Contraceptive Recommendations for Women with Immune-Mediated Inflammatory Diseases: A Delphi Consensus.

INTRODUCTION: Immune-mediated inflammatory diseases (IMID) are a group of disorders characterized by chronic inflammation caused by an altered immune regulation in targeted organs or systems. IMID itself could have an implied increased risk of venous thromboembolism (VTE) and this risk varies throughout the course of the disease as well as with some contraceptive methods and treatments. The aim of this study was to present some key considerations in relation to contraception in women with IMID. METHODS: This was an exploratory study conducted in Spain following the online modified Delphi methodology with two rounds of participation. Four questionnaires were designed for each medical specialty: gastroenterology, rheumatology, dermatology, and gynecology. Each questionnaire was divided in three domains: general recommendations about IMID, specific recommendations, and contraceptive methods for patients with IMID. A 5-point Likert scale measured agreement with each statement, with an 80% agreement threshold. Following the first round, the percentage of each response was calculated for every item. Subsequently, a second round was conducted to reach a consensus on the items for which discrepancies were observed. RESULTS: A total of 52 and 50 experts participated in the first and second round, respectively. Participants agreed on the existence of a higher risk of VTE in inflammatory bowel diseases, psoriasis, and rheumatoid arthritis diseases. Regarding recommendations for contraceptive methods in patients with IMID, experts considered the hormonal intrauterine device (IUD) as a first-line contraceptive (80.0%) and low doses of progesterone-only pills if the latter is not recommended (88.0%). Most of the interviewees concurred on the importance of the patients' contraceptive needs during the disease course (98.1%). CONCLUSION: Raising awareness and promoting a multidisciplinary relationship among the physicians involved in the therapeutic decisions by considering all the risk factors when prescribing a contraceptive method is important to prevent VTE in women with IMID.

Hexim1, a Novel Regulator of Leptin Function, Modulates Obesity and Glucose Disposal.

Leptin triggers signaling events with significant transcriptional responses that are essential to metabolic processes affecting obesity and glucose disposal. We asked whether hexamethylene bis-acetamide inducible-1 (Hexim1), an inhibitor of RNA II polymerase-dependent transcription elongation, regulates leptin-Janus kinase 2 signaling axis in the hypothalamus. We subjected C57BL6 Hexim1 heterozygous (HT) mice to high-fat diet and when compared with wild type, HT mice were resistant to high-fat diet-induced weight gain and remain insulin sensitive. HT mice exhibited increased leptin-pY(705)Stat3 signaling in the hypothalamus, with normal adipocyte size, increased type I oxidative muscle fiber density, and enhanced glucose transporter 4 expression. We also observed that normal Hexim1 protein level is required to facilitate the expression of CCAAT/enhancer-binding proteins (C/EBPs) required for adipogenesis and inducible suppressor of cytokine signaling 3 (SOCS) expression. Further support on the role of Hexim1 regulating C/EBPs during adipocyte differentiation was shown when HT 3T3L1 fibroblasts failed to undergo adipogenesis. Hexim1 selectively modulates leptin-mediated signal transduction pathways in the hypothalamus, the expression of C/EBPs and peroxisome proliferator-activated receptor-γ (PPAR γ) in skeletal muscle and adipose tissue during the adaptation to metabolic stress. We postulate that Hexim1 might be a novel factor involved in maintaining whole-body energy balance.

Candidemia en niños y factores de riesgo asociados / Candidemia in children and associate factors of risk

Cada vez es más frecuente la adquisición de infecciones fúngicas intrahospitalarias, generando una mayor morbilidad y mortalidad, sobre todo en pacientes que presentan factores de riesgo. Determinar la prevalencia, en los pacientes hospitalizados en el Hospital de Niños "JM de Los Ríos" (Caracas-Venezuela), de infecciones sistémicas ocasionadas por las distintas especies de Candida en el período 2002-2006. Estudio retrospectivo, transversal, descriptivo y no experimental. Se ubicaron las historias clínicas de estos pacientes y se recopilaron de un formato los siguientes datos: edad, sexo, servicio de hospitalización, diagnóstico de egreso, factores de riesgo relacionados con la infección. Se utilizó como prueba de análisis estadístico medidas de tendencia central. Se logró el aislamiento de microorganismos en un 21,68 por ciento (7,14 por ciento correspondieron a cepas de Candida). El sexo masculino predominó con un 58,61 por ciento, los lactantes fueron el grupo más afectado con un 38,14 por ciento. El uso de antibióticos de amplio espectro predominó entre los factores de riesgo. El 71,16 por ciento de los aislamientos correspondieron a cepas del grupo de Candida no albicans, representando las especies de Candida parapsilosis y Candida tropicalis casi las dos terceras partes de los aislamientos y asociándose con mayor frecuencia al uso de catéteres venosos centrales. El 75 por ciento de las cepas de Candida aisladas en hemocultivo han sido reportadas como sensibles a fluconazol y anfotericina B por la literatura médica mundial.

