Some Drugs Have Two Faces: Paradoxical Colitis in a Patient with Psoriatic Arthritis Previously Treated with Etanercept and IL-17 Inhibitors

Tumor necrosis factor-alpha (TNF-α) and interleukin-17 (IL-17) inhibitors are among the most potent treatments for inflammatory arthropathies including rheumatoid arthritis, psoriasis, and spondyloarthropathies. The availability of these biologic agents have revolutionized the management of these conditions and improved patient outcomes. Though generally safe, these biologics may contribute to the induction or exacerbation of colitis. This paradoxical colitis has been observed in patients on TNF-α inhibitor etanercept and IL-17 inhibitors (secukinumab and ixekizumab). We report a case of a 46-year-old female with psoriasis and psoriatic arthritis who presented with gastrointestinal symptoms after treatment with etanercept and IL-17 inhibitors. She was later diagnosed with paradoxical indeterminate colitis that was masked and treated by subsequent biologics given for her RA and psoriatic arthritis. In this report, we will discuss the importance of considering paradoxical colitis in the differential diagnosis for patients even several years after TNF-α/IL-17 inhibitor initiation and explain why careful consideration must be made when initiating these colitis-inducing agents to treat patients with inflammatory disorders.

Crop domestication as a step towards reproductive isolation

Speciation, Darwin's mystery of mysteries, is a continuous process that results in genomic divergence accompanied by the gradual increment of reproductive barriers between lineages. Since the beginning of research on the genetics of speciation, several questions have emerged such as: What are the genetic bases of incompatibilities? How many loci are necessary to prevent hybridization and how are they distributed along genomes? Can speciation occur despite gene flow and how common is ecological speciation? Early stages of divergence are key to understand the ecology and genetics of speciation, and semi-isolated species where hybrids can still be produced are particularly relevant This article is protected by copyright. All rights reserved.

Margin Status Post Cervical Conization Predicts Residual Adenocarcinoma In Situ (AIS) and Occult Adenocarcinoma in a Predominantly Hispanic Population

Background: Adenocarcinoma in situ (AIS) of the cervix, is increasing in incidence, particularly in women of reproductive age. Fertility preservation is often desired. In a predominantly Hispanic population, we sought to determine the incidence of occult cervical cancer co-existing with AIS, and evaluate how conization margin status correlates with residual disease upon hysterectomy. Methods: A retrospective study utilizing a comprehensive cancer center database was conducted. Data from patients with histologically proven AIS of the cervix were abstracted. Results: Of 47 patients that met the criteria, 23 (49%) were Hispanic, 21 (45%) were White, two (4%) were Asian, and one (2%) was Black. The median age was 37. Forty-two patients underwent cervical conizations; 13/42 (48%) had positive margins upon conization; 28/42 (67%) underwent hysterectomies. Furthermore, 6/13 (46%) patients with positive conization margins had residual disease in hysterectomy specimens, with 2/13 (15%) found to have invasive cancer. In contrast, 0/14 (0%) of patients with negative margins had residual disease (p = 0.036, Chi-squared 4.41, df = 1). In total, 2/27 (7%) patients who underwent hysterectomies had invasive cancer (7%). Conclusions: Positive margins upon cervical conization for AIS of the cervix were correlated with a relatively high rate of residual AIS and occult invasive cancer. Negative conization margins were correlated with no residual disease. Those patients may be candidates for fertility-sparing treatment.

What Are Women Told When Requesting Family Planning Services at Clinics Associated with Catholic Hospitals? A Mystery Caller Study

CONTEXT

Catholic Church directives restrict family planning service provision at Catholic health care institutions. It is unclear whether obstetrics and gynecology clinics that are owned by or have business affiliations with Catholic hospitals offer family planning appointments.

METHODS

Mystery callers phoned 144 clinics nationwide that were found on Catholic hospital websites between December 2014 and February 2016, and requested appointments for birth control generally, copper IUD services specifically, tubal ligation and abortion. Chi-square and Fisher's exact tests assessed potential correlates of appointment availability, and multivariable logistic regressions were computed if bivariate testing suggested multiple correlates.

RESULTS

Although 95% of clinics would schedule birth control appointments, smaller proportions would schedule appointments for copper IUDs (68%) or tubal ligation (58%); only 2% would schedule an abortion. Smaller proportions of Catholic-owned than of Catholic-affiliated clinics would schedule appointments for birth control (84% vs. 100%), copper IUDs (4% vs. 97%) and tubal ligation (29% vs. 72%); for birth control and copper IUD services, no other clinic characteristics were related to appointment availability. Multivariable analysis confirmed that tubal ligation appointments were less likely to be offered at Catholic-owned than at Catholic-affiliated clinics (odds ratio. 0.1); location and association with one of the top 10 Catholic health care systems also were significant.

CONCLUSIONS

Adherence to church directives is inconsistent at Catholic-associated clinics. Women visiting such clinics who want highly effective methods may need to rely on less effective methods or delay method uptake while seeking services elsewhere.

Investigations of in vitro bioaccessibility from interesterified stearic and oleic acid-rich blends

Interesterification was previously found to impact stearic acid absorption in a randomized cross-over study, when human volunteers consumed a 70 : 30 wt% high-oleic sunflower and canola stearin blend (NIE) compared to the same blend which had undergone either chemical (CIE) or enzymatic (EIE) interesterification.

[Monitoring vancomycin in an intensive care unit: A retrospective survey on 66 patients]

OBJECTIVES

The study objectives were to check whether recommended vancomycin doses were related to pharmacological objectives for intensive care patients: steady-state plasma concentration (SSc) and ratio SSc/MIC (Minimal Inhibiting Concentration). The authors tried to identify variability factors for vancomycin plasmatic concentrations at peak.

