A phase II multicenter study of the anti-CD19 antibody drug conjugate coltuximab ravtansine (SAR3419) in patients with relapsed or refractory diffuse large B-cell lymphoma previously treated with rituximab-based immunotherapy.

This phase II, single-arm, multicenter study examined the efficacy and safety of coltuximab ravtansine (an anti-CD19 antibody drug conjugate) in 61 patients with histologically documented (de novo or transformed) relapsed or refractory diffuse large B-cell lymphoma who had previously received rituximab-containing immuno-chemotherapy. Patients had received a median of 2.0 (range 0-9) prior treatment regimens for diffuse large B-cell lymphoma and almost half (45.9%) had bulky disease (≥1 lesion >5 cm) at trial entry. Patients received coltuximab ravtansine (55 mg/m2) in 4 weekly and 4 biweekly administrations until disease progression or unacceptable toxicity. Forty-one patients were eligible for inclusion in the per protocol population. Overall response rate (International Working Group criteria) in the per protocol population, the primary end point, was 18/41 [43.9%; 90% confidence interval (CI:) 30.6-57.9%]. Median duration of response, progression-free survival, and overall survival (all treated patients) were 4.7 (range 0.0-8.8) months, 4.4 (90%CI: 3.02-5.78) months, and 9.2 (90%CI: 6.57-12.09) months, respectively. Common non-hematologic adverse events included asthenia/fatigue (30%), nausea (23%), and diarrhea (20%). Grade 3-4 adverse events were reported in 23 patients (38%), the most frequent being hepatotoxicity (3%) and abdominal pain (3%). Eye disorders occurred in 15 patients (25%); all were grade 1-2 and none required a dose modification. Coltuximab ravtansine monotherapy was well tolerated and resulted in moderate clinical responses in pre-treated patients with relapsed/refractory diffuse large B-cell lymphoma. (Registered at: clinicaltrials.gov identifier: 01472887).

Depressive symptoms in adolescents in Jamaica / Síntomas depresivos en adolescentes de Jamaica

BACKGROUND: Depression in adolescents is often overlooked and misdiagnosed; however, it is an important mental health problem which is associated with major functional impairments across daily domains of living, and considerable morbidity. The aim of this research is to examine the prevalence of self-reported depressive symptoms among Jamaican adolescents, and the associated sociodemographic factors. SUBJECTS AND METHOD: This cross-sectional study included 3003 students between 10 and 15 years old in Jamaica. Survey methodology was used in the collection of the data. RESULTS: Of the sample of students, 47% were males. One hundred and thirty-four (4.5%) reported having depressive symptoms. The factors significantly associated with depressive symptoms were negative community attributes (B = 1.1; p = 0.001), protective factors within the home (B = 0.72; p = 0.000), gender (B = 1.92; p = 0.000), and learning problems (B = 3.1; p = 0.000). CONCLUSION: Results indicate rates of depressive symptomatology reported among adolescents in Jamaica are consistent with rates reported in the literature.

ANTECEDENTES: La depresión en los adolescentes es a menudo pasada por alto y mal diagnosticada, a pesar de que constituye un problema de salud mental importante. El mismo se halla asociado con deterioros funcionales mayores en todos los dominios de la vida diaria, y conlleva una morbosidad considerable. El objetivo de esta investigación es examinar la prevalencia de síntomas depresivos autoreportados entre adolescentes jamaicanos, así como pasar revista a los factores sociodemográficos asociados. MÉTODO: Este estudio transversal incluyó 3003 estudiantes jamaicanos entre 10 y 15 años de edad. La metodología de encuestas fue usada en la recogida de datos. RESULTADOS: De la muestra de estudiantes, 47% eran varones. Ciento treinta y cuatro (4.5%) reportaron tener síntomas depresivos. Los factores significativamente asociados con los síntomas de depresión fueron atributos comunitarios negativos (B = 1.1; p = 0.001), factores de protección en el hogar (B = 0.72; p = 0.000), género (B = 1.92; p = 0.000), y problemas de aprendizaje (B = 3.1; p = 0.000). CONCLUSIÓN: Los resultados indican que las tasas de sintomatología depresiva reportadas entre los adolescentes en Jamaica concuerdan con las tasas reportadas en la literatura.

