Madriaga, Maria Fredeline Joi V.

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The promise of new therapeutic avenues for the treatment of a range of conditions has led researchers to consider the use of stem cells. These cells have the capacity to become some or even all of the 206 different cell types found in the human body. It has even been suggested that one day stem cells may be able to form whole organs and hence contribute to organ transplantation therapies. Stem cells come in a wide variety of types. Adult stem cells have been found in nearly every tissue of the human body, where they carry out a role in tissue regeneration. Embryonic stem cells are located in the human embryo at the blastocyst stage (5 to 6 days of age). Embryos at this age are often unwanted in reproductive technology treatment, and some parents have donated them for research. Cord blood stem cells are derived from the umbilical cord which is often still routinely discarded at birth. The key ethical issues concern the destruction of human embryos for stem cell derivation. On the grounds that the human embryo is a human life with moral value justifying its protection, the extraction of embryonic stem cells is unethical. The use of adult stem cells and umbilical cord blood stem cells have generally been considered to be free of any particular ethical issues. In fact they have been applauded as ethically superior alternatives to the use of embryonic stem cells. One limitation to the possible use of embryonic stem cells in therapy is that they will likely be rejected by the recipient. In an attempt to overcome this researchers are attempting to produce cloned human embryos to derive genetically near-identical stem cells for possible treatment.
GENITOURINARY SYSTEM

Cranberry Juice Not Effective Against Urinary Tract Infections, Study Suggests
ScienceDaily (Dec. 8, 2010) Drinking cranberry juice has been recommended to decrease the incidence of urinary tract infections, based on observational studies and a few small clinical trials. However, a new study published in the January 1 issue of Clinical Infectious Diseases, and now available online, suggests otherwise. College-aged women who tested positive for having a urinary tract infection were assigned to drink eight ounces of cranberry juice or a placebo twice a day for either six months or until a recurrence of a urinary tract infection, whichever happened first. Of the participants who suffered a second urinary tract infection, the cranberry juice drinkers had a recurrence rate of almost 20 percent, while those who drank the placebo suffered only a 14 percent recurrence.

"We assumed that we would observe a 30 percent recurrence rate among the placebo group. It is possible that the placebo juice inadvertently contained the active ingredients that reduce urinary tract infection risk, since both juices contained Vitamin C," explained study author Betsy Foxman, PhD, of the University of Michigan School of Public Health in Ann Arbor. She added, "Another possibility is that the study protocol kept participants better hydrated, leading them to urinate more frequently, therefore decreasing bacterial growth and reducing urinary tract infection symptoms."
http://www.sciencedaily.com/releases/2010/12/101208172324.htm

Does cranberry juice prevent or treat urinary tract infection?

by Raphael J. Kiel, Joan Nashelsky
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* EVIDENCE-BASED ANSWER Cranberry juice (200 mL daily to 250 mL 3 times daily) or cranberry concentrate tablets (at least 1:30 parts concentrated juice twice daily) reduce recurrent, symptomatic urinary tract infection (UTI) in women by 12% to 20% (absolute risk reduction [ARR]) compared with placebo (number needed to treat [NNT]=58) (strength of recommendation: A). There is no conclusive evidence that cranberryjuice effectively treats UTI (SOR: D). * EVIDENCE SUMMARY A Cochrane review found only a small number of poor-quality trials, providing insufficient support to recommend cranberry juice to prevent UTI. (1) However, 2 recent randomized studies, not included in the Cochrane review, found that women taking cranberry juice have fewer symptomatic UTIs. In women with prior Escherichia coli UTI, 50 mL of cranberry-lingonberry juice concentrate daily for 6 months reduced the recurrence of symptomatic UTI from 36% in the control group to 16% in the treated group (NNT=5). (2)

