Effects of anthracycline, cyclophosphamide and taxane chemotherapy on QTc measurements in patients with breast cancer

Aim

Acute and subacute cardiotoxicity are characterized by prolongation of the corrected QT interval (QTc) and other measures derived from the QTc interval, such as QTc dispersion (QTdc) and transmural dispersion of repolarization (DTpTe). Although anthracyclines prolong the QTc interval, it is unclear whether breast cancer patients who undergo the ACT chemotherapy regimen of anthracycline (doxorubicin: A), cyclophosphamide (C) and taxane (T) may present with QTc, QTdc and DTpTe prolongation.

Methods

Twenty-three consecutive patients with breast cancer were followed prospectively during ACT chemotherapy and were analyzed according to their QT measurements. QTc, QTdc and DTpTe measurements were determined by a 12-lead electrocardiogram (EKG) prior to chemotherapy (baseline), immediately after the first phase of anthracycline and cyclophosphamide (AC) treatment, and immediately after T treatment. Serum troponin and B-type natriuretic peptide (BNP) levels were also measured.

Results

Compared to baseline values, the QTc interval was significantly prolonged after the AC phase (439.7 ± 33.2 ms vs. 472.5 ± 36.3 ms, p = 0.001) and after T treatment (439.7 ± 33.2 ms vs. 467.9 ± 42.6 ms, p < 0.001). Troponin levels were elevated after the AC phase (23.0 pg/mL [min-max: 6.0–85.0] vs. 6.0 pg/mL [min-max: 6.0–22.0], p < 0.001) and after T treatment (25.0 pg/mL [min-max: 6.0–80.0] vs. 6.0 pg/mL [min-max: 6.0–22.0], p < 0.001) compared to baseline values.

Conclusion

In this prospective study of patients with non-metastatic breast cancer who underwent ACT chemotherapy, significant QTc prolongation and an elevation in serum troponin levels were observed.

A randomized pilot study of the use of concept maps to enhance problem-based learning among first-year medical students

BACKGROUND

Medical student education is challenging, and concept maps (CMs) can help students link new and existing knowledge, promote critical thinking and identify knowledge gaps.

AIMS

To study the feasibility, acceptability, and effectiveness of CMs in problem-based learning (PBL) tutorials.

METHOD

Students and tutors were randomized to tutorials that used or did not use CMs. A mixed-methods approach generated qualitative and quantitative results of participants' perspectives on and the effects of CMs in PBL tutorials.

RESULTS

Student survey response rate was 71% (122/172). Most students (82.6%) planned to use CMs in the future at least occasionally, and students in CM tutorials endorsed increased likelihood of using CMs in the future (p = 0.02) versus students in non-CM tutorials. Qualitative analyses identified consistent associations between CMs and recurrent themes: integration of physiological mechanisms, challenging students' knowledge of the material, and identification of knowledge gaps. Quantitative assessment of final exam scores revealed a statistically significant increase in the students' scores in CM tutorials versus students in non-CM tutorials with an a priori α of <0.10.

CONCLUSIONS

CMs are well accepted by students and faculty, feasible to incorporate into PBL tutorials, and may result in improved exam performance and student learning of physiologic concepts.

Mortality from lung cancer and other diseases related to smoking among fishermen in north east Italy

OBJECTIVES

To study the mortality of fishermen. This was suggested by a cluster of cases of lung cancer in Chioggia, a large fishing harbour in the Veneto. The aim was to weight occupation against smoking with respect to risk of lung cancer.

METHODS

7530 fishermen registered in the 1971-86 port authority registers of Chioggia and Venice were followed up for mortality from 1971 to 1989. Of 475 causes of death, 460 were traced. Standardised mortality ratio (SMR) was calculated with the regional population as a reference. A nested case-control study was carried out in Chioggia decedents only by interviewing next of kin. Complete data were obtained in 172 (70% response). Cases (lung cancer deaths) and controls (other causes of death) were compared for smoking and occupation, as a group of non-fishermen was available in the cohort. Logistic regression analysis was used to adjust for confounding factors.

RESULTS

SMRs were high for lung cancer but low for other diseases related to smoking: circulatory and respiratory disease, tumours of the mouth, pharynx, oesophagus, and bladder. Likewise, SMRs were high for liver cancer but low for other diseases related to alcohol: digestive and circulatory disease, buccal, pharyngeal, and oesophageal tumours. In the case-control study, the risk of lung cancer was found to be related to smoking, and there was no interaction between occupation and smoking. When adjusted for age and smoking, the occupational indicators had no influence on the risk of mortality from lung cancer.

CONCLUSIONS

Among fishermen in north east Italy the greatest health hazard is lung cancer, and the factor involved in this risk is smoking, not occupation. Smoking, however, was linked with long hours at sea in another study.

