[Sexual dysfunction induced by antidepressants and antipsychotics]

The interest in sexual dysfunction induced by psychotropic drugs has increased considerably in recent years because of the new-generation antidepressants (AD) and antipsychotics (AP) being put into medical practice. These drugs are widely used to treat not only depression and schizophrenia, but also anxiety and affective disorders. Other, additional indications for the use of antidepressants are appetite disorders, premenstrual syndrome, chronic pain, etc. Neuroleptics are administered to treat resistant depressions, aggressiveness, impulsivity, and alcoholism. Impaired sexual functioning due to AD and AP lowers quality of life in patients and increases the risk of their refusing treatment, the result of which is a phenomenon associated with the occurrence of recurrent mental illnesses. There are few scientific data on the nature and prevalence of sexual dysfunctions induced by these medications. This topic is universally underestimated as it is rarely touched upon by specialists during their consultations. The aim of the review is to show the side effects of AP and AD on the sexual sphere, to compare different classes of the drugs, and to propose possible management strategies to correct these undesirable effects.

[A look into the past: improves in obstetrical and neonatal outcome in maternity since the 19th century]

OBJECTIVE

Evaluate changes in obstetrical and neonatal outcome of women who delivered in maternity hospital since the 19(th) century.

MATERIALS AND METHODS

Data from a historic cohort of 1022 women who delivered between 1871 and 1874 in the hôtel Dieu hospital of Marseille were compared to those from 1159 women who delivered from 2005 to 2006 in the level 3 maternity of Nord hospital of Marseille (contemporary cohort). Deliveries that had occured before 22 weeks and/or with a foetal birth weight of less than 500 g were excluded.

RESULTS

A total of 2131 pregnancies were included: 1011 and 1120 in historic and contemporary cohort, respectively. Despite comparable mean term of delivery, mean birth weight of neonates from historic cohort were significantly lower: 2971 g (550-4900 g) vs 3250 g (500-5375 g), respectively (p<0.001). Stillbirths were reported in 72 (7.1%) cases in historic cohort compared to nine (0.8%) in contemporary cohort (p<0.001). Neonatal mortality was 3.7% in historic cohort and 1.9% in contemporary cohort (p=0.012). A total of 99 (9.8%) maternal deaths were reported in historic cohort, while none in contemporary cohort (p<0.001). A wide majority of maternal deaths were caused by maternal infection (72.9%); 5.2% were caused by postpartum haemorrhage.

CONCLUSION

Our results illustrate the tremendous impact on maternal and neonatal outcome of advances in obstetrical management. The significant increase in the median foetal birth weight is likely to be related to wide changes in environmental conditions and behaviour.

Sex differences in the GSK3β-mediated survival of adherent leukemic progenitors

Therapeutic resistance of acute myeloid leukemia stem cells, enriched in the CD34(+)38(-)123(+) progenitor population, is supported by extrinsic factors such as the bone marrow niche. Here, we report that when adherent onto fibronectin or osteoblast components, CD34(+)38(-)123(+) progenitors survive through an integrin-dependent activation of glycogen synthase kinase 3β (GSK3β) by serine 9-dephosphorylation. Strikingly, GSK3β-mediated survival was restricted to leukemic progenitors from female patients. GSK3β inhibition restored sensitivity to etoposide, and impaired the clonogenic capacities of adherent leukemic progenitors from female patients. In leukemic progenitors from female but not male patients, the scaffolding protein RACK1, activated downstream of α(5)β(1)-integrin engagement, was specifically upregulated and controlled GSK3β activation through the phosphatase protein phosphatase 2A (PP2A). In a mirrored manner, survival of adherent progenitors (CD34(+)38(-)) from male but not female healthy donors was partially dependent on this pathway. We conclude that the GSK3β-dependent survival pathway might be sex-specific in normal immature population and flip-flopped upon leukemogenesis. Taken together, our results strengthen GSK3β as a promising target for leukemic stem cell therapy and reveal gender differences as a new parameter in anti-leukemia therapy.

[Treatment of gout in patients with chronic kidney disease]

Hyperuricemia and its clinical manifestations, such as gout, are frequently encountered in patients with chronic renal disease and renal transplants. Usual treatments are either contraindicated or are prone to side-effects in these patients. Presently, there is no clear concensus regarding therapeutic guidelines of hyperuricemia and gout in this subset of patients. Steroids remain the more effective and safer treatment in absence of superimposed infection. Though allopurinol is not recommended for prophylaxis of hyperuricemia, this drug is still the cornerstone in the treatment of patients suffering from gout and is rather well tolerated when posology is adapted.

Diosgenin induces death receptor-5 through activation of p38 pathway and promotes TRAIL-induced apoptosis in colon cancer cells

Previously, we demonstrated that diosgenin induced apoptosis in colorectal cancer cell lines HCT-116 and HT-29. HT-29 cells have been reported to be one of the most resistant colorectal cancer cell lines to TRAIL-induced apoptosis. In this study, we investigated the effect of diosgenin on TRAIL-induced apoptosis in HT-29 cells. We showed that diosgenin sensitizes HT-29 cells to TRAIL-induced apoptosis. Mechanisms underlying this sensitization mainly involved diosgenin-induced p38 MAPK pathway activation and subsequent DR5 overexpression. Furthermore, we showed that diosgenin alone, TRAIL alone or combination treatment increased COX-2 expression and that the use of a COX-2 inhibitor further increased apoptosis induction.

