An evaluation of the safety of continuing trastuzumab despite overt left ventricular dysfunction.

Background: The major limitation in the use of trastuzumab therapy is cardiotoxicity. We evaluated the safety of a strategy of continuing trastuzumab in patients with breast cancer despite mild, asymptomatic left ventricular impairment. Methods: Charts of consecutive patients referred to a cardio-oncology clinic from January 2015 to March 2017 for decline in left ventricular ejection fraction (lvef), defined as a fall of 10 percentage points or more, or a value of less than 50% during trastuzumab therapy, were reviewed. The primary outcome of interest was change in lvef, measured before and during trastuzumab exposure and up to 3 times after initiation of cardiac medications during a median of 9 months. Results: All 18 patients referred for decline in lvef chose to remain on trastuzumab and were included. All patients were treated with angiotensin converting-enzyme inhibitors or beta-blockers, or both. After initiation of cardiac medications, lvef increased over time by 4.6 percentage points (95% confidence interval: 1.9 percentage points to 7.4 percentage points), approaching baseline values. Of the 18 patients, 17 (94%) were asymptomatic at all future visits. No deaths occurred in the group. Conclusions: Many patients with mildly reduced lvef and minimal heart failure symptoms might be able to continue trastuzumab without further decline in lvef, adverse cardiac events, or death when treated under the supervision of a cardiologist with close follow-up.

Prevalence of tuberculous lymphadenitis in children in Wardha district, Maharashtra State, India.

SETTING: Rural area of Wardha district, Maharashtra State, Central India. OBJECTIVE: To determine the prevalence of tuberculous lymphadenitis in children aged 0-14 years in the study area and to assess factors that may contribute towards the prevalence. DESIGN: House to house survey of a population of 23,229 in 35 neighbouring villages with 7900 children aged 0-14 years from May 1993 to May 1994 and from March 1995 to February 1996. RESULTS: The prevalence of tuberculous lymphadenitis/1000 children was 4.43. The maximum prevalence was in the 5-9 years age group. The prevalence was 34 times higher in children with positive family history of tuberculosis than in those without a history. There was an association between prevalence and the living standards of the children, with a higher prevalence in families that belonged to an underprivileged social class living in thatched, improvised houses. Multiple cervical lymph nodes >2 cm and with matting and fluctuation were found to be characteristic clinical features. CONCLUSION: The prevalence of peripheral lymphadenopathy was 27.2/1000 children and that of tuberculous lymphadenitis was 4.43/1000. Positive history of contact in the family was a significant epidemiological indicator of tuberculous glands.

Prevalence of sputum-positive pulmonary tuberculosis in tribal and non-tribal populations of the Ashti and Karanja tahsils in Wardha district, Maharashtra State, India.

SETTING: Ashti and Karanja tahsils, Wardha district, Maharashtra State, Central India. OBJECTIVE: To find and compare the prevalence of bacillary positive pulmonary tuberculosis amongst the different tribes and in the non-tribal population. DESIGN: Prevalence study of pulmonary tuberculosis by house-to-house survey of symptoms among tribal (n = 20596) and non-tribal (n = 93 670) populations aged 5 years and over, between September 1989 and November 1990. RESULTS: The prevalence of smear and/or culture-positive tuberculosis/100000 population was 133 in the tribal and 144 in the non-tribal population. The difference in prevalence of symptomatic individuals and sputum-positive cases among the tribal and the non-tribal populations was statistically significant only in the symptomatic individuals/100000 (P = 0.01). The prevalence of cases in both groups was higher in males than females; however this difference was significant only in the tribal group (P = 0.05). Only two of the 46 tribes encountered, the Mana and Pawara tribes, showed a high prevalence, of 730 and 612/100000, respectively. The three other tribes with positive cases (the Gond group) had prevalences comparable to that of the nontribal population. CONCLUSION: The prevalence of tuberculosis in tribal people was comparable to that of the non-tribal population.

Comparative evaluation of two maternal weight-height indices during pregnancy.

Three hundred forty one primiparous women and their offsprings were the subjects of the study. Mothers were subjected to weight and height measurement as well as hemoglobin estimation. The weight for height ratio index (WHRI) and weight-height product index (WHPI) were calculated. Both WHRI and WHPI were studied in relation to birth weight (BW). WHPI was found to be superior over WHRI as it explained greater per cent variation in birth weight. The means for BW increased and incidence of low birth weight babies decreased significantly with increase of WHPI in each WHRI group.

Epidemiology of early neonatal mortality.

PIP: During 1981-1991 at a rural teaching hospital (Kasturba Hospital) of Mahatma Gandhi Institute of Medical Sciences in Sevagram, Wardha, India, 454 of 13,939 newborns died during the early neonatal period for an early neonatal mortality rate (ENMR) of 33.7/1000 live births. The ENMR for boys was not significantly different from that for girls (36.1 vs. 28.6). Community medicine specialists analyzed data on these early neonatal deaths to examine distribution of early neonatal mortality, especially its relationship with prematurity, low birth weight, birth order, and by sex. They calculated average percent deaths (APD) per hour to examine the dynamics in early neonatal mortality. The mean age at death was lower among newborns of birth order greater than 2 than those of birth order less than 2 (23.47 vs. 26.85 hours; p 0.001). ENMR was higher for newborns of birth order greater than 2 than those of birth order less than 2 (41.74% vs. 27.35%; P 0.001). The mean age at death increased as gestation increased (10.34 for 28 weeks; 24.27 for 28-33 weeks, 31.53 for 33-37 weeks, and 34.43 for 37 weeks; p 0.001). ENMR decreased as gestation increased (850 for 28 weeks; 375 for 28-33 weeks, 147.02 for 33-37 weeks, and 8.77 for 37 weeks; p 0.001). The mean age at death increased as birth weight increased for newborns weighing less than 1500 gms through 2000-2500 gms (23.36-37.13 hours; p 0.001). It was lowest among those weighing more 3000 gms (11.55 gms). ENMR fell as birth weight increased (614.33 for 1500 gms, 116.19 for 1500-2000 gms, 19.38 for 2000-2500 gms, 10.99 for 2500-3000 gms, and 5.41 for 3000 gms; p 0.001). The APD/hour for the first hour of life was 3.74% for a relative risk of 12.9. It decreased steadily as the hours of life increased (3.08% for 1-6 hours, 1.19% for 6-24 hours, 0.67% for 24-72 hours, and 0.29% for 72-168 hours). Knowledge of time of likely death can help providers know where they need to focus their attention to prevent early neonatal deaths.^ieng