[Urinary tract symptoms and erectile dysfunction in obstructive sleep apnea: Systematic review]

OBJECTIVE

The objective of this work was to make a review of urinary tract symptoms and erectile dysfunction involved in obstructive sleep apnea (OSA) but also to study their physiopathology and potential treatments.

METHODS

We conducted a literature review in the Pubmed database using PRISMA guidelines and the MeSH terms: sleep apnea, urinary incontinence, erectile dysfunction, sexuality. All French and English articles published up to 2020 were evaluated.

RESULTS

The initial evaluation identified 240 articles from which 30 were included. References lists review allowed the inclusion of 26 additional articles. Nocturia, overactive bladder (OAB) and erectile dysfunction (ED) were associated with OSA. Increased levels of natriuretic peptides are behind nocturia. Nocturia is associated with higher Apnea/Hypopnea Index (AHI) (49±11 vs 24±8 episodes/hour with P=0.0001). The severity of nocturia is proportional to the severity of OSA with a positive predictive value of 71%. Intermittent nocturnal hypoxemia causes peripheral axonal damage with subsequent urgency incontinence. There is correlation between severity of OAB and the severity of OSA especially when the latter is moderate or severe. An odds ratio of 0.45 (CI95%: 0.18-0.71) is found for ED in patients who don't have OSA, associating the latter to an increased risk of ED. Intermittent nocturnal hypoxemia, the decrease in the levels of nitric oxide, and the increase in blood pressure and levels of endothelin 1 contribute to the development of ED. An early treatment of OSA with continuous positive airway pressure (CPAP) may allow a partial but significant control of urinary symptoms and erectile dysfunction associated with OSA.

CONCLUSION

OSA is associated with urinary tract symptoms (nocturia and OAB) and erectile dysfunction. The severity of associated symptoms is related to the severity of OSA. Urinary and sexual troubles are reversible after treatment of OSA by CPAP. OSA research is reasonable in case of pathologic nocturia or ED with loss of morning erections.

Structure-Activity Relationship Studies of Retro-1 Analogues against Shiga Toxin

High-throughput screening has shown that Retro-1 inhibits ricin and Shiga toxins by diminishing their intracellular trafficking via the retrograde route, from early endosomes to the Golgi apparatus. To improve the activity of Retro-1, a structure-activity relationship (SAR) study was undertaken and yielded an analogue with a roughly 70-fold better half-maximal effective concentration (EC₅₀) against Shiga toxin cytotoxicity measured in a cell protein synthesis assay.

Synthesis, Chiral Separation, Absolute Configuration Assignment, and Biological Activity of Enantiomers of Retro-1 as Potent Inhibitors of Shiga Toxin

The Shiga toxin (Stx) family is composed of related protein toxins produced by the bacteria Shigella dysenteriae and certain pathogenic strains of E. coli. No effective therapies for Stx intoxication have been developed yet. However, inhibitors that act on the intracellular trafficking of these toxins may provide new options for the development of therapeutic strategies. This study reports the synthesis, chromatographic separation, and pharmacological evaluation of the two enantiomers of Retro-1, a compound active against Stx and other such protein toxins. Retro-1 works by inhibiting retrograde transport of these toxins inside cells. In vitro experiments proved that the configuration of the stereocenter at position 5 is not crucial for the activity of this compound. X-ray diffraction data revealed (S)-Retro-1 to be slightly more active than (R)-Retro-1.

Iatrogénie des antidépresseurs

Les inhibiteurs sélectifs de la recapture de la sérotonine (ISRS) sont à ce jour les antidépresseurs les plus prescrits dans le traitement de l’épisode dépressif caractérisé. Cependant de plus en plus d’études s’interrogent sur leurs risques de saignements dus à une inhibition de l’agrégation plaquettaire ainsi qu’à une augmentation de la sécrétion d’acide gastrique. Ces effets dépendent du degré d’inhibition de la recapture de la sérotonine de la molécule. Le risque hémorragique semble essentiellement situé au niveau gastro-intestinal haut, avec peu de micro saignements cérébraux en population générale. La co-prescription d’acide acétyl salicylique et/ou d’anti-inflammatoires non stéroïdiens majore le risque, alors que celui-ci semble atténué par la prescription d’inhibiteurs de la pompe à protons. Via l’inhibition du cytochrome P450, le risque est majoré lorsque l’antidépresseur est associé au Warfarin ou au Clopidogrel, plus particulièrement pour la Fluoxétine et la Fluoxamine, et de manière moins importante pour la Sertraline et le Citalopram. Il est également discuté l’arrêt du traitement ou, en fonction de l’évaluation clinique, du switch par une autre classe d’antidépresseurs 15 jours avant une chirurgie chez les patients à hauts risques de saignements. Ces données doivent être prises en considération dans l’évaluation de la balance/bénéfice risque lors de la prescription d’un traitement antidépresseur.

Variable age at onset in insulin-dependent diabetes mellitus, by the marker-association-segregation-chi 2 method

The marker-association-segregation-chi 2 (MASC) method with consideration of age, for nonaffected persons, and of age at onset, for affected persons, was applied to a sample of 308 HLA-typed families. Hazard rates modeling the instantaneous risk of catching the disease were estimated under the exponential distribution and with satisfactory goodness of fit. This class of models shows that the hypothesis of the absence of parental imprinting cannot be rejected for insulin-dependent diabetes mellitus.