Progestin-only contraception and venous thromboembolism.

Combined oral contraceptives (COC) are the most popular contraceptive method in developed countries. Since their introduction there have been numerous changes and modifications in its composition with the aim to improve safety and tolerability while maintaining contraceptive efficacy. Most of the changes have been conducted on the progestin component, since most of the combinations include ethinyl estradiol as oestrogen. One of the adverse effects of COC is the increased risk of venous thromboembolism (VTE) in two clinical forms of presentation: deep vein thrombosis or pulmonary embolism. This review details the changes in haemostasis induced by progestin-only contraceptives and the risk of VTE in women who utilize this type of contraception; the relationship with other risk factors such as thrombophilia; the interactions of these contraceptives with anticoagulant treatment and finally the eligibility criteria for the use of hormonal contraception in women with previous VTE or thrombophilia carriers.

Valoración del grado de conocimientos y experienciaen nutrición artificial entre los especialistasen medicina intensiva de la Región de Murcia / Evaluation of intensivit´s knowledge and experience in artificial nutrition in the Murcia region (Spain)

Objetivos. El conocimiento de la nutrición artificial es un apartado obligatorio en la formación de los especialistas en medicina intensiva por su importancia en el tratamiento del paciente crítico. En el presente estudio se pretende valorar la formación recibida y el grado de conocimientos adquiridos entre los intensivistas de nuestra área. Métodos. Se llevó a cabo una encuesta en tiempo real entre los intensivistas de cinco hospitales de nuestra región. La encuesta constaba de 29 ítems, divida en tres apartados: formación, conocimientos generales y conocimientos en el paciente crítico. Resultados. Se recogieron 52 encuestas (38 especialistas y 14 médicos residentes, o MIR).De ellos, un 83 por ciento había recibido formación sobre el tema durante el período MIR, pero el 66 por ciento la consideraba insuficiente. Esta opinión era significativamente mayor (p < 0,05) en el grupo MIR. Un 66 por ciento de los encuestados adecuaba las dietas a las características del paciente, pero sólo conocían y manejaban "toda" la gama de productos de cada tipo de nutrición un 25 por ciento en el caso de las dietas orales, un 22 por ciento en el de la nutrición enteral y un 36 por ciento en el de la nutrición parenteral. La nota media (desviación estándar [DE]) en el conocimiento de nutrición en el paciente crítico fue de 6,19 (1,80), significativamente mayor (p < 0,05) en los especialistas que en los MIR. Conclusiones. La formación en nutrición se recibe fundamentalmente en el período MIR, aunque en general se considera que es insuficiente. La mayoría de los profesionales utiliza correctamente las dietas existentes. Por último, el grado de conocimientos es medio, y es significativamente mayor en los profesionales con más experiencia (AU)

Ingenol esters induce apoptosis in Jurkat cells through an AP-1 and NF-kappaB independent pathway.

BACKGROUND: Ingenol derivatives have received constant and multidisciplinary attention on account of their pleiotropic pattern of biological activity. This includes activation of protein kinase C (PKC), tumour-promotion, anticancer, and anti-HIV properties, and the possibility of dissecting co-cancerogenic and clinically useful activities has been demonstrated. Certain ingenol esters show powerful anticancer activity, and a structure-activity relationship model to discriminate between their apoptotic and non-apoptotic properties has been developed. RESULTS: The polyhydroxylated southern region of ingenol was selectively modified, using the anticancer and PKC activator ingenol 3,20-dibenzoate (IDB) as a lead compound. The evaluation of IDB analogues in apoptosis assays showed strict structure-activity relationships, benzoylation of the 20-hydroxyl being required to trigger apoptosis through a pathway involving caspase-3 and occurring at the specific cell cycle checkpoint that controls the S-M phase transition. Conversely, a study on the activation of the PKC-dependent transcription factors AP-1 and NF-kappaB by IDB analogues showed significant molecular flexibility, including tolerance to changes at the 3- and 20-hydroxyls. IDB-induced apoptosis was independent of activation of PKC, since it was not affected by treatment with the non-isoform-selective PKC inhibitor GF 109230X0. CONCLUSIONS: Remarkable deviations from the tumour-promotion pharmacophore were observed for both the apoptotic and the PKC-activating properties of IDB analogues, showing that ingenol is a viable template to selectively target crucial pathways involved in tumour promotion and development. Since the apoptotic and the PKC-activating properties of ingenoids are mediated by different pathways and governed by distinct structure-activity relationships, it is possible to dissect them by suitable chemical modification. In this context, the esterification pattern of the 5- and 20-hydroxyls is critical.

New glycosides from Capsicum annuum L. var. acuminatum. Isolation, structure determination, and biological activity.

Investigation of polar extracts from ripe fruits of Capsicum annuum L. var. acuminatum yielded three new glycosides, capsosides A (1) and B (2) and capsianoside VII (3), along with seven known compounds (4-10). The chemical structures were elucidated mainly by extensive nuclear magnetic resonance methods and mass spectrometry, and the biological activities of icariside E(5) (4) were tested by different assays. Icariside E(5), in contrast to capsaicin, neither induces an increase in the intracellular levels of reactive oxygen species nor affects the mitochondria permeability transition, and it does not signal through the vanilloid receptor type 1. Interestingly, this compound protects Jurkat cells from apoptosis induced by the oxidative stress mediated by serum withdrawal. These results suggest that icariside E(5) may have antioxidant properties that strengthen the importance of peppers in the Mediterranean diet.

[Hepatic inflammatory pseudotumor: apropos a case with a response to steroid treatment]. / Seudotumor inflamatorio hepático: a propósito de un caso con respuesta a tratamiento esteroideo.

A new case of hepatic inflammatory pseudotumor (HIP) is reported. A 66-year-old woman presented with fever and toxic syndrome. Analysis demonstrated an elevation in erythrocyte sedimentation, CRP, leukocytosis and normocytic anemia. A lesion was observed on ultrasonography in the right hypoechoic hepatic lobe with echos within (mosaic pattern). The lesion was hypodense on CT scan and was hypervascularized on angiography. NMR was hypointense on T1 and hyperintense on T2. The patient underwent surgery with intraoperative biopsy being performed. Hepatectomy was not carried out given negativity of malignancy. Following surgery the patient remained asymptomatic and the analytical alterations normalized. After a asymptomatic 5-year period the clinical-analytical alterations reappeared following erysipelas. Fever showed partial response to non steroid antiinflammatory drugs and a satisfactory response to corticoids. Studies are required to evaluate the role of corticoid treatment in this disease.

[Serum LDH and myeloma. Correlation with the degree of bone marrow infiltration]. / LDH Sérica y mieloma. Correlación con el grado de infiltración medular.

The authors study the serum lactate dehydrogenase (LDH) activity in multiple myeloma patients in relation to survival, plasma cells bone marrow infiltration, and creatinine and paraprotein serum values. Twenty five patients seen between 1979 and 1983 were studied considering two groups, one with LDH values higher than 100 IU/1 and the other with LDH values lower than 100 IU/1. Patients having more than 100 IU/1 showed a more marked bone marrow infiltration. Paraprotein concentration was higher in patients having less than 100 IU/1. No correlation was observed for the other factors considered.