Retrospective analysis of arterial occlusive events in the PACE trial by an independent adjudication committee.

BACKGROUND: The phase 2 PACE (Ponatinib Ph+ ALL and CML Evaluation) trial of ponatinib showed robust long-term benefit in relapsed Philadelphia chromosome-positive (Ph+) leukemia; arterial occlusive events (AOEs) occurred in ≥ 25% of patients based on investigator reporting. However, AOE rates vary depending on the definitions and reporting approach used. METHODS: To better understand clinically relevant AOEs with ponatinib, an independent cardiovascular adjudication committee reviewed 5-year AOE data from the PACE trial according to a charter-defined process and standardized event definitions. RESULTS: A total of 449 patients with chronic myeloid leukemia (CML) or Ph+ acute lymphoblastic leukemia (ALL) received ponatinib (median age 59 y; 47% female; 93% ≥ 2 prior tyrosine kinase inhibitors (TKIs); median follow-up, 37.3 months). The adjudicated AOE rate (17%) was lower than the non-adjudicated rate (i.e., rate before adjudication; 25%). The only adjudicated AOE in > 2% of patients was peripheral arterial occlusive disease (4%). Exposure-adjusted incidence of newly occurring adjudicated AOEs decreased over time. Patients with multiple baseline cardiovascular risk factors had higher adjudicated AOE rates than those without risk factors. CONCLUSIONS: This independent adjudication study identified lower AOE rates than previously reported, suggesting earlier overestimation that may inaccurately reflect AOE risk with ponatinib. This trial was registered under ClinicalTrials.gov identifier NCT01207440 on September 23, 2010 ( https://clinicaltrials.gov/ct2/show/NCT01207440 ).

Population structure and genetic connectivity of the scalloped hammerhead shark (Sphyrna lewini) across nursery grounds from the Eastern Tropical Pacific: Implications for management and conservation.

Defining demographically independent units and understanding patterns of gene flow between them is essential for managing and conserving exploited populations. The critically endangered scalloped hammerhead shark, Sphyrna lewini, is a coastal semi-oceanic species found worldwide in tropical and subtropical waters. Pregnant females give birth in shallow coastal estuarine habitats that serve as nursery grounds for neonates and small juveniles, whereas adults move offshore and become highly migratory. We evaluated the population structure and connectivity of S. lewini in coastal areas and one oceanic island (Cocos Island) across the Eastern Tropical Pacific (ETP) using both sequences of the mitochondrial DNA control region (mtCR) and 9 nuclear-encoded microsatellite loci. The mtCR defined two genetically discrete groups: one in the Mexican Pacific and another one in the central-southern Eastern Tropical Pacific (Guatemala, Costa Rica, Panama, and Colombia). Overall, the mtCR data showed low levels of haplotype diversity ranging from 0.000 to 0.608, while nucleotide diversity ranged from 0.000 to 0.0015. More fine-grade population structure was detected using microsatellite loci where Guatemala, Costa Rica, and Panama differed significantly. Relatedness analysis revealed that individuals within nursery areas were more closely related than expected by chance, suggesting that S. lewini may exhibit reproductive philopatric behaviour within the ETP. Findings of at least two different management units, and evidence of philopatric behaviour call for intensive conservation actions for this highly threatened species in the ETP.

Comparison of incidence/occurrence of cardiovascular events between ponatinib vs bosutinib among patients with at least one prior line of tyrosine kinase inhibitors in chronic myeloid leukemia in a community setting in the United States.

INTRODUCTION: In this real-world study, the incidence of cardiovascular events (CV) including major adverse cardiac events (MACE), arterial occlusive events (AOE), and venous occlusive events (VOE) was evaluated in chronic myeloid leukemia (CML) patients treated with ponatinib or bosutinib in a US commercial database population. MATERIALS AND METHODS: CML patients aged ≥18 years with use of 1 or 2 prior tyrosine kinase inhibitors prescribed bosutinib or ponatinib were selected from the IBM® MarketScan® Research database. Cox proportional hazard model analyses were conducted to examine any difference in CV event risk. RESULTS: Ponatinib and bosutinib was associated with similar incidence and risk of CV events, including MACEs (HR: 1.02; 95% CI: 0.35, 3.01), AOEs (HR: 0.90; 95% CI: 0.43, 1.85) and VOEs (HR: 0.92; 95% CI: 0.44, 1.94). CONCLUSION: Treatment with ponatinib or bosutinib was not associated with significant differences in the incidence of CV events in CML patients.

Are burn patients really at risk for thrombotic events?