In a placebo-controlled randomized trial, women with prior UTI who took 1 tablet of concentrated cranberry juice (at least 1:30 parts concentrated juice) twice daily (n=50) or drank 250 mL of pure unsweetened cranberry juice 3 times a day for 12 months (n=50) reduced their incidence of symptomatic UTI.3 Women who drank the juice had an ARR of 12% (32% symptomatic UTI on placebo group, 20% in cranberry juice group, NNT=8.3) over 1 year. Use of cranberry juice tablets produced an ARR of 14% (32% symptomatic UTI in placebo group; 18% in cranberry tablet group, NNT=7.1). Self-reported compliance was 75% to 90% in the juice group and 90% in the tablet group. No dose-response studies have been done to determine the optimal volume of juice or number of tablets needed to prevent infection. Studies have used between 200 mL once a day to 250 mL 3 times a day of the juice or 1 cranberry tablet taken twice daily. The subject dropout rate was as high as 34% in one study using juice, (4) implying that cranberry juice which is acidic and astringent at full strength--may not be acceptable to many patients as a prophylactic therapy over a long period. The 1-month compliance rate of patients taking cranberry tablets was between 88% and 100%, suggesting that this form of cranberry may improve compliance. The cost of cranberry juice and cranberry tablets was estimated at $1400 and $624 per year, respectively. (3) This must be balanced against the cost of treating symptomatic UTIs. No randomized trials have tested the more readily available and palatable cranberry juice cocktail-which is mixed with water, a sweetener, and vitamin C--to prevent recurrent UTI.
http://findarticles.com/p/articles/mi_m0689/is_2_52/ai_97724151/

Cranberry juice does not inhibit bacterial growth and will not sterilize the urinary tract. Also, cranberry juice does not prevent or treat UTI by changing the pH of the urine. Rather, the suspected mechanism of action is that proanthocyanidins contained in cranberry juice prevent bacterial adherence to uroepithelial cells, thus reducing the development of UTI. (5) Cranberry juice has been shown to reduce uroepithelial cell adherence by bacteria resistant to trimethoprimsulfamethoxazole. (6) * RECOMMENDATIONS FROM OTHERS No national practice guidelines have recommended cranberry juice as a preventive strategy for recurrent UTI but, anecdotally, patients are often advised to try cranberry juice to prevent UTI. * CLINICAL COMMENTARY The protective value of cranberry juice against UTI bacteria is supported by a significant body of data from in vitro studies. The published studies examining the clinical use of cranberry juice for UTI prevention suffer from a number of flaws, including small sample size, poor design, lack of randomization, lack of placebo control, heterogeneous endpoints, and a focus on the geriatric population. Even the best of these studies suffers from a major defect: failure to use commonly available cranberry juice cocktail as the experimental intervention.

Despite these flaws, the weight of the clinical evidence suggests that cranberry juice is an effective intervention for the prevention of UTIs--especially in high-risk populations. Unfortunately, cranberry juice is expensive and its taste is displeasing to some, thus limiting its usefulness. Cranberry capsules/ tablets offer a reasonable alternative, but their composition varies greatly by manufacturer, and patient compliance may be poor. The decision to use cranberry juice should be left to the patient and her clinician. Given the evidence, cranberry juice is best suited for secondary prevention of recurrent UTI. Patients with recurrent UTI who are being considered for antibiotic prophylaxis and are willing to drink the juice are ideal candidates. Although the studies have yet to establish an ideal dose, 3 glasses a day should be sufficient. Brett Robbins, MD, and Steven Bondi, Internal Medicine Pediatrics Residency, University of Rochester, NY.

