Use Of OCs Research Articles

Outcomes of biological therapy in patients with severe asthma with chronic rhinosinusitis in Saudi Arabia: patients with nasal polyps versus those without nasal polyps

BackgroundThis study’s purposes were to evaluate the impact of biological therapies on outcomes in patients with severe asthma (SA) and chronic rhinosinusitis (CRS) and to compare these effects among those with NP (CRSwNP) versus those without NP (CRSsNP) in the “real-world” setting in Saudi Arabian patients.MethodsFrom March to September 2022, a retrospective observational cohort study was undertaken at the severe asthma clinics of the Armed Forces Hospital—Southern Region (AFHSR) and King Khalid University Hospital, Abha, Saudi Arabia, to delineate the effects of dupilumab therapy. Outcomes were assessed, including clinical outcomes, FEV1, and laboratory findings before and one year after dupilumab. Post-therapy effects were compared between CRSwNP and CRSsNP.ResultsFifty subjects were enrolled, with a mean age of 46.56. There were 27 (54%) females and 23(46%) males. Significant improvements in clinical parameters (frequency of asthma exacerbations and hospitalizations, the use of OCs, anosmia, SNOTT-22, and the ACT), FEV1, and laboratory ones (serum IgE and eosinophilic count) were observed 6 and 12 months after using dupilumab (p < 0.001), respectively. However, after 12 months of dupilumab therapy, there were no significant differences between those with and without NP with regards to clinical (anosmia, ACT, and OCs use), laboratory (eosinophilic count, serum IgE level) parameters, and FEV1%.ConclusionsPatients with CRS experienced significant improvements in clinical, FEV1, and laboratory outcomes after dupilumab therapy. However, these improvements were not maintained when comparing CRSwNP with CRSsNP. There were no significant differences between those with and without NP regarding ACT and OCs use or laboratory (eosinophilic count, serum IgE level) parameters. Further prospective multicenter studies are warranted.

Ex vivo lung perfusion and the Organ Care System: a review.

With the increasing prevalence of heart failure and end-stage lung disease, there is a sustained interest in expanding the donor pool to alleviate the thoracic organ shortage crisis. Efforts to extend the standard donor criteria and to include donation after circulatory death have been made to increase the availability of suitable organs. Studies have demonstrated that outcomes with extended-criteria donors are comparable to those with standard-criteria donors. Another promising approach to augment the donor pool is the improvement of organ preservation techniques. Both ex vivo lung perfusion (EVLP) for the lungs and the Organ Care System (OCS, TransMedics) for the heart have shown encouraging results in preserving organs and extending ischemia time through the application of normothermic regional perfusion. EVLP has been effective in improving marginal or borderline lungs by preserving and reconditioning them. The use of OCS is associated with excellent short-term outcomes for cardiac allografts and has improved utilization rates of hearts from extended-criteria donors. While both EVLP and OCS have successfully transitioned from research to clinical practice, the costs associated with commercially available systems and consumables must be considered. The ex vivo perfusion platform, which includes both EVLP and OCS, holds the potential for diverse and innovative therapies, thereby transforming the landscape of thoracic organ transplantation.

Factors influencing poor response to type 2 targeted therapies in severe asthma: a retrospective cohort study

BackgroundA significant breakthrough has been made in treating severe asthma, with the recognition of various asthma phenotypes and an updated management guideline. Type 2 targeted therapies, such as benralizumab and omalizumab; have been identified as an effective treatment for severe asthma, improving patient response, lung function tests and asthma symptom control. This study aimed to evaluate factors contributing to poor response to therapy.MethodsA retrospective single-center cohort study of 162 patients with severe asthma who started biologic therapy; their data were retrieved from medical records for further analysis. Poor responders were patients remained clinically and functionally uncontrolled despite even after augmenting all treatment options.ResultsChildhood-onset asthma, bronchiectasis, poor symptom control (ACT below 19), severe airway obstruction (< 60% predicted), and maintenance oral corticosteroid (mOCS) use were significantly associated with poor response to omalizumab and benralizumab; p = 0.0.4 and 0.01; 0.003 and 0.01; 0.01 and 0.001, 0.05 and 0.04; 0.006 and 0.02, respectively. However, chronic rhinosinusitis and IgE < 220kIU/L were associated with higher poor response rates to omalizumab (p = 0.01 and 0.04, respectively). At the same time, female patients and those with blood eosinophils level < 500 cells/mm3 had a higher poor response rate to benralizumab (p = 0.02 and 0.01, respectively). Ischemic heart disease (IHD), bronchiectasis, and continued use of OCS increased the likelihood of poor response to omalizumab by 21, 7, and 24 times (p = 0.004, 0.008, and 0.004, respectively). In contrast, the female gender, childhood-onset asthma and higher BMI increased the likelihood of poor response to benralizumab by 7, 7 and 2 times more, p = 0.03, 0.02 and 0.05, respectively.ConclusionPoor response to omalizumab treatment was independently associated with ischemic heart disease (IHD), bronchiectasis, and a history of maintenance oral corticosteroid (mOCS) use. Conversely, poor response to benralizumab therapy was independently linked to female gender, childhood-onset asthma and higher body mass index (BMI).

