SAT0577 USE OF CONTRACEPTIVE METHODS IN MEXICAN WOMEN WITH RHEUMATIC DISEASES

Background:

The importance of safe and effective contraception for women with rheumatic diseases has been increasing.1Several studies have demostrated that carefully planned pregnancies are related with better outcomes making the use of contraceptive methods (CM) more significant.

Objectives:

To describe the use of methods of contraception among Rheumatoid Arthritis (RA) and Systemic Lupus Erythematosus (SLE).

Methods:

A Cross-sectional study where women aged 18-45 followed in our CEER outpatient clinic, at Monterrey, Mexico, were questioned about the use of CM. Sociodemographic data was collected from the medical record.

CM were classified as Ineffective (10-25% pregnant each year), effective (6-9% pregnant each year) and highly effective (<1% pregnant each year). Methotrexate, Mycophenolate, Cyclophosphamide, Thalidomide and Leflunomide were considered as teratogenic drugs.

The statistical analysis was performed using SPSS 24.0. Ap<0.05was taken to indicate statistical significance.

Results:

A total of 91 patients were included, 35 (38.5%) SLE patients with a median age of 30 years (22-39) and 56 (61.5%) RA patients with a median age of 34.5 years (27.25-40). From the total population, 58 (63.7%) reported the use of teratogenic drugs, with a higher use in RA patients (p <.001). Socio-demographic characteristics are listed inTable 1.

Table 1.

Socio-demographic characteristics.

RA(n=56)SLE(n=35)pAge,years, median (IQR)34.5 (27.25-40)30(22-39)Disease duration,years, median (IQR)3.5 (1.25-7.75)4 (1-7)Onset of Sexual activity,n (%)46 (82.1)24 (68.6).135Onset of Sexual activity age, median (IQR)18 (17-20)14 (17-20)Sexually Active,n (%)*34 (60.7)18 (51.4).384Use of teratogenic drugs,n (%)44 (78.6%)14 (40%)<.001

RA, Rheumatoid Arthritis; SLE, Systemic Lupus Erythematosus. *Sexual activity in the last month.

Among the patients that had started sexual activity (SLE=24, RA=46), the most common CM was tubal ligation 26 (28.6%)Graphic 1. In this group, 49 (70%) patients received contraceptive counseling, however, 21 (42%) patients were using innefective CM.Table 2.

According to effectiveness, highly efective were the most frequent method used in patients that had started sexual activity (n=39, 55.7%)Graphic 2.

Conclusion:

Despite highly effective CM were more frequent in patients that had started sexual activity, 42% of patients that received contraceptive counseling reported the use of inneffective methods. It is neccesary to promote the counseling and use of contraception and provide a multidisciplinary support among rheumatoid patients.

Table 2.

Methods according to effectiveness in patients that received contraception counseling.

GRADE OF EFFECTIVENESSn (%)PatientsThat receive Contraceptive counselingInneffectiveEffectiveHigly effectiveRA= 4630 (65.21)12 (40)1(3.3)17 (56.6)SLE= 2419 (79.16)9 (47.3)1 (5.2)9 (47.36)Total = 70 *49 (70)21 (42)2 (4.08)26 (53.06)

RA= Rheumatoid Arthritis; SLE= Systemic Lupus Erythematosus. * Total of patients that have started sexual activity.

References:

[1]Sammaritano, L. R. (2014). Contraception in Rheumatic Disease Patients. InContraception and Pregnancy in Patients with Rheumatic Disease(pp. 201-227). Springer, New York, NY.

Figure 1.

Graphic 1. This graphic shows the frequence in percentage % of contraceptive methods used by Rheumatoid Arthritis (RA) n=56 and Systemic Lupus Erythematosus (SLE) n=35 patients, which are categorized by the grade of effectiveness. Only were included patients that had started sexual activity.

Figure 2.

Graphic 2. This graphic shows the percentage of use according to the effectiveness of contracetive methods. RA, Rheumatoid Arthritis; SLE, Systemic Lupus Erythematosus. Only were included patients that had started sexual activity.

Disclosure of Interests:

None declared

The European contribution to "Sugarbaker's protocol" for the treatment of colorectal peritoneal carcinomatosis

INTRODUCTION

In 1981, Dr. PH Sugarbaker, challenging oncological orthodoxy, considered carcinomatosis to be a locoregional stage of the disease that was still susceptible to treatment with curative intent. To this end he developed a new therapeutic alternative based on the combined treatment. The macroscopic disease treated by maximum radical oncological cytoreductive surgery (through the peritonectomies described by him), followed by treatment of the residual microscopic disease with the direct intra-abdominal application of intraoperative chemotherapy with locoregional intensification, modulated by hyperthermia and early normothermic postoperative intra-abdominal chemotherapy. Using this new therapeutic regimen, known as "Sugarbaker s Protocol", his group has reported 45% survival rates in carcinomatosis of colorectal origin at 5 years, and, in selected groups of patients, 50% survival rates at 5 years. The scientific community, however, has criticized these results considering that: it is a personal experience, with a not homogenous treatment protocol with developmental modifications over time, that it is a retrospective non-randomized study, and finally that the cytostatics used in his protocol are obsolete. Various European groups have replied to these main criticisms confirming the good results that this new therapeutic alternative offers for patients with carcinomatosis of colorectal origin. The purpose of this article is to present these contributions.