Depression among cardiovascular disease patients on a consultation-liaison service at a General Hospital in Jamaica / La depresión entre los pacientes con enfermedades cardiovasculares en el servicio de interconsulta psiquiátrica del Hospital General de Jamaica

OBJECTIVE: The prevalence of cardiovascular disease in Jamaica and other Caribbean countries has been steadily rising. Depression has been associated with increased morbidity and mortality in patients with cardiovascular disease. Against this background, the authors compared the co-occurrence of depressive illnesses among general hospital inpatients with cardiovascular disease and those without cardiovascular disease. METHOD: Psychiatric and non-psychiatric diagnoses on all inpatients referred to the consultation-liaison psychiatry service at a general hospital in Jamaica were recorded over a one-year period and analysed using chi-square, t-tests, binary logistic regression and odds ratio. Statistical significance was taken at the 0.05 level. RESULTS: Of the 201 patients referred, 17.9% had cardiovascular disease and 19.9% had depressive illnesses. One third of patients with cardiovascular disease were depressed. They were also significantly more likely than other patients to have a depressive illness (OR = 2.93, 95% CI: 1.25, 6.85). CONCLUSION: Special attention to the prevention, detection and treatment of depression should be applied to patients with cardiovascular disease.

OBJETIVO: La prevalencia de las enfermedades cardiovasculares en Jamaica y otros países del Caribe se ha mantenido en constante crecimiento. La depresión ha estado asociada con un aumento de la morbilidad y la mortalidad en los pacientes con enfermedades cardiovasculares. Frente a este antecedente, los autores compararon la co-ocurrencia de las enfermedades depresivas entre los pacientes con enfermedades cardiovasculares ingresados en el hospital general, con aquellos que no sufrían estas enfermedades. MÉTODO: Los diagnósticos psiquiátricos y no psiquiátricos de todos los pacientes remitidos al servicio de interconsulta de psiquiatría del hospital general de Jamaica, fueron registrados por un período de un año, y analizados utilizando pruebas de chi-cuadrado, pruebas t, regresión logística binaria, y el cociente de probabilidades (odds ratio). La significación estadística fue tomada en el nivel 0.05. RESULTADOS: De los 201 pacientes remitidlos, 17.9% tenían enfermedades cardiovasculares, y el 19.9% tenían enfermedades depresivas. Una tercera parte de los pacientes con enfermedades cardiovasculares se sentían deprimidos. Asimismo eran significativamente más propensos a padecer enfermedades de depresión, en comparación con los otros pacientes (OR = 2.93, 95% CI: 1.25, 6.85). CONCLUSIÓN: Debe prestarse especial atención a la prevención, detección y tratamiento de la depresión en pacientes con la enfermedad cardiovascular.

Suicide ideation in Jamaican youth: sociodemographic prevalence, protective and risk factors / Ideación suicida en la juventud jamaicana: prevalencia sociodemográfica, factores de riesgo y factores de protección

OBJECTIVE: To determine the prevalence of suicidal ideation and examine the association between suicidal ideation and sociodemographic characteristics, protective and risk factors among Jamaican youth. METHOD: In this cross-sectional study, an interviewer administered school-based survey was conducted among 2997 students 10-15 years old in Jamaica. Although there were a number of questions on suicide, this paper focusses on one question "During the past year, did you ever seriously consider attempting suicide?" as the measure of suicidal ideation. RESULTS: The prevalence rate of suicidal ideation was 9.7%. Logistic regression analysis revealed that significant correlates of suicidal ideation were being female (odds ratio = 1.49), being depressed (odds ratio = 5.78), living in a rural area (odds ratio = 0.62), likes oneself (odds ratio = 0.58), indulging in aggressive behaviour (odds ratio = 1.43), has considered harming others (odds ratio = 3.11), protective factors in the home (odds ratio = 0.62), involvement in risky behaviour (odds ratio = 1.56) and being teased/bullied (odds ratio = 1.69). CONCLUSION: These findings have implication for prevention and treatment of suicidal behaviour in children and adolescents.

