Therapeutic itinerary of colorectal cancer patients treated in the state of Rio Grande do Sul / Itinerário terapêutico de pacientes com câncer colorretal tratados no interior do Rio Grande do Sul

Objectives: The objective of the study was to evaluate the therapeutic itinerary of patients treated in a specialized center, including its trajectory in seeking treatment and their clinical and epidemiological characteristics. Methods: This is a cross-sectional prospective descriptive study; patients with colorectal cancer aged over 18 years and who signed the consent form were included in the analysis. Tumor characteristics, such as staging and tumor features; epidemiological characteristics such as age, gender, profession and itinerary in the form of the number of clinical visits needed to obtain the diagnosis; the main symptoms; and mean time between diagnosis and onset of treatment were evaluated. Results: 34% of patients initially sought primary care (first level of care in the public health system) and 50% were diagnosed in secondary care (second level of care in the public health system); the mean number of visits until obtaining a diagnosis was 2.5 times; and 52% of patients received palliative therapy and 40% had a stage IV diagnosis. Conclusions: The mean time between the diagnosis and the onset of treatment is in line with the recommendations of the Ministry of Health of Brazil. However, it was found that the patients are unaware of the symptoms of the disease, since the mean time between the onset of symptoms until the decision to visit the doctor was 177 days - which may have been a determining factor for a diagnosis in an advanced stage of disease.

Objetivos: O objetivo do estudo foi avaliar o itinerário terapêutico de pacientes tratados em um centro especializado, compreendendo sua trajetória na busca do tratamento e as características clínicas e epidemiológicas. Métodos: estudo descritivo prospectivo transversal; foram incluídos na análise pacientes portadores de câncer colorretal (CCR) maiores de 18 anos que assinaram o termo de consentimento. Foram avaliadas características tumorais, como estadiamento e características do tumor; características epidemiológicas como idade, sexo e profissão e a trajetória como número de consultas até o diagnóstico, principais sintomas e tempo médio entre o diagnóstico e início do tratamento. Resultados: 34% dos pacientes procuraram inicialmente a atenção primária (primeiro nível de atenção na saúde pública), 50% receberam o diagnóstico na atenção secundária (segundo nível de atenção na saúde pública), a média de consultas até o diagnóstico foi de 2,5 vezes, 52% dos pacientes fizeram terapia paliativa e 40% fizeram diagnóstico em estádio IV. Conclusões: o tempo médio entre o diagnóstico e o início do tratamento está de acordo com o recomendado pelo Ministério da Saúde do Brasil; entretanto, identificou-se que os pacientes desconhecem os sintomas da doença, uma vez que a média de tempo entre o início dos sintomas até a tomada de decisão de procurar um médico foi de 177 dias, o que pode ter sido determinante para um diagnóstico na fase avançada da doença.

Increased atherothrombotic markers and endothelial dysfunction in steroid users.

BACKGROUND: The use of androgenic anabolic steroids (AAS) may be associated with changes in atherothrombotic markers and endothelial function. The purpose of this study was to compare atherothrombotic markers and endothelial function of AAS users and non-users. DESIGN: Cross-sectional study. METHODS: Ten athletes who were users of AAS (confirmed by urine analysis) and 12 non-user athletes were evaluated. Body weight, blood pressure, exercise load (hours/week), complete blood count (CBC), platelets, fibrinogen, lipids, high-sensitivity C-reactive protein (hs-CRP), follicle-stimulating hormone, testosterone and estradiol were measured. Endothelium-dependent and independent functions were assessed by brachial artery ultrasound. RESULTS: AAS users had higher body mass and blood pressure (p < 0.05). Platelet count was higher whereas HDL-cholesterol was lower in AAS users compared with non-users (p < 0.05). Levels of hs-CRP were higher in AAS users (p < 0.001). Follicle-stimulating hormone was suppressed in all users and not suppressed in non-users (p < 0.001). Compared with non-users, flow-mediated dilation was significantly reduced in AAS users (p = 0.03), whereas endothelium-independent function was similar in both groups. Additionally, flow-mediated dilation was positively associated with levels of HDL- cholesterol (r = 0.49, p = 0.03). CONCLUSIONS: AAS users present important changes in blood lipids as well as in inflammatory markers, which are compatible with increased cardiovascular risk. Furthermore, this profile is accompanied by a reduction in the endothelial function.

Clinical and epidemiological evaluation of patients with colorectal cancer from Rio Grande do Sul

Colorectal cancer has a high incidence in Brazil, with the South and Southeast regions presenting the largest number of cases. OBJECTIVE: Identify the epidemiological characteristics and the regimens used as first-line treatment of patients with colorectal cancer treated at a cancer center in Santa Cruz do Sul (RS, Brazil) from 2006 to 2011. METHODS: The records of 130 patients were retrospectively evaluated. Clinical and epidemiological characteristics, such as age, gender, ethnic group, stage of disease, primary site of disease and first-line treatment, were evaluated. The association of significance was evaluated using the chi-square and Fischer exact tests. The confidence interval used was 95% (p<0.05). RESULTS: The mean age of patients with colorectal cancer in this study was 60.8 years, with higher incidence of the disease in men. At diagnosis, 40% of the patients had advanced disease stage IV. The regimen of 5-fluorouracil/folic acid (68.5%) was used as first-line treatment. CONCLUSION: This study showed high prevalence of colorectal cancer in patients of advanced age with the diagnosis made in the later stage of the disease. This fact demonstrates the importance of prevention campaigns that encourage periodic examinations in patients over 50 years of age. (AU)

No Brasil, o câncer colorretal apresenta uma elevada incidência, sendo as Regiões Sul e Sudeste as com maior número de casos. OBJETIVO: Identificar as características epidemiológicas e os esquemas terapêuticos utilizados como primo-tratamento dos pacientes portadores de câncer colorretal atendidos em um centro especializado em oncologia em Santa Cruz do Sul (RS) no período de 2006 a 2011. MÉTODO: Foram avaliados retrospectivamente 130 prontuários de pacientes portadores de câncer colorretal. Características clínicas e epidemiológicas como idade, sexo, cor da pele, estádio da doença, sítio primário da doença e primo-tratamento foram avaliadas. A associação de significância foi avaliada pelos testes do qui-quadrado e exato de Fischer. O intervalo de confiança utilizado foi de 95% (p<0,05). RESULTADOS: A idade média dos pacientes encontrada neste estudo foi de 60,8 anos com incidência maior da doença entre os homens. No momento do diagnóstico, 40% dos pacientes estavam com a doença no estádio IV. Como primo-tratamento o esquema terapêutico mais utilizado foi o 5-fluoracil/ácido folínico (68,5%). CONCLUSÃO: Este estudo ratificou a alta prevalência do câncer colorretal em pacientes com idade mais avançada, com o diagnóstico realizado na fase mais avançada da doença. Esse fato evidencia a importância da realização de campanhas de prevenção que estimulem a realização de exames periódicos nos pacientes com idade acima de 50 anos. (AU)