Experiences of Patients with Breast Cancer Participating in a Prehabilitation Program: A Qualitative Study.

Background: Breast cancer (BC) is the most prevalent cancer diagnosis among women worldwide. Several randomized controlled trials and systematic reviews have shown the benefits of exercise before, during, and after cancer treatment to manage side effects related to cancer and its therapies. However, these are poorly implemented across the disease-span, specifically, during the preoperative setting. Methods: Patients diagnosed with BC and participating in a randomized controlled trial on the effects of a prehabilitation program based on Nordic walking, muscle strengthening, and therapeutic education were invited to participate in this qualitative substudy. Two groups of eight patients each were recorded, transcript and analyzed using a specialized software (Atlas-Ti®, version 24). Results: During the axial codification phase, 22 unique codes and 6 main themes were identified related to their experience with the program, namely, (1) information received prior to participating; (2) motivation to participate; (3) barriers; (4) facilitators; (5) perceived degree of support from healthcare workers as well as peers; and (6) satisfaction with the characteristics of the prehabilitation program. Conclusions: Patients interviewed showed great interest in prehabilitation as a way to prepare both physically and mentally for surgery. In order to implement these interventions, healthcare systems need to acknowledge barriers and facilitators as well as the need for these programs to be supervised and monitored to avoid adverse events.

Prehabilitation in Patients With Breast Cancer Receiving Neoadjuvant Therapy to Minimize Musculoskeletal Postoperative Complications and Enhance Recovery (PREOPtimize): A Protocol for a Randomized Controlled Trial.

OBJECTIVE: The aim of this study is to assess the effects of a prehabilitation program (PREOPtimize), consisting of Nordic Walking and resistance training exercises plus health education among patients with breast cancer, who are receiving neoadjuvant therapy to enhance postoperative functionality of the affected arm. A secondary aim will be to compare the short-term effects of the intervention on other patient-reported outcome measures. METHODS: This will be an assessor-blind, randomized controlled trial with a parallel group design conducted at a tertiary hospital. A sample of 64 patients with breast cancer scheduled for surgery and undergoing neoadjuvant chemotherapy will be recruited for the trial and randomly allocated to either (1) a prehabilitation program consisting of 2 weekly sessions of 75 minutes of Nordic Walking, muscle strengthening exercises, and health education sessions conducted between the fourth month of treatment and surgery or (2) usual care. Patients in both groups will be assessed at baseline, before surgery, and at 1 and 3 months after surgery. Assessed outcomes include functionality of the affected arm (QuickDash), arm volume, range of motion, handgrip strength, pain, fatigue, functional capacity, physical activity levels, and health-related quality of life. Adherence to the intervention in the prehabilitation group and adverse events will also be recorded. IMPACT: Prehabilitation for patients affected by breast cancer is rarely implemented in clinical practice. The results obtained with the PREOPtimize trial could show that prehabilitation is a feasible intervention for patients with breast cancer receiving neoadjuvant therapy that might enhance postoperative recovery of upper arm function as well as improve overall physical performance and health-related quality of life.

Trichomonas vaginalis 62 kDa proteinase as a possible virulence factor.

The aim of this study was to analyze the presence of 62 kDa proteinase and anti-62 kDa proteinase antibody in clinical samples of symptomatic and asymptomatic infected women. Proteinase was detected in all the swabs vaginal of infected women. Significantly, amounts of antigen (mean optical density (OD) values) were detected in swabs vaginal of symptomatic as compared to asymptomatic women. This protein was not detected in the group of patients with Trichomonas vaginalis-culture-negative results and in the groups of samples infected with other agents. Antibody to 62 kDa was detected in the swabs vaginal the only 66.6% of the symptomatic and 55.5% of the asymptomatic infected women. Antibody to 62 kDa was also detected in 7/30 of the swabs vaginal from uninfected women. No significant difference was observed in mean OD values of vaginal swabs of T. vaginalis-infected symptomatic as compared to asymptomatic women. The presence of proteinase in 100% of T. vaginalis-infected women suggested that 62 kDa proteinase could be a virulence factor.

Purified capsular polysaccharide of Neisseria meningitidis serogroup A as immune potentiator for antibody production.