December 16, 2010 Drinking cranberry juice does not appear to ward off urinary tract infection (UTI) in young women, according to a study published in the January 2011 issue of Clinical Infectious Diseases. One of the most common bacterial infections, UTI affects approximately 11% of all US women each year, with 1 in 5 infections affecting those 18 to 24 years old. Not only are antibiotic prevention plans and treatment of UTI expensive ($1.6 million in 1995 dollars), but they also contribute to drug resistance. "Because antibiotic therapy is a major driver of resistance, and adversely affects the normal microbiota, preventive strategies that reduce the need for antibiotic therapy are particularly important," write Betsy Foxman, PhD, from the University of Michigan School of Public Health in Ann Arbor, and colleagues. Relatively inexpensive cranberry juice is a folk remedy shown to be effective in preventing UTI recurrence in observational studies and in small or open randomized trials. Seeking more substantial evidence, the investigators launched a double-blind, placebo-controlled trial testing its impact on recurrent infections. The researchers studied 319 otherwise healthy college women, with a mean age of 21 years, who were diagnosed with acute UTI at the Michigan Health Service laboratory between August 2005 and October 2007. They observed the participants for 6 months or until a second infection occurred and assumed that 30% of the women would experience another UTI during the observation period. The subjects were randomly assigned to drink 8 ounces of 27% low-calorie cranberry juice cocktail (n = 155) or the same amount of a placebo juice (n = 164) at 2 times a day throughout

the 6-month follow-up. Self-collected vaginal and rectal specimens and a clean-catch midstream urine specimen were presented by the women at baseline and at 3 months and 6 months. These were cultured to determine the presence of uropathogens. Information about UTI and other symptoms, risk factors for infection, diet, and other factors was collected at various times during the trial through on-site questionnaires, telephone interviews, and online surveys. Cranberry Juice Drinkers Had Higher UTI Recurrence At the studys conclusion, 230 (72%) of the women had completed the full protocol. Selfreported compliance was similar between the cranberry juice group and the placebo group. Pertinent findings, adjusted for sexual activity and UTI history, are as follows:

Among all participants, the recurrence rate was 16.9% (95% confidence interval [CI], 12.8% - 21.0%). The group drinking cranberry juice had a slightly higher recurrence rate (20.0% vs 14.0%). Symptoms reported by the participants at 3 days, 1 to 2 weeks, and at 1 month or longer were similar between the groups.

Among those with 2 or more previous UTIs, the risk for occurrence was significantly greater (22% vs 10%; P = .0007), but cranberry juice had no significant impact on those with or without such a history. Rebecca Kolp, MD, an obstetrician-gynecologist at Massachusetts General Hospital in Boston, has never recommended cranberry juice to patients with UTI. Dr. Kolp told Medscape Medical News that she was not surprised by the findings. "I've heard a lot of people say they feel cranberry juice helps, but there was never any scientific proof," Dr. Kolp said. "I think there are a lot of other preventative steps they can take such as staying well hydrated and urinating after intercourse." The investigators acknowledged 3 possible limitations to their study:

The placebo may have unintentionally contained the active ingredients in cranberry juice, as the exact ingredients have not been isolated with full certainty. Cranberry juice and the placebo both contain ascorbic acid, which is suggested to reduce the risk for UTI, an association that has not been found in controlled trials. Because the study prescribed liquids, participants may have experienced better hydration than usual, and their more frequent urination may have stunted bacterial growth and decreased mild UTI symptoms.

A strength of the study, according to Andrew Steele, MD, professor of urogynecology at Saint Louis University School of Medicine, in St. Louis, Missouri, is its reliable diagnostics, which exceeded symptoms assessment by culturing specimens.

"When you deal with recurrent urinary tract infection in women, the first question you've always got to always ask yourself is, 'Is this really an infection?'" Dr. Steele said. "There are a lot of other things that can cause infection symptoms." The researchers noted that their findings are similar to those of 2 previous studies: one, whose 305 subjects had a neuropathic bladder after a spinal cord injury, and another whose participants were much older than the population in which UTI most often occurs. "Of interest, in the only other large trial of cranberry juice compared with placebo juice, conducted among 376 British inpatients 60 years, the incidence of symptomatic UTI was also lower than anticipated in the placebo group, but there was no significant difference between groups," the study authors write.
http://www.medscape.com/viewarticle/734360 The National Institutes of Health supported the study. The study authors, Dr. Kolp, and Dr. Steele have disclosed no relevant financial relationships.