Cardiac amyloidosis (CA), a significant condition resulting in infiltrative cardiomyopathy and heart failure with preserved ejection fraction (HFpEF), is caused by extracellular deposition of amyloid fibrils in the heart. Even though this has been known for an extended period, its prevalence in elderly patients with heart failure is increasingly being recognized. Recent advances in diagnosis with non-invasive methods like technetium pyrophosphate-labeled cardiac scintigraphy (i.e., Tc-PYP scan) and treatment options with tafamidis have played a pivotal role in awareness of the burden of this disease. Management of cardiac complications like heart failure, atrial arrhythmias, conduction block, ventricular arrhythmias, coronary artery disease, and aortic stenosis is now more critical than ever. We aim to review and outline the recent advances in diagnoses of CA. We also review management strategies for cardiac complications of CA with a brief summary of disease-modifying therapies.
Rituximab has a myriad of clinical uses, ranging from its disease modifying action in rheumatoid arthritis, to its role in chemotherapy for cancer. Being an anti CD20 monoclonal antibody, it controls inflammation by targeting peripheral B cells including those present in the synovium. The use of Rituximab is associated with some side effects such as cytopenias and increased risk of infections such as JC virus reactivation leading to multifocal encephalopathy. The role of Rituximab as an immunosuppressant has been established. However, its association with tuberculosis in endemic countries like India is yet to be understood well. The study was a cross sectional study of the two cases reported about the incidence of tuberculosis in patients receiving infusions of rituximab for rheumatoid diseases. These adverse drug reactions were reported to the nearest pharmacovigilance center through the Vigiflow portal of WHO and were assessed for their causality as per the WHO scale. A 45 year old male patient, a known case of Systemic Lupus Erythematosus, presented to a tertiary care hospital with high grade fever with chills and rigors after which he was diagnosed with pleural effusion due to tuberculosis. The patient was on immunosuppressants which included Rituximab, Mycophenolate Sodium, Prednisolone and Hydroxychloroquine. Rituximab was withdrawn and the remaining medications were continued as per the initial plan. A 19 year old male patient, a known case of dermatomyositis and dilated cardiomyopathy, presented to a tertiary care hospital with complaints of fever with chills and rigors, and breathlessness on exertion which was followed by the diagnosis of miliary tuberculosis. Earlier, the patient was on Rituximab, Cyclophosphamide, Hydroxychloroquine and Prednisolone. Plan of further infusions of Rituximab and Cyclophosphamide was terminated while the remaining medications were continued. Both the patients were put on anti tubercular therapy and are now improving. The association of bacterial infections like tuberculosis with the use of Rituximab is not well understood. However, Rituximab being an immunosuppressant can be considered to be related to this infection. In our case series we readdress this association through a literature review.
Background: Improved survival outcomes in breast cancer has brought attention to major cardiovascular and cerebrovascular adverse events (MACCE). Racial disparities in these events among breast cancer survivors are understudied. Methods: Using National Inpatient Sample datasets (October 2015-December 2017, ICD-10-CM), we investigated racial disparities in the hospitalized breast cancer survivors for MACCE. They were further sub-categorized on the basis of prior chemotherapy or radiation therapy (CT/RT). Results: Of 1,301,320 breast cancer survivor women, 75.8% were White, 11.3% were Black, and 16.1% had prior CT/RT. All-cause in-hospital mortality was highest in Asian or Pacific Islanders (3.2%) in the whole breast cancer survivor population; and in Native Americans (4.7%) in CT/RT subgroup. Native Americans (4.1%) had the highest incidence of acute myocardial infarction (AMI) in the overall population, whereas White patients (2.9%) predominated in CT/RT subgroup. White patients (29.6%) had the highest prevalence of arrhythmia, regardless of the prior CT/RT. For strokes, Asian or Pacific Islanders (3.9%) and Black patients (3.8%) had a higher prevalence. All-cause mortality, AMI, arrhythmia, and stroke had the highest adjusted odds in Asian or Pacific Islanders (1.19), Native Americans (1.31), White patients (1), and Black patients (1.12) respectively. Black patients had the lowest quartile income and a longer median stay. White patients had the highest transfer to nursing facilities, whereas Asian or Pacific Islanders had the highest mean hospital expenditures. Conclusions: Racial disparities exist in MACCE among breast cancer survivors. Further research, especially pooling and analyzing real-world data is needed on the prevalence of MACCE in breast cancer survivors, particularly in subgroups with different cancer-related treatments.
Background: The purpose of the study was to study awareness and knowledge amongst girls about breast self-examination and breast cancer.Methods: An educational interventional study was carried out among 150 students of V. S. Hospital, School of Nursing. Students were educated about prevalence and severity of breast cancer as well as early detection techniques in an interactive lecture. Pre- and post-tests were administered before and after session. Data was analysed by using Epi Info 3.5.3.Results: It was found that 91% subjects were aware of the term of breast self-examination (BSE). Post intervention, awareness increased by 100%. Half of the subjects believed that practice of breast self-examination should begin at the age of 20 years, poste intervention, awareness increased in 93%. Approximately one fourth of the students were aware of the ideal frequency of performing BSE, after the intervention, awareness level increased to 83%. Only 27% of subjects were aware of technique of BSE. Post the intervention, it was found that 87% became aware about the correct technique. There was improvement of 49% in knowledge about indicators of breast cancer.Conclusions: There was increase in awareness among girls about breast self-examination and breast cancer after intervention.
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