing on conditions of interest to gastroenterologists . Peppermint ( alone or in combination ) has supportive evidence for use in patients with dyspepsia , irritable bowel syndrome , and as an intraluminal spasmolytic agent during barium enemas or endoscopy . Ginger appeared to be effective in relieving nausea and vomiting due to motion sickness or pregnancy . Probiotics were useful in childhood diarrhea or in diarrhea due to antibiotics ; one particular formulation ( VSL#3 ) prevented pouchitis . Acupuncture appeared to ameliorate postoperative nausea and vomiting and might be useful elsewhere . There is even a suggestion that homeopathy has efficacy in treatment of gastrointestinal problems or symptoms . The major problem in interpreting these CAM data is the generally low quality of the RCTs , although that quality might not be different compared to RCTs in the general medical literature . Gastroenterologists should become familiar with these techniques ; it is likely that their patients already are OBJECTIVE Current recommendations for treatment of Helicobacter pylori infection include a proton pump inhibitor in combination with two antibiotics . We evaluated the potential activity of a probiotic food as an adjuvant to antibiotic triple therapy for eradication of H. pylori infection in children from Buenos Aires , Argentina . METHODS Sixty-five children who tested positive for H. pylori , as diagnosed by (13)C-urea breath test and endoscopy , were included in this study . Patients were r and omized to receive 1-wk triple therapy plus probiotic food ( treated group ) or milk placebo ( control ) that was administered for 3 mo . Probiotic food consisted of 250 mL of a commercial yogurt containing Bifidobacterium animalis and Lactobacillus casei ( 10(7 ) colony-forming units/mL ) . Post-treatment urea breath test controls were performed 1 and 3 mo after the end of triple therapy . RESULTS We found no significant differences in H. pylori eradication rates ( ERs ) at 1 and 3 mo between the treated group ( ER = 45.5 % and 42.4 % ) and the control group ( ER = 37.5 % and 40.6 % ) . Relative risks between groups were 0.87 ( 95 % confidence interval 0.58 - 1.32 , P = 0.345 ) in the first month and 0.97 ( 95 % confidence interval 0.64 - 1.46 , P = 0.542 ) in the third month . CONCLUSIONS We could not demonstrate an adjuvant effect of the studied probiotic food to triple therapy in the eradication of H. pylori infection in children in Buenos Aires , Argentina . However , we found lower ERs than those reported for the same therapeutic scheme in developed countries , indicating that bacterial resistance and alternative therapeutic strategies should be studied Purpose of review This review summarizes the clinical efficacy of probiotics and prebiotics in gastrointestinal disorders and examines the mechanisms of action related to their therapeutic effect . Recent findings The demonstration that immune and epithelial cells can discriminate between different microbial species has extended the known mechanism(s ) of action of probiotics beyond simple barrier and antimicrobial effects . It has also confirmed that probiotic bacteria modulate mucosal and systemic immune activity and epithelial function . The progressive unraveling of these mechanisms of action has led to new credence for the use of probiotics and prebiotics in clinical medicine . Level I evidence now exists for the therapeutic use of probiotics in infectious diarrhea in children , recurrent Clostridium difficile – induced infections and postoperative pouchitis . Level II evidence is emerging for the use of probiotics in other gastrointestinal infections , prevention of postoperative bacterial translocation , irritable bowel syndrome , and in both ulcerative colitis and Crohn disease . Nevertheless , one consistent feature has emerged over the past year : Not all probiotic bacteria have similar therapeutic effects . Future clinical trials will need to incorporate this fact into trial planning and design . Summary The use of probiotics and prebiotics as therapeutic agents for gastrointestinal disorders is rapidly moving into the “ mainstream . ” Mechanisms of action explain the therapeutic effects and r and omized ; controlled trials provide the necessary evidence for their incorporation into the therapeutic armamentarium Background Prevalence of  allergic diseases in infants , whose parents and siblings do not have allergy , is approximately 10 % and reaches 20–30 % in those with an allergic first-degree relative . Intestinal microbiota may modulate immunologic and inflammatory systemic responses and , thus , influence development of sensitization and allergy . Probiotics have been reported to modulate immune responses and their supplementation has been proposed as a preventive intervention . Objective The World Allergy Organization ( WAO ) convened a guideline panel to develop evidence -based recommendations about the use of probiotics in the prevention of allergy . Methods We identified the most relevant clinical questions and performed a systematic review of r and omized controlled trials of probiotics for the prevention of allergy . We followed the Grading of Recommendations Assessment , Development and Evaluation ( GRADE ) approach to develop recommendations . We search ed for and review ed the evidence about health effects , patient values