Prevalence of Genitourinary Infections with Sodium Glucose Co-transporter-2 (sglt2) inhibitors in patients with type 2 diabetes

Objectives: The present study was conducted to observe the prevalence of urine and genital infections by the SGLT-2 inhibitors patients with type 2 diabetes Methods: This multi centre cross sectional study was conducted on type 2 diabetic patients using two different SGLT-2 inhibitors dapagliflozin and empagliflozin either as monotherapy or combination therapy over a period of 03 months from 02-02-2020 to 02-05-2020. The risk of urinary and genital tract infection was assessed on the basis of structured questionnaire performa and medical records. Results: Out of 615, 296(48%) patients were using dapagliflozin and 319(52%) were using empagliflozin. Male to female ratio in both group were i.e dapagliflozin: 65 %( 192) and 35 %( 104) empagliflozin 72 %( 230) and 28 %( 89%) respectively. The risk of urinary infection in dapagliflozin group was 4.3% while it was 6.5% in and empagliflozin. On the other hand the risk of genital tract infection was 3% in dapagliflozin and 4.3% empagliflozin respectively. The prevalence of genital infection was more in female 6(67%) by dapagliflozin and 10(71%) by empagliflozin versus male 3(33%) by dapagliflozin and 4(29%) by empagliflozin respectively. Similarly the prevalence of urinary infection was more in female 8(62%) by dapagliflozin and 14(67%) by empagliflozin versus male 5(38%) by dapagliflozin and 7(33%) by empagliflozin respectively. A significant co relation was found between prevalence of genitourinary infection with female sex and uncontrolled diabetes with p.value 0.001 and 0.003 respectively. Conclusion: SGLT-2 inhibitors are not associated with increased of risk of genitourinary infection in diabetic patients. Keywords: SGLT-2 Inhibitors, Dapagliflozin, Empagliflozin, Genitourinary infection

Mondor’s disease of the penis due to asymptomatic infective prostatitis provoking episodes of secondary sclerotizing lymphangitis

Mondor’s disease of the penis is an under-reported condition caused by superficial thrombophlebitis of the dorsal vein or thrombosis of the deep venous network of the penis. This is a benign, self-limiting condition, characterized by a sudden, indurated swelling of the aforementioned veins. The possible causes comprise traumatism, neoplasms, excessive sexual activity, or coagulation inherited deficit. An accompanied lymphangitis is discussed, eventually as a distinct variety. The differential diagnosis must be established by the means of ultrasound, which is the imaging diagnostic technique of choice. We describe the case of Mondor’s sclerotizing lymphangitis secondary to recurrent episodes of genitourinary infection previously diagnosed as recurrent superficial Mondor thrombophlebitis of the penis.

Incidence and Factors Associated With Genitourinary Infections Among Type 2 Diabetes Mellitus Patients on SGLT2 Inhibitors: A Single-Center Retrospective Cohort Study

Background: The efficacy of SGLT2 inhibitors for diabetes is consistent across several studies; however, the risk of genitourinary infection due to these drugs has also been cited. Objective: To determine the incidence and factors associated with genitourinary infection among type 2 diabetes mellitus patients on SGLT2 inhibitor seen at the University of Santo Tomas Hospital Methodology: The study utilized a retrospective cohort design. Participants included 253 Type 2 diabetes mellitus patients who started SGLT2 inhibitor treatment from January 1, 2014 to June 30, 2019. Data collection via medical charts review was performed from April 1 to October 1, 2020. Multiple logistic regression analysis was performed to determine the factors associated with genitourinary infection. Stata MP version 14 software was used for data analysis. Results: The 3-month and 6-month incidence of genitourinary infection among patients treated with SGLT2 inhibitors are 2.37% and 21.78%, respectively. A significant difference in the probability of genitourinary infection across the three drugs was observed (p=0.0019). Pairwise analysis showed lower probability of infection among patients treated with canagliflozin compared to empagliflozin and dapagliflozin. Factors associated with genitourinary infection include high HbA1c at the time of treatment initiation and SUR and insulin use. The same set of factors were recorded for males. Among females, only HbA1c and eGFR at the time of SGLT2 inhibitor initiation were significantly associated with genitourinary infection. Conclusion: The study results revealed that genitourinary infection is common among patients taking SGLT2 inhibitors, especially dapagliflozin and empagliflozin. Several factors were associated with urinary and genital infection, and risk factors vary by sex. These factors include high BMI, high HbA1c levels at the time of treatment initiation, longer duration of diabetes, low eGFR, and concomitant use of insulin and/or SUR.

Factors influencing choices of empirical antibiotic treatment for bacterial infections in a scenario-based survey in Vietnam

Background Antimicrobial stewardship (AMS) programmes have been implemented around the world to guide rational use of antibiotics but implementation is challenging, particularly in low- and middle-income countries, including Vietnam. Understanding factors influencing doctors’ prescribing choices for empirical treatment can help design AMS interventions in these settings. Objectives To understand doctors’ choices of antibiotics for empirical treatment of common bacterial infections and the factors influencing decision-making. Methods We conducted a cross-sectional survey among medical professionals applying for a postgraduate programme at Hanoi Medical University, Vietnam. We used a published survey developed for internal medicine doctors in Canada. The survey was self-administered and included four clinical scenarios: (i) severe undifferentiated sepsis; (ii) mild undifferentiated sepsis; (iii) severe genitourinary infection; and (iv) mild genitourinary infection. Results A total of 1011/1280 (79%), 683/1188 (57.5%), 718/1157 (62.1%) and 542/1062 (51.0%) of the participants selected combination therapy for empirical treatment in scenarios 1, 2, 3 and 4, respectively. Undifferentiated sepsis (OR 1.82, 95% CI 1.46–2.27 and 2.18, 1.51–3.16 compared with genitourinary) and severe infection (1.33, 1.24–1.43 and 1.38, 1.21–1.58 compared with mild) increased the likelihood of choosing a combination therapy and a carbapenem regimen, respectively. Participants with higher acceptable minimum threshold for treatment coverage and young age were also more likely to prescribe carbapenems. Conclusions Decision-making in antibiotic prescribing among doctors in Vietnam is influenced by both disease-related characteristics and individual factors, including acceptable minimum treatment coverage. These findings are useful for tailoring AMS implementation in Vietnam and other, similar settings.

Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis among women with genitourinary infection and pregnancy-related complications in Tehran: A cross-sectional study

The present study investigates the prevalence of Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), and Trichomonas vaginalis (TV) among women with genitourinary infection and pregnancy-related complications in Tehran. It also evaluates the demographic information, symptoms, and sequelae. Endocervical samples were obtained over a period of eight months from 360 women including 180 symptomatic patients and 180 patients with pregnancy-related complications and infertility. CT, NG, and TV were detected in 10.8%, 6.9%, and 8.3% of all patients, respectively. The prevalence of CT, NG, and TV among women in the symptomatic group was 11.1%, 7.2%, and 13.3%, respectively, and among women with pregnancy-related complications and infertility was 10.6%, 6.7%, and 3.3%, respectively. Associations between chlamydia and ectopic pregnancy ( p = 0.001), and infertility ( p < 0.001) were observed. Abortion ( p = 0.008), infertility ( p = 0.005), and ectopic pregnancy ( p < 0.001) were associated with gonorrhea. Abnormal vaginal discharge ( p = 0.02) and vulvar itching ( p = 0.02) were associated with trichomoniasis. Overall, the prevalence rates of CT, NG, and TV were high in these patient groups. These high prevalences suggest that screening programs are required to reduce the burden of these sexually transmitted infections and their effects on genitourinary symptoms, pregnancy-related complications, and infertility.

Effect of the Sodium-Glucose Cotransporter 2 Inhibitor, Dapagliflozin, on Genitourinary Infection in an Animal Model of Type 2 Diabetes

Purpose: To investigate the effect of dapagliflozin, a sodium-glucose cotransporter 2 inhibitor, on inflammatory cytokines of urogenital tissue in a rat model of type 2 diabetes (T2DM) to infer pharmaceutical influence of dapagliflozin on genitourinary infection or inflammation.Methods: Study animals were divided into the following 4 groups of 10 animals each: (1) the Otsuka Long-Evans Tokushima Fatty (OLETF)-DA group treated with dapagliflozin at 1.0 mg/kg/day, (2) the OLETF-VO group treated with voglibose at 0.6 mg/kg/day, (3) the control group (OLETF-CO) given water, and (4) the Long-Evans Tokushima Otsuka (LETO) rats were included as nondiabetic control group. Changes in blood glucose, 24-hour urine volume, and urine glucose were measured. The interleukin-1β (IL-1β) and interleukin-18 (IL-18) levels in the bladder and the urethra were quantified, respectively.Results: The urine glucose level and the 24-hour urine volume at 12 weeks of treatment were significantly higher in the OLETF-DA group than that in any other group (P<0.05). The cytokine analysis of the bladder and urethra showed higher IL18 and IL-1β in the OLETF-DA and the OLETF-CO groups than that in the OLETF-VO and LETO groups (P<0.05). The cytokine levels did not differ between the OLETF-DA and the OLETF-CO groups, and the level of IL-18 in the OLETF-DA group was higher in the urethra than in the bladder.Conclusions: This study revealed that dapagliflozin increased the urine glucose concentration, resulting in an inflammatory response remain in the urogenital tract as the untreated diabetic rats. Therefore, when treating patients with T2DM with dapagliflozin, careful attention should be paid to genitourinary infection or inflammation.

Pattern of Body Mass Index and Common Health Problems in Women of Reproductive Age Group in a Private Clinic in Kathmandu

Introduction: High Body Mass Index is one of the risk factors for many chronic diseases and adverse health outcomes. It is associated with an increased risk of coronary heart disease, ischemic stroke, high blood pressure and type 2 diabetes mellitus. It also have many adverse effect on reproductive health of the women like sub fertility, polycystic ovarian disease, menstrual abnormality etc. The purpose of this study is to find Basal Metabolic Rate and the diseases pattern of reproductive age woman in Nepal. Methods: This is a descriptive study of women of reproductive age (15 to 49 years) attending a private gynaecology clinic in Kathmandu Valley from October 2016 to June 2017. Six hundred and eight women of current reproductive age group participated in this study. Women’s particulars and complaints were noted down. Detailed history was taken. Height, weight and blood pressure were recorded and general examination was done. BMI was calculated as BMI is weight in kilogram divided by height in meter square, and it was interpreted as per WHO guidelines. Results: Out of the total 608 participants, 243 (40%) were overweight, 96 (15.8%) were obese. Regarding the common health problems, 154 (25.3%) have sub fertility and 199 (32%) had genitourinary infection. Similarly, 90 (14.8%) had menstrual problems. Conclusions: Prevalence of overweight and obesity has risen significantly comparing to the study done decade ago in same setting. Similarly, sub fertility rate has also risen whereas the prevalence of genitourinary infections has decreased. Keywords: BMI; genitourinary infection; Nepal-reproductive age women; sub fertility.