MATERIAL AND METHODS

All the articles published in the English language by European groups in the world s medical literature have been reviewed using the Pubmed-MEDLINE database to identify the relevant articles related to the treatment of carcinomatosis of colorectal origin using cytoreduction and intraperitoneal chemotherapy from January 1980 to January 2008.

RESULTS

The European contribution during these 25 years in favour of the "Sugarbaker s Protocol" has consisted fundamentally in: a) one multicenter retrospective study; b) two randomized prospective phase III studies; and c) the use of oxaliplatin and irinotecan as new cytostatic agents in the protocols for intraperitoneal chemotherapy. At the same time, two new transcendental European contributions have been made in which the possibility has been considered of combined simultaneous treatment for patients with hepatic metastases and carcinomatosis, and the introduction, as a selection factor, of patients responsive to intravenous induction chemotherapy within the regimen of sandwich treatment (with systemic neoadjuvant and adjuvant chemotherapy) complementary to intraperitoneal chemotherapy.

CONCLUSIONS

The results obtained by European groups using "Sugarbaker s protocol" and "Elias protocol" with oxaliplatin compel us to request that these treatments be considered by all professionals involved in the treatment of patients with colorectal carcinomatosis as the best treatment currently available for this condition. Furthermore a randomized, prospective, multicenter study should be carried out to clarify its value and the degree of scientific evidence. A validation of this treatment will change, in the future, the dogmatic consideration of carcinomatosis as an incurable disease stage.

Measurement of problem behaviour during medication evaluations

BACKGROUND

The focus of this review is on methods that are currently being used to evaluate the behavioural effects of medication for individuals with intellectual disabilities. First we describe what has been identified as the ideal criteria for conducting clinical trials and how these criteria may be adapted to do less controlled evaluations. The central theme is a review of the biological measures (e.g. labs, drug levels), behavioural rating scales and direct observation measures that are often used to evaluate medication effects. Issues related to how the side effects of medication can affect behaviour will also be discussed.

CONCLUSION

The importance of encouraging communication and collaboration across all systems of care and the use of socially valid measures are discussed.

Peritoneal carcinomatosis of colorectal origin. Current treatment. Review and update

Colorectal cancer is the most frequent tumor of the digestive tract. The high incidence of abdominal dissemination; the poor prognosis of these patients, with median survival consistently ranging from 5 to 9 months in all studies of peritoneal carcinomatosis from colorectal cancer; the failure of adjuvant systemic chemotherapy treatment with a maximal survival of 18 months despite the development of new cytostatic drugs, and new combinations of use, make it crucial to search for and develop new treatment strategies. We review the principles of Sugarbaker s treatment protocol, which involves the combination of maximum cytoreductive radical oncological surgery for the treatment of all macroscopically disseminated disease with maximum perioperative intraperitoneal intensification chemotherapy to treat residual microscopic disease. We present the results of several scientific papers, all of them phase II studies with more than 10 patients treated, published in the medical literature by the main groups working in this line of treatment, together with the only phase III study reported and published so far, and finally the results of a recently reported retrospective international multicenter study. With this new alternative therapeutic approach, overall mean survival is 40% at 36 months, and 20% at 5 years. Based on these results, this new therapeutic approach is proposed as the treatment of choice for these unfortunate patients.

Epidemiology of celiac sprue: a community-based study

OBJECTIVE

To address the frequency and outcome of celiac disease in a United States community.

METHODS

We identified all Olmsted County, Minnesota, residents diagnosed with this condition during the period, 1960 through 1990, using the resources of the Rochester Epidemiology Project. Twenty-eight incident cases (19 women, nine men) were identified.

RESULTS

The overall age- and gender-adjusted incidence of celiac disease in the community was 1.2 per 100,000 person-yr (95% CI 0.7, 1.6). There were no significant changes in incidence over time, although rates did increase; the incidence was similar in men and women and rose with age in both genders (p < 0.05). Survival in this inception cohort was 100% at 6 months and 96% at 5 yr, which was not significantly different from expected. The estimated prevalence on January 1, 1991, was 21.8 per 100,000.

CONCLUSION

This study provides the first epidemiologic data on celiac disease in the United States.