Polypharmacy and Reversible Drug Induced QT Prolongation in a Patient with Advanced Cancer: Case Report.

QT prolongation is related to the development of ventricular arrhythmias such as Torsade de Pointes (TdP) that can lead to sudden cardiac death. Several drugs used in the treatment of patients with advanced cancer may induce QT prolongation due to their interference with cardiac ion channels. Some patients may be at higher risk if predisposing factors are present. Herein we present the case of a patient with advanced cancer under anti-tumor treatment with radical intention that developed a reversible drug-induced QT prolongation when simultaneously treated with methadone, haloperidol and fluoxetine that presented with chest pain and bradycardia. An approach to cancer patients at risk for drug-induced QT prolongation is discussed highlighting the need of a thorough medication review with a special focus in the patient with polypharmacy.

Characterization of a cohort of metastatic lung cancer patients harboring KRAS mutations treated with immunotherapy: differences according to KRAS G12C vs. non-G12C.

Approximately 20% of lung adenocarcinomas harbor activating mutations at KRAS, an oncogene with the ability to alter the tumor immune microenvironment. In this retrospective study, we examined 103 patients with KRAS-mutant lung adenocarcinoma who were treated with immunotherapy-based regimens and we evaluated the clinical outcomes according to PD-L1 expression and the type of KRAS mutation. Among all patients included, 47% carried KRAS G12C mutation whereas 53% harbored KRAS non-G12C mutations. PD-L1 status was available for 77% of cases, with higher expression among KRAS G12C tumors (p = 0.01). Better overall survival and progression-free survival were observed in high PD-L1 expression tumors, regardless of KRAS mutation type. The heterogeneous nature of KRAS-mutant tumors and the presence of other co-mutations may contribute to different outcomes to immunotherapy-based strategies.

Variable responses of human and non-human primate gut microbiomes to a Western diet.

BACKGROUND: The human gut microbiota interacts closely with human diet and physiology. To better understand the mechanisms behind this relationship, gut microbiome research relies on complementing human studies with manipulations of animal models, including non-human primates. However, due to unique aspects of human diet and physiology, it is likely that host-gut microbe interactions operate differently in humans and non-human primates. RESULTS: Here, we show that the human microbiome reacts differently to a high-protein, high-fat Western diet than that of a model primate, the African green monkey, or vervet (Chlorocebus aethiops sabaeus). Specifically, humans exhibit increased relative abundance of Firmicutes and reduced relative abundance of Prevotella on a Western diet while vervets show the opposite pattern. Predictive metagenomics demonstrate an increased relative abundance of genes associated with carbohydrate metabolism in the microbiome of only humans consuming a Western diet. CONCLUSIONS: These results suggest that the human gut microbiota has unique properties that are a result of changes in human diet and physiology across evolution or that may have contributed to the evolution of human physiology. Therefore, the role of animal models for understanding the relationship between the human gut microbiota and host metabolism must be re-focused.

[Reducing the incidence of ventilator-associated pneumonia following heart surgery: 13-year experience of epidemiologic surveillance in a teaching hospital]. / Reducción de incidencia de neumonía asociada a ventilación mecánica post cirugía cardíaca: experiencia de 13 años de vigilancia epidemiológica en un hospital universitario.

OBJECTIVES: To report the results of 13 years worth of epidemiologic surveillance of ventilator-associated pneumonia (VAP) following heart surgery and the main interventions applied in order to reduce VAP incidence. METHODS: This is a retrospective and descriptive study of active epidemiologic surveillance of VAP. National diagnostic criteria were used. Interventions associated with a decrease in VAlP incidence in adults who underwent heart surgery are described. RESULTS: A significant and sustained reduction was observed in the rate of VAP; being 56.7 per 1,000 ventilator-days in 1998 vs 4.7 per 1,000 ventilator-days in 2010 (p < 0.001). The strongest reduction was observed following 2003 (34.4 to 14.8 per 1,000 ventilator-days in 2004, p < 0.001). The interventions with greatest impact were the implementation of an early-weaning protocol, the introduction of trained nurses to perform the mechanical ventilator equipment management and the routine use of alcohol-based hand rubs. CONCLUSION: Epidemiologic surveillance associated with the establishment of a multifactorial intervention program applied in collaboration with the attending team, have demonstrated a significant reduction of VAP incidence after heart surgery.

