Venous Thromboembolism and Oral Contraceptives

Anti-obesity effects of gut microbiota are associated with lactic acid bacteria

The prevalence of obesity is rapidly becoming endemic in industrialized countries and continues to increase in developing countries worldwide. Obesity predisposes people to an increased risk of developing metabolic syndrome. Recent studies have described an association between obesity and certain gut microbiota, suggesting that gut microbiota might play a critical role in the development of obesity. Although probiotics have many beneficial health effects in humans and animals, attention has only recently been drawn to manipulating the gut microbiota, such as lactic acid bacteria (LAB), to influence the development of obesity. In this review, we first describe the causes of obesity, including the genetic and environmental factors. We then describe the relationship between the gut microbiota and obesity, and the mechanisms by which the gut microbiota influence energy metabolism and inflammation in obesity. Lastly, we focus on the potential role of LAB in mediating the effects of the gut microbiota in the development of obesity.

Tailoring combination oral contraceptives to the individual woman

BACKGROUND

Over the last 50 years, there has been intense interest in the type of progestin used in combined oral contraceptives (COC) in an attempt to exploit novel properties and minimize adverse events. At the same time, the dose of synthetic estrogen, ethinylestradiol, in COC pills has been reduced to minimize risks for ischemic stroke, myocardial infarction, and venous thromboembolism. New formulations, including extended-cycle or continuous-use COCs or those that use a natural estrogen, estradiol, may offer improvements over their predecessors.

METHODS

A Medline search was performed to encompass studies published since 1990 that pertain to the pharmacology of estrogens and progestins used in COCs, risks and adverse events associated with COCs, and extended or continuous-use COCs.

RESULTS

New progestins structurally related to progesterone and spironolactone may exhibit more selective binding to the progesterone receptor and lack androgenic adverse effects associated with progestins structurally related to testosterone. Recently, COCs containing natural (17β-estradiol) or conjugated estrogen (estradiol valerate) rather than ethinylestradiol have been developed in order to move to a more natural estrogen. Although many of the new progestins incorporated into COCs have not demonstrated the negative effects on lipid metabolism and other adverse events associated with the traditional progestins, the goal of attaining good cycle control has yet to be achieved. Extended-cycle and continuous-use regimens are now available that reduce the frequency of menses, but breakthrough bleeding remains a problem.

CONCLUSIONS

Appropriate counseling to raise awareness of the specific characteristics of the different COC options available may optimize adherence and patient acceptability.

Incidence and risk factors for venous thromboembolism in patients with nonsurgical isolated lower limb injuries

PURPOSE

The aim of our study was to determine the incidence of venous thromboembolism (VTE) in patients with nonsurgical isolated lower limb injury and to determine the risk factors associated with the development of the condition.

METHODS

This observational study was conducted in French hospital emergency departments (EDs). Patients older than 18 years presenting with nonsurgical isolated lower limb injury below the knee in the ED were included. Deep VTE was diagnosed with compression ultrasound. The final diagnosis of VTE was confirmed by an expert panel.

RESULTS

Three thousand six hundred ninety-eight patients were included, and compression ultrasound examination was obtained in 2761 (75%) of them who were retained in the analysis. Deep venous thrombosis occurred in 177 patients and nonfatal pulmonary embolism in 1 patient. The incidence of VTE, mainly distal and asymptomatic, was 6.4% (95% confidence interval, 5.5%-7.4%). In a multivariate analysis, predictive variables of VTE were age of at least 50 years (odds ratio, 3.14; P < .0001), rigid immobilization (odds ratio, 2.70; P < .0001), no weight bearing (odds ratio, 4.11; P = .0015), and severe injury (odds ratio, 1.88; P = .0002). The discriminant analysis showed that age was the only variable independent of an antithrombotic prophylaxis associated with VTE.

CONCLUSION

The incidence of VTE was 6.4% in patients with nonsurgical lower limb injury. Rigid immobilization, recommendation not to bear weight, severe injury, and age of at least 50 years should be considered as risk factors for VTE. Emergency physicians should also take age into account when prescribing antithrombotic prophylaxis.