and preferences , and re source use ( up to November 2014 ) . We followed the GRADE evidence -to-decision framework to develop recommendations . Results Currently available evidence does not indicate that probiotic supplementation  reduces the risk of developing allergy in children . However , considering all critical outcomes in this context , the WAO guideline panel determined that there is a likely net benefit from using probiotics result ing primarily from prevention of eczema . The WAO guideline panel suggests : a ) using probiotics in pregnant women at high risk for having an allergic child ; b ) using probiotics in women who breastfeed infants at high risk of developing allergy ; and c ) using probiotics in infants at high risk of developing allergy . All recommendations are conditional and supported by very low quality evidence . Conclusions WAO recommendations about probiotic supplementation for prevention of allergy are intended to support parents , clinicians and other health care professionals in their decisions whether to use probiotics in pregnancy and during breastfeeding , and whether to give them to infants OBJECTIVE To review the biomedical literature up to and including 2003 , and determine the extent of the evidence related to the therapeutic application of chiropractic manipulation for paediatric health conditions . No critical appraisal of the evidence is undertaken . DATA SOURCES The indexed manual therapy sector including medical , chiropractic , physiotherapy , naturopathic and osteopathic literature was search ed . This included PubMed ; the Manual , Alternative , and Natural Therapy Index System ; the Cumulative Index to Nursing and Allied Health Literature ; the Index to Chiropractic Literature ; the Paediatric Economic Data base Evaluation Project ; the Cochrane Library ; the Canadian Coordinating Office for Health Technology Assessment data base ; and the Agency for Healthcare Research and Quality data base . Other re sources included research conference and symposium proceedings , and the references of identified studies . RESULT The search identified 1731 articles , of which 166 met the eligibility criteria . Two review ers determined by consensus each citation 's appropriate level on the strength of evidence scale . There was one systematic review , nine r and omized controlled trials , one observational study , 141 descriptive case studies and 14 conference abstract s. SUMMARY Health cl aims made by practitioners regarding the application of chiropractic manipulation as a health care intervention for paediatric health conditions are , for the most part , supported by low levels of scientific evidence . Chiropractors , in particular , employ manipulation for the treatment of a wide variety of paediatric health conditions . The evidence rests primarily with clinical experience , descriptive case studies and a few r and omized controlled trials . There is a need for more rigorous scientific inquiry to examine the value of manipulative therapy in the treatment of paediatric conditions . To advance the health interests of paediatric patients , health care decisions made on the basis of expert opinion or clinical experience must integrate the best research evidence available from high- quality , scientific studies BACKGROUND AND OBJECTIVE : It has been suggested that probiotics may decrease  infant mortality and nosocomial infections because of their ability to suppress colonization and translocation of bacterial pathogens in the gastrointestinal tract . We design ed a large double-blinded placebo-controlled trial using Lactobacillus reuteri to test this hypothesis in preterm infants . METHODS : Eligible infants were r and omly assigned during the first 48 hours of life to either daily probiotic administration or placebo .  Infants in the intervention group were administered enterally 5 drops of a probiotic preparation containing 108 colony-forming units of L reuteri DSM 17938 until death or discharge from the NICU . RESULTS : A total of 750 infants ≤2000 g were enrolled . The frequency of the primary outcome , death , or nosocomial infection , was similar in the probiotic and placebo groups ( relative risk 0.87 ; 95 % confidence interval : 0.63–1.19 ; P = .376 ) . There was a trend toward a lower rate of nosocomial pneumonia in the probiotic group ( 2.4 % vs 5.0 % ; P = .06 ) and a nonsignificant 40 % decrease in necrotizing enterocolitis ( 2.4 % vs 4.0 % ; P = .23 ) . Episodes of feeding intolerance and duration of hospitalization were lower in infants ≤ 1500 g ( 9.6 % vs 16.8 % [ P = .04 ] ; 32.5 days vs 37 days [ P = .03 ] ) . CONCLUSIONS : Although L reuteri did not appear to decrease the rate of the composite outcome , the trends suggest a protective role consistent with what has been observed in the literature . Feeding intolerance and duration of hospitalization were decreased in premature infants ≤1500 OBJECTIVE To assess , among women with HIV , whether long-term oral Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14 supplementation can prevent bacterial vaginosis ( BV ) and enhance the cure rate of metronidazole  among those with BV . METHODS A r and omized , double-blind , placebo-controlled trial conducted among 65 HIV-infected women with an aberrant microbiota ( Nugent score 4 - 10 ) who were r and omized to receive daily probiotics or placebo for 