Intrinsically Cross‐Linked ECM‐Like Multilayers for BMP‐2 Delivery Promote Osteogenic Differentiation of Cells

AbstractSurface coatings prepared by layer‐by‐layer technique permit loading of growth factors (GFs) and their spatially controlled release. Here, native chondroitin sulfate (nCS), oxidized CS (oCS100), or mixture of both (oCS50) are combined with collagen I (Col I) to fabricate polyelectrolyte multilayers (PEMs) that exhibit structural, mechanical, and biochemical cues like the natural extracellular‐matrix. The use of oCS enables intrinsic cross‐linking of PEM that offers higher stability, stiffness, and better control of bone morphogenetic protein‐2 (BMP‐2) release compared to nCS. oCS100 PEMs have enhanced stiffness, promote Col I fibrillization, and present BMP‐2 in a matrix‐bound manner. oCS50 PEMs show intermediate effects on osteogenesis, soft surface, high water content but also moderately slow BMP‐2 release profile. C2C12 myoblasts used for osteogenesis studies show that oCS PEMs are more stable and superior to nCS PEMs in supporting cell adhesion and spreading as well as in presenting BMP‐2 to the cells. oCS PEMs are triggering more osteogenesis as proved by the quantitative real‐time polymerase chain reaction, immune and histochemical staining. These findings show that intrinsic cross‐linking in oCS/Col I multilayers provides a successful tool to control GFs delivery and subsequent cell differentiation which opens new opportunities in regenerative therapies of bone and other tissues.

Oral Contraceptive Use and Breast Cancer Risk for BRCA1 and BRCA2 Mutation Carriers: Systematic Review and Meta-Analysis of Case-Control Studies.

Simple SummaryThe aim of the present work was to systematically review and meta-analysis the available evidence regarding the effects of oral contraceptives using on breast cancer risk in BRCA germline mutations. The included studies were published between 2002 and 2021. Data were pooled from nine case–control studies, comprising a total of 33,162 woman. The association between oral contraceptive use and risk of breast cancer may differ in breast cancer defined by BRCA mutation status. This meta-analysis showed a diverse effect of oral contraceptive use against breast cancer in BRCA carrier mutations. However, futher case control studies are necessary to examine breast cancer risk.Oral contraceptive use is one of the major modifiable risk factors for breast cancer. To investigate the effect of oral contraceptive taking on breast cancer risk by BRCA 1 and BRCA 2 mutation status, we conducted a systematic review and meta-analysis of case-controlled studies. Therefore, English language articles were retrieved by searching MEDLINE (PubMed), EMBASE and the Cochrane Library up to August 2021. Data were pooled from none case–control studies, comprising a total of 33,162 subjects, including 23,453 who had never used oral contraceptives. Overall meta-analysis indicated a statistically insignificant risk reduction: OR = 0.86, 95% CI: 0.70 to 1.06, p = 0.1594. However, increased breast cancer risk was associated with age at first use of OCs ≥20 years: OR = 1.21, 95% CI:1.07 to 1.36, p = 0.002. Multivariable meta-regression with covariates of age of first OC use (β = 0.21, 95% CI: −0.25 to 0.67, p = 0.3767), duration of OC use (β = −0.08, 95% CI; −0.51 to 0.34, p = 0.7093), and time since last OC use (β = 0.32, 95% CI: −0.22 to 0.85, p = 0.2461) did not have a significant effect on the breast cancer risk. This meta-analysis suggests a diverse effect of oral contraceptive use against breast cancer in BRCA carrier mutation. The association between OC use and breast and ovarian cancers needs more investigation.