The development of new immune potentiators for human vaccines is an important and expanding field of research. In the present study, the ability of the capsular polysaccharide from Neisseria meningitidis serogroup A (CPS-A), a mannose-containing carbohydrate, to enhance the antibody production against a co-administered model vaccine antigen, is examined. A protein-meningococcal serogroup C capsular polysaccharide (CPS-C) conjugate was selected as the model antigen for this study. After subcutaneous immunization of Balb/C mice, the conjugate mixed with CPS-A induced higher anti-CPS-C IgG and IgG(2a) antibody levels and higher anti-meningococcal serogroup C bactericidal titers than the conjugate alone or mixed with CPS-C. The immuno-stimulatory properties exhibited by CPS-A and the fact that vaccines based on purified CPS-A has been safely used during decades to fight the serogroup A meningococcal disease, support the proposal to use CPS-A as immune potentiator for human vaccination studies.

Immunologic memory response induced by a meningococcal serogroup C conjugate vaccine using the P64k recombinant protein as carrier.

In this study, we used an adoptive lymphocyte transfer experiment to evaluate the ability of the P64k recombinant protein to recruit T-helper activity and induce immunologic memory response to the polysaccharide moiety in a meningococcal serogroup C conjugate vaccine. Adoptive transfer of splenocytes from mice immunized with the glycoconjugate conferred antipolysaccharide immunologic memory to naive recipient mice. The observed anamnestic immune response was characterized by more rapid kinetics, isotype switching from IgM to IgG and higher antipolysaccharide antibody titers compared with those reached in groups transferred with splenocytes from plain polysaccharide or phosphate-immunized mice. The memory response generated was also long lasting. Sera from mice transferred with cells from conjugate-immunized mice were the only protective in the infant rat passive protection assay, and also showed higher bactericidal titers. We demonstrated that priming the mice immune system with the glycoconjugate using the P64k protein as carrier induced a memory response to the polysaccharide, promoting a switch of the T-cell-independent response to a T-cell dependent one.

Safety and preliminary immunogenicity of MenC/P64k, a meningococcal serogroup C conjugate vaccine with a new recombinant carrier.

This study reports the preliminary assessment of the safety and immunogenicity of the first serogroup C conjugate vaccine candidate that includes meningococcal P64k recombinant protein as the carrier (MenC/P64k). Twenty volunteers were recruited for a double-blind, randomized, controlled phase I clinical trial, receiving a single dose of MenC/P64k (study group) and a single dose of the commercial polysaccharide vaccine AC (control group). Only mild reactions were observed. No statistical differences were detected between the antipolysaccharide C IgG responses of both groups as well as between bactericidal serum titre (P > 0.05). The MenC/P64k vaccine was found to have a good safety profile, to be well tolerated and immunogenic.

Comparison of three ELISA protocols to measure antibody responses elicited against serogroup C meningococcal polysaccharide in mouse, monkey and human sera.

In this study we compared the following ELISA protocols to measure antibody levels against serogroup C meningococcal polysaccharide: a traditional protocol using poly-L-Lysine mixed with the polysaccharide as coating antigen, a second protocol coating with a mixture of methylated human serum albumin with the C polysaccharide, a modified protocol coating with derivatized polysaccharide and a modification to the last one, specifically without adding ammonium thiocyanate to the sample buffer. Serum bactericidal activity of mouse, monkey and human sera were measured and correlation coefficients were calculated. For all serum types the modified ELISA protocol showed the highest correlation coefficients while the traditional protocol showed the lower ones. We demonstrated that the traditional protocol measures non-specific antibodies to the C polysaccharide, because no differences were detected between pre-immune and post-immune human sera (P>0.05), while the modified protocol detected the highest difference (P<0.01).