6 months . Those with BV ( Nugent score 7 - 10 ) additionally received metronidazole for 10 days ( 400 mg twice daily ) . RESULTS We did not find an enhanced cure rate of BV among women with HIV treated with adjuvant probiotics to metronidazole treatment . Among women with an intermediate vaginal flora , probiotics tended to increase the probability of a normal vaginal flora ( odds ratio 2.4 ; P=0.1 ) and significantly increased the probability of a beneficial vaginal pH ( odds ratio 3.8 ; P=0.02 ) at follow-up . CONCLUSION Supplementation of probiotic L. rhamnosus GR-1 and L. reuteri RC-14 did not enhance the cure of BV among women living with HIV , but may prevent the condition among this population . TRIAL REGISTRATION NCT00536848 Objective To assess the efficacy and safety of intravaginal estriol administration on  urinary incontinence , urogenital atrophy , and recurrent urinary tract infections in postmenopausal women . Design Eighty-eight postmenopausal women with urogenital aging symptoms were enrolled in this prospect i ve , r and omized , placebo-controlled study . Participants were r and omly divided into two groups , with each group consisting of 44 women . Women in the treatment group received intravaginal estriol ovules : 1 ovule ( 1 mg ) once daily for 2 weeks and then 2 ovules once weekly for a total of 6 months as maintenance therapy . Women in the control group received inert placebo vaginal suppositories in a similar regimen . We evaluated urogenital symptomatology , urine cultures , colposcopic findings , urethral cytologic findings , urethral pressure profiles , and urethrocystometry before as well as after 6 months of treatment . Results After therapy , the symptoms and signs of urogenital atrophy significantly improved in the treatment group in comparison with the control group . Thirty ( 68 % ) of the treated participants , and only seven ( 16 % ) of the control participants registered a subjective improvement of their incontinence . In the treated participants , we observed significant improvements of colposcopic findings , and there were statistically significant increases in mean maximum urethral pressure , in mean urethral closure pressure as well as in the abdominal pressure transmission ratio to the proximal urethra . Urethrocystometry showed positive but not statistically significant modifications . Conclusions Our results show that intravaginal administration of estriol may represent a satisfactory therapeutic choice for those postmenopausal women with urogenital tract disturbances who have contraindications or refuse to undergo st and ard hormone therapy Urogenital infections afflict an estimated one billion people each year . The size of this problem and the increased prevalence of multi-drug resistant pathogens make it imperative that alternative remedies be found . A r and omized , placebo-controlled trial of 64 healthy women given daily oral capsules of Lactobacillus rhamnosus GR-1 and Lactobacillus fermentum RC-14 for 60 days showed no adverse effects . Microscopy analysis showed restoration from asymptomatic bacterial vaginosis microflora to a normal lactobacilli colonized microflora in 37 % women during lactobacilli treatment compared to 13 % on placebo ( P=0.02 ) . Lactobacilli were detected in more women in the lactobacilli-treated group than in the placebo group at 28 day ( P=0.08 ) and 60 day ( P=0.05 ) test points . Culture findings confirmed a significant increase in vaginal lactobacilli at day 28 and 60 , a significant depletion in yeast at day 28 and a significant reduction in coliforms at day 28 , 60 and 90 for lactobacilli-treated subjects versus controls . The combination of probiotic L. rhamnosus GR-1 and L. fermentum RC-14 is not only safe for daily use in healthy women , but it can reduce colonization of the vagina by potential pathogenic bacteria and yeast INTRODUCTION Early enteral nutrition with fibre and probiotics has been effective in preventing bacterial translocation and is therefore expected to reduce the incidence of postoperative bacterial infections . PATIENTS AND METHODS In a prospect i ve r and omized trial including 172 patients following major abdominal surgery or liver transplantation , the incidence of bacterial infections was compared in patients receiving either a ) conventional parenteral or enteral nutrition  , b ) enteral nutrition with fibre and lactobacillus plantarum 299 or c ) enteral nutrition with fibre and heat inactivated lactobacilli ( placebo ) .  Liver transplant recipients were also treated with selective bowel decontamination ( SBD ) .  