Counteracting side effects of combined oral contraceptives through the administration of specific micronutrients.

The occurrence of side effects related to the use of combined oral contraceptives (COCs) - or even the fear of them - often affects patients' compliance and their quality of life. Such adverse effects include both physical and psychological alterations. Therapies based on COCs are related to lower levels of vitamins and minerals, including vitamins B, C and E, zinc, magnesium, and selenium. This review gathers scientific evidence about the effectiveness of the administration of specific micronutrients to address nutritional needs and recover adverse conditions. We reviewed literature searching through different databases (MEDLINE, Scopus, Google Scholar). We used different keywords, including micronutrients, COCs, side effects, B vitamins, vitamin C, vitamin E, vitamin D, zinc, magnesium, selenium and Centella Asiatica. We narrowed the search down to English literature, including both preclinical and clinical studies. The outcome of database search was to highlight beneficial effects of specific micronutrients on the evaluated side reactions. Based on the collected evidence, dietary supplementations of specific micronutrients, whose depletion occurs during COC treatments, have significant beneficial effects. By acting on different aspects and pathways, such supplementation prevents and counteracts discomforts and side effects related to COC treatments. Considering the wide use of OCs, taking appropriate dietary supplements could be an effective approach in clinical practice, tailoring therapies and improving both safety and tolerability.

Optimal Planning with Consumer Feedback: A Simulation of a Socialist Economy

ABSTRACT Mathematical optimization can be used to increase the effectiveness of economic planning in socialist economies. Cockshott and Cottrell [Towards a New Socialism, Spokesman: 1993] have proposed a model of socialism in which optimal planning is made responsive to consumer demand. A point of contention has been the emphasis on labor values in their model. The use of labor values could mean that the environmental impact of production is insufficiently reflected in planning targets. This paper discusses how alternative values (opportunity cost valuations, OCs) can be calculated using linear optimization and presents a computer simulation of a socialist economy based on these values. An agent-based consumer model was developed to model the behavior of consumers. An alternative version of the simulation based on labor values is used for comparison. It is found that in specific circumstances the use of OCs does indeed result in a stronger emphasis on more environmentally friendly production than the labor value model. Relevant literature on optimal planning, distribution under socialism and valuation will be reviewed, followed by a presentation of the simulation and a discussion of some of its results for a series of small test economies.

Use of Oral Contraceptives as a Potential Risk Factor for Breast Cancer: A Systematic Review and Meta-Analysis of Case-Control Studies Up to 2010.

Despite numerous studies evaluating the risk of breast cancer among oral contraception users, the effect of oral contraceptive on developing breast cancer remains inconclusive. Therefore, we conducted a systematic review of literature with meta-analysis in order to quantitative estimate this association. The bibliographic database MEDLINE and EMBASE, and reference lists of identified articles were searched, with no language restrictions, from the start of publication to August 2010. We performed a reanalysis and overall estimate of 79 case-control studies conducted between 1960–2010, including a total of 72,030 incidents, histologically confirmed cases of breast cancer and 123,650 population/hospital controls. A decrease was observed in cancer risk in OC users before age 25 years (0.91, 0.83–1.00). However, the use of OCs before the first full-term pregnancy had a significant increased risk of breast cancer (OR, 1.14, 1.01–1.28, p = 0.04), as did OC use longer than 5 years (1.09, 1.01–1.18, p = 0.02). Pooled crude odds ratios of breast cancer in ever-users of oral contraceptives was 1.01 [95% confidence interval (CI), 0.95–1.07], compared with never-users. There was no significant increase in risk among premenopausal women (1.06, 0.92–1.22), postmenopausal women (0.99, 0.89–1.10), or nulliparous women (1.02, 0.82–1.26). Oral contraceptives do not appear to increase the risk of breast cancer among users. However, OC use before a first full-term pregnancy or using them longer than 5 years can modify the development of the breast cancer.