Reducción de incidencia de neumonía asociada a ventilación mecánica post cirugía cardíaca: experiencia de 13 años de vigilancia epidemiológica en un hospital universitario / Reducing the incidence of ventilator-associated pneumonia following heart surgery: 13-year experience of epidemiologic surveillance in a teaching hospital

Objectives: To report the results of 13 years worth of epidemiologic surveillance of ventilator-associated pneumonia (VAP) following heart surgery and the main interventions applied in order to reduce VAP incidence. Methods: This is a retrospective and descriptive study of active epidemiologic surveillance of VAP. National diagnostic criteria were used. Interventions associated with a decrease in VAlP incidence in adults who underwent heart surgery are described. Results: A significant and sustained reduction was observed in the rate of VAP; being 56.7 per 1,000 ventilator-days in 1998 vs 4.7 per 1,000 ventilator-days in 2010 (p < 0.001). The strongest reduction was observed following 2003 (34.4 to 14.8 per 1,000 ventilator-days in 2004, p < 0.001). The interventions with greatest impact were the implementation of an early-weaning protocol, the introduction of trained nurses to perform the mechanical ventilator equipment management and the routine use of alcohol-based hand rubs. Conclusion: Epidemiologic surveillance associated with the establishment of a multifactorial intervention program applied in collaboration with the attending team, have demonstrated a significant reduction of VAP incidence after heart surgery.

Objetivos: Comunicar los resultados de 13 años de vigilancia epidemiológica de neumonía asociada a ventilación mecánica (NAVM) post cirugía cardíaca y las principales intervenciones implementadas para reducir su incidencia. Metodología: Estudio retrospectivo, descriptivo, de vigilancia epidemiológica activa de NAVM utilizando los criterios del ]Ministerio de Salud (MINSAL) y de las intervenciones asociadas con una disminución de la tasa de NAVM en adultos operados de cirugía cardíaca. Resultados: Se observó una reducción significativa y sostenida de la tasa de NAVM, siendo 56,7 por 1.000 días de ventilación mecánica (VM) en 1998 vs 4,7 por 1.000 días de VM en 2010 (p < 0,001). La mayor reducción fue observada a partir de 2003 (desde 34,4 a 14,8 por 1.000 días de VM en 2004, p < 0,001). Las intervenciones con mayor impacto fueron la implementación de un protocolo de extubación precoz, la incorporación de enfermeras capacitadas en el manejo de los equipos de VM y el uso rutinario de alcohol gel. Conclusión: La vigilancia epidemiológica asociada a un programa de intervención multifactorial aplicado en conjunto con el equipo tratante permitió reducir significativamente la incidencia de NAVM post cirugía cardíaca.

Smoking, exposure to secondhand smoke, and smoking restrictions in Tijuana, Mexico

OBJETIVO: Calcular la prevalencia del consumo de tabaco, de la exposición a humo ajeno o ambiental y de la existencia de medidas restrictivas contra el tabaquismo en el hogar y en el lugar de trabajo entre residentes de Tijuana, una de las ciudades más grandes de México. MÉTODOS: Esta encuesta domiciliaria transversal se llevó a cabo en Tijuana, Baja California, México, durante 2003 y 2004. Una muestra poblacional de 400 adultos residentes de Tijuana respondió a una encuesta sobre el tabaquismo y 397 de las encuestas se sometieron a análisis. RESULTADOS: Cerca de 22,9% (intervalo de confianza de 95% [IC95%]: 18,7% a 27,1%) de los adultos residentes de Tijuana declararon que fumaban en el momento de la encuesta y 53,9% (IC95%: 48,8% a 58,9%) declararon estar expuestos crónicamente a humo ajeno o ambiental. Alrededor de 44,4% (IC95%: 37,9% a 50,9%) de los adultos en Tijuana dijeron que había reglamentos contra el tabaquismo en su lugar de trabajo, mientras que en 65,8% (IC95%: 61,0% a 70,6%) de los hogares de Tijuana no se fumaba dentro del hogar. CONCLUSIONES: Los resultados subrayan la necesidad de incrementar las medidas para el control del tabaquismo, especialmente las orientadas a hacer cumplir los reglamentos existentes contra la contaminación ambiental por humo de tabaco, todo a fin de extender la protección contra dicha contaminación más allá de los entornos privados a los públicos y frenar la epidemia de tabaquismo en Tijuana y en otras partes de México.

Smoking, exposure to secondhand smoke, and smoking restrictions in Tijuana, Mexico.

OBJECTIVE: To estimate the prevalence of tobacco use, exposure to secondhand smoke, and smoking restrictions in the home and workplace among residents of Tijuana, one of Mexico's largest cities. METHODS: This cross-sectional household survey was conducted in Tijuana, Baja California, Mexico, during 2003 and 2004. A population-based sample of 400 Tijuana adult residents responded to a tobacco survey, and 397 of the surveys were analyzed. RESULTS: About 22.9% (95% confidence interval (CI): 18.7%-27.1%) of Tijuana adults reported current smoking, and 53.9% (95% CI: 48.8%-58.9%) reported chronic exposure to secondhand smoke. Approximately 44.4% (95% CI: 37.9%-50.9%) of Tijuana adults had a nonsmoking policy in their workplace, while 65.8% (95% CI: 61.0%-70.6%) of Tijuana households were smoke-free. CONCLUSIONS: The results underline the need for increased tobacco control efforts, particularly stricter enforcement of existing passive smoking regulations, in order to expand protection from secondhand smoke from private settings to public ones and to curb the tobacco epidemic in Tijuana and elsewhere in Mexico.