Body surface area and baseline blood pressure predict subclinical anthracycline cardiotoxicity in women treated for early breast cancer.

BACKGROUND AND AIMS: Anthracyclines are highly effective chemotherapeutic agents which may cause long-term cardiac damage (chronic anthracycline cardiotoxicity) and heart failure. The pathogenesis of anthracycline cardiotoxicity remains incompletely understood and individual susceptibility difficult to predict. We sought clinical features which might contribute to improved risk assessment. METHODS: Subjects were women with early breast cancer, free of pre-existing cardiac disease. Left ventricular ejection fraction was measured using cardiovascular magnetic resonance before and >12 months after anthracycline-based chemotherapy (>3 months post-Trastuzumab). Variables associated with subclinical cardiotoxicity (defined as a fall in left ventricular ejection fraction of ≥5%) were identified by logistic regression. RESULTS: One hundred and sixty-five women (mean age 48.3 years at enrollment) completed the study 21.7 months [IQR 18.0-26.8] after starting chemotherapy. All received anthracyclines (98.8% epirubicin, cumulative dose 400 [300-450] mg/m2); 18% Trastuzumab. Baseline blood pressure was elevated (≥140/90mmHg, mean 147.3/86.1mmHg) in 18 subjects. Thirty-four subjects (20.7%) were identified with subclinical cardiotoxicity, independent predictors of which were the number of anthracycline cycles (odds ratio, OR 1.64 [1.17-2.30] per cycle), blood pressure ≥140/90mmHg (OR 5.36 [1.73-17.61]), body surface area (OR 2.08 [1.36-3.20] per standard deviation (0.16m2) increase), and Trastuzumab therapy (OR 3.35 [1.18-9.51]). The resultant predictive-model had an area under the receiver operating characteristics curve of 0.78 [0.70-0.86]. CONCLUSIONS: We found subclinical cardiotoxicity to be common even within this low risk cohort. Risk of cardiotoxicity was associated with modestly elevated baseline blood pressure-indicating that close attention should be paid to blood pressure in patients considered for anthracycline based chemotherapy. The association with higher body surface area suggests that indexing of anthracycline doses to surface area may not be appropriate for all, and points to the need for additional research in this area

Obstetric interventions in two groups of hospitals in Catalonia: A cross-sectional study

Background: Childbirth assistance in highly technological settings and existing variability in the interventions performed are cause for concern. In recent years, numerous recommendations have been made concerning the importance of the physiological process during birth. In Spain and Catalonia, work has been carried out to implement evidence-based practices for childbirth and to reduce unnecessary interventions. To identify obstetric intervention rates among all births, determine whether there are differences in interventions among full-term single births taking place in different hospitals according to type of funding and volume of births attended to, and to ascertain whether there is an association between caesarean section or instrumental birth rates and type of funding, the volume of births attended to and women's age. Methods: Cross-sectional study, taking the hospital as the unit of analysis, obstetric interventions as dependent variables, and type of funding, volume of births attended to and maternal age as explanatory variables. The analysis was performed in three phases considering all births reported in the MBDS Catalonia 2011 (7,8570 births), full-term single births and births coded as normal. Results: The overall caesarean section rate in Catalonia is 27.55% (CI 27.23 to 27.86). There is a significant difference in caesarean section rates between public and private hospitals in all strata. Both public and private hospitals with a lower volume of births have higher obstetric intervention rates than other hospitals (49.43%, CI 48.04 to 50.81). Conclusions: In hospitals in Catalonia, both the type of funding and volume of births attended to have a significant effect on the incidence of caesarean section, and type of funding is associated with the use of instruments during delivery. © 2014 Escuriet et al.; licensee BioMed Central Ltd

Magnetic Iron Oxide Nanoparticles: Synthesis and Surface Functionalization Strategies

Surface functionalized magnetic iron oxide nanoparticles (NPs) are a kind of novel functional materials, which have been widely used in the biotechnology and catalysis. This review focuses on the recent development and various strategies in preparation, structure, and magnetic properties of naked and surface functionalized iron oxide NPs and their corresponding application briefly. In order to implement the practical application, the particles must have combined properties of high magnetic saturation, stability, biocompatibility, and interactive functions at the surface. Moreover, the surface of iron oxide NPs could be modified by organic materials or inorganic materials, such as polymers, biomolecules, silica, metals, etc. The problems and major challenges, along with the directions for the synthesis and surface functionalization of iron oxide NPs, are considered. Finally, some future trends and prospective in these research areas are also discussed