PATIENTS AND METHODS

This monocentric, observational, and retrospective survey was performed on 66 intensive care patients treated by antibiotics including vancomycin, alone or in combination, as a curative treatment for a severe infection with Gram-positive bacteria. Vancomycin was dosed at 15mg/kg during the first hour, then 40 to 60mg/kg per 24hour. Vancomycin SSc and bacteria MIC were recorded. The SSc/MIC ratio was determined and was considered efficient when superior to 8.

RESULTS

Forty-two percent of vancomycin SSc were within the effectiveness rate. Twenty-three percent of SSc/MIC ratios were superior to 8. The rate of clinical recovery was 71 %. The length of antibiotherapy was identified as positively interacting with biological effectiveness, unlike severe sepsis, a factor of negative interaction on vancomycin SSc in this study.

CONCLUSION

Less than half of the SSc and less than a quarter of the SSc/MIC ratios were at effective rates in our study. Therefore, adequacy between dosage, administration, and monitoring should be reviewed.

Problem Gambling Within a Chinese Speaking Community

The purpose of this study was to obtain preliminary data on pathological gambling rates within a metropolitan Chinese community to determine if more costly extensive epidemiological surveys were justified. Two thousand survey questionnaires were distributed to parents through children attending a local Chinese speaking school. A response rate of 27.4% was obtained. Over a quarter of respondents were born overseas in either Mainland China or Hong Kong. Results indicated that gambling was not a popular activity with 60.0% of respondents stating that they never gambled. Of those who gambled, a third of respondents identified lotto as the preferred form. Using a Chinese translation version of the SOGS and a cut-off score of 10, a prevalence estimate of 2.9% for pathological gambling was found with males showing a higher rate (4.3%) as compared to females (1.6%). Respondents reporting a prior history of gambling in their country of origin were more likely to be classified as probable pathological gamblers. Despite the use of a sample of convenience, changes to the wording of two items in the Chinese translation of the SOGS and the possibility of false positive cases in the present study, it is concluded that further research into problem gambling in this community should be undertaken.

Synthesis and distribution of rat Sertoli cell proteoglycans are modulated by linoleate and vitamin E

In rat Sertoli cells, linoleate addition modified cell membrane fatty acid composition and changes depended on linoleate concentrations. In presence of the lowest 18:2 n-6 concentrations (2.5 and 7.5 microM), decrease in proteoglycan synthesis paralleled increase in n-6 linoleate-derived metabolites. At high concentration (21 microM), linoleate accumulated in membranes and level of n-6 linoleate-derived metabolites returned to basal value, without change in proteoglycan synthesis. Linoleate modified proteoglycan distribution in Sertoli cells by an increase in peripheral proteoglycans and a concomitant decrease in medium proteoglycans. Vitamin E (100 microM) did not alter fatty acid composition in control and linoleate-treated cells, but enhanced proteoglycan production. Furthermore, this agent counteracted linoleate-induced modifications in proteoglycan cell distribution.

The biosynthesis of polyunsaturated fatty acids by rat sertoli cells

1. The biosynthesis of polyunsaturated fatty acids (PUFA) of the n-6 and n-3 series was investigated in cultured Sertoli cells. 18:2n-6, 18:3n-6, 20:2n-6, 18:3n-3 and 20:3n-3 were added individually at a concentration of 20 mumol to culture media. 2. Maximum incorporation of 20- and 22-carbon PUFA into membrane lipids was observed after 72 hr of incubation with all the exogenous substrates used. 3. As reported in other cell systems, the delta 6 desaturation was the first rate-limiting step; the major factor regulating this activity was the concentration of linoleic acid or alpha-linolenic acid in the medium. 4. Our data show that the delta 5-desaturation represents a second regulatory step in PUFA biosynthesis. 5. The sum of n-6 and n-3 PUFA of the 22 carbon chain length constantly represented between 11 and 12% of total fatty acids, regardless of the exogenous substrate used. 6. Our kinetic studies of the incorporation of PUFA of the n-6 and n-3 series did not permit detection of a delta 8 desaturase activity.

Metabolic utilization of linoleate and alpha-linolenate in cultured Sertoli cells

1. The capacity of cultured Sertoli cells to synthesize long-chain polyunsatured fatty acids (PUFA) from the essential fatty acid (EFA) precursors 18:2 n-6 and 18:3 n-3 was tested, and the concentrations of each EFA required to obtain maximal incorporation into membrane lipids were determined. 2. The two EFA were added to the culture medium as free fatty acids complexed to albumin in a molar ratio of 12:1. 3. When the substrates were added individually, the maximal levels of biosynthesis were obtained with 0.7 micrograms/ml of 18:2 n-6 and 2 micrograms/ml of 18:3 n-3. 4. When the two EFA were added together, clear alterations in the behavior of the desaturases with regard to the n-6 and n-3 fatty acids were observed. 5. It was found that a concentration of 0.35 micrograms/ml of each EFA represented the "ideal" required level in order to ensure optimal incorporation of 22-carbon PUFA into the membrane lipids. 6. These results provide the first data on the definition of EFA requirements for Sertoli cells in culture.

[Interaction of two isomers, N-nitrosomethylphenylamine, N-nitroso derivative, and p-nitrosomethylaniline with microorganisms]

There exists a relationship between the chemical structure C--NO or N--NO and biological effects. p-nitrosomethylaniline, a C-nitroso compound, in contrast to its isomer, N-nitrosomethylphenylamine, a N-nitroso derivate, shows a marked action against microoganisms and is, alone, reduced enzymatically.