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BACKGROUND Trastuzumab improves dramatically the prognosis of HER2-positive breast cancer patients, but it may lead to cardiotoxicity with left ventricular (LV) systolic dysfunction. Its effects on right ventricular (RV) function have not however been elucidated. We sought to assess LV and RV deformation mechanics during treatment with trastuzumab in breast cancer patients. METHODS AND RESULTS We studied 101 consecutive women (mean age 54.3 ± 11.4 years) receiving trastuzumab for 12 months; 62 of them (61.4%) had previously received anthracyclines and 26 (25.7%) were receiving taxanes concurrently with trastuzumab. Comprehensive two-dimensional echocardiography with speckle tracking imaging of LV and RV global longitudinal strain (GLS) and RV free wall longitudinal strain (FWLS) analyses were performed at baseline and every 3 months up to treatment completion. Cardiotoxicity was defined as a decrease of baseline LV ejection fraction > 10 percentage units to a value < 50%. At 3 months, only LV GLS was significantly reduced (-19.5 ± 2.7 to -18.7 ± 2.8, P = 0.0410), while at 6 months, LV GLS, RV GLS and RV FWLS had significantly declined reaching their lowest values (-17.9 ± 6.1, P = 0.002, -19.6 ± 5.2, P = 0.003 and -19.7 ± 5.6, P = 0.004, respectively). Ten women (9.9%) developed cardiotoxicity. A RV GLS percent change of -14.8% predicted cardiotoxicity with 66.7% sensitivity and 70.8% specificity (area under the curve 0.68, 95% confidence interval 0.54-0.81), classifying correctly 90% of women with cardiotoxicity. This cut-off is quite similar to the 15% change of LV GLS previously suggested as predictive of cardiotoxicity. CONCLUSIONS Deformation mechanics of both the left and right ventricle follow similar temporal pattern and degree of impairment during trastuzumab therapy, confirming the global and uniform effect of trastuzumab on myocardial function.

Byline: T. Sathyanarayana Rao, Mahesh. Gowda, Kanchana. Ramachandran, Chittaranjan. Andrade There are substantial variations in the stated number of farmers committing suicide in India, each year, partly related to variations in the operationalization of the concept of farming as a profession. If these variations are ignored, and if data from the National Crime Records Bureau (NCRB) are accepted, it emerges that there have been 5650 farmer suicides in 1 year (2014), itself. Maharashtra is considered to be India's farmer suicide epicenter [sup][1] and has recorded 20,504 farmer suicides since 2001.[sup][2] Psychosocial Versus Socioeconomic Origins of Farmer Suicide Concerns about farmer suicide are not new, and studies on the subject have suggested different explanations for the act. One school of thought has suggested the primacy of an impaired mental health state, implying that the psychosocial needs of farmers have been neglected, and that caring community professionals need to address farmer distress.[sup][3] This school of thought additionally envisages a role for early psychiatric intervention as a primary preventive measure. In this connection, reports on the lack of psychiatrists offering to help have been of concern.[sup][4] However, there is evidence from studies in Karnataka, Kerala, Tamil Nadu, and other states in India that the role of socioeconomic stress in farmer suicide may be greater than the role of mental disorders.[sup][5],[6],[7],[8] Studies have not discovered conclusive evidence of psychiatric morbidity behind farmer suicides; rather these studies and other statistical data point toward severe socioeconomic adversity as the primary trigger. The NCRB 2014 data also support this conclusion as they indicate that almost 75% of the 5650 suicides that were recorded during 2014 were by small and marginal farmers holding up to two hectares of land; these sections of farmers are exposed to severe socioeconomic hardship. The same NCRB report attributed reasons such as bankruptcy, indebtedness, crop failure, and other farming-related issues to more than 60% of the suicide cases. It is therefore necessary to further investigate these adverse socioeconomic conditions and address the root cause of the suicide risk with the best pragmatic remedies. Socioeconomic Risk Factors in Farming Farming in India is a financially perilous profession with the annual farm income subject to many uncertainties. Farm work involves physical stress and can even be physically hazardous. There is psychological stress associated with coping with the regulatory framework and the dynamics of managing a farm business.[sup][9] The greatest risks, however, are economic in nature. More than 80% of Indian farmers have land holdings below two hectares. This fragmented and small land holding makes farming a risky economical proposition even under the best of conditions. In reality, the conditions are hardly anywhere near best. The smallness of the holding straightaway denies the farmers the benefits of mechanization, modern irrigation, and other investment-based technological improvements. As a result, productivity is suboptimal. The unpredictable, diminishing pattern of rainfall over India adversely impacts the farm output. Other climatic vagaries, such as hailstorms, can cause substantial crop damage. Migration from villages to towns and cities has decreased the availability of labor and increased its costs. The income earned from crops depends on the prevailing market situation, the greed of middlemen, the logistics of selling the produce, and other factors. Often, the government-administered minimum support price (MSP) may not even cover the cost of production. Consider, for example, the case of sugarcane production; the MSP is only INR 1000–1100 per unit against a production cost of INR 900–1000. On the surface, it appears that the farmer will make a (small) profit. …