Progesterone Reduces Cocaine Use in Postpartum Women with a Cocaine Use Disorder: A Randomized,Double-Blind Study.

BACKGROUND: Progesterone modulates multiple brain functions implicated in the pathogenesis ofdrug addiction. During high endogenous progesterone states, women reduce use of cocaine. We sought to test whether progesterone replacement reduces cocaine use in postpartum women with a cocaine use disorder (CUD). METHODS: A 12-week, double-blind, parallel, randomized, placebo-controlled pilot trial with a 3-month post trial follow-up. 25 women within 12 weeks of deliverywere randomized to placeboand 25 to100 mgs of oral micronized progesterone, administered twice daily. Participants were recruited from obstetrical clinics. Randomization and allocation were performed by the study biostatistician. Attrition was 18% and the analysis included all50participants. Outcomes were self-reported days of cocaine use and positive urine toxicology assays for cocaine metabolites. FINDINGS: Participants randomized to placebo compared to progesterone had increased likelihood of cocaine use per week (RR=1·19; 95% confidence interval (CI)=1·05 to 1·36; p<0·01). At the three-month post trial visit the difference between groups was not significant (Likelihood RatioΧ2 =5·16; P=·08). There were no group differences in rates of submission of a positive urine test. A post hoc analysis showed a higher rate of relapse for participants randomized to placebo (HR=4·71; 95% CI= 1·09 to 20·5). We did not observe groups differences in the rate of adverse events. INTERPRETATION: These preliminary findings support the promise of progesterone treatment in postpartum women with a CUD and could constitute a therapeutic break through. FUNDING: US National Institute on Drug Abuse; Veterans Administration.

The high-affinity CXCR4 antagonist BKT140 is safe and induces a robust mobilization of human CD34+ cells in patients with multiple myeloma.

PURPOSE: CXCR4 plays an important role in the retention of stem cells within the bone marrow. BKT140 (4F-benzoyl-TN14003) is a 14-residue bio stable synthetic peptide, which binds CXCR4 with a greater affinity compared with plerixafor (4 vs. 84 nmol/L). Studies in mice demonstrated the efficient and superior mobilization and transplantation of stem cells collected with GCSF-BKT140, compared with those obtained when using stem cells obtained with each one of these mobilizing agent alone. These results have served as a platform for the present clinical phase I study. EXPERIMENTAL DESIGN: Eighteen patients with multiple myeloma who were preparing for their first autologous stem cell transplantation were included. Patients received a standard multiple myeloma mobilization regimen, consisting of 3 to 4 g/m(2) cyclophosphamide (day 0), followed by granulocyte colony-stimulating factor (G-CSF) at 5 µg/kg/d starting on day 5 and administered between 8 and 10 pm until the end of stem cell collection. A single injection of BKT140 (0.006, 0.03, 0.1, 0.3, and 0.9 mg/kg) was administered subcutaneously on day 10 in the early morning, followed by G-CSF 12 hours later. RESULTS: BKT140 was well tolerated at all concentrations, and none of the patients developed grade 3 and 4 toxicity. A single administration of BKT140 at the highest dose, 0.9 mg/kg, resulted in a robust mobilization and collection of CD34(+) cells (20.6 ± 6.9 × 10(6)/kg), which were obtained through a single apheresis. All transplanted patients received ∼5.3 × 10(6) CD34(+) cells/kg, which rapidly engrafted (n = 17). The median time to neutrophil and platelet recovery was 12 and 14 days, respectively, at the highest dose (0.9 mg/kg). CONCLUSIONS: When combined with G-CSF, BKT140 is a safe and efficient stem cell mobilizer that enabled the collection of a high number of CD34(+) cells in 1 and 2 aphaeresis procedures, resulting in successful engraftment.

ACR Appropriateness Criteria® on treatment of uterine leiomyomas.

