Concentration of low-density lipoproteins (LDL) is significantly reduced after nilotinib discontinuation.

Dyslipidemia is a frequent side effect associated with nilotinib treatment. Patients with chronic myeloid leukemia (CML) under treatment with nilotinib who develop dyslipidemia have been shown to have a higher risk of presenting atherosclerotic cardiovascular disease (ACVD). Therapeutic discontinuation in selected individuals could be a strategy in order to prevent the development of ACVD. Observational study of patients with CML under nilotinib treatment. The lipid values were gathered before starting with nilotinib and after 3 months. Such values were also measured before discontinuation in patients who suspended nilotinib treatment, as well as 3 and 12 months later. 32 patients were included, 19 of them treated in monotherapy with nilotinib. The concentrations of total cholesterol and low-density lipoproteins (LDL) increased significantly after 3 months of treatment (27.29 mg/dL ± 22.88, p < 0.01). Of the total number of patients treated, 12 discontinued the treatment. LDL concentration was significantly reduced after 3 months of the nilotinib discontinuation (- 27.58 mg/dL ± 38.30, p = 0.030), remaining substantially lower after 12 months, compared to the time previous to discontinuation (- 24.58 mg/dL ± 37.31, p = 0.043). Nilotinib suspension reduces significantly LDL concentrations. These data support the strategy of therapeutic discontinuation in order to prevent future cardiovascular complications, especially in patients with prior cardiovascular risk factors.

Behavior of echocardiographic parameters of right ventricular function after tricuspid surgery.

Evaluation of right ventricular (RV) function after tricuspid valve surgery is complex. The objective was to identify the most appropriate RV function parameters for this purpose. This prospective study included 70 patients undergoing cardiac and tricuspid valve (TV) surgery. RV size and function parameters were determined at 3 months and 1-year post-surgery. Categorical variables were analyzed with the McNemar test and numerical variables with the Student's t-test for related samples or, when non-normally distributed, the Wilcoxon test. Spearman's rho was used to determine correlations between variables at 3 months and 1 year. RV diameters were reduced at 3 months post-surgery and were then unchanged at 1 year. Tricuspid annular plane systolic excursion (TAPSE) and S' wave values were worse at 3 months and then improved at 1 year (t-score-2.35, p 0.023; t-score-2.68; p 0.010). There was no significant reduction in free wall longitudinal strain (LS) or shortening fraction (SF) at 3 months (t-score 1.421 and - 1.251; p 0.218 and 0.172), and they were only slightly below pre-surgical values at 1 year. No relationship was found between RV function parameters and mortality or major complications. During the first few months after TV surgery, LS may be a more appropriate parameter to evaluate global ventricular function in comparison to TAPSE. At 1 year, good correlations are observed between TAPSE, S' wave, and LS values.

¿Es necesario realizar un screening cardiovascular en los pacientes migrantes? / Is it necessary to perform cardiovascular screening in migrant patients?

Los pacientes migrantes que llegan a España a menudo proceden de países donde no existe acceso universal a la sanidad. Aunque la prevalencia de hipertensión arterial (HTA) es menor en África occidental que en España, existe una mayor prevalencia de HTA enmascarada debido a la ausencia de cribados de salud. Esto también puede producir que no se diagnostiquen a los pacientes con HTA secundaria. Presentamos el caso de un varón senegalés de 36 años, sin antecedentes patológicos conocidos, residente desde hacía un año en España, que debutó con una emergencia hipertensiva. En el momento del diagnóstico, el paciente presentaba daño grave de órgano diana (cardiopatía hipertensiva, retinopatía hipertensiva). Tras el estudio, se le diagnosticó hipertensión arterial secundaria a malformación de la arteria renal. Después de realizar la angioplastia, la presión arterial se normalizó y, a los 18 meses, el daño a los órganos diana se había reducido.(AU)