Routine laboratory parameters , nutritional parameters and the cellular immune status were measured preoperatively and on postoperative days 1 , 5 and 10 . RESULTS Patients were comparable regarding preoperative ASA-classification , Child-Pugh classification of cirrhosis , operative data and immunosuppression . The incidence of bacterial infections after liver , gastric oder pancreas resection was 31 % in the conventional group a ) compared to 4 % in the lactobacillus-group b ) and 13 % in the placebo-group c ) . In the analysis of 95 liver transplant recipients , 13 % group b)- patients developed infections compared to 48 % group a)- patients and 34 % group c)- patients . The difference between groups a ) and b ) was statistically significant in both cases . In addition , the duration of antibiotic therapy was significantly shorter in the lactobacillus-group . Cholangitis and pneumonia were the most frequent infections and enterococci the most frequently isolated bacteria . Fibre and lactobacilli were well tolerated in most cases . CONCLUSION Fibre and probiotics could lower the incidence of bacterial infections following major abdominal surgery in comparison to conventional nutrition with or without SBD . With this new concept , costs can be reduced by shortening the duration of antibiotic therapy and sparing SBD Probiotics have been proposed for a number of urogenital infectious conditions . In this study , we examine a possible effect on human papillomavirus (HPV)-related precancerous lesions in cervical cytology . We conducted a prospect i ve controlled pilot study , in which 54 women with an HPV+low- grade squamous intraepithelial lesion diagnosis in their PAP smear were followed for 6 months . The intervention group consumed a daily probiotic drink during the study period ; the control group received no treatment , according to common care policy . Outcome measures were the control PAP smear and HPV status after 6 months . Probiotic users had a twice as high chance of clearance of cytological abnormalities ( 60 vs. 31 % , P=0.05 ) . HPV was cleared in 19 % of control patients versus 29 % of probiotic users ( P=0.41 ) . This exploratory pilot study suggests that the probiotic studied promotes the clearance of HPV-related cytological abnormalities . If confirmed , this would represent an entirely new option to manage cervical cancer precursors Introduction Preventing carriage of potentially pathogenic micro-organisms from the aerodigestive tract is an infection control strategy used to reduce the occurrence of ventilator-associated pneumonia  in intensive care units . However , antibiotic use in selective decontamination protocol s is controversial . The purpose of this study was to investigate the effect of oral administration of a probiotic , namely Lactobacillus , on  gastric and respiratory tract colonization/infection with Pseudomonas aeruginosa strains . Our hypothesis was that an indigenous flora should exhibit a protective effect against secondary colonization . Methods We conducted a prospect i ve , r and omized , double-blind , placebo-controlled pilot study between March 2003 and October 2004 in a 17-bed intensive care unit of a teaching hospital in Clermont-Ferr and , France . Consecutive patients with a unit stay of longer than 48 hours were included , 106 in the placebo group and 102 in the probiotic group .  Through a nasogastric feeding tube , patients received either 109 colony-forming units unity forming colony of Lactobacillus casei rhamnosus or placebo twice daily , from the third day after admission to discharge . Digestive tract carriage of P. aeruginosa was monitored by cultures of gastric aspirates at admission , once a week thereafter and on discharge . In addition , bacteriological analyses of respiratory tract specimens were conducted to determine patient infectious status . Results The occurrence of P. aeruginosa respiratory colonization and /or infection was significantly delayed in the probiotic group , with a difference in median delay to acquisition of 11 days versus 50 days ( P = 0.01 ) , and a nonacquisition expectancy mean of 69 days versus 77 days ( P = 0.01 ) . The occurrence of ventilator-associated pneumonia due to P. aeruginosa in the patients receiving the probiotic was less frequent , although not significantly reduced , in patients in the probiotic group ( 2.9 % ) compared with those in the placebo group ( 7.5 % ) . After multivariate Cox proportional hazards modelling , the absence of probiotic treatment increased the risk for P. aeruginosa colonization in respiratory tract ( adjusted hazard ratio = 3.2 , 95 % confidence interval – 1.1 to 9.1 ) . Conclusion In this pilot study , oral administration of a probiotic delayed respiratory tract colonization/infection by P. aeruginosa . Trial registration The trial registration number for this study is NCT00604110 Purpose To assess the effects of the combination of pelvic floor rehabilitation and intravaginal estriol administration on  stress urinary incontinence ( SUI ) , urogenital atrophy and recurrent urinary tract infections in postmenopausal women . Methods Two-hundred-six postmenopausal women with urogenital aging symptoms were enrolled in this prospect i ve r and omized controlled study . Patients were r and omly divided into two groups and each group consisted of 103 women . Subjects in the treatment group received intravaginal estriol ovules , such as 1 ovule ( 1 mg ) once daily for 2 weeks and then 2 ovules once weekly for a total of 6 months as maintenance therapy plus pelvic floor rehabilitation . Subjects in the control group received only intravaginal estriol in a similar regimen . We evaluated urogenital symptomatology , urine cultures , colposcopic findings , urethral cytologic findings , urethral pressure profiles and urethrocystometry before , as well as after 6 months of treatment . Results After therapy , the symptoms and signs of urogenital atrophy significantly improved in both groups . 