Emerging cancer therapies and cardiovascular risk

Journal of Thrombosis and Thrombolysis - The cardiovascular (CV) toxicity profiles of traditional cancer therapies such as anthracyclines and radiation therapy are familiar to many cardiologists....     

Psychopharmacoteratophobia: Excessive fear of malformation associated with prescribing psychotropic drugs during pregnancy: An Indian perspective

“Psychopharmacoteratophobia is the fear or avoidance of prescribing psychotropic medicine to a pregnant woman on a given indication in anticipation of fetal malformation.” It is rooted in the tragedy associated with thalidomide use and is increasing due to the inability to predict accurately, strict legal provision of consumer protection, ethical and legal issues involved, and pitfalls in the available evidence of teratogenicity. In the Indian setting, the physicians face more challenges as the majority of the patients may ask them to decide, what is the best for their health. Most guidelines emphasize more on what not to do than what to do, and the locus of decision is left to the doctor and the patient. In this review, we have focused on relevant issues related to psychopharmacoteraophobia that may be helpful to understand this phenomenon and help to address the deprivation of a mentally ill woman from the required treatment.KEY WORDS: Causality, drugs, fetal malformation, mental illness, pregnancy, psychotropic drugs, teratogenicity     

Interleukin-6 and E-selectin in acute coronary syndromes and stable angina pectoris

Objectives

The purpose of the study was to compare the serum levels of interleukin-6 (IL-6), E-selectin, and trans-fatty acids (TFA) between those with stable and unstable angina pectoris.

Methods

From September 2008 to March 2009, a case?Ccontrol study was performed at two university hospitals. We included 89 patients with acute coronary syndrome (ACS) including patients with myocardial infarction and those with unstable angina pectoris (case group) and 93 patients with stable angina pectoris (control group). The two groups were matched with respect to demographic characteristics and risk factors of cardiovascular diseases. Serum levels of IL-6 and E-selectin were measured using the enzyme linked immunosorbent assay, while TFA and lipoproteins were measured using gas chromatography and enzymatic methods, respectively.

Results

No significant differences between baseline characteristics of the two study groups were observed. Patients with stable angina had significantly higher serum levels of total cholesterol (187.0?±?3.7 vs. 171.6?±?4.2?mg/dl; p?=?0.009), low density lipoproteins (104.8?±?2.4 vs. 95.4?±?2.7; p?=?0.017), and TFA (1.41?±?0.47 vs. 1.24?±?0.69?mg/dl; p?=?0.047) compared to those with ACS. Serum levels of IL-6 were found to be significantly higher in those with stable angina compared to those with ACS (102.4?±?1.9 vs. 224.6?±?3.6; p?=?0.007). However, patients with ACS had higher levels of E-selectin (53.5?±?25.7 vs. 49.2?±?23.5???g/dl; p?=?0.52), but the difference did not reach statistical significance.

Conclusion

In the current study, inflammation as measured by IL-6 and E-selectin was not found to play an important role in progression of ischemic heart disease from stable angina to unstable angina or myocardial infarction, which is contrary to previous studies.     

Nurses’ clinical reasoning concerning management of peripheral venous cannulae

Aim. The aim was to describe nurses’ clinical reasoning regarding peripheral venous cannulae management by focusing on the clinical information and circumstances considered during the decision‐making process. Background. On every shift nurses make several decisions, among others concerning the management of peripheral venous cannulae. Thrombophlebitis is a common complication associated with its use, although more severe complications can arise. There are clinical practice guidelines within the area, but they are not always adhered to. Previous studies have examined decisions related to the management of peripheral venous cannulae, but did not include observations in a naturalistic setting. Design. A qualitative study combining observations and interviews. Methods. Participant observation facilitated open interviews about the clinical reasoning behind decision‐making in observed situations, as well as semi‐structured interviews regarding clinical reasoning about the general management of peripheral venous cannulae. Transcribed interview texts were analysed with content analysis. Results. Three main categories describe clinical information and circumstances: the individual patient situation, the nurse’s work situation and experience of peripheral venous cannulae management. The overall theme of the interview texts was that the clinical reasoning was a balancing act between minimising patient discomfort and preventing complications from the peripheral venous cannulae. Conclusions. At all times the patients’ well‐being was considered, but the ways the nurses approached this differed depending on how they considered clinical information in the individual patient situation, circumstances in their own work situation and their experience of peripheral venous cannulae management. Relevance to clinical practice. Knowledge of the clinical information and circumstances considered in naturalistic settings, is valuable when implementing and adjusting clinical practice guidelines to local settings. This knowledge is also useful in nursing education as student nurses’ and nurses’ ability to balance between preventing complications and avoiding discomfort is important for enhancing patient care.     