Migrant patients arriving in Spain often come from countries where there is no universal access to healthcare. Although the prevalence of arterial hypertension (HTN) is lower in West Africa than in Spain, there is a higher prevalence of masked HT due to the absence of health screening. Furthermore, patients with secondary hypertension may not be diagnosed. We present the case of a 36-year-old Senegalese man, with no known pathological history, resident for a year in Spain, who debuted with a hypertensive emergency. At the time of diagnosis, the patient had severe end-organ damage (hypertensive heart disease, hypertensive retinopathy). After the study, he was diagnosed with arterial hypertension secondary to malformation of the renal artery. After performing angioplasty, blood pressure normalized and, at 18 months, target organ damage had reduced. Migrants who arrive in our country must be incorporated into health screening systems to diagnose and treat possible unknown pathologies. In our case, the clue to secondary hypertension was the development of resistant hypertension with target organ damage in a young subject.(AU)

Surgical management of tricuspid regurgitation: a new algorithm to minimise recurrent tricuspid regurgitation.

INTRODUCTION: Recurrent tricuspid regurgitation (TR) is frequently observed after cardiac surgery; however, the correct approach remains controversial. We developed an algorithm for action on the tricuspid valve (TV) and conducted a 1-year follow-up study. The aim was to assess the efficacy of the algorithm to minimise residual TR after TV surgery. The hypothesis was that the TR rate at 1 year would be reduced by selecting the surgical approach in accordance with a set of preoperative clinical and echocardiographic variables. METHODS: A prospective, observational, single-centre study was performed in 76 consecutive patients with TV involvement. A protocol was designed for their inclusion, and data on their clinical and echocardiographic characteristics were gathered at 3 months and 1-year postsurgery. The treatment of patients depended on the degree of TR. Surgery was performed in all patients with severe or moderate-to-severe TR and in those with mild or moderate TR alongside the presence of certain clinical or echocardiographic factors. They underwent annuloplasty or extended valve repair when the TV was distorted. If repair techniques were not feasible, a prosthesis was implanted. Residual TR rates were compared with published reports, and predictors of early/late mortality and residual TR were evaluated. RESULTS: TR was functional in 69.9% of patients. Rigid ring annuloplasty was performed in 35.7% of patients, De Vega annuloplasty in 27.1%, extended repair in 11.4% and prosthetic replacement in 25.7%. TR was moderate or worse in 8.19% of patients (severe in 3.27%) at 1 year postintervention. No clinical, surgical or epidemiological variables were significantly associated with residual TR persistence, although annulus diameter showed a close-to-significant association. Total mortality was 12.85% for all causes and 10% for cardiovascular causes. In multivariate analysis, left ventricular ejection fraction was related to both early and late mortality. CONCLUSIONS: Severe residual TR was significantly less frequent than reported in other series, being observed in less than 4% of patients at 1-year postsurgery.

Is it necessary to perform cardiovascular screening in migrant patients? / ¿Es necesario realizar un screening cardiovascular en los pacientes migrantes?

Migrant patients arriving in Spain often come from countries where there is no universal access to healthcare. Although the prevalence of arterial hypertension (HTN) is lower in West Africa than in Spain, there is a higher prevalence of masked HT due to the absence of health screening. Furthermore, patients with secondary hypertension may not be diagnosed. We present the case of a 36-year-old Senegalese man, with no known pathological history, resident for a year in Spain, who debuted with a hypertensive emergency. At the time of diagnosis, the patient had severe end-organ damage (hypertensive heart disease, hypertensive retinopathy). After the study, he was diagnosed with arterial hypertension secondary to malformation of the renal artery. After performing angioplasty, blood pressure normalized and, at 18 months, target organ damage had reduced. Migrants who arrive in our country must be incorporated into health screening systems to diagnose and treat possible unknown pathologies. In our case, the clue to secondary hypertension was the development of resistant hypertension with target organ damage in a young subject.

Can the 'Learn in peace, educate without violence' intervention in Cote d'Ivoire reduce teacher violence? Development of a theory of change and formative evaluation results.