61/83 ( 73.49 % ) of the treated patients , and only 10/103 ( 9.71 % ) of the control patients referred a subjective improvement of their incontinence . In the patients treated by combination therapy with estriol plus pelvic floor rehabilitation , we observed significant improvements of colposcopic findings , and there were statistically significant increases in mean maximum urethral pressure ( MUP ) , in mean urethral closure pressure ( MUCP ) , as well as in the abdominal pressure transmission ratio to the proximal urethra ( PTR ) . Conclusions Our results showed that combination therapy with estriol plus pelvic floor rehabilitation was effective and should be considered as a first-line treatment for symptoms of urogenital aging in postmenopausal women BACKGROUND We have already reported that , for patients undergoing elective colon cancer operations , perioperative infection can be prevented by a single intravenous dose of an antibiotic given immediately beforeh and if mechanical bowel preparation and the administration of oral antibiotics are implemented . Synbiotics has been reported to reduce the rate of infection in patients after pancreatic cancer operations . The effectiveness of oral antibiotics and probiotics in preventing postoperative infection in elective colon cancer procedures was examined in a r and omized controlled trial . METHODS Three hundred ten patients with colon cancer r and omly were assigned to one of three groups . All patients underwent mechanical bowel preparation and received a single intravenous dose of flomoxef immediately before operation . Probiotics were administered in Group A ; oral antibiotics were administered in Group B ; and neither probiotics nor oral antibiotics were administered in Group C. Stool sample s were collected 9 and 2 days before and 7 and 14 days after the procedure . Clostridium difficile toxin and the number of bacteria in the intestine were determined . RESULTS The rates of incisional surgical-site infection were 18.0 % , 6.1 % , and 17.9 % in Groups A , B , and C , and the rates of leakage were 12.0 % , 1.0 % , and 7.4 % in Groups A , B , and C , respectively , indicating that both rates were lesser in Group B than in Groups A and C ( P = .014 and P = .004 , respectively ) . The detection rates of C. difficile toxin were not changed among the three groups . CONCLUSION We recommend oral antibiotics , rather than probiotics , as bowel preparation for elective colon cancer procedures to prevent surgical-site infections At the end of a long week in the office , you sink back into your chair , reflecting on some of the more memorable patients you cared for and counseled . Through gentle history taking , you discovered that urinary incontinence is the underlying cause of an elderly patient 's increasing social isolation . During a careful physical examination , you detected bruising on the torso of a woman with chronic headaches and began to explore the longst and ing abusive relationship between the woman and her alcoholic partner . You discontinued procainamide therapy in a 72-year-old man who had asymptomatic premature ventricular contractions after myocardial infa rct ion . To prevent bleeding from esophageal varices , you started -blocker therapy in a woman with long-st and ing cryptogenic cirrhosis and portal hypertension . In couples ' therapy , discussing the future quality of life of a middle-aged gay man with human immunodeficiency virus infection , you journeyed through emotionally intense dialogue about advance directives . You presented the risk factors for major and minor bleeding to a 39-year-old woman who was considering warfarin therapy because of recently diagnosed atrial fibrillation and valvular heart disease . You listened to , made diagnoses for , treated , advised , and comforted many patients . Yet there were some hiccoughs in your practice along the way . You stumbled while debating the pros and cons of breast cancer screening with a healthy 48-year-old woman who has been staying current with information on the Internet . You question ed the merits of a personalized walking program suggested to you by a motivated 66-year-old man with severe claudication . Explaining that you wanted to review the best current evidence on these issues , you resolved to address your uncertainties before these patients made their next office visits , in a week 's time . Sighing deeply , you acknowledge that you have little time to read . You subscribe to three journals , which you browse months after they arrive-either when your journal stack becomes precariously high or when your guilt is sufficiently motivational . You sometimes find the conclusions of individual articles conflicting or confusing . You know that some of the decisions and suggestions you made this week , specifically your decisions about stopping procainamide therapy and starting -blocker therapy and your advice about bleeding risks from anticoagulant therapy , were based on the best current research evidence [ 1 - 3 ] . On the other h and , your patients ' inquiries about breast cancer screening and exercise treatment for claudication highlight your need for a concise , current , rigorous synthesis of the best available evidence on each of these topics : in brief , a systematic review [ 4 , 5 ] . Incorporating Research Evidence into Clinical Decision Making The foregoing scenario is familiar to practitioners . In a typical week , we encounter patients with diverse problems ; exercise numerous clinical , interpersonal , and