Particulate matter in aerosols produced by two last generation electronic cigarettes: a comparison in a real-world environment

The design of e-cigarettes (e-cigs) is constantly evolving and the latest models can aerosolize using high-power sub-ohm resistance and hence may produce specific particle concentrations. The aim of this study was to evaluate the aerosol characteristics generated by two different types of electronic cigarette in real-world conditions, such as a sitting room or a small office, in number of particles (particles/cm3). We compared the real time and time-integrated measurements of the aerosol generated by the e-cigarette types Just Fog and JUUL. Real time (10s average) number of particles (particles/cm3) in 8 different aerodynamic sizes was measured using an optical particle counter (OPC) model Profiler 212-2. Tests were conducted with and without a Heating, Ventilating Air Conditioning System (HVACS) in operation, in order to evaluate the efficiency of air filtration. During the vaping sessions the OPC recorded quite significant increases in number of particles/cm3. The JUUL e-cig produced significantly lower emissions than Just Fog with and without the HVACS in operation. The study demonstrates the rapid volatility or change from liquid or semi-liquid to gaseous status of the e-cig aerosols, with half-life in the order of a few seconds (min. 4.6, max 23.9), even without the HVACS in operation. The e-cig aerosol generated by the JUUL proved significantly lower than that generated by the Just Fog, but this reduction may not be sufficient to eliminate or consistently reduce the health risk for vulnerable non e-cig users exposed to it.

Determining the Educational Value of an Emergency Medicine Rotation for Non-Emergency Medicine Residents

Background Residents from diverse specialties perform clinical rotations in the emergency department (ED). There is little research about the value of the ED rotation for them. Objectives We sought to determine the learning objectives of non-EM residents (NEMRs) in the ED, the effectiveness of the rotation, and the highest-yield components of their experience. Methods From 2017-2019, we surveyed NEMR on their pre-rotation learning objectives and their comfort level with 15 common ED presentations/procedures before and after the rotation. We assessed how well their objectives were met, the highest-yield components of their rotation, and opportunities for improvement. Results We collected responses from 56 (47%) pre-rotation and 61 (51%) post-rotation residents over a two-year period. The five most commonly cited learning goals were: management of acutely ill patients, triage skills, procedural competence, and ultrasound. Seventy-eight percent (78%) of residents reported their learning goals were moderately to very well met during their rotation. NEMRs' level of comfort improved in all the commonly encountered clinical experiences in the ED in a statistically significant manner. They cited on-shift teaching by attending physicians and senior EM residents as the most valuable learning resource. Conclusion NEMR from diverse medical and surgical specialties could identify specific learning objectives for their EM rotation with common themes, and the majority felt their educational goals were met. They gained comfort with the management and triage of all the assessed common ED conditions. By collecting and defining their specific needs and goals, we are better equipped to improve the quality and value of the rotation.

[Comparative study of the evolution of inflammatory colitis treated with an elemental diet, glutamine and 5-ASA. An experimental study in rats]

The objective of the present investigation was to study the evolution of untreated inflammatory disease of the colon as compared to disease treated with an elemental diet plus glutamine, with 5-ASA and with a combination of the three. A total of 120 female Wistar-Tecpar rats aged 180 days and weighing on average 290 g were studied. Inflammatory disease of the colon was induced with 10% acetic acid and the animals were divided at random into four groups of 30 rats each. Group A, which received a standard diet and no type of treatment, was used as control. Group B received an elemental diet supplemented with glutamine. Group C received a standard diet and daily 5-ASA enemas, 15 mg/ml. Group D received an elemental diet supplemented with glutamine plus daily 5-ASA enemas. Ten animals were picked at random from each group and sacrificed on the 7th, 14th and 21st days of treatment after intravenous injection of Evans blue for visualization of the damaged areas. Changes in weight and the macroscopic aspects of the abdominal cavity and the colon were evaluated and the involved segment was resected for macroscopic and microscopic analysis. The highest weight loss occurred in group D animals on the 14th and 21st days. The number of complications was larger in group A animals, with intestinal perforation, peritonitis and death (P = 0.0053). Complications were of equal intensity in groups B and C and no complications were detected in group D. Macroscopic evaluation showed a lower frequency of ulcers on the 7th day in group B (P = 0.0113) and D (P = 0.0294). Group D animals showed a significantly reduced frequency of ulcers on the 14th day (P = 0.0140). Microscopic examination showed a better evolution in groups B (P = 0.0113) and D (P = 0.0294) on the 7th day and in group D on 14th day (P = 0.0105) compared to A. We conclude that the combination of an elemental diet containing glutamine and treatment with 5-ASA leads to more rapid healing of the colon lesions induced by 10% acetic acid in rats.

Work and chronic health effects among fishermen in Chioggia, Italy

OBJECTIVES

To evaluate whether there is an association between deep-sea fishing and common chronic disease.

METHODS

The study was cross-sectional, simultaneously considering groups of fishermen and non-fishermen. Information on life-style and work was collected by means of questionnaires, and clinical data were collected by specialists in: Internal Medicine (general clinical examination), Cardiology (ECG, measurement of arterial pressure), Pneumology (measurement of spirometric volumes), ENT (clinical examination of the ear, nose and throat, including audiometry), Ophthalmology (examination of lens). Beside the common statistical methods, the logistic stepwise regression analysis was used in order to find the risk factors of the diseases, and to correct the risk estimates for the confounding variables.

RESULTS

Fisherman had prolonged hours of continuous work, which were found to be correlated with high cigarette and alcohol consumption. Significant associations were found between, on the one hand, work accidents, noise-induced hearing loss, solar keratosis, cataracts, obstructive bronchitis, rhino-sinusitis, otitis media with tympanic perforation, ECG alterations, and, on the other hand, various aspects of fisherman occupation, mainly fishing in high sea and work duration as fisherman.

CONCLUSION

Deep-sea fishing is a stressful and risky work; a reduction in the number of years at sea with reduced exposure to noise, poor weather conditions and sun, and a lower consumption of cigarettes and alcohol might result in fewer skin, eye respiratory and cardiovascular diseases, and injuries.