Relationship Between Oral Contraceptives and the Risk of Gliomas and Meningiomas: A Dose-Response Meta-Analysis and Systematic Review

Glioma and meningioma are the most common primary brain tumors in adults. Epidemiologic studies of the relationship between female hormone exposure and exogenous hormone use and the risk of meningioma and glioma in females have yielded inconsistent results. Two investigators comprehensively searched 3 electronic databases, including PubMed, Embase, and Cochrane Library. A total of 11 case-control studies were enrolled for meta-analysis. Dose-response meta-analyses were conducted. Compared with the non-oral contraceptives (OCs) female users, the female OC users might have reduced risk of glioma (risk ratio [RR], 0.87; 95% confidence interval [CI], 0.77-0.97; I2= 42.6%). However, there was no obvious evidence of an association between OC use and the risk of meningioma in females (RR, 0.99; 95% CI, 0.87-1.13; I2= 42.7%). Using OCs for >10 years in females may significantly decrease the risk of glioma to 30% (RR, 0.7; 95% CI, 0.6-0.81; I2= 0%). The dose-response meta-analyses indicated that the risk of glioma in females significantly decreased when the duration of oral OC use was >7.5 years. OC use may not increase the risks of glioma and meningioma in females. Instead, the long-term use of OCs may significantly decrease the risk of glioma, and the benefits are even more pronounced when the time window is >7.5 years. Nonetheless, the pooled results in this study suggest that OC use may not increase the risk of meningioma. Therefore, our conclusion should be validated and supplemented in future larger studies.

Basophil activation and serum IL‐5 levels as possible monitor biomarkers in severe eosinophilic asthma patients treated with anti‐IL‐5 drugs

Background: Eosinophilic asthma (EA) is characterized by abnormal production and release of type 2 cytokines, such as interleukin-5 (IL-5), from T helper type 2 (Th2) lymphocytes and type 2 innate lymphoid cells (1). The aim of this study was to evaluate the usefulness of the basophil phenotype assessment and serum IL-5 assay in monitoring a series of severe EA patients treated with anti IL-5 drugs and correlate the results of these tests with baseline patients’ characteristics and clinical response, with particular attention to systemic steroid use and asthma exacerbations. Methods: Blood samples of 19 severe asthma patients were collected at T3 and T6 for evaluation of serum levels of IL-5 and basophil phenotype assessment. Results: All patients experienced an improvement of lung function, with an increase of FEV1 from a mean value of 71.9 to 83.8% of the theoretical value (+12%). Oral corticosteroids were progressively reduced and finally stopped in 14 (73.7%) of the 19 patients after six months of follow-up. Patients who achieved a complete response to anti-IL5 treatment showed a rate of activated basophils CD3negCRTH2posCD203cposCD125pos (4.78 ± 2.26%) at T0 significantly lower than that of patients not achieving the complete response (34.57 ± 14.01%, p=0.05). Conclusions: This pilot study in EA patients shows that the determination of activated basophils, that express CD125 is related to anti IL5/IL5Rα drug mechanism of action and subsequent immune response, proving to be a biomarker that identifies the patient’s phenotype that responds to therapy and that requires the concomitant use of OCS.

Therapeutic switch from omalizumab to mepolizumab in patients with uncontrolled severe eosinophilic asthma: treatment effect by exacerbations in previous year and maintenance use of OCS

Therapeutic switch from omalizumab to mepolizumab in patients with uncontrolled severe eosinophilic asthma: treatment effect by exacerbations in previous year and maintenance use of OCS