OBJECTIVES: To gather evidence on whether a brief intervention (Apprendre en paix et éduquer sans violence, developed by the Ivorian Ministry of Education and Graines de Paix) to promote peace in primary schools by reducing teacher violence perpetration and improving pedagogical techniques was acceptable to teachers and affected change in intermediate outcomes. DESIGN: Mixed-methods formative research. SETTING: Primary schools in Tonkpi region, Cote d'Ivoire. PARTICIPANTS: 160 teachers participating in the peace training, surveyed three times during implementation; qualitative in-depth interviews with 19 teachers and teacher-counsellors. INTERVENTIONS: Learn in peace, educate without violence-a brief intervention with primary school teachers designed to promote peace in primary schools. OUTCOMES: For survey data, we generated composite measures of intermediate outcomes (teachers' awareness of consequences of violence, self-efficacy in applying positive classroom management methods, acceptance of physical discipline practices in school) and used random intercept linear mixed-effects models to compare responses over time. Qualitative research included open-ended questions about acceptability and perceived need for such an intervention. A framework analysis was undertaken. RESULTS: Four-months post-training (vs pretraining), teachers had higher self-efficacy in applying positive classroom management methods (pre-mean=26.1; post-mean=27.5; p<0.001) and borderline lower acceptance of physical discipline practices (premean=4.2; postmean=3.6; p=0.10). We found no change in teacher awareness of the consequences of violence. Qualitatively, teachers found the intervention acceptable and understandable, perceiving it as useful because it provided methods for non-violent discipline. Teachers had mixed views about whether the techniques improved classroom dynamics. CONCLUSIONS: Data suggest that the intervention is acceptable and leads to change in intermediate outcomes for teachers. Further evaluation in a randomised controlled trial is warranted.

Arterial hypertension assessment in a population with chronic myeloid leukemia.

Treatment of chronic myeloid leukaemia (CML) is based on tyrosine kinase inhibitors (TKI), whose introduction in 2001 improved the survival rate after 5 years from 40 to 90%. The longevity increase has been accompanied by a higher incidence of cardiovascular events (CVE) that can be explained due to the sum of cardiovascular risk factors (CVRF) together with the secondary effects of the TKI. The effect of the TKI over the blood pressure control is still unknown. An observational cross-sectional study of patients with CML under treatment with TKI (imatinib, dasatinib and nilotinib) was conducted. Blood pressure was analyzed through sphygmomanometer and 24-h ambulatory blood pressure monitoring (ABPM). A total of 73 patients were included, 57 treated with a single line of treatment. 32.9% of the total of individuals under this study showed uncontrolled blood pressure according to the ABPM. The factors related to uncontrolled BP were overweight, dyslipidemia, alcohol use, pulse wave velocity a high/very high cardiovascular risk. The subjects who received treatment with nilotinib did present worse control of their blood pressure in ABPM than those treated with imatinib and dasatinib (p = 0.041). This finding could indicate that an uncontrolled blood pressure is implied in the pro-inflammatory and pro-atherogenic mechanism underlying the development of the cardiovascular disease in those patients under treatment with nilotinib. The ABPM is a useful tool in the diagnosis and treatment of HT, being the reason why it should be included in the assessment of patients with CML whose HT diagnosis proves uncertain.

Measuring violence perpetration: Stability of teachers' self-reports before and after an anti-violence training in Cote d'Ivoire.

BACKGROUND: Epidemiological studies of interpersonal violence commonly use self-reported violence perpetration as an outcome measure, but few studies have investigated the stability of and influences on self-reports. OBJECTIVE: To assess changes in teachers' self-reported use of physical violence against students before and after a one-day violence prevention training, and factors associated with changed reports in Cote d'Ivoire. METHODS: Before and after the training, 157 teachers completed surveys containing 32 questions adapted from the ICAST-CI. Changes in physical violence usage were summarized over lifetime, past school term, and past-week timeframes, and the consistency in responses assessed via intraclass correlation coefficients (3,k), percent agreement, and kappa statistics. Factors associated with changed reports were assessed using robust multiple linear regression with 1,000 bootstrapped replications. RESULTS: Although reports before and after the training should have remained constant, the proportion of teachers reporting 1+ act of violence dropped substantially (lifetime: 73% to 47%). Most teachers (73%) changed 1+ response. Kappa for individual items showed ranging disagreement (lifetime: 0.275-0.795). Variables significantly associated with greater numbers of changed reports included: greater mental health distress (lifetime: beta = 1.061, 95% CI = 0.229, 2.404), older age (past school term: beta = 0.067, 95% CI = 0.018, 0.113); and variables targeted during training, including increasing awareness of consequences of violence (past week: beta = 0.241, 95% CI = 0.046, 0.435) and decreasing acceptance of physical discipline practices in schools (past school term: beta= -0.169, 95% CI= -0.338, -0.045). CONCLUSIONS: Interpreting self-reports of violence perpetration requires caution. Formal investigations into reliability and validity of self-reported violence perpetration and victimization are needed.

