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Query: UMLS:C0011849 (diabetes)
 277,896 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Urinary tract infections (UTIs) are the most common infections seen in the hospital setting, and the second most common infections seen in the general population. Due to women's anatomy, UTIs are especially problematic for them, and up to one-third of all women will experience a UTI at some point during their lifetimes. Appropriate treatment of a UTI requires accurate classification that includes infection site, complexity of the infection, and the likelihood of recurrence. The predominant pathogen in both complicated and uncomplicated UTI remains pathogenic Escherichia coli, although Klebsiella sp. and Proteus appear with increased frequency in complicated UTI. Most often, bacteria cause UTIs by ascending means through the urethra into the bladder. Bacteria must possess virulence factors to cause UTI. Host defense factors that predispose patients to UTI include urinary stasis, abnormal urinary tract anatomy, diabetes mellitus, debility, and aging. Estrogen-related issues and short urethras predispose women to UTI. Although urine culture, with >105 colony-forming units/mL (CFU/mL) in symptomatic patients, remains the diagnostic "gold standard," correlation of the patient's history and physical examination with urinalysis (including nitrite dipstick and leukocyte esterase test) results usually suffices to diagnose UTI. Three-day of antimicrobial treatment is recommended for simple cystitis. Acute pyelonephritis, an infection of the kidney parenchyma tissue, is treated with antibiotics for 7 to 14 days depending on the antimicrobial agent used and the severity of infection. In addition, patient classification determines the need for hospitalization or for urological imaging studies. Women with recurrent UTIs merit consideration for antimicrobial prophylaxis. Self-administered topical vaginal estradiol cream is an important adjunct in UTI prevention for postmenopausal women. Asymptomatic bacteruria only merits antimicrobial therapy in high-risk patients or those colonized with Proteus species.
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PMID:Urinary tract infections in women. 1144 91

Estrogen replacement therapy (ERT) is used not only for the short-term control of menopausal symptoms but long-term for disease prevention. This study examined the influence of selected clinical conditions on the use of ERT and the duration of ERT use among women enrolled in a state Medicaid program. We identified 60,531 women, aged >/=45 years, who were enrolled in Maryland Medicaid continuously for at least 2 of 3 years. ERT use was determined through prescription claims submitted for reimbursement. The presence or risk of selected clinical conditions (e.g., osteoporosis, heart disease, estrogen-sensitive cancers) was determined by screening Medicaid claims files for related diagnoses, procedures, or prescription claims. Multiple logistic regression was used to model ERT use, and proportional hazards regression was used to model duration of use. Fourteen percent of these women filled an ERT prescription, with use varying by age, race, and place of residence. Oral dosage forms were the most popular (80.8%), followed by vaginal cream or ring (22.2%), and transdermal patch (7.3%). In adjusted models, osteoporosis, heart disease, hypertension, hyperlipidemia, diabetes, ovarian cancer, and thromboembolic disease were positively associated and dementia and breast cancer were negatively associated with ERT use. None of these medical conditions predicted the duration of estrogen therapy. Use of ERT was very low among these women despite coverage of prescription medications, and the presence of clinical indications had no influence on the length of therapy among these women despite known benefits for long-term preventive therapy.
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PMID:Clinical correlates of estrogen replacement therapy use and duration of use among medicaid recipients. 1170 94

Estrogen receptors (ESR) 1 and 2 are expressed in the normal and atherosclerotic arteries mediating the atheroprotective action of estrogen to artery wall cells. Whether variants of these receptor genes associate with autopsy-verified coronary artery wall atherosclerosis is not known. This study investigated whether variants of the ESR1 gene are associated with autopsy-verified coronary artery wall atherosclerosis and thrombosis. Coronary arteries were taken from 300 white Finnish male autopsy cases aged 33-69 years included in the Helsinki Sudden Death Study. Areas of coronary wall covered with fatty streaks, fibrotic, calcified, and complicated lesions were measured using computer-assisted planimetry and related to ESR1 PvuII genotypes (P/P, P/p, and p/p) determined by PCR. The mean area of complicated lesions of three major coronaries and the presence of coronary thrombosis were significantly associated with the ESR1 genotype in men aged 53 years or older (median age as a cut off point). No such association was found in men aged under 53 years. After adjusting for age and body mass index the men aged 53 years or over with P/p and P/P genotype had areas of complicated lesions on average two- and fivefold larger than subjects with the p/p genotype. The age and body mass index adjusted odds ratios for coronary thrombosis were 6.2 for P/p and 10.6 for P/P compared to men with the p/p genotype. After additional adjustment for diabetes and hypertension the ESR1 genotype persisted as an independent predictor of complicated lesions ( P=0.007) and coronary thrombosis. In conclusion, the ESR1 gene is a potential candidate behind the pathogenesis of acute coronary events.
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PMID:Coronary artery wall atherosclerosis in relation to the estrogen receptor 1 gene polymorphism: an autopsy study. 1189 38