technical skills ; and make many decisions . The factors that affect these decisions and their outcomes are complex . For instance , each patient has unique sociodemographic characteristics , cultural circumstances , and personal preferences . Each physician has unique knowledge , experiences , and values . Moreover , practitioners and their patients make decisions within the context of a rapidly changing health care system that influences the availability , accessibility , and cost of diagnostic tests and therapies [ 6 ] . Timely , useful evidence from the biomedical literature should be an integral component of clinical decision making . If one treatment has been shown to be better than another , we need to know , so that we can recommend the treatment to the appropriate patients . The worldwide effort to develop new tests and treatments , and to determine their usefulness , has never been stronger , and our patients and their families expect us to be fonts of the knowledge that results from this effort [ 7 ] . Unfortunately , it is easy for current best research evidence to pass us by [ 8 ] . We may lack the time , motivation , and basic skills needed to find , critically appraise , and synthesize information , all of which we must do if we are to integrate the results of original studies into our practice . Fortunately , several potent methods are emerging that can greatly enhance our ability to interpret and apply research evidence ; foremost among them is the systematic review . This article begins a series in Annals that will examine systematic review s in detail and explore their many applications . Systematic review s represent the best chance that most practitioners will have to underst and and accurately apply the key signals arising from the robust and increasingly productive search for solutions to medical problems . A properly conducted systematic review faithfully summarizes the evidence from all relevant studies on the topic of interest , and it does so concisely and transparently . What Is a Systematic Review ? Systematic review s are scientific investigations in themselves , with pre-planned methods and an assembly of original studies as their subjects . They synthesize the results of multiple primary investigations by using strategies that limit bias and r and om error [ 9 , 10 ] . These strategies include a comprehensive search of all potentially relevant articles and the use of explicit , reproducible criteria in the selection of articles for review . Primary research design s and study characteristics are appraised , data are synthesized , and results are interpreted . When the results of primary studies are summarized but not statistically combined , the review may be called a qualitative systematic review . A quantitative systematic review , or meta- analysis , is a systematic review that uses statistical methods to combine the results of two or more studies . The term overview is sometimes used to denote a systematic review , whether quantitative or qualitative . Summaries of research that lack explicit descriptions of systematic methods are often called narrative review s. Review articles are one type of integrative publication ; practice guidelines , economic evaluations , and clinical decision analyses are others . These other types of integrative articles often incorporate the results of systematic review s. For example , practice guidelines are systematic ally developed statements intended to assist practitioners and patients with decisions about appropriate health care for specific clinical circumstances [ 11 ] . Evidence -based practice guidelines are based on systematic review s of the literature , appropriately adapted to local circumstances and values . Economic evaluations compare both the costs and the consequences of different courses of action ; the knowledge of consequences that are considered in these evaluations is often generated by systematic review s of primary studies . Decision analyses quantify both the likelihood and the valuation of the expected outcomes associated with competing alternatives . Differences between Systematic and Narrative Review s All review s , narrative and systematic alike , are retrospective , observational research studies and are therefore subject to systematic and r and om error . Accordingly , the quality of a review - and thus its worth-depends on the extent to which scientific review methods have been used to minimize error and bias . This is the key feature that distinguishes traditional narrative review s from systematic review s ( Table 1 ) . If a review is prepared according to the steps outlined in the right column of Table 1 , it is more likely to be systematic and to provide unbiased conclusions . If review methods approximate those found in the middle column of Table 1 , the article is more likely to be a narrative review , and the conclusions are less likely to be based on an unbiased summary of all relevant evidence . Table 1 . Differences between Narrative Review s and Systematic Review s Systematic review s are generated to answer specific , often narrow , clinical questions in depth . These questions can be formulated explicitly according to four variables : a specific population and setting ( such as elderly out patients ) , the condition of interest ( for example , hypertension ) , an exposure to a test