Enfermedad cardiovascular progresiva en paciente bajo tratamiento con nilotinib / Progressive cardiovascular disease in a patient under treatment with nilotinib

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Progressive cardiovascular disease in a patient under treatment with nilotinib. / Enfermedad cardiovascular progresiva en paciente bajo tratamiento con nilotinib.

The development of cardiovascular disease appears in subjects with several cardiovascular risk factors. However, other agents could be related to the appearance of cardiovascular disease, like chemotherapy drugs. We present a 63 years-old man with very high cardiovascular risk and chronic myeloid leukemia under treatment with nilotinib. Despite a good control of cardiovascular risk factors, he development a severe and accelerated peripheral arterial disease. Peripheral arterial disease occurs in 5-20% patients under treatment with nilotinib and it is more frequently in subjects with several cardiovascular risk factors.

Organocatalytic Enantioselective Synthesis of α-Hydroxyketones through a Friedel-Crafts Reaction of Naphthols and Activated Phenols with Aryl- and Alkylglyoxal Hydrates.

An efficient organocatalytic asymmetric synthesis of α-hydroxyketones has been developed. Quinine-derived thiourea catalyzed the enantioselective Friedel-Crafts alkylation of naphthols and activated phenols with aryl- and alkylglyoxal hydrates, providing the corresponding chiral α-hydroxyketones with high yields (up to 97%) and excellent enantioselectivities (up to 99% ee).

Tratamiento de la esquizofrenia con olanzopina / Treatment of the schizophrenia with olanzapine

Tratamiento de la olanzapina como tratamiento para la esquizofrenia. Evaluar la olanzapina como tratamiento para la esquizofrenia. Evaluar la seguridad y eficacia de la olanzopina en el tratamiento de la esquizofrenia. Diseño corresponde a un estudio de tipo experimental de campo, así mismo corresponde a un estudio de prueba de hipótesis. Para el diagnóstico de la esquizofrenia el ICD-10. Para la evaluación de los síntomas positivos y negativos: el PANSS y el ICG. Paralas la evaluación de los síntomas extrapiramidales: AIMS, Bames de acatisia, SAS. Exámenes de laboratorio (química sanguínea y hematología) y EKG y evaluación de signos vitales. Estuvo conformada por 17 pacientes masculinos (85 por ciento) y pacientes femeninos (15 por ciento), con edades comprendidas entre 19 y 46 años, 40 por ciento tenían entre 19 y 29 años. El 95 por ciento tenían dx de E. paraboíde y un 55 por ciento presentaron inicio de la enfermedad entre 1,5 y 24 años y el 100 por ciento tenía tratamiento previo con haloperidol. Período de estudio I (Preterapia con haloperidol y selección): la dosis de haloperidol no excedió los 20 mg días durante este período, se permitió el uso de drogas anticolinérgicas (Bíperiden) si el paciente presentaba efectos extrapiramidales. Se realizó ex.serológico para descartar hepatitis. Comprendía una semana e incluía la visita 1. Ser extendió por 7 semanas, desde la visita 2 a la 8, las cuales fueron semanales. Los pacientes detuvieron su tto. con haloperidol en la visita 2 e iniciaron tto. con olanzopina a dosis de 10 mg v.o H/S. Se realizaron exámenes de laboratorio (visitas 2 a 8) EKG, peso, signos vitales y se utilizaron las escalas descritas antes para evaluar eficacia y seguridad en cada una de las visitas. Las dosis de olanzopina se podía ajustar en forma ascendente o descendente en incremento o disminución de 5 mg en frecuencia no mayor de 7 días