This article reviews the published literature on the relationship between combined OCs (oral contraceptives) administration and metabolic and cerebro- and cardiovascular effects. All retrospective studies show an increase in the risk of thromboembolic accidents, while only a few of the prospective studies do. A study of the Royal College of General Practitioners (RCGP) states that the risk of myocardial infarction is multiplied by 5.22 in OCs users, and that smoking, but not age, greatly increases the risk. All studies document an increase in risk of cerebrovascular effects; high arterial pressure and smoking increase the risk, but obesity does not. Synthetic estrogens increase triglyceride levels according to dosage, but progesterone does not. Estrogen increases cholesterol level, estroprogestational agents increase it slightly, while progesterone does not cause any increase. Synthetic estrogens tend to increase low density lipoprotein cholesterol and derivates of progesterone do not; high density lipoprotein levels are increased by estrogens but decreased by progesterone. Age, smoking and diabetes increase the risk. Recent studies of the RCGP eliminate the responsibility of estroprogestins in causing diabetes, while other authors think the opposite. In general, the literature does not agree on the metabolic side effects of combined OC use, and conclusions are often opposite between retrospective and prospective studies. There still are not any epidemiological studies on the metabolic side effects of the mini-pill.
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PMID:[True and false regarding metabolic risk in contraception]. 1226 91

There are hormones from 2 sources which determine the menstrual cycle. The pituitary produces luteinizing hormone and follicle stimulating hormone and the ovaries secrete estrogen and progesterone. For clinical use, a cheap source of progesterone has been found in the Mexican yam. Since the 1st oral contraceptives were tested in Puerto Rico in the late 1950s, there has been a trend toward reducing the dosage. Estrogen prevents ovulation in 95-98% of patients. Other factors are also involved. Although it is estimated that 80-100 million women in the world today use oral contraceptives, this method is not always followed for long periods. From 25 to 60% discontinue the use within the 1st year. Increased risk of unfavorable side effects occurs in those with high blood pressure, migraine headaches, diabetes, epilepsy, undiagnosed genital bleeding, or gallbladder disease. Women over age 40 run a greater risk of heart attacks. Intravenous blood clots are the major risk. Severe abdominal, chest, or leg pains, severe headaches, and eye problems may be symptoms of blood clots. With the 21-day package the user takes a pill a day for 3 weeks and then none during menstruation. The sequential type of medication is no longer used. Minipills are taken every day. Missing taking pills is the most common cause of failure of the method. Estrogen replacement therapy for menopausal women is a temporary treatment to relieve physical distress. Depo-Provera, containing a long-acting progesterone agent, may be injected every 3 months instead of daily oral contraceptives. When progesterone is used with an IUD it acts locally. Hormones to maintain pregnancy are no longer used. Use of hormones as a test for pregnancy has been discontinued. Estrogen-progesterone injections given to inhibit milk production may cause serious side effects.
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PMID:The pills: oral contraceptives and other hormones. 1230 26

Experiments on laboratory animals, histological and epidemiological tests indicate an association between estrogen therapy and endometrial carcinoma. Such association however, has never been totally proved. It is true that, if the association exists, it is more likely to be found in patients who are obese, or with diabetes, or in sterile patients, and that the carcinogenic lesion is usually limited. The relationship between estrogen therapy and a diminution in the incidence of osteo-articular ailments in postmenopausal women also has never been demonstrated, as is the relation between estrogen therapy and myocardial infarctus. Estrogen therapy, however, is benefical to cutaneo-throphic disorders, and to the general state of health of the postmenopausal woman. The proper judgment for or against estrogen therapy must be made by the physician after careful examination of every single case.
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PMID:[Estrogens and cancer of the endometrium (author's transl)]. 1230 41

Although combined oral contraceptives (OCs) do not create a true cardiovascular risk, they may increase the impact of existing vascular risk factors. Pill use disturbs metabolism of lipids and carbohydrates as well as the balance of water and sodium. New combinations with lower doses of steroids have significantly reduced these risks, and the development of new and less androgenic progestins for low dose pills is expected to reduce them further. The diabetogenic effect of OCs has been noted since 1963. Among normal women, the observed modifications in carbohydrate metabolism are minor and temporary, with increases in levels of blood sugar maximal at the beginning of use and normalizing after 12 months. Among women with family histories of diabetes or who have had gestational diabetes, use of combined OCs can entail irreversible deterioration of glucose tolerance or diabetes. The number of women with poor glucose tolerance increases with the duration of pill use. Reversibility of the condition decreases with duration of use. The proportion of women with poor glucose tolerance who develop diabetes is higher than among normal subjects. Women with poor glucose tolerance must be considered at risk of diabetes. Ethinyl estradiol is responsible for the early modification of glucose tolerance, which regresses after about 6 months of use. Hyperinsulinemia is caused by the direct stimulation of progestins on insulin secretion by the pancreas as well as by the development of peripheral resistence to glucose utilization resulting from a decrease of insulin receptors. The effect on insulin resistence is among the most androgenic progestins. Chronic hyperinsulinism represents a classic risk factor for atherosclerosis because of the effects on the arterial wall: proliferation of smooth muscle fibers, inhibition of lipolysis, and development of lesions of the intima analogous to those of atheroma. Estrogen is primarily responsible for the increased blood pressure of pill users, but the development of hypertension is also correlated with the progestin content. Progestins have an antidiuretic effect which contributes to increases in blood pressure when added to the estrogen stimulation of the renin-aldosterone-angiotensin system. Gestodene, a new progestin in the gonane series, is the most powerful synthetic progesterone yet known. Its uniqueness derives from the dissociation between its very powerful antigonadotropic activity even at small doses and its androgenic effects which only appear at considerably higher doses. Most of the metabolic effects of progestins are linked to their degree of androgenicity. Different studies of gestodene tolerance in a triphasic formulation have concluded that it is innocuous. The use of gestodene in a low-dose triphasic formulation may result in a combined OC that does not increase the individual atheromatous risk of the user.
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PMID:[Combined estrogen-progestagen contraception and glucid and water-sodium metabolism]. 1234 1