Impact of surgical technique on the development of post-operative vasoplegia

Introduction Vasoplegia after cardiothoracic surgery is associated with severe post-operative complications and worse outcomes. Despite recent innovations, lung transplantation (LTx) remains one of the highest risk surgeries. We hypothesise that the avoidance of cardiopulmonary bypass (CPB) and the use of lesser invasive surgical approaches, namely the “minimally invasive” thoracotomy approach (MI) compared to the traditional Clam shell technique (CS), may reduce the incidence of vasoplegia post-operatively. Furthermore, we explore the association of vasoplegia and endothelial dysfunction by analysing the plasma release of endocan. Methods 90 patients received a LTx between October 2013 and June 2015 at Harefield Hospital. 40 were recruited in our prospective study. Clinical data, including surgical approach, use of CPB and OCS were recorded. Vasoplegia in the first 48 hours was defined according to Tsiouris et al (1). Plasma levels of endocan were then measured by ELISA at baseline and at 0, 6, 12, 24, 48 after Ltx. Data were analysed and reported as appropriate. Results 7 patients (44%) in the CPB group developed vasoplegia vs. 6 (46%) in the off-group (p 0.305), 3 after unexpected conversion to CPB (30% of the unexpected CPB group, p 0.302). Within the surgical approach groups, 8 patients (32%) of the CS group developed vasoplegia compared to 5 patients (33%) of the MILT-group (p 1.000). Patients in the vasoplegic group showed a tendency for longer CPB time (146 [81, 230] min vs. 110 [44, 184] min, p 0.470) and surgery duration (335 [290, 425] min vs. 310 [270, 435] min, p 0.690). Only 1 patient developed vasoplegia after OCS-LTx (20%, p 1.000). 2 patients in the vasoplegia group (15%) required re-exploration for bleeding vs. 2 (7%) in the no-vasoplegia group (7%, p 0.584). One patient required ECMO during the ITU stay and he was vasoplegic. Endocan levels were similar during the first 48 hours after LTx and between groups. Discussion Here, we demonstrate a high incidence of vasoplegia after LTx. The development of vasoplegia was not affected by either the surgical approach or the use of CPB. In addition, we found no evidence for association between vasoplegia and endothelial dysfunction. However, vasoplegia may be related to longer duration of CPB and surgery. Further studies are needed to identify mechanisms of vasoplegia following LTx.

Oral contraceptive and breast cancer: do benefits outweigh the risks? A case \u2013 control study from Jordan

BackgroundOral contraceptives (OCs) use has been linked to increased risk of breast cancer (BC) in several reports from the world. Limited number of similar studies have been conducted in the Middle Eastern female population. This study aimed to explore any possible correlation between the contemporary and duration of OCs use among Jordanian women and the risk of breast cancer.MethodsA case control study was conducted in 450 Jordanian women (225 as cases and 225 as controls), aged 18 to 65. Chi-square test was used to study the association between risk of breast cancer and different factors. Mann Whitney-U test was employed to evaluate the relation between time-dependent risk factor and breast cancer.ResultsOur results indicated that regular use of OCs exhibited association with increased risk of breast cancer (OR = 2.25, 95% CI 1.34–2.79; p = 0.002), while the duration of OCs use was not associated with the increased risk of breast cancer (p > 0.05). In addition, other factors demonstrated significant association with the increased risk of breast cancer such as age at puberty, age at menopause, previous pregnancies, menopausal status, and family history of cancer.Conclusionsregular use of OCs may be associated with increased risk of breast cancer in Jordanian women. A larger sample size in multi-center setting study is required to confirm this finding among the Jordanian female population.

Microbial community responses determine how soil–atmosphere exchange of carbonyl sulfide, carbon monoxide, and nitric oxide responds to soil moisture

Abstract. Carbonyl sulfide (OCS) plays an important role in the global sulfur cycle and is relevant for climate change due to its role as a greenhouse gas, in aerosol formation and atmospheric chemistry. The similarities of the carbon dioxide (CO2) and OCS molecules within chemical and plant metabolic pathways have led to the use of OCS as a proxy for global gross CO2 fixation by plants (gross primary production, GPP). However, unknowns such as the OCS exchange from soils, where simultaneous OCS production (POCS) and consumption (UOCS) occur, currently limits the use of OCS as a GPP proxy. We estimated POCS and UOCS by measuring net fluxes of OCS, carbon monoxide (CO), and nitric oxide (NO) in a dynamic chamber system fumigated with air containing different mixing ratios [OCS]. Nine soils with different land use were rewetted and soil–air exchange was monitored as soils dried out to assess responses to changing moisture. A major control of OCS exchange was the total amount of available sulfur in the soil. POCS production rates were highest for soils at WFPS (water-filled pore space) &gt;60 % and rates were negatively related to thiosulfate concentrations. These moist soils switched from a net source to a net sink activity at moderate moisture levels (WFPS 15 % to 37 %). For three soils we measured NO and CO mixing ratios at different mixing ratios of OCS and revealed that NO and potentially CO exchange rates are linked to UOCS at moderate soil moisture. High nitrate concentrations correlated with maximum OCS release rates at high soil moisture. For one of the investigated soils, the moisture and OCS mixing ratio was correlated with different microbial activity (bacterial 16S rRNA, fungal ITS RNA relative abundance) and gene transcripts of red-like cbbL and amoA.

