European Society of Cardiology quality indicators for the prevention and management of cancer therapy-related cardiovascular toxicity in cancer treatment.

AIMS: To develop quality indicators (QIs) for the evaluation of the prevention and management of cancer therapy-related cardiovascular toxicity. METHODS AND RESULTS: We followed the European Society of Cardiology (ESC) methodology for QI development which comprises (i) identifying the key domains of care for the prevention and management of cancer therapy-related cardiovascular toxicity in patients on cancer treatment, (ii) performing a systematic review of the literature to develop candidate QIs, and (iii) selecting of the final set of QIs using a modified Delphi process. Work was undertaken in parallel with the writing of the 2022 ESC Guidelines on Cardio-Oncology and in collaboration with the European Haematology Association, the European Society for Therapeutic Radiology and Oncology and the International Cardio-Oncology Society. In total, 5 main and 9 secondary QIs were selected across five domains of care: (i) Structural framework, (ii) Baseline cardiovascular risk assessment, (iii) Cancer therapy related cardiovascular toxicity, (iv) Predictors of outcomes, and (v) Monitoring of cardiovascular complications during cancer therapy. CONCLUSION: We present the ESC Cardio-Oncology QIs with their development process and provide an overview of the scientific rationale for their selection. These indicators are aimed at quantifying and improving the adherence to guideline-recommended clinical practice and improving patient outcomes.

Asthma and wheezing as the cause of school absence.

A survey was conducted on children attending 30 primary schools (15 each for boys ad girls) in Al-Ain City of United Arab Emirates (UAE) to assess the impact of asthma on school absenteeism. There are 28,447 primary school children (50% boys and 50% girls) aged 6-14 years in the Al-Ain Educational District, all of whose school health records were investigated with respect to school absence caused by asthma during the academic year 1991-1992. Results showed that overall 1910 (6.7%) pupils were diagnosed as having asthma and wheezing during the preceding year by school doctors and nurses. Out of 14,217 boys, 1146 (8.1%) had asthma and wheezing, and 764 of 14,230 girls (5.4%) had the same condition. Overall 1,255 (4.9%) pupils were absent from school for at least 1 day during the year. Of 1146 boys with wheezing or asthma, 707 (62%) missed at least 1 day of school due to asthma, and of 764 girls who were asthmatic or wheezing, 548 (72%) missed school for at least 1 day in the year. There was a very highly statistically significant difference between sexes of children who were asthmatic or wheezing and missed school at least 1 day (p < 0.0001). Absenteeism most commonly occurred during spring for both boys (42%) and girls (45%). Absence from school due to asthma occurred least during autumn for both boys (26%) and girls (22%). This study confirms that asthma is a common chronic disease among primary school children in Al-Ain, UAE, and is a common cause of absenteeism from school.

Formation and some factors influencing the activity of progesterone hydroxylases by Aspergillus niger.

The formation of progesterone hydroxylases by Aspergillus niger 173 was investigated. The constitution of the fermentation medium influenced both the yield and the type of enzymes catalyzing the transformation of progesterone. The enzyme yield also varied with the pH value at which induction was performed as well as with the buffer used. The transformation activity of progesterone was more pronounced with mycelia induced in citrate-phosphate than in phosphate buffer. The results demonstrated that induction of 6beta-hydroxylase was favoured at pH values near neutrality while that of 11alpha-hydroxylase in the presence of citrate ions. The transformation activity of progesterone was optimal at pH 5.0. The action of 11alpha-hydroxylase was also optimal at pH 5.0, but other hydroxylase showed pH optima between 2.2 and 4.0. Progesterone concentrations higher than 6 mg in 50 ml reaction mixture was a limiting factor for the rate of transformation activity.

Stereospecific inversion of l-alpha-methylfluorene-2-acetic acid to its d-enantiomer in the dog.

1. After administration of dl-alpha-methylfluorene-2-acetic acid to dogs, the optical rotation of the drug in blood increased with time. Of the total drug in blood, the d-enantiomer increased from 61 to 80% between 3 and 24 h after administration; by 384 h it was 100%. 2. Both l- and d-enantiomers had plasma half-lives and excretion characteristics similar to those of the dl-racemic mixture, indicating that the increase in the proportion of the d-enantiomer was not due to more rapid excretion of the l-enantiomer. 3. Studies of optical rotation and circular dichroism demonstrated that the l-enantiomer was converted to the d-enantiomer in the blood of the dog, but the d-enantiomer remained unchanged. After administration of the l-enantiomer, the d-enantiomer increased from 26 to 71% of the total drug in blood between 0-3 and 2 days after administration; 14 days after dosing, almost all of the drug was present as the d-enantiomer. 4. Isomerization of l-alpha-methylfluorene-2-acetic acid to its d-enantiomer also occurs in rat, monkey and man.