Flatfoot in Müller-Weiss syndrome: a case series

<p>Abstract</p> <p>Introduction</p> <p>Spontaneous osteonecrosis of the navicular bone in adults is a rare entity, known as Müller-Weiss syndrome. We report here on our experience with six patients with Müller-Weiss syndrome accompanied by flatfoot deformity, but on a literature search found no reports on this phenomenon. Because the natural history and treatment are controversial, an understanding of how to manage this deformity may be helpful for surgeons when choosing the most appropriate operative procedure.</p> <p>Case presentation</p> <p>Six patients (five women, one man; average age, 54 years) with flatfoot caused by osteonecrosis of the navicular bone were followed up between January 2005 and December 2008 (mean follow-up period, 23.2 months). Conservative treatment, such as physical therapy, and non-steroidal anti-inflammatory drugs were used, but failed. Physical examinations revealed flattening of the medial arch of the involved foot and mild tenderness at the mid-tarsal joint. Weight-bearing X-rays (anterior-posterior and lateral views), computed tomography, and MRI scans were performed for each case. Talonavicular joint arthrodesis was performed in cases of single talonavicular joint arthritis. Triple arthrodesis was performed in cases of triple joint arthritis to reconstruct the medial arch. Clinical outcomes were assessed using the American Orthopaedic Foot and Ankle Society ankle-hindfoot scale; the scores were 63.0 pre-operatively and 89.8 post-operatively. All patients developed bony fusion.</p> <p>Conclusions</p> <p>The reason for the development of flatfoot in patients with Müller-Weiss syndrome is unknown. Surgical treatment may achieve favorable outcomes in terms of deformity correction, pain relief, and functional restoration. The choice of operative procedure may differ in patients with both flatfoot and posterior tibial tendon dysfunction.</p

Las personas que viven con VIH/SIDA y su vínculo con los antirretrovirales provistos por el Programa Nacional en Argentina People living with HIV/AIDS and their link with the antiretrovirals provided by the National Programme in Argentina

El Estado argentino se compromete, mediante la Ley Nacional de SIDA, a suministrar gratuitamente los ARV. Reconociendo la complejidad que envuelve el proceso de gestión de ARV desde Programa Nacional y dando por sentado que las PVVS son el fin último del mismo, se piensa que es fundamental indagar en sus opiniones. El objetivo es explorar el suministro de ARV desde la perspectiva de las PVVS, en un hospital público de Rosario, respecto a: 1) valoración del Programa y de la información recibida, 2) tiempos de espera, 3) la provisión en relación con la disponibilidad de ARV para sostener el tratamiento. Estudio de abordaje cualitativo, con entrevistas durante enero y febrero de 2007, se realizan en presencia de una psicóloga. Se definen criterios de selección de los entrevistados y ejes para las entrevistas. Las PVVS entrevistadas son 15 y opinan con autoridad respecto al Programa, señalando problemas en el suministro de ARV. Reconocen dificultades del sostenimiento en el tiempo en la toma de ARV y sus consecuencias en relación a la muerte y a la calidad de vida. El Programa se caracteriza por convivencia de rasgos que responden a políticas garantizadas por el Estado y a programas que responden a la emergencia. Aparece la necesidad de repensar el Programa como política de salud genuina, considerando a los ARV como medicamentos esenciales.<br>In accordance with the National AIDS Law, the Argentinian State is committed to supply antiretroviral medication (ARV) free of charge. Due to the complexity of the National ARV Program management process, and the fact that people with HIV/AIDS (PLHA) are the beneficiaries of the Program, it is considered relevant to ascertain their opinion. The aim of this work is to examine the supply of ARV by the National HIV/AIDS Program, from the perspective of PLHA, in a public hospital of the city of Rosario, in relation to: 1) value of the Program and the information received from it; 2) waiting times; 3) availability of ARV to continue the treatment. It is a qualitative study with interviews during January and February 2007 consisting of structured questions and patient criteria selection, in the presence of a psychologist. 15 PLHA were interviewed and gave their considered opinion about the Program and its background. They acknowledge difficulties in the continuity of ARV treatment and the consequences with respect to death and quality of life. The Program shows the coexistence between characteristics of a policy guaranteed by the state and others from programs that respond to emergencies. It shows the need to rethink the Program as a genuine health policy, considering ARV as essential medicine