Omalizumab as alternative to chronic use of oral corticosteroids in severe asthma.

Systemic/oral corticosteroids (OCS) have been used for decades in the management of acute asthma exacerbations and chronically in patients with uncontrolled severe asthma. However, while OCS are effective at treating acute exacerbations, there is only empirical evidence regarding the efficacy of OCS at reducing the rate of exacerbations. Evidence, although scarce, is suggestive of high exacerbation rates in severe asthma patients even when receiving maintenance treatment with OCS. In addition, use of OCS is associated with undesirable effects. Despite all this, physicians have continued to use OCS for managing severe asthma and acute exacerbation due to the lack of availability of effective alternatives. Fortunately, in the last decade several biologics have been proven safe and effective for patients with uncontrolled severe asthma. This has led to the Global Initiative for Asthma (GINA) recommending the use of biologics, instead of maintenance OCS, in patients with severe asthma (GINA Step 5). These include one biologic targeting immunoglobulin E (IgE) (omalizumab), and different biologics targeting interleukin-5 (IL-5), the IL-5 receptor (IL-5R) or IL-4 receptor α-unit (IL-4R α), including mepolizumab (subcutaneous), reslizumab (intravenous), benralizumab (subcutaneous) and dupilumab (subcutaneous). Omalizumab for the treatment of severe allergic asthma reduces exacerbations, irrespective of blood eosinophil levels. Anti-IL-5/IL-5R biologics are indicated in patients with severe eosinophilic asthma and repetitive exacerbations, irrespective of the presence or absence of allergy. Recently, an anti-IL4Rα biologic has been approved by the FDA for eosinophilic phenotype or oral corticosteroid-dependent asthma. Finally, physicians should consider using biologics as an alternative to chronic OCS therapy.

Association of Combined Estrogen–Progestogen and Progestogen-Only Contraceptives with the Development of Cancer

OCs have been classified as cancer-causing agents, especially leading to increases in breast cancer and cervical cancer. A review of the recent scientific literature was performed to see whether this still appears to be the case. The recent literature supports the cancer-causing role of OCs especially for breast cancer and cervical cancer. Studies also indicate that progesterone-only contraceptives (such as implants and vaginal rings) also can cause cancer. This is especially true for breast cancer and cervical cancer.

Coupled Biological and Abiotic Mechanisms Driving Carbonyl Sulfide Production in Soils

Understanding soil production of the trace gas carbonyl sulfide (OCS) is key to its use as a tracer of ecosystem function. Underlying its application is the observation that vascular plants consume atmospheric OCS via their stomatal pores in proportion with CO2 photosynthesis and that soil fluxes of OCS are negligible in comparison. Recent soil-centered studies demonstrate that soils can produce OCS and contribute as much as a quarter of the atmospheric terrestrial flux. Despite the potential widespread importance of soil OCS emissions, insufficient data exist to predict variations in OCS production across ecosystems, and the chemical and biological drivers of OCS production are virtually unknown. In this study, we address this knowledge gap by investigating variables controlling OCS soil production including soil physical and chemical properties, microbial community composition, and sulfur speciation in two independent surveys. We found that soil OCS production was nearly ubiquitous across the 58 sites, increased exponentially with temperature, and was insensitive to visible light conditioning. Soil pH, N, and C/N were predictors of OCS soil production rates in both soil surveys. Patterns in soil S speciation and predicted microbial S-cycling pathways both pointed to S-containing amino acids such as cysteine and methionine and their derivatives as potential precursors for OCS production. Elevated sulfate levels were associated with OCS production in some soils. This study provides new mechanistic insight into OCS production in soils and presents strategies to represent soil OCS fluxes that facilitate the use of OCS as a tracer for leaf-level processes related to carbon and water cycling.