OBJETIVO: Determinar la prevalencia de ideación suicida y examinar la asociación entre la ideación suicida y las características sociodemográficas, así como los factores de protección y riesgo entre la juventud jamaicana. MÉTODO: En este estudio transversal, un entrevistador administró una encuesta escolar entre 2997 estudiantes de 10-15 años de edad en Jamaica. Aunque había varias preguntas sobre el suicidio, el documento se centraba en la siguiente, con el objeto de medir la ideación suicida: "¿Consideraste alguna vez seriamente cometer suicidio el año pasado?" RESULTADOS: La tasa de prevalencia de ideación suicida fue 9.7%. El análisis de regresión logística reveló que los correlatos significativos de ideación suicida fueron: ser mujer (cociente de probabilidades OR = 1.49), estar deprimido (cociente de probabilidades OR = 5.78), vivir en un área rural (cociente de probabilidades OR = 0.62), gustarse a sí mismo (cociente de probabilidades OR = 0.58), permitirse un comportamiento agresivo (cociente de probabilidades OR = 1.43), considerar hacer daño a otros (cociente de probabilidades OR = 3.11), factores de protección en la casa (cociente de probabilidades OR = 0.62), involucrarse en conductas arriesgadas (cociente de probabilidades OR = 1.56) y ser víctima de burla o acoso abusivo (cociente de probabilidades OR = 1.69). CONCLUSIÓN: Estos hallazgos tienen implicaciones en cuanto a prevenir y tratar la conducta suicida en niños y adolescentes.

Mental illness and public health: exploring the role of general hospital physicians at a teaching hospital in Jamaica / Enfermedades mentales y salud pública: explorando el papel de los médicos del hospital general en un hospital docente de Jamaica

OBJECTIVES: Against the public health implications of untreated mental illness among general hospital inpatients, this study aimed firstly to examine hospital physicians' level of referral to a psychiatric service, and secondly, to explore the extent of these doctors' knowledge of psychiatric issues by com­paring their reasons for referring patients with patients'final psychiatric diagnoses. METHODS: Over a one-year period, data were collected on all patients referred to a consultation liaison psychiatric service at a multi-disciplinary teaching hospital. Reasons for referral and final psychiatric diagnosis were recorded. Official hospital census data were also used in the calculation ofreferral rates. Chi-square or Fisher's Exact tests were used as appropriate to explore potential associations between reasons for referral and psychiatric diagnosis. Statistical significance was taken at the 0.05 level. RESULTS: The referral rate was 1.5%. Strange and disruptive behaviour as reasons for referral were strongly associated with the presence of underlying medical conditions as the cause of mental disturbance. Anxiety and psychotic symptoms as reasons for referral were associated with anxiety and psychotic disorders respectively. Depression was often given as a reason for referral when clinical depression was absent, but adjustment issues were prominent. CONCLUSIONS: The psychiatric service was underutilized. Generally, the psychiatric knowledge of phy­sicians was fair. However, closer attention to underlying medical conditions as a potential cause for psychiatric disturbance, as well as to the difference between maladjustment and depression, seems warranted. It is possible that clinicians were less able to detect mild to moderate cases of psychiatric illness.

OBJETIVOS: Haciendo frente a las implicaciones que para la salud pública tienen las enfermedades mentales sin tratamiento entre los pacientes hospitalizados en el hospital general, este estudio se propuso en primer lugar examinar el nivel alcanzado por los médicos del hospital con respecto a la remisión de pacientes a un servicio psiquiátrico; en segundo lugar, se busca explorar el alcance de los conocimientos de estos doctores con respecto a los problemas psiquiátricos, comparando sus razones para la remisión de pacientes con los diagnósticos psiquiátricos finales de los pacientes. MÉTODOS: Por un periodo de un año, se recopilaron datos de todos los pacientes remitidos al servicio de psiquiatría de enlace de consulta en un hospital docente multidisciplinario. Se registraron las razones para la remisión y el diagnóstico psiquiátrico final. También se usaron datos del censo hospitalario oficial en el cálculo de las tasas de remisión. La prueba de chi-cuadrado la prueba de Fisher fueron usadas como medios apropiados para explorar las asociaciones potenciales entre las razones para la remisión y el diagnóstico psiquiátrico. La importancia estadística se tomó al nivel 0.05. RESULTADOS: La tasa de remisión fue 1.5%. Los comportamientos problemáticos y raros como razones para la remisión estuvieron fuertemente asociados con la presencia de condiciones médicas subyacentes como la causa de la perturbación mental. La ansiedad y los síntomas sicóticos como razones para la remisión estuvieron asociadas con la ansiedad y desórdenes sicóticos respectivamente. La depresión fue señalada a menudo como una razón para la remisión cuando la depresión clínica estaba ausente, pero los problemas de adaptación tenían preeminencia. CONCLUSIONES: El servicio psiquiátrico estuvo subutilizado. Por lo general, el conocimiento psiquiátrico de los médicos era aceptable. Sin embargo, mayor atención merecen las condiciones médicas subyacentes así como causa potencial del trastorno psiquiátrica, así como la diferencia entre la inadaptación y la depresión. Es posible que los médicos clínicos fueran menos capaces de detectar los casos leves a moderados de enfermedad mental.