Economic risk factors for HIV infection among women in rural Haiti: implications for HIV prevention policies and programs in resource-poor settings

AIMS

The goals of this study were to (1) estimate the prevalence of HIV infection among women accessing services at a women's health center in rural Haiti and (2) to identify economic risk factors for HIV infection in this population.

METHODS

Women who accessed healthcare services at this center between June 1999 and December 2002 were recruited to participate. The analysis was based on data from a case-control study of sexually transmitted diseases (STDs) in rural Haiti. HIV prevalence in the study population was 4%.

RESULTS

In multivariate analyses, partner occupation was associated with HIV infection in women, with mechanic (OR 9.0, 95% CI 1.8-45) and market vendor (OR 4.2, 95% CI 1.6-11) reflecting the strongest partner occupational risk factors. Partner's occupation as a farmer reduced the risk of infection in women by 60% (95% CI 0.14-1.1). Factors indicating low socioeconomic status (SES), such as food insecurity (OR 2.0, 95% CI 0.75-5.6) and using charcoal for cooking (OR 1.7, 95% CI 0.72-3.8) suggested an association with HIV infection.

CONCLUSIONS

Given pervasive gender inequality in Haiti, women's economic security often relies on their partners' income earning activities. Our findings show that although factors reflecting poverty are associated with HIV-positive status, stronger associations are observed for women whose partners indicated a more secure occupation (e.g., mechanic or market vendor). Policies and programs that expand access to education and economic opportunities for women and girls may have long-term implications for HIV prevention in Haiti and other resource-poor settings.

Calcification of articular cartilage in human osteoarthritis

OBJECTIVE

Hypertrophic chondrocyte differentiation is a key step in endochondral ossification that produces basic calcium phosphates (BCPs). Although chondrocyte hypertrophy has been associated with osteoarthritis (OA), chondrocalcinosis has been considered an irregular event and linked mainly to calcium pyrophosphate dihydrate (CPPD) deposition. The aim of this study was to determine the prevalence and composition of calcium crystals in human OA and analyze their relationship to disease severity and markers of chondrocyte hypertrophy.

METHODS

One hundred twenty patients with end-stage OA undergoing total knee replacement were prospectively evaluated. Cartilage calcification was studied by conventional x-ray radiography, digital-contact radiography (DCR), field-emission scanning electron microscopy (FE-SEM), and synovial fluid analysis. Cartilage calcification findings were correlated with scores of knee function as well as histologic changes and chondrocyte hypertrophy as analyzed in vitro.

RESULTS

DCR revealed mineralization in all cartilage specimens. Its extent correlated significantly with the Hospital for Special Surgery knee score but not with age. FE-SEM analysis showed that BCPs, rather than CPPD, were the prominent minerals. On histologic analysis, it was observed that mineralization correlated with the expression of type X collagen, a marker of chondrocyte hypertrophy. Moreover, there was a strong correlation between the extent of mineralization in vivo and the ability of chondrocytes to produce BCPs in vitro. The induction of hypertrophy in healthy human chondrocytes resulted in a prominent mineralization of the extracellular matrix.

CONCLUSION

These results indicate that mineralization of articular cartilage by BCP is an indissociable process of OA and does not characterize a specific subset of the disease, which has important consequences in the development of therapeutic strategies for patients with OA.

[Comparison of patients with paroxysmal junctional tachycardia and syncope with those without syncope]

INTRODUCTION

The purpose of the study was to determine the possible mechanisms of presyncope in patients who have paroxysmal junctional tachycardias (PJT) and a normal surface ECG between tachycardias.

METHODS

Among 419 patients consecutively recruited for PJT, aged from 10 to 88 years (47+/-19), 78 of them had presented at least one syncope; they had a normal ECG in sinus rhythm. Transesophageal programmed atrial stimulation was performed using one and two atrial extrastimuli delivered in control state and if necessary after infusion of 20-30 microg of isoproterenol; arterial blood pressure was monitored; vagal maneuvers and tilt test (n=25) were performed; echocardiogram was systematic.

RESULTS

Age, sex, method of induction, tachycardia mechanism and the mean heart rate in tachycardia were similar in patients with and without syncope. Syncope was related to a vagal reaction induced by the PJT in 31 patients, to a fast rate during PJT in 15 patients, to a sinus node dysfunction in six patients, to a coronary ischemia in five patients, to a tetany induced by PJT in three patients, to an advanced age in three patients, to multiple causes in three patients and remained unexplained in eight patients. Radiofrequency ablation of reentrant circuit, performed in 28 patients, suppressed syncope in 26 of them.

CONCLUSION

Presyncope or syncope occurred in 18% of patients who had a history of paroxysmal junctional tachycardia. Several mechanisms were implicated; the most frequent causes were coronary ischemia or sick sinus syndrome in old patients, vasovagal reaction or fast rate in tachycardia or tetany in patients of all ages.