A prospective study of cancer risk among Agricultural Health Study farm spouses associated with personal use of organochlorine insecticides

BackgroundOrganochlorine insecticides (OCs) have historically been used worldwide to control insects, although most have now been banned in developed countries. Evidence for an association between OC exposures and cancer predominantly comes from occupational and population based-studies among men. We evaluated the association between the use of specific OCs and cancer among the female spouses of pesticide applicators in the Agricultural Health Study.MethodsAt enrollment (1993–1997), spouses of private applicators in the cohort provided information about their own use of pesticides, including seven OCs (aldrin, chlordane, dieldrin, DDT, heptachlor, lindane, and toxaphene), and information on potential confounders. We used Poisson regression to estimate relative risks (RRs) and 95% confidence intervals (CIs) for cancers (n ≥ 3 exposed cases) reported to state cancer registries from enrollment through 2012 (North Carolina) and 2013 (Iowa), and use of the individual OCs, as well as use of any of the specific OCs.ResultsAmong 28,909 female spouses, 2191 (7.58%) reported ever use of at least one OC, of whom 287 were diagnosed with cancer. Most cancers were not associated with OC use. Risk of glioma was increased among users of at least one OC (Nexposed = 11, RR = 3.52, 95% CI 1.72–7.21) and specifically among lindane users (Nexposed = 3, RR = 4.45, 95% CI 1.36–14.55). Multiple myeloma was associated with chlordane (Nexposed = 6, RR = 2.71, 95% CI 1.12–6.55). Based on 3 exposed cases each, there were also positive associations between pancreatic cancer and lindane, and ER-PR- breast cancer and dieldrin. No other associations with breast cancer were found.ConclusionsOverall, there were some associations with OC use and cancer incidence, however we were limited by the small number of exposed cancer cases. Future research should attempt to expand on these findings by assessing environmental sources of OC exposures, to fully evaluate the role of OC exposures on cancer risk in women.

Tabagismo e uso de anticoncepcionais orais relacionados a fenômenos tromboembólicos: relato de caso e revisão de literatura

PurposeConduct a review of the literature on smoking and use of oral contraceptives related to thromboembolic events, with presentation of the case of proximal thrombosis of the superior mesenteric artery and extensive necrosis of the small intestine in a female patient with probable coagulopathy caused by the association of oral contraceptive with smoking. Materials and methodsThis study consisted of a literature review, with selection of national and international scientific articles through research in PubMed, Lilacs and SciELO database. ResultsThe relationship between the use of combined oral contraceptives and increased risk of thromboembolic disease is based on the procoagulant action of OCs, which translates into a risk factor for the occurrence of arterial and venous thrombosis. Smoking alone has moderately increased risk of venous thrombosis compared with non‐smokers. Besides that, there is a relation between the superior mesenteric artery thrombosis with the use of oral contraceptives associated with smoking. ConclusionAll analysed studies have confirmed the use of OCs and smoking as risk factors for the development of thromboembolic diseases. The study based on the clinical history of the patient suggests a case of secondary arterial thrombosis coagulopathy by combining smoking with the use of combined OCs.

Impact of Reminder Systems in Clinical Settings to Improve Family Planning Outcomes: A Systematic Review.

This systematic review evaluated the evidence on the impact of family planning reminder systems-interventions intended to remind patients of behaviors to achieve reproductive health goals (e.g., daily text messages reminding oral contraceptive [OC] users to take a pill)-to provide information to guide national recommendations on quality family planning services. Multiple databases including PubMed were searched during 2010-2011 for peer-reviewed articles published in English from January 1985 through February 2011 describing studies evaluating reminder systems to improve family planning outcomes. Studies were excluded if they focused primarily on HIV or sexually transmitted infection prevention, focused solely on men, or were conducted outside the U.S., Europe, Australia, or New Zealand. The initial search identified 16,129 articles, five of which met the inclusion criteria. Three studies examined the impact of OC reminder systems; two found a statistically significant positive impact on correct use. Two studies examined the impact of reminder systems among depot medroxyprogesterone acetate (DMPA) users; one found a statistically significant positive impact on correct use. Although mixed support was found for the effectiveness of reminder system interventions on correct use of OCs and DMPA, the highest-quality evidence yielded null findings. The evidence base would be strengthened by the development of additional studies, especially RCTs, which objectively measure outcomes, examine additional contraceptive methods, and have sufficient sample sizes to detect behavioral outcomes at least 12 months post-intervention.