The formation of intracellular reactive oxygen and nitrogen species (ROS and RNS) has been implicated in the pathogenesis of a variety of diseases. In excess, ROS and their byproducts may cause oxidative damage and be cytotoxic to cells. Recently, it has been established that these oxidants can also act as subcellular messengers in gene regulatory and signal transduction pathways. Estrogen, on the other hand, is known to offer protection from coronary artery diseases in post-menopausal women and to be involved in various ROS-related diseases, such as Alzheimer's and Parkinson's diseases, diabetes and aging. The existence of estrogen receptors in these tissues lead us to investigate whether ROS can regulate their expression. We demonstrated here, for the first time, that oxidative stress induced by hydrogen peroxide (H(2)O(2)), Fe(2+), 2,2'-azobis(2-amidinopropane)dihydrochloride (AAPH) and activated macrophages, affect the expression of estrogen receptors alpha and beta (ERalpha and ERbeta) differently, demonstrating cell-specific response which can be blocked by antioxidants. This data suggest that oxidative stress and the production of ROS/RNS function as physiological regulators of ERalpha and ERbeta expression. This may provide a new insight into the ERbeta-dependent protective action of estrogen and phytoestrogens in inflammation involving diseases, and may contribute to the development of novel therapeutic treatment strategies.
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PMID:The effect of oxidative stress on ERalpha and ERbeta expression. 1236 22

Adiponectin or adipocyte complement-related protein of 30 kDa (Acrp30) is a circulating protein produced exclusively in adipocytes. Circulating Acrp30 levels have been associated with insulin sensitivity in adult mice and humans, yet the Acrp30 profile over the lifespan and its hormonal regulation in vivo have not been previously described. Hence, we set forth to determine whether hormonal and metabolic changes associated with sexual maturation, reproduction, aging, and calorie restriction affect Acrp30. In mice, Acrp30 levels increase during sexual maturation by 4-fold in males and 10-fold in females. Neonatal castration (CX) allows Acrp30 of adults to reach female levels. CX in adults does not lead to female Acrp30 levels unless glucocorticoid exposure is elevated simultaneously by implant. Ovariectomy of infant mice does not interfere with the pubertal rise of Acrp30. However, ovariectomy in adults increases Acrp30. Estrogen suppressed Acrp30 in mice and 3T3-L1 adipocytes. In parallel to changes in estrogen action, Acrp30 decreased in late gestation but increased in both calorie-restricted and old (anovulatory) mice. The reduction of Acrp30 in lactating dams is consistent with a suppressive effect of prolactin and a stimulating effect of bromocriptine. In summary, Acrp30 levels in serum are under complex hormonal control and may play a key role in determining systemic insulin sensitivity under the respective conditions.
Diabetes 2003 Feb
PMID:Sexual differentiation, pregnancy, calorie restriction, and aging affect the adipocyte-specific secretory protein adiponectin. 1254 May 96

Estrogen is involved in breast carcinogenesis. Hypotheses have been raised that its effect is modified by enzymes such as catechol-O-methyltransferase (COMT) that deactivate potentially genotoxic estrogen metabolites. We have investigated the association between the functional genetic Val108/158Met polymorphism in COMT and breast cancer risk in a large population-based case-control study performed in the genetically homogeneous Swedish population. We determined COMT genotype in 1534 women with invasive breast cancer and in 1504 control women and calculated odds ratios (OR) and 95% confidence intervals (CI) from logistic regression models. There was no overall association between COMT genotype and breast cancer risk. However, the L allele was associated with an increased risk for lobular breast cancer, with OR 2.0 (95% CI 1.2-3.5) for HL and 1.7 (95% CI 0.9-3.0) for LL. In exploratory subset analyses, we found no statistically significant interaction, but some indication of a positive association between HL and LL genotypes and breast cancer among women with diabetes mellitus and a negative association among nulliparous women. Based on our findings, COMT activity alone does not seem to play a major role in breast carcinogenesis, but may be of importance in certain histotypes or in conjunction with other exposures.
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PMID:Catechol-O-methyltransferase gene polymorphism and post-menopausal breast cancer risk. 1272 96


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