There continues to be debate about the routine use of deep vein thrombosis (DVT) prophylaxis in burn patients. The concern is that routine prophylaxis may lead to adverse events. The debate hinges on the incidence of DVT and its relation to the risk-benefit ratio. This study seeks to estimate the true rate of DVT in burn patients, and to evaluate possible risk factors to its development. The Nationwide Inpatient Sample was queried for all patients with age ≥18 years with ICD-9 codes for burn injuries. Demographic data, comorbidities, burn data, length of stay, total charges, procedures, presence of central venous catheter, and mortality were recorded. Patients were classified based on the presence of DVT. Student's t-test, χ test, and logistic regression were performed. 36,638 burn patients were identified. DVT rate was 0.8%. Patients with DVT were older, had longer hospitalizations, more procedures, and higher charges. On logistic regression, black race, TBSA ≥20%, history of previous venous thrombotic events, blood transfusion, and mechanical ventilation were the significant factors associated with DVT. Patients with DVT were almost twice as likely to die during the admission (P = .011). This is the largest series to date examining the risk factors for DVT in burn patients. DVT developed in approximately 0.8% of burn patients. Black race, TBSA ≥20%, blood transfusions, and mechanical ventilation were associated with approximately 2-fold odds of developing DVT. Identification of these additional risk factors may allow targeted patient prophylaxis. Additionally, patients with DVT incurred higher total charges and longer hospitalization.

An analysis of prehospital deaths: Who can we save?

BACKGROUND: Since their inception in the late 1970s, trauma networks have saved thousands of lives in the prehospital setting. However, few recent works have been done to evaluate the patients who die in the field. Understanding the epidemiology of these deaths is crucial for trauma system performance evaluation and improvement. We hypothesized that specific patterns of injury could be identified and targeted for intervention. METHODS: Medical examiner reports in a large, urban county were reviewed including all trauma deaths during 2011 that were not transported to a hospital (i.e., died at the scene) or dead on arrival. Age, sex, date of death, mechanism, and list of injuries were recorded. An expert panel reviewed each case to determine the primary cause of death, and if the patient's death was caused by potentially survivable injuries or nonsurvivable injuries. RESULTS: A total of 512 patients were included. Patients were 80% male, died mostly of blunt (53%) and penetrating (46%) causes, and included 21% documented suicides. The leading cause of death was neurotrauma (36%), followed by hemorrhage (34%), asphyxia (15%), and combined neurotrauma/hemorrhage (15%). The anatomic regions most frequently injured were the brain (59%), chest (54%), and abdomen (35%). Finally, 29% of the patient deaths were classified as a result of potentially survivable injuries given current treatment options, mostly from hemorrhage and chest injuries. CONCLUSION: More than one of every five trauma deaths in our study population had potentially survivable injuries. In this group, chest injuries and death via hemorrhage were predominant and suggest targets for future research and implementation of novel prehospital interventions. In addition, efforts targeting suicide prevention remain of great importance. LEVEL OF EVIDENCE: Epidemiologic study, level V.

Brain ischemia in patients with intracranial hemorrhage: pathophysiological reasoning for aggressive diagnostic management.

Patients with intracranial hemorrhage have to be managed aggressively to avoid or minimize secondary brain damage due to ischemia, which contributes to high morbidity and mortality. The risk of brain ischemia, however, is not the same in every patient. The risk of complications associated with an aggressive prophylactic therapy in patients with a low risk of brain ischemia can outweigh the benefits of therapy. Accurate and timely identification of patients at highest risk is a diagnostic challenge. Despite the availability of many diagnostic tools, stroke is common in this population, mostly because the pathogenesis of stroke is frequently multifactorial whereas diagnosticians tend to focus on one or two risk factors. The pathophysiological mechanisms of brain ischemia in patients with intracranial hemorrhage are not yet fully elucidated and there are several important areas of ongoing research. Therefore, this review describes physiological and pathophysiological aspects associated with the development of brain ischemia such as the mechanism of oxygen and carbon dioxide effects on the cerebrovascular system, neurovascular coupling and respiratory and cardiovascular factors influencing cerebral hemodynamics. Consequently, we review investigations of cerebral blood flow disturbances relevant to various hemodynamic states associated with high intracranial pressure, cerebral embolism, and cerebral vasospasm along with current treatment options.

Evaluación radiográfica del grado y radio de curvatura en conductos mesio vestibulares de primeros molares superiores / Radiographic evaluation of the curvature degree and radius in the mesiobuccal canals of maxillary first molars / Avaliação radiográfica do grau e rádio de curvatura em canais mésio-vestibulares de primeiros molares superiores

Objetivo: Determinar el grado y radio de curvatura y su asociación de los conductos radiculares de las raíces mesiales de molares superiores humanos de población Ecuatoriana. Materiales y métodos: Se examinaron un total de 50 primeros mo-lares superiores humanos extraídos, obtenidos del banco de dientes del Subcentro de salud de Tumbaco Pichincha Ecuador, los criterios de exclusión fueron dientes previamente endodonciados, con presencia de caries, reabsorciones o fracturas ra-diculares. Se tomaron radiografías periapicales con técnica de paralelismo, el grado de curvatura se midió en sentido mesio distal con el método de Schneider 1971, y se obtuvo el radio de las curvaturas con la técnica descrita por Estrela 2008. Los datos obtenidos se analizaron mediante la prueba U de Mann Whitney con nivel de significancia del 5%. Resultados: Se determinó que el ángulo de la curvatura fue 10%, 58% y 32% para bajo, moderado y severo respectivamente, mientras que el radio de la curvatura fue 64%, 34%, y 2% para leve, moderado y severo respectivamente. Existió una diferencia estadís-ticamente significativa entre el ángulo moderado y radio leve de los grupos estudiados (p=0,02) Conclusión: Se determinó que es más frecuente el ángulo de curvatura moderado y radio leve.