Hepatitis B y C en pacientes pediátricos con infección por el virus de inmunodeficiencia humana / Hepatitis B and C in patient pediatric with infection for the HIV

Muchos pacientes con infección VIH presentan coinfección con el virus de hepatitis B (VHB) y C (VHC). Se desconcen datos sobre evolución de la hepatitis B y C en niños con infección VIH vertical y horizontal. Determinar características de la infección por VHB y VHC en niños con infección VIH. Estudio clínico, longitudinal y comparativo, incluyendo pacientes pediátricos con infección VIH controlados en el Hospital "J.M de Los Ríos", desde 1984 hasta junio 2006, con seguimiento > de 6 meses, serologías para VHB y VHC, registrándose datos de evolución de infección por VHB, VHC y VIH. Se establecieron dos grupos, Grupo I: Pacientes VIH de transmisión vertical, Grupo II: Pacientes VIH de transmisión horizontal. Incluidos con serologías VHB, n=90. Grupo I 75.55 por ciento, Grupo II 24.44 por ciento. Del total de pacientes 18.89 por ciento presentaron coinfección VIH-VHB, Grupo I 13,23 por ciento, Grupo II 36,36 por ciento sin diferencias significativas. Del Grupo I 55,56 por ciento presentaron infección aguda por VHB y 44,44 por ciento infección crónica, Grupo II 62,5 por ciento infección aguda y 37,5 por ciento crónica, evolución sin diferencias. No hubo progresión de la infección VIH en coinfectados de ambos grupos. Incluidos con serologías VHC, n=84 . Grupo I 77,4 por ciento. Grupo II 22,6 por ciento. Presentaron coinfección VIH-VHC 7,14 por ciento de todos los pacientes, Grupo I 4,62 por ciento, Grupo II 15,79 por ciento diferencia no significativa. La hepatitis B es frecuente en niños con infección VIH siendo ambas, infecciones prevenibles. La evolución de la infección por VHB fue similar en niños con infección VIH vertical y horizontal. Un 7,14 por ciento presentó coinfección VIH-VHC.

Increased diagnosis of Lemierre syndrome and other Fusobacterium necrophorum infections at a Children's Hospital.

OBJECTIVE: To assess the apparent increase in the diagnosis of Lemierre syndrome (LS) and other Fusobacterium necrophorum infections at a large children's hospital. Infections with F necrophorum ranged from peritonsillar abscess to potentially fatal LS. LS is an oropharyngeal infection characterized by septic thrombophlebitis of head and neck veins, complicated by dissemination of septic emboli to pulmonary and systemic sites. METHODS: Review of the medical and laboratory records was conducted of all patients who were seen at or admitted to the Children's Hospital of Wisconsin with the diagnosis of LS and/or isolation of F necrophorum from a clinical specimen between January 1995 and January 2002. RESULTS: During the 7-year period of the study, there was an increase in the isolation of F necrophorum from patients who were seen at Children's Hospital of Wisconsin, as well as the number of cases of LS. There was 1 isolation of F necrophorum from clinical specimens per year from 1996 to 1999, which increased to 10 isolates of the organism from January 2000 to January 2002. During the most recent period, January 2001-January 2002, 5 cases of LS were diagnosed, a distinctive entity not recognized previously at the institution. CONCLUSIONS: The cause for the recent increase in the number of serious infections caused by F necrophorum infection diagnosed at our institution is unclear but does not seem to be related to changes in microbiologic techniques or patient demography. We speculate that it could be attributable, in part, to alterations in antibiotic usage patterns in our region. Clinicians need to be aware of the increasing clinical importance of F necrophorum infections and the life-threatening nature of LS.