Uterine leiomyomas (fibroids) are the most common tumors in women of reproductive age and a cause of significant morbidity in this patient population. Depending on the fibroid location, they can be the cause of a variety of symptoms, such as abnormal uterine bleeding, constipation, urinary frequency, and pain. Historically, hysterectomy has been the primary treatment option, and uterine fibroids remain the leading cause for hysterectomy in the United States. However, women who do not wish to undergo hysterectomy now have a variety of less invasive options available, including uterine artery embolization. This article discusses uterine artery embolization as well as some of the other treatment strategies for symptomatic uterine fibroids. In many situations, there may be no single best treatment option but several viable alternatives. Each option is discussed with consideration of outcomes, complications, and, when possible, cost-effectiveness. The recommendations in this article are the result of evidence-based consensus of the ACR Appropriateness Criteria® Expert Panel on Interventional Radiology.

Etiology and treatment of overactive bladder in women.

Overactive bladder (OAB) is a condition that affects millions of women in the United States (US). Although the etiology is largely unknown, risk factors include Caucasian race, insulin-dependent diabetes mellitus, and history of depression. Patients present with urgency with or without urinary incontinence and often have urinary frequency and nocturia. Most patients can be evaluated in the office setting utilizing simple testing. Current treatments consist of behavioral/lifestyle modification, usually in combination with antimuscarinic drug therapy. Improvements in the adverse effect profiles of antimuscarinic drugs have positively impacted quality of life. When appropriately evaluated, most patients presenting to primary care providers can be effectively treated.

Maximizing effectiveness of bisphosphonate therapy for osteoporosis.

While highly prevalent, osteoporosis is greatly underdiagnosed and undertreated in clinical practice. Even when appropriate treatments are prescribed, patient adherence to bisphosphonate therapy is low. As osteoporosis is a silent disease, and therapy is required for many months before benefit is realized, strategies to increase bone mineral density (BMD) and improve medication adherence are important aspects of every patient's care plan. Osteoporotic bone loss occurs without symptoms, and there are often no warning signs before a fracture occurs. Osteoporotic fractures are the most severe consequence of osteoporosis. Bisphosphonates are the most frequently prescribed treatment option for postmenopausal osteoporosis, as they effectively increase BMD, slow bone turnover, and reduce fracture rates. Strategies to improve adherence to osteoporosis therapy include reducing dosing frequency, changing the route of administration, educating the patient about optimum bisphosphonate administration, and sending patient reminders.

The vulvar dermatoses.

INTRODUCTION: Dermatologic diseases of the vulva may cause dyspareunia. These disorders may be overlooked by gynecologists and urologists because of lack of residency training experience. Dermatologists who are most familiar with these diseases are infrequently trained in vulvovaginal examination. As such, these disorders are often improperly diagnosed and treated. AIM: To describe the presentation and management of the major vulvar dermatoses including irritant and allergic contact dermatitis, lichen sclerosus, lichen simplex chronicus, and lichen planus. MAIN OUTCOME MEASURE: Data from a peer review literature search on the topic of vulvar dermatoses. METHODS: The literature for this review article was obtained through a Medline search. Appropriate dermatology textbooks were utilized for additional information. RESULTS: A comprehensive survey of the vulvar dermatoses. CONCLUSION: Vulvar dermatoses must be considered a part of the differential diagnosis of any woman with a sexual pain disorder. As such, healthcare providers who evaluate and treat women with dyspareunia must become familiar with the most common dermatologic disorders of the vulva.

Domestic violence homicide in Oklahoma: 1998-1999.

BACKGROUND: Domestic violence homicide is a significant public health issue for healthcare providers. The objective of this study was to review all domestic violence homicides in Oklahoma from 1998-1999 in order to identify strategies to prevent domestic violence homicides. METHODS: All domestic violence homicides from the years 1998-1999 were identified and reviewed by the Oklahoma Domestic Violence Fatality Review Board (ODVFRB) through records provided by the Oklahoma State Bureau of Investigation (OSBI) list of homicides resulting from domestic violence. In addition eleven other sources were utilized to compliment the OSBI data. RESULTS: The ODVFRB reviewed 113 domestic violence fatalities in Oklahoma for the years 1998-1999. Of the 113 cases reviewed, 69 (61%) were committed by intimate partners (IP) and 44 (39%) were committed by other family members. Sixty-two percent of perpetrators had a documented history of committing domestic violence. Law enforcement had responded to domestic disturbances before the death event in at least 32% of the fatal cases. Firearms were used in 59% of the homicides. CONCLUSIONS: Through in depth multidisciplinary review of domestic violence homicide cases and subsequent system changes, domestic violence deaths can be prevented.