Optimización del uso de Agentes estimulantes del Receptor de la Eritropoyetina (AREs) en pacientes con neoplasias hematológicas basado en el nivel de hemoglobina reticulocitaria / Optimizing the use of Erythropoietin-Receptor stimulating Agents (ERAs) in patients with hematopoietic malignancies based on the level of reticulocyte hemoglobin

Los agentes estimulantes del Receptor de la Eritropoyetina (AREs) se usan en el tratamiento de la anemia de hemopatías malignas (HM). Sin embargo, la tasa de respuestas es variable por diversos factores como el déficit funcional de hierro (DFF). El nivel de hemoglobina (Hb) reticulocitaria es un parámetro fácil de obtener que ha mostrado su utilidad en el diagnóstico del DFF. El objetivo de este estudio fue identificar qué pacientes con HM tratados con AREs presentan DFF y si la Hb reticulocitaria predice la respuesta hemoglobínica en estos enfermos. Se incluyeron 42 pacientes con diagnostico de Mieloma Múltiple (n=17), Linfoma no Hodgkin (n=14), Linfoma de Hodgkin (n=3), Leucemia Linfática Crónica (n=4), Síndrome Mielodisplásico (n=2), Leucemia Linfoblástica Aguda (n=1) y Leucemia Mieloblástica Aguda (n=1). Veinticinco fueron tratados con Epoetina-beta, diez y seis con Darbepoetina y uno con Epoetina alfa.La respuesta fue favorable en el 28%, 53% y 58% de lospacientes a las 3, 6 y 12 semanas de tratamiento, respectivamente. Se detectó DFF en el 17% de los pacientes. En cuanto a la respuesta, no hubo diferencias estadísticamente significativas entre los pacientes con y sin DFF, si bien, a mitad de tratamiento, fue ligeramente superior en el grupo sin DFF (57% vs 43%, p>0.05). El nivel basal de Hb reticulocitaria se correlacionó con el grado de respuesta global a las 12 semanas de finalizar el tratamiento. Así, el 79% de los pacientes respondedores tenían una Hb reticulocitaria inicial >36·5 pg, mientras que este porcentaje bajó al 30% en los no respondedores (p = 0.024)En resumen, la Hb reticulocitaria es un método sensible ypreciso para detectar DFF en pacientes con HM bajo tratamiento con AREs. Además, un nivel elevado de Hb reticulocitaria basal es un parámetro que se asocia con respuesta favorable al tratamiento

The Erythropoietin-Receptor stimulating Agents (ERAs) areindicated in the supportive treatment of the anemia in hematological malignancies (HM). However, the response rate is variable due to factors such as the functional iron deficiency (FID). The level of the reticulocyte hemoglobin (RHb) is an easy-to-obtain parameter very useful for the diagnostic of the FID.The purpose of this study was to evaluate which patientswith HM treated with ERAs present FID. In addition, wetried to asses if the level of RH predicts the response in these patients.We included 42 patients with the following diagnostics:Multiple Myeloma (n= 17), Non Hodgkin Lymphoma(n=14), Hodgkin Lymphoma (n=3), Chronic lymphocyticLeukemia (n=4), Myelodisplastic syndrome (n=2), Acutelymphoblastic Leukemia (n=1), and Acute mieloblasticLeuKemia (n=1). Twenty five of them were treated withEpoetin beta, sixteen with darbepoetin alfa and one withEpoetin alfa at standard doses. The response was favorable in 28%, 53% and 58% of patients at the third, sixth and twelfth week of the treatment, respectively. FID was detected in 17% of the patients. Theresponse rate was not statistical significant different between patients with and without FID, although it was slightly superior in the group without FID (57% vs. 43%, p>0.05). Seventy nine percent of patients with a favorable response at twelve weeks showed an initial RH >36·5 pg, while this percentage was only 30% in patients who did not respond (p=0.024).In conclusion, RH is a sensitive and specific method to detect FID in patients with HM who are treated with ERAs.Furthermore, the high level of RH at the baseline is a predictor of favorable response of treatment, in these patients

