Fetal death in utero and miscarriage in a patient with Crohn's disease under therapy with ustekinumab: case-report and review of the literature.

BACKGROUND: Ustekinumab is a fully human monoclonal antibody against the p40 subunit of interleukin (IL) 12 and 23 which is involved in the pathogenesis of several inflammatory diseases. Ustekinumab is approved for psoriasis and psoriatic arthritis treatment and has been successfully evaluated in phase II and III trials for patients with Crohn's disease (CD). CASE PRESENTATION: We report here the case of a patient who became pregnant during treatment with ustekinumab for a refractory CD and which ended in miscarriage. CONCLUSION: Ustekinumab is a relatively new pharmacotherapy and in addition to this clinical case, we reviewed the published literature concerning the use of this treatment during pregnancy and its consequences on pregnancy and fetus outcome.

[Malarial vectors in French Guiana: study in an epidemic focus near Cayenne (1989-1998)]. / Vecteurs de paludisme en Guyane Française: étude dans un foyer épidémique proche de Cayenne (1989-1998).

Malaria has long constituted a major public health problem for French Guyana, limiting its demographic and economic development. From 1949 to 1960, due to chemoprophylaxis and DDT spraying in houses, the number of malaria cases decreased markedly. After 1975, important migratory movements contributed to increasing the incidence of malaria. In 1989, numerous cases were observed when some 500 immigrants settled in a formerly uninhabited area, known as Cabassou BP 134. It is located 7 km (S-E) from the main city of Cayenne and bordered by secondary forest and swamps. The entomological study initiated in 1990 included weekly biting-landing catches (3 hours) on human bait in houses from dusk onwards as well as locating breeding places around the settlement to collect larvae by dipping. Anopheles specimens were identified and the females dissected to detect infections by Plasmodium and also to determine the rate of parous specimens. Control measures included deltamethrin (15 mg/m2) and DDT (2 g/m2) spraying, every four months, of interior walls and thermal fogging of naled around the houses. Cold ULV aerosol of fenitrothion (500 ml/ha) was also used to treat the swamp borders. In April 1990, a health education programme was begun and in June, 288 impregnated bednets (deltamethrin 15 mg/m2) were treated. From 1990 to 1998, 1,588 (498 larvae + 1090 adults) Anopheles (Nyssorhynchus) were collected: An. aquasalis 797 (311 L + 486 A). An. braziliensis 139 (87 L + 52 A). An. darlingi 652 (100 L + 552 A). No infected female was found among the 710 dissected. The number of malaria cases decreased abruptly in the fall of 1990 when An. darlingi disappeared and only one case due to P. vivax was detected between 1995 and 1998. An. darlingi (parous rate = 72%) appears to be the main if not the sole vector of malaria in this locality. As in the past, a focus of malaria appears when immigrants from endemic countries settle in a formerly uninhabited place where An. darlingi are breeding.

[Malaria in the Americas]. / Le paludisme dans les Amériques.

In 1996, malaria involving Plasmodium vivax, Plasmodium falciparum, and, to a lesser extent, Plasmodium malariae was endemic in 21 countries in the Americas. The Amazon river basin and bordering areas including the Guyanas were the most affected zones. Until the mid 1970s, endemic malaria appeared to be under control. However in the ensuing 15 year period, the situation deteriorated drastically. Although trends varied depending on location, aggregate indexes indicated a twofold increase with recrudescence in previously settled areas and emergence in newly populated zones. Since 1990, the situation has worsened further in some areas where increased incidences have been associated with a high levels of drug-resistant Plasmodium falciparum. However this species remains in minority except in the Guyanas where the highest annual incidences (100 to 500 cases per 1000) and the most drug-resistant Plasmodium have been reported. The causes underlying this deterioration are numerous and complex. In regions naturally prone to transmission of the disease, outbreaks have been intensified by unrestrained settlement. The resulting deforestation has created new breeding areas for Anopheles darlingi, the main vector of malaria in the Americas. Migration of poor populations to newly opened farming and mining areas has created highly exposed areas for malaria infection. Implementation of adequate medical care and prevention measures has been hindered by a lack of money and sociopolitical unrest. Climatic phenomenon related the El Nino have also been favorable to the return of malaria to the region. Except with regard to financial resources and political unrest, the same risk factors for malaria are present in French Guiana.

Glucose metabolism, enzymic analysis and product formation in chemostat culture of Hanseniaspora uvarum.

The physiology of Hanseniaspora uvarum K5 was studied in glucose-limited chemostat cultures and upon glucose pulse. Up to a dilution rate of 0.28 h-1, glucose was completely metabolized in biomass and CO2. Above this value, increase in the dilution rate was accompanied by sequential production of metabolites (glycerol, acetate and ethanol) and decrease in cell yield. Similar results were observed upon glucose pulse. From the enzyme activities (pyruvate dehydrogenase, pyruvate decarboxylase, NAD and NADP-dependent acetaldehyde dehydrogenases, acetyl coenzyme A synthetase and alcohol dehydrogenase) and substrate affinities, the following conclusions were drawn with respect to product formation of cells: (1) pyruvate was preferentially metabolized via pyruvate dehydrogenase, when biomass and CO2 were the only products formed; (2) acetaldehyde formed by pyruvate decarboxylase was preferentially oxidized in acetate by NADP-dependent aldehyde dehydrogenase; acetate accumulation results from insufficient activity of acetyl-CoA synthetase required for the complete oxidation of acetate; (3) acetaldehyde was oxidized in ethanol by alcohol dehydrogenase, in addition to acetate production.