Non Alcoholic Fatty Liver Disease in Southern Iran: A Population Based Study

Background

Population based studies on prevalence and risk factors of NAFLD in Iranian population are few. The prevalence of NAFLD and non alcoholic steatohepatitis (NASH) in Iranians varies from 2.9% to 7.1% in general population and 55.8% in patients with type 2 diabetes mellitus.

Objectives

To determine the prevalence and determinants of non alcoholic fatty liver disease (NAFLD) in a sample of adult Iranian general population.

Patients and Methods

This was a cross-sectional study being performed in Shiraz, southern Iran during a 10-month period from November 2010 to September 2011 through cluster random sampling of Iranian general population in Shiraz region. All individuals undergone anthropometric, blood pressure measurements, thorough medical history and physical examinations. Laboratory measurements included fasting blood glucose (FBS), lipid profile, complete blood count (CBC) and liver function tests. NAFLD was diagnosed by transabdominal ultrasonography.

Results

819 subjects were included in this study among which were 340 males (41.5%) and 479 females (58.5%) with the mean age of 43.1 ± 14.1 years. NAFLD was diagnosed in 176 (21.5%) subjects. Patients with NAFLD were significantly older (P < 0.001), had higher proportion of male gender (P = 0.004) and had higher BMI (P < 0.001). They also had higher prevalence of hypertension (P < 0.001), high FBS (P < 0.001), high cholesterol (P = 0.026), high triglyceride (P < 0.001) and high waist circumference (P < 0.001). Taking all these together, patients with NAFLD had significantly higher prevalence of metabolic syndrome when compared to healthy subjects (P < 0.001).

Conclusion

The prevalence of NAFLD in this group of Iranian adult general population is 21.5%. NAFLD in Iranian population is associated with male gender, old age, obesity, and features of metabolic syndrome.     

Pattern of ankylosing spondylitis in an Iranian population of 98 patients

The prevalence and pattern of ankylosing spondylitis (AS) can vary from country to country, according to genetic and environmental factors. This study aims to analyze the patterns of disease in a population of Iranian patients with AS. We performed a prospective study (2002–2007) analyzing 98 patients with diagnosis of AS according to the modified New York criteria. Selected patients underwent complete clinical (initial symptom, axial and peripheral involvement, heel enthesitis, extra-articular manifestations) and radiological (sacroiliac, lumbar, thoracic, and cervical spine) investigations, and these data were compared with sex, age at onset, and HLA-B27. There was predominance of men (71.4%), adult onset (>16 years, 90.8%), and positive HLA-B27 (73.4%). Family history of AS was noted in 14.3% of the patients. The predominant initial symptoms were inflammatory low back pain (44.2%). Radiological findings included syndesmophytes in 34.7% and “bamboo spine” in 16.3% of patients. Acute anterior uveitis was noted in 44.9% of patients. Male sex was associated with involvement of shoulder (P = 0.001). Female sex and juvenile-onset AS were associated with extra-articular involvement. Positive HLA-B27 was associated with hip involvement (P = 0.042) and adult-onset AS (P = 0.035). Analysis of the patterns of disease in this population of 98 southern Iranian patients with AS revealed that female sex and juvenile-onset AS were associated with extensive extra-axial involvement; and HLA-B27 was associated with hip involvement. The study was conducted in Rheumatology Clinic of Hafez Hospital of Shiraz University of Medical Sciences, Shiraz, Iran.     

Implications of Streptococcus pneumoniae penicillin resistance and serotype distribution in Kuwait for disease treatment and prevention

Streptococcus pneumoniae causes serious infections. Treatment is difficult because of the emergence of penicillin resistance in S. pneumoniae. Pneumococcal vaccines offer the promise of control and prevention of pneumococcal infections. Serotype prevalence and penicillin susceptibility data for a country will predict the usefulness of the vaccines in that country. In Kuwait, the 23-valent polysaccharide and the 7-valent conjugate vaccines are being used without knowledge of the prevalent serotypes in the country. To obtain the necessary background information, data on penicillin susceptibility and serogroups were obtained from 397 consecutive clinical isolates collected during 2004 and 2005. Two hundred fifty-three isolates (64%) were penicillin resistant, and resistance was significantly higher in patients ≤15 years old and among the upper respiratory tract and eye isolates. The most common serotypes were 23F, 19F, 6A, 6B, 14, and 19A. Among the penicillin-resistant strains, the most common serotypes were 23F, 19F, 6B, 14, and 9A. Among the invasive strains, the most common serotypes were 14, 23F, 19A, and 9V. The polysaccharide vaccine gave 82% coverage against invasive infections in all age groups >2 years. The coverage of the 7-valent conjugate vaccine against invasive serotypes in children ≤2 years old was 55%. This moderate coverage by the conjugate vaccine against invasive infections in children necessitates a revised strategy on the use of the present conjugate vaccine and shows the need for formulation of an improved vaccine for superior coverage for Kuwait and possibly other countries of the Arabian Gulf.