Objective: Determining the curvature degree and radius and its root canals association in mesial roots of human maxil-lary molars of Ecuadorian population.Materials and methods: A total of 50 human maxillary first molars extracted were studied which were obtained from the Tumbaco health sub-center's teeth bank, Pichincha Ecuador, facts as teeth with a previous root canal treatment, cavities, root resorptionand fracture were the exclusion criteria. Periapical films withparal-leling technique were taken; the curvature degree was measured mesio-distally with the Schneider 1971 technique and the curvature radius was obtained with the technique described by Estrela 2008. The data collected were analyzed with the Mann Whitney's U Test with significance level of 5%. Results:The curvature angle was determined as 10%, 58% and 32% for low, moderate and severe respectively;and the curvature radius was 64%, 34% and 2% for mild, moderate and severe respectively. Among the groups studied, there was a statistically significant difference between the moderate angle and the mild radius (p=0,02). Conclusion: The study found that the moderate curvature angle and mild radiusare the most frequent.

Objetivo: Determinar o grau e o raio de curvatura e a sua associação dos canais radiculares das raízes mesiais dos molares superiores humanos da população equatoriana. Materiais e métodos: Foram examinados um total de 50 primeiros molares superiores humanos extraídos , obtidos do banco de dentes da Unidade Básica de Saúde localizada em Tumbaco Pichincha no Equador. Os critérios de exclusão foram dentes com endodontia prévia, dentes com presença de lesões de cárie dentária , dentes com reabsorções ou com fraturas radiculares. Foram feitas radiografias periapicais com a técnica do paralelismo, o grau de curvatura foi medido no sentido mesiodistal com o método de Schneider 1971, e foi obtido o raio de curvatura com a técnica descrita por Estrela 2008. Os dados obtidos foram analisados pelo teste U de Mann Whitney com nível de significância de 5%. Resultados: Determinou-se que o ângulo da curva foi de 10%, 58% e 32% para baixo, moderado e severo, respectivamente, enquanto que o raio da curvatura foi de 64%, 34%, e 2% para leve, moderado e severo, respectiv-amente. Houve uma diferença estatisticamente significante entre o ângulo moderado e o raio leve nos grupos de estudo (p = 0,02) Conclusão: determinou-se que o ângulo de curvatura moderado e o raio leve são os mais frequentes.

El trauma craneal por accidente del tránsito en terapia de cirugía / Cranial trauma due to traffic accident in surgical therapy

Se estudió la morbilidad y mortalidad del trauma craneoencefálico por accidente del tránsito en 165 pacientes ingresados en la unidad de terapia de cirugía del Hospital Militar "Dr. Carlos J. Finlay" durante el año 1990. Se concluyó que la contusión cerebral y el hematoma subdural son las causas más frecuentes de la alta letalidad. Se plantea que la medición intracraneal es necesaria y que la tomografía axial computadorizada de cráneo debe ser realizada de urgencia, si está disponible, para mejorar el diagnóstico y tratamiento del trauma craneoencefálico

Valoración morfológica de pacientes en edad geriátrica por el médico de la familia / Morphologic evaluation in patients with geriatric age for physician family

Se investiga una muestra de 455 ancianos entre 60 y 79 años de edad pertenecientes a dos circunscripciones del Policlínico Docente Playa, a los cuales se les realizó un estudio morfológico mediante la utilización del índice porcentual de peso para la talla, así como los indicadores de la composición coroporal. Se señala que la muestra para el estudio se dividió por sexo y se indica que se encontró un aumento paralelo de la grasa subcutánea y de la masa corporal activa a medida que aumentaba el peso corporal, se informa que se confirmó el valor relativo que presenta el indicador peso para la talla para evaluar el estado nutricional del sujeto, y se halló que poseen un mayor valor en este sentido los indicadores de la composición corporal

Aspectos de la sexualidad en un grupo de adolescentes atendidos por el médico de la familia / Sexuality aspects in a group of teenegers attended by family doctors

Se realiza un estudio prospectivo sobre algunos aspectos de la sexualidad en 82 adolescentes pertenecientes al Policlínico Docente de Playa atendido por los médicos de la familia. Se concluye que en nuestra área el nivel de instrucción es independiente del medio familiar (p < 0,05), existe precocidad en la realización del primer coito, el aborto fue más frecuente en las solteras, y aunque conocen los métodos anticonceptivos, no son utilizados por los adolescentes

Polineuropatía diabética: tratamiento / Diabetic polineuropathy: treatment

Se estudiaron 56 pacientes diabéticos atendidos en la consulta externa, 27 (48,21 %) presentaron polineuropatía diabética simétrica predominantemente sensitiva, asociada en 4 de ellos (14,81 %) con otras formas de polineuropatía diabética. Recibieron tratamiento con hidrocloruro de procaína y heparina en venoclisis por 15 días y la respuesta terapéutica fue satisfactoria en 23 casos (85,11 %) con desaparición de los síntomas subjetivos y mejoría evidente de los objetivos