or treatment ( such as pharmacologic management ) , and one or more specific outcomes ( such as cardiovascular and cerebrovascular events and mortality ) [ 12 ] . Thus , an example of a well-formulated , clinical ly relevant question is , Does pharmacologic treatment of hypertension in the elderly prevent strokes and myocardial infa rct ions or delay death ? If the question that is driving the review is not clear from the title , abstract , or introduction , or if no methods section is included , the paper is more likely to be a narrative review than a systematic review [ 13 ] . Most narrative review articles deal with a broad range of issues related to a given topic rather than addressing a particular issue in depth [ 9 ] . For example , a narrative review on diabetes ( such as that which might be found in a textbook chapter ) might include sections on the physiology and pathophysiology of carbohydrate , lipid , and protein metabolism ; the epidemiology of and prognosis associated with diabetes ; diagnostic and screening approaches ; and preventive , therapeutic , rehabilitative , and palliative interventions . Thus , narrative review s may be most useful for obtaining a broad perspective on a topic ; they are less often useful in furnishing quantitative answers to specific clinical questions . Narrative review s are appropriate for describing the history or development of a problem and its management . Narrative review s may better describe cutting-edge developments if research is scant or preliminary or if studies are very limited by flawed design or execution [ 13 ] . They may be particularly useful for discussing data in light of underlying theory and context . Narrative review s can draw analogies and can conceptually integrate two independent fields of research , such as Treatment and prevention of pediatric infectious diseases of three commercial probiotic products were evaluated by a double-blind , r and omized , controlled trial . Test subjects under age 5 , 1062 in total , were distributed r and omly into four groups . This investigation showed that L. casei rhamnosus can control bacterial , viral and respiratory infections ; a multi-species probiotic reduced gastrointestinal disease significantly . Long-term consumption of L. rhamnosus T cell-1 decreased the incidence of bacterial infection INTRODUCTION Postoperative sore throat is a common complication which can lead to discomfort after operation and delay in patients ' returning to normal daily activities . The present study was carried out to evaluate the influence of intravenous hydrocortisone on preventing postoperative sore throat followed by laryngeal mask airway use . METHODS Sixty patients who were scheduled to undergo urogenital surgery were divided into two groups . Five minutes before anesthesia induction , 100 mg of intravenous hydrocortisone or placebo with the same volume were given to the patients r and omly . At the end of the operation and after LMAs were removed , patients were asked about having sore throat at hours 2 , 4 and 24 after operation . RESULTS There were three and six cases of sore throat after operation in hydrocortisone and in placebo groups respectively which showed no significant statistical difference ( P=0.472 ) . No cases of moderate or severe pain were reported in any of the patients in both groups and no statistically significant difference was observed regarding pain severity in recovery , hours 2 , 4 or 24 after operation . CONCLUSION Based on the statistical data obtained from this research , administrating intravenous hydrocortisone five minutes before anesthesia induction has no effect on postoperative sore throat severity and degree in urogenital surgeries Background —Acupuncture has recently been studied in assisted reproductive treatment ( ART ) although its role in reproductive medicine is still debated . Objectives —To determine the effectiveness of acupuncture  in the outcomes of ART . Search strategy —All reports which describe r and omised controlled trials of acupuncture in assisted conception were obtained through search es of the Menstrual Disorders and Subfertility Group Specialised Register , CENTRAL , Ovid MEDLINE ( 1996 to August 2007 ) , EMBASE ( 1980 to August 2007 ) , CINAHL ( Cumulative Index to Nursing & Allied Health Literature ) ( 1982 to August 2007 ) , AMED , National Research Register , Clinical Trials register ( www . clinical trials.gov ) , and the Chinese data base of clinical trials . Selection Criteria —R and omised controlled trials of acupuncture for couples who were undergoing ART comparing acupuncture treatment alone or acupuncture with concurrent ART versus no treatment , placebo or sham acupuncture plus ART for the treatment of primary and secondary infertility . Women with medical illness deemed contraindications for ART or acupuncture were excluded . Data Collection and Analysis —Sixteen r and omised controlled trials were identified that involved acupuncture and assisted conception . Thirteen trials were included in the review and three were excluded . Quality assessment and data extraction were performed independently by two review authors . © 2010 Elsevier Inc. All rights reserved . Corresponding author : Eric Manheimer , MS , Research associate , University of Maryl and School of Medicine , Center for Integrative Medicine East Hall , 520 W. Lombard