The incidence of infective endocarditis during pregnancy has been reported to be 0.006%. The maternal mortality rate can reach 33%, with most deaths related to heart failure or an embolic event. The rate of fetal mortality can reach 29%. Heart diseases are the most important nonobstetric causes of maternal death during pregnancy, accounting for 10% of maternal deaths. As many as 3% of women have a form of cardiac disease diagnosed during or in the period preceding pregnancy, with 70 to 80% of the cardiac conditions having congenital causes.

BackgroundNeoadjuvant chemotherapy (NAC) is the standard treatment for patients with locally advanced breast cancer, showing improvement in disease-free survival (DFS) and overall survival (OS) rates in patients achieving pathological complete response (pCR). The relationship between immunohistochemistry-based molecular subtyping (IMS), chemo sensitivity and survival is currently a matter of interest. We explore this relationship in a Hispanic cohort of breast cancer patients treated with NAC.MethodsA retrospective survival analysis was performed on Colombian females with breast cancer treated at Instituto de Cancerología-Clinica Las Américas between January 2009 and December 2011. Patients were classified according to immunohistochemistry-based subtyping into the following five groups: Luminal A, Luminal B, Luminal B/HER 2+, HER2-enriched, and triple-negative breast cancer. Demographic characteristics, recurrence pattern, and survival rate were reviewed by bivariate and multivariate analysis.ResultsA total of 328 patients fulfilled the study’s inclusion parameters and the distribution of subtypes were as follows: Luminal A: 73 (22.3%), Luminal B/HER2−: 110 (33.5%), Luminal B/HER2+: 75 (22.9%), HER2-enriched: 30 (9.1%), and triple-negative: 40 (12.2%). The median follow-up was 41 months (interquartile range: 31–52). Pathological response to NAC was as follows: complete pathological response (pCR) in 28 (8.5%) patients, partial 247 (75.3%); stable disease 47 (14.3%), and progression 6 (1.8%) patients. The presence of pCR had a significant DFS and OS in the entire group (p = 0.01) but subtypes had different DFS in Luminal B (p = 0.01) and triple negative (p = 0.02) and also OS in Luminal B (p = 0.01) and triple negative (p = 0.01).ConclusionspCR is associated with an improved overall survival and disease-free survival rates in this group of Hispanics patients. Advanced stages, Luminal B subtypes, triple-negative tumours and non-pCR showed lower DFS.

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Adherence to the SFA tool was excellent. The low to moderate correlation between the abnormalities found in the objective SFA and the subjective fatigue tests suggest that objective evaluation of the functional capacity provides a potentially useful and independent end-point for clinical trials and therapeutic interventions. These assessment tools should be used complementary to each other to better assess the functional status of patients with advanced lung cancer. Large trials of objective functional assessment are justified.

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Detection of iron deficiency remains poorly understood and costly due to inappropriate screening. Low ferritin is a definitive diagnosis of iron deficiency, but screening with ferritin is not allowed. Therefore surrogates in the blood count have been used to justify obtaining the serum ferritin. The purpose of this research was to analyze the role of Hemoglobin (Hgb), Mean Corpuscular Volume (MCV), and RBC Distribution Width (RDW) as surrogates in screening for iron deficiency. All 2,563 patients with serum ferritin levels gathered over 12 months were reviewed. The relative utility of Hgb, MCV, and RDW in screening for low ferritin levels was shown through multiple Receiver Operator Characteristic (ROC) curves. 264 patients had a ferritin less than 10 ng/ml and 210 between 11 to 20 ng/ml. Results indicate that when viewed independently MCV correlates most closely to low ferritin as seen in Figure 1. RDW and Hgb in both males and females demonstrate a weaker association though remains of value. Table1 lists the values at which the three screening tools were 95% and 100% sensitive for detecting ferritin levels of 10 ng/ml and below. In contrast the data indicate that for ferritin levels from 11 to 20 ng/ml all three screening variables have poor sensitivity and specificity. This is demonstrated clearly in Figure 2. The data suggest that the most severe iron deficiency (ferritin under 10 ng/ml) can be well predicted by abnormalities in the blood count; however less severe iron deficiency (ferritin 10 to 20 ng/ml) cannot be anticipated from the blood count. The blood count does not appear to be a practical alternative to ferritin for screening for iron deficiency. Table 1: Sreening Variable Sensitivities* 100% Sensitivity 95% Sensitivity *values for ferritin less than 11 ng/ml MCV >98.2 >90.0 RDW <12.2 <13.1 Hgb Males >15.0 >13.7 Hgb Females >14.2 >12.6 Figure 1 Figure 1. Figure 2 Figure 2.

After treatment with imatinib, the majority of patients with chronic myelogenous leukemia (CML) achieve hematologic remission. This includes normalization of blood counts (red cells, white cells, and platelets) normalization of the white cell differential, and disappearance of abnormal immature cells from the peripheral blood. However, abnormal erythropoiesis may be more subtle than abnormal red cell counts. We reviewed two other indices of erythropoiesis, the mean cell volume (MCV) and the red cell distribution width (RDW). We studied 15 patients with a diagnosis of CML confirmed by BCR-ABL, in whom the first-line therapy was imatinib. Treatment dosage varied from 400 – 800 mg/day. Pre-treatment, all patients had an elevated white cell count, 14 of 15 had a low hemoglobin, and 11 of 15 had an abnormal high platelet count. None had an abnormal MCV (mean, 91.3, range 82 – 97), and 13 of 15 had an abnormal RDW (mean 16.2, range 14.1 – 19.2). After treatment was started, all 15 achieved a normal white cell count, hemoglobin, and platelet count within 3 months. All continued to have a normal MCV, with no apparent change (mean 92.1, range 82 – 98). However, after treatment 14 of 15 developed a normal RDW (mean 13.7, range 12.0 – 15.2). The RDW progressively declined during the first 3 months after treatment and reached an asymptote at that time. We conclude that hematopoiesis normalizes qualitatively as well as quantitatively after successful imatinib therapy of CML. Future study will determine whether an isolated elevated RDW will predict relapse or briefer duration of remission.