Obesidad central. Su importancia como factor de riesgo cardiovascular en atención primaria

La obesidad constituye un importante problema de salud en los países desarrollados, con una prevalencia que se cifra entre el 30 por ciento-50 por ciento. Numerosos autores han resaltado la importancia de la distribución de la grasa corporal como valor predictivo de riesgo cardiovascular. Otros autores demuestran la interrelación existente entre obesidad troncular (calculada mediante el índice cintura/cadera), diabetes mellitus, hipertensión arterial y dislipidemia, conjunto sindrómico denominado por Reaven como 'síndrome X', cuyo nexo común sería la insulinorresistencia. A través de la aplicación de un test de regresión logística simple obtenemos una función de probabilidad que nos permite calcular el riesgo cardiovascular en el paciente afecto de un síndrome metabólico crónico mediante la determinación de la obesidad central, por lo que en este tipo de paciente debemos realizar un enfoque integral que nos permita un correcto control de los factores de riesgo, entre los cuales se incluye la obesidad central (AU)

Economic Evaluation of In Vitro Fertilization with Embryo Transfer and Neosalpingostomy by Laparotomy or Laparoscopy

Three cohorts of infertile women were treated for bilateral tubal obstruction. From July 1990 to July 1994, 37 distal tubal obstruction were treated with laparoscopic bilateral neosalpingostomy using a Coherent ultrapulse carbon dioxide (CO2) laser. Before July 1990, 72 with distal obstruction had neosalpingostomy by laparotomy using the CO2 laser and microsurgical techniques. From July 1990 to December 1994, 127 women with all forms of bilateral tubal obstruction were treated with a first cycle of in vitro fertilization-embryo transfer (IVF-ET). The groups were comparable for age and length of infertility. The live birth rates were 19% (14/72) and 22% (8/37), and the ectopic pregnancy rates 7% (5) and 8% (3) in the laparotomy and laparoscopy groups, respectively. The corresponding rates for the IVF-ET group were 19% (24) and 3% (4). The estimated costs for a live birth were $8573 after laparoscopy and $27,773 and $28,100 after laparotomy and IVF-ET, respectively. The reproductive performance after bilateral laparoscopic neosalpingostomy in selected patients is at least equal to that after neosalpingostomy by laparotomy and a single IVF-ET cycle. The least expensive live birth is associated with laparoscopic neosalpingostomy.

Changes in the Use of Thrombolytic Therapy in Seattle Area Hospitals from 1988 to 1992: Results from the Myocardial Infarction Triage and Intervention Registry.

Background: Thrombolytic therapy has been shown to reduce mortality in select patients with acute myocardial infarction (AMI). The determinants of eligibility for therapy are changing as more information about the safety and efficacy of thrombolytic therapy is obtained. In the United States, there is some concern that thrombolytic therapy is underutilized, particularly in women and older patients. The purpose of this investigation is to examine change in the use of thrombolytic therapy in a single community from the years 1988 to 1992. Particular attention was paid to women and older patients. Methods: From January 1988 through December 1992, 9154 patients who developed AMI were admitted to coronary care units in 19 hospitals in the metropolitan Seattle area. The hospital records of each consecutive patient were reviewed, and key information was entered into the Myocardial Infarction Triage and Intervention database. Patients who developed AMI after hospital admission for another medical condition were excluded, as were the small numbers of patients with AMI complicated by cardiac arrest and resuscitation prior to hospital admission. This population-based study contains first admissions for AMI during the 5 year period of the registry. Results: The use of thrombolytic therapy in all patients increased from 18% to 24% (p <.0001) during the 5 year period; women (10-16%) and patients 75 years and older (3-10%) had proportionately greater increases in utilization. Despite widespread awareness of its importance, the median time from symptom onset to hospital arrival did not change during the 5 years, although there was a slight decrease in the time from hospital arrival to treatment with thrombolytic therapy. Conclusions: The change in use of thrombolytic therapy indicates that age and gender are less often used as exclusions for receiving thrombolytic therapy. It is possible that exclusionary criteria are being modified, with the result that this important treatment is being received by more people. The finding that there was no change in the time from acute symptom onset to hospital arrival requires intensive study. In particular, more needs to be known about patient decisionmaking, and innovative community interventions to reduce delay times must be evaluated.