Street Baltimore , MD 21201 , emanheimer@compmed.umm.edu , Telephone : 410 - 706 - 6169 , Fax : 410 - 706 - 6214 . * Both authors contributed equally to this work . The Cochrane Complementary Medicine Field is the group within the Cochrane Collaboration focused on facilitating the conduct of Cochrane systematic review s of CAM therapies . The CAM Field represents an international collaborative effort among research ers , clinicians , consumers , and CAM practitioners from nearly every continent . The Field ’s central office is located at the Center for Integrative Medicine , University of Maryl and School of Medicine , 520 W. Lombard St , Baltimore , MD 21201 . For more information , contact Eric Manheimer at : emanheimer@compmed.umm.edu . Publisher 's Discl aim er : This is a PDF file of an unedited manuscript that has been accepted for publication . As a service to our customers we are providing this early version of the manuscript . The manuscript will undergo copyediting , type setting , and review of the result ing proof before it is published in its final citable form . Please note that during the production process errors may be discovered which could affect the content , and all legal discl aim ers that apply to the journal pertain . NIH Public There have been over twenty prospect i ve , r and omized trials of the use of probiotics to prevent  necrotizing enterocolitis ( NEC ) in premature babies . A Cochrane meta- analysis of 16 of the studies ( 1 ) including 2842 preterm infants , reported that ‘ enteral probiotics supplementation significantly reduced the incidence of severe NEC ( stage II or more ) ( typical RR , 0.35 ; 95 % CI , 0.24–0.52 ) and mortality ( typical RR , 0.40 ; 95 % CI , 0.27–0.60 ) with no evidence of harm . They concluded , ‘ Enteral supplementation of probiotics prevents severe NEC and all-cause mortality in preterm infants ’ . In a sensitivity analysis , including only the 4 highest quality studies , the results and conclusions were unchanged . For neonates born at < 32 weeks of gestation , the number needed to treat in order to prevent one NEC or one death is twenty . The risks of probiotics are minimal . A more recently published systematic review included several additional r and omized controlled trials , mostly published in the Chinese literature , and analysed a total of 20 publications and over 3800 preterm infants ; it came to similar conclusions as the Cochrane meta- analysis ( 2 ) . Probiotics are used in many European units but only rarely in North-America . In spite of the evidence , this safe and effective treatment for one of the most serious complications of prematurity has never been studied in the United States and perhaps never will . Probiotics will probably never be approved by the U.S. Food and Drug Administration ( FDA ) . Instead , they will remain in regulatory purgatory , neither approved nor unapproved , an evidence -based treatment that can not become the st and ard of care , a safe and effective treatment that is not on hospital formularies in the United States . Probiotics fall into a peculiar lacuna of the regulatory system . Most innovative treatments are either drugs or devices , and the regulatory pathways for evaluating and approving them are fairly well defined by federal law . The FDA has jurisdiction over both drugs and devices . Probiotics are neither drugs nor devices , and they are made by companies that generally market health products to the general public . In contrast , in Canada , probiotics are under the jurisdiction of the Natural Health Products Directorate ( NHPD ) which has rigorous requirements for quality control and detailed labelling . But the NHPD does not evaluate overtly medical cl aims made about a product . It has little experience dealing with either a product that could actually decrease major complications or save lives in a particularly fragile population where mortality is rather common . Probiotics are quite inexpensive to manufacture . People can even make them at home . They are in most yogurts . For pennies , some parents buy them for their preterm infants in health food stores . Some mothers have started adding probiotics to their breast milk . In these cases , the medical team can either be unaware a preterm infant is in fact receiving probiotics or tacitly not interfere with these parental initiatives . Given the low cost of probiotics and Articles in the series A Different View are edited by William Meadow ( wlm1@uchicago.edu ) . We encourage you to offer your own different view either in response to A Different View you do not fully agree with , or on an unrelated topic . Send your article to Dr. Meadow ( wlm1@uchicago.edu )
Probiotic interventions were effective for treatment and prevention of BV , prevention of recurrences of c and idiasis and UTIs , and clearing HPV lesions .
Although clinical practice recommendations were limited by the strength of evidence , probiotic interventions were effective in treatment and prevention of urogenital infections as alternatives or co-treatments .
INTRODUCTION Probiotics are a complementary and integrative therapy useful in the treatment and prevention of urogenital infections in women .
This study extends the work of research ers who systematic ally investigated the scientific literature on probiotics to prevent or treat urogenital infections .