Updates on HIV nonoccupational postexposure prophylaxis.

PURPOSE OF REVIEW: Adolescents and young adults continue to contribute to new HIV infections despite improved antiretroviral regimens and HIV preexposure and postexposure prophylaxis (PrEP and PEP). Knowledge about nonoccupational HIV PEP (nPEP) is relevant and important for all pediatricians as adolescents present under a variety of circumstances disclosing past sexual activity. RECENT FINDINGS: nPEP is effective in preventing HIV infection, and newer regimens have been shown to increase compliance amongst users, have less side effects, and lead to less HIV resistance. Yet, research on physician prescription practices shows a lack of knowledge regarding appropriate HIV nPEP medication regimens, dosing, and follow-up recommendations. Updated national guidelines are available to providers who may be unfamiliar with indications and drug regimens for nPEP. Studies also provide different strategies to increase nPEP use and compliance among patients as well as ways to increase provider awareness of appropriate nPEP prescription. SUMMARY: Research of HIV nPEP shows that it is effective when used correctly, but there needs to be increased education and awareness to increase provider prescription and patient use as well as institutional changes to help patients complete the full course of medication.

ß-caryophyllene enhances the transcriptional upregulation of cholesterol biosynthesis in breast cancer cells.

ß-caryophyllene (BCP) exhibits anti-proliferative properties in cancer cells. Here, we examine the hypothesis that BCP induces membrane remodeling. Our data show that high concentrations of BCP increase membrane permeability of human breast cells (hBrC) causing detachment and cell death. At a sub-lethal concentration of BCP, we show that BCP induces a striking upregulation of genes involved in cholesterol biosynthesis, including the gene that encodes for HMGCoA reductase (HMGCR), the rate-determining step in cholesterol biosynthesis. In addition, stearoyl-CoA desaturase (SCD) is also upregulated which would lead to the enhanced formation of monounsaturated fatty acids, specifically oleate and palmitoleate from stearoyl CoA and palmitoyl CoA, respectively. These fatty acids are major components of membrane phospholipids and cholesterol esters. Together, these data suggest that cells respond to BCP by increasing the synthesis of components found in membranes. These responses could be viewed as a repair mechanism and/or as a mechanism to mount resistance to the cytotoxic effect of BCP. Blocking HMGCR activity enhances the cytotoxicity of BCP, suggesting that BCP may provide an additional therapeutic tool in controlling breast cancer cell growth.

Capnography Use During Intubation and Cardiopulmonary Resuscitation in the Pediatric Emergency Department.

OBJECTIVE: Capnography is indicated as a guide to assess and monitor both endotracheal intubation and cardiopulmonary resuscitation (CPR). Our primary objective was to determine the effect of the 2010 American Heart Association (AHA) guidelines on the frequency of capnography use during critical events in children in the emergency department (ED). Our secondary objective was to examine associations between patient characteristics and capnography use among these patients. METHODS: A retrospective chart review was performed on children aged 0 to 21 years who were intubated or received CPR in 2 academic children's hospital EDs between January 2009 and December 2012. Age, sex, time of arrival, medical or traumatic cause, length of CPR, return of spontaneous circulation (ROSC), documented use of capnography and colorimetry, capnography values, and adverse events were recorded. RESULTS: Two hundred ninety-two patients were identified and analyzed. Intubation occurred in 95% of cases and CPR in 30% of cases. Capnography was documented in only 38% of intubated patients and 13% of patients requiring CPR. There was an overall decrease in capnography use after publication of the 2010 AHA recommendations (P = 0.05). Capnography use was associated with a longer duration of CPR and return of spontaneous circulation. CONCLUSIONS: Despite the 2010 AHA recommendations, a minority of critically ill children are being monitored with capnography and an unexpected decrease in documented use occurred among our sample. Further education and implementation of capnography should take place to improve the use of this monitoring device for critically ill pediatric patients in the ED.