58 research outputs found
Chemotherapy cardiotoxicity: cardioprotective drugs and early identification of cardiac dysfunction.
Background: Chemotherapy cardiotoxicity is an emerging
problem and it is very important to prevent cardiac
dysfunction caused by anticancer drugs. The aim of this
study was to assess the alterations of the cardiac function
induced by chemotherapy in a follow-up of 2 years and to
evaluate the cardioprotective role of angiotensin-converting
enzyme inhibitors (ACEIs) in the prevention of cardiac
dysfunction.
Methods: A prospective study was carried out using
patients with breast cancer (85 women; median age
57W12years) and other inclusion and exclusion criteria. On
the basis of treatment, patients were divided into six groups:
fluorouracil-epirubicincyclophosphamide, FEC (group A);
FEC and trastuzumab (B); trastuzumab (C); FEC and
taxotere (D); FEC, paclitaxel and trastuzumab (E); and
chemotherapy and cardioprotective drugs (F). Cardiological
evaluation including electrocardiogram and conventional
echocardiogram with tissue Doppler imaging (TDI) was
carried out at T0 (before starting chemotherapy), T1 (after
6months from the start of chemotherapy) and T2 (2 years
after the end of chemotherapy).
Results: Significant changes in the TDI parameters of
systolic and diastolic function were observed at T1 and T2 in
all patients. A significant reduction of left ventricular
ejection fraction (LVEF) was observed only at T2.
In the patients treated with ACEI (F), these changes
were less significant than in other groups and they
do not have significant changes in the indices of diastolic
function.
Conclusion: TDI is more sensitive than conventional
echocardiogram in the early diagnosis of cardiac
dysfunction and ACEIs seem to have an important role in the
prevention of cardiotoxicity
Modeling secondary level of HIV contact tracing: its impact on HIV intervention in Cuba
<p>Abstract</p> <p>Background</p> <p>Universal HIV testing/treatment program has currently been suggested and debated as a useful strategy for elimination of HIV epidemic in Africa, although not without practical issues regarding the costs and feasibility of a fully implemented program.</p> <p>Methods</p> <p>A mathematical model is proposed which considers two levels of detection of HIV-infectives through contact tracing of known infectives in addition to detections through other means such as random screening. Simulations based on Cuban contact tracing data were performed to ascertain the potential impact of the different levels of contact tracing.</p> <p>Results</p> <p>Simulation studies illustrate that: (1) contact tracing is an important intervention measure which, while less effective than random screening, is perhaps less costly and hence ideal for large-scale intervention programs in developing countries with less resources; (2) the secondary level of contact tracing could significantly change the basic disease transmission dynamics, depending on the parameter values; (3) the prevalence of the epidemic at the time of implementation of contact tracing program might be a crucial factor in determining whether the measure will be effective in preventing disease infections and its eventual eradication.</p> <p>Conclusions</p> <p>Our results indicate that contact tracing for detection of HIV infectives could be suitably used to remedy inadequacies in a universal HIV testing program when designing timely and effective intervention measures.</p
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Guideline-directed medical therapy in severe heart failure with reduced ejection fraction: an analysis from the HELP-HF registry.
AIM: Persistent symptoms despite guideline-directed medical therapy (GDMT) and poor tolerance of GDMT are hallmarks of patients with advanced heart failure (HF) with reduced ejection fraction (HFrEF). However, real-world data on GDMT use, dose, and prognostic implications are lacking. METHODS AND RESULTS: We included 699 consecutive patients with HFrEF and at least one 'I NEED HELP' marker for advanced HF enrolled in a multicentre registry. Beta-blockers (BB) were administered to 574 (82%) patients, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers or angiotensin receptor-neprilysin inhibitors (ACEi/ARB/ARNI) were administered to 381 (55%) patients and 416 (60%) received mineralocorticoid receptor antagonists (MRA). Overall, â„50% of target doses were reached in 41%, 22%, and 56% of the patients on BB, ACEi/ARB/ARNI and MRA, respectively. Hypotension, bradycardia, kidney dysfunction and hyperkalaemia were the main causes of underprescription and/or underdosing, but up to a half of the patients did not receive target doses for unknown causes (51%, 41%, and 55% for BB, ACEi/ARB/ARNI and MRA, respectively). The proportions of patients receiving BB and ACEi/ARB/ARNI were lower among those fulfilling the 2018 HFA-ESC criteria for advanced HF. Treatment with BB and ACEi/ARB/ARNI were associated with a lower risk of death or HF hospitalizations (adjusted hazard ratio [HR] 0.63, 95% confidence interval [CI] 0.48-0.84, and HR 0.74, 95% CI 0.58-0.95, respectively). CONCLUSIONS: In a large, real-world, contemporary cohort of patients with severe HFrEF, with at least one marker for advanced HF, prescription and uptitration of GDMT remained limited. A significant proportion of patients were undertreated due to unknown reasons suggesting a potential role of clinical inertia either by the prescribing healthcare professional or by the patient. Treatment with BB and ACEi/ARB/ARNI was associated with lower mortality/morbidity
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OPTImal PHARMacological therapy for patients with heart failure: Rationale and design of the OPTIPHARM-HF registry.
AIMS: Patients with heart failure (HF) remain often undertreated for multiple reasons, including treatment inertia, contraindications, and intolerance. The OPTIimal PHARMacological therapy for patients with Heart Failure (OPTIPHARM-HF) registry is designed to evaluate the prevalence of evidence-based medical treatment prescription and titration, as well as the causes of its underuse, in a broad real-world population of consecutive patients with HF across the whole ejection fraction spectrum and among different clinical phenotypes. METHODS: The OPTIPHARM-HF registry (NCT06192524) is a prospective, multicenter, observational, national study of adult patients with symptomatic HF, as defined by current international guidelines, regardless of ejection fraction. Both outpatients and inpatients with chronic and acute decompensated HF will be recruited. The study will enroll up to 2500 patients with chronic HF at approximately 35 Italian HF centres. Patients will be followed for a maximum duration of 24âmonths. The primary objective of the OPTIPHARM-HF registry is to assess prescription and adherence to evidence-based guideline-directed medical therapy (GDMT) in patients with HF. The primary outcome is to describe the prevalence of GDMT use according to target guideline recommendation. Secondary objectives include implementation of comorbidity treatment, evaluation of sequence of treatment introduction and up-titration, description of GDMT implementation in the specific HF population, main causes of GDMT underuse, and assessment of cumulative rate of cardiovascular events. CONCLUSION: The OPTIPHARM-HF registry will provide important implications for improving patient care and adoption of recommended medical therapy into clinical practice among HF patients
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