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Anthracycline-induced cardiotoxicity:A case report and review of literature

World Journal of Cardiology 2021年第1期13卷 28-37页

作者： Esther G Chong Eric H Lee Reena Sail Laura Denham gayathri nagaraj Chung-Tsen Hsueh Department of Medicine Loma Linda UniversityLoma LindaCA 92350United States Department of Hematology/Oncology Compassionate Cancer Care Medical GroupFountain ValleyCA 92708United States Department of Hematology/Oncology Scripps MD Anderson Cancer CenterSan DiegoCA 92121United States Department of Pathology and Human Anatomy Loma Linda UniversityLoma LindaCA 92350United States Division of Medical Oncology and Hematology Department of MedicineLoma Linda UniversityLoma LindaCA 92350United States

BACKGROUND Doxorubicin and other anthracycline derivatives inhibit topoisomerase II and is an important class of cytotoxic chemotherapy in cancer *** use of anthracycline is limited by dose-dependent cardiotoxicity,which may manifest initially as asymptomatic cardiac dysfunction with subsequent progression to congestive heart *** baseline assessment and periodic monitoring of cardiac function for patients receiving anthracycline agents,there are unmet needs in prediction and prevention of anthracycline-induced cardiotoxicity(AIC).CASE SUMMARY A 35-year-old African American female was found to have a 9-cm high-grade osteosarcoma of right femur and normal baseline cardiac function with left ventricular ejection fraction of approximately 60%-70%determined by transthoracic and dobutamine stress *** underwent perioperative doxorubicin and cisplatin chemotherapy with 3 cycles before surgery and 3 cycles after surgery,and received a total of 450 mg/m2 doxorubicin at the end of her treatment *** was evaluated regularly during chemotherapy without any cardiac or respiratory *** two months after her last chemotherapy,the patient presented to the emergency department with dyspnea for one week and was intubated for acute hypoxic respiratory *** showed an ejection fraction of 5%-10%with severe biventricular *** attempts to optimize cardiac function,the patient’s hemodynamic status continued to decline,and resuscitation was not successful on the seventh day of *** autopsy showed no evidence of osteosarcoma,and the likely cause of death was cardiac failure with the evidence of pulmonary congestion,liver congestion,and multiple body cavity *** We present a case of 35-year-old African American female developing cardiogenic shock shortly after receiving a cumulative dose of 450 mg/m2 doxorubicin over 9 *** monitoring and management of patients receivin

关键词： Anthracycline Cardiotoxicity Doxorubicin Troponin Brain natriuretic peptide Case report

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High Prevalence of Ciprofloxacin Resistance in Community Associated <i>Staphylococcus aureus</i>in a Tertiary Care Indian Hospital

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Advances in Microbiology 2014年第2期4卷 133-141页

作者： Bhavya Chakrakodi Sushma Prabhakara Savitha nagaraj Jerome Etienne gayathri Arakere Reference Centre for Staphylococci Hospices Civils de Lyon Lyon France Faculte de Medicine Lyon Est University of Lyon Inserm U851 Lyon France Society for Innovation and Development Indian Institute of Science Bengaluru India St. John’s Hospital and Medical College Bengaluru India

We have studied the nature of ciprofloxacin resistance in methicillin sensitive and resistant Staphylococcus aureus among patients in a tertiary care hospital in Bengaluru, South India. All the isolates were highly resistant to ciprofloxacin. Molecular characterization of these samples performed using Staphylococcal Cassette Chromosome typing and multilocus sequence typing showed that 37.5% of total isolates and 59% of MRSA were sequence type (ST)772 and the rest were other STs. This indicates high prevalence of CA-MRSA in this tertiary care hospital serving the Indian community. Mutations responsible for ciprofloxacin resistance among these isolates in DNA gyrase (gyrA and gyrB) and topoisomerase IV (grlA and grlB) were analyzed by PCR amplification of specific fragments and sequencing. We found that for ST772 and five other STs present in this collection, single mutation in the gyrA gene, Ser-84→Leu, was sufficient for the high resistance. In vitro generation of ciprofloxacin resistance in two sensitive ST772 isolates by exposure to increasing antibiotic concentrations also resulted in the same single mutation of gyrA. The factors responsible for high ciprofloxacin resistance are varied and are dependent on the genetic background of the isolates and the environment. This is the first report on the mechanism of ciprofloxacin resistance among the most prevalent Indian CA-MRSA.

关键词： Ciprofloxacin Resistance Indian ST772 Staphylococcus Aureus gyrA Mutations

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