Prevalencia de la discapacidad visual en el adulto diabético en Cuba / Prevalence of visual impairment among adult diabetics in Cuba

Objetivo: Describir la discapacidad visual del diabético de 50 años y más de edad y la cobertura de la atención oftalmológica en Cuba durante el año 2016. Métodos: Se realizó una investigación epidemiológica, descriptiva y transversal que tomó la encuesta rápida de ceguera evitable realizada en Cuba en el año 2016, la cual incluyó la retinopatía diabética validada por la Organización Mundial de la Salud. Con los datos obtenidos en los cuestionarios se confeccionó una base de datos donde se tomaron todos los diabéticos conocidos o no con discapacidad visual. Resultados: La prevalencia de cualquier tipo de discapacidad visual en el diabético es de 25,4 por ciento (21,8-28,9). El riesgo de desarrollar discapacidad visual moderada, grave y ceguera es de 19,4 por ciento (16,5-22,3), 2,8 por ciento (1,0-4,6) y 3,2 por ciento (1,5-4,8) respectivamente. La catarata es la primera causa de discapacidad. El riesgo de discapacidad visual en el diabético es similar para uno y otro sexo y se incrementa con la edad. Las coberturas de tratamiento son bajas. Conclusiones: En Cuba, alrededor de un cuarto de los diabéticos tienen algún riesgo de discapacidad visual. El diabético tiene mayor riesgo de discapacidad visual moderada; sin embargo, el riesgo de discapacidad visual grave y de ceguera es el mismo para toda la población de 50 años y más de edad. La catarata y la retinopatía diabética son las causas más frecuentes de discapacidad visual en el diabético. Se evidencian dificultades con la atención oftalmológica, que incluye el examen y la cobertura de tratamiento de la catarata y del láser para la retinopatía diabética(AU)

Objective: Describe visual impairment among diabetics aged 50 years and over, and the coverage of ophthalmological care in Cuba in the year 2016. Methods: A descriptive cross-sectional epidemiological study was conducted based on the Rapid Assessment of Avoidable Blindness survey developed in Cuba in the year 2016, which included diabetic retinopathy with validation by the World Health Organization. The data obtained from the questionnaires were transferred to a database of visually impaired known and unknown diabetics. Results: Prevalence of any sort of visual impairment among diabetics is 25.4 percent (21.8-28.9). Risk of developing moderate visual impairment, severe visual impairment or blindness is 19.4 percent (16.5-22.3), 2.8 percent (1.0-4.6) and 3.2 percent (1.5-4.8), respectively. Cataract is the leading cause of impairment. Risk of visual impairment among diabetics is similar in the two sexes and increases with age. Treatment coverage is low. Conclusions: In Cuba, about one fourth of the diabetics are at some risk of visual impairment. Diabetics are at a higher risk of moderate visual impairment. However, the risk of severe visual impairment and blindness is the same as for the population aged 50 years and over. Cataract and diabetic retinopathy are the most common causes of visual impairment among diabetics. Difficulties were found in ophthalmological care, including examination and treatment coverage for cataract and laser therapy for diabetic retinopathy(AU)

Caracterización clínica y epidemiológica de la maculopatía diabética en adultos de 50 años y más en Cuba / Clinical and epidemiological characterization of diabetic maculopathy in adults aged 50 years and over in Cuba

RESUMEN Objetivo: Determinar las características clínicas y epidemiológicas de la maculopatía diabética en adultos de 50 años y más en Cuba. Métodos: Se realizó una investigación epidemiológica, descriptiva transversal, que tomó la Encuesta Rápida de Ceguera Evitable realizada en Cuba en el año 2016, la cual incluyó la retinopatía diabética validada por la Organización Mundial de la Salud. Resultados: La prevalencia de cualquier grado de maculopatía fue de 8,5 por ciento (6,1 a 10,8) y la maculopatía observable y remitible fue de 4,2 por ciento (2,2 a 6,0). El riesgo de desarrollar maculopatía resultó mayor en el sexo femenino, con el 9,3 por ciento (6,6-12,9), y en los diabéticos que tenían entre 60 y 69 años de edad, de 9,2 por ciento (5,7-14,0). Este riesgo se incrementaba si existía descontrol de la glicemia y si la enfermedad tenía 15 años y más de evolución. La asociación con la retinopatía observable fue de 2,5 por ciento. La discapacidad visual moderada por maculopatía fue de 1,4 % y la grave junto con la ceguera de 0,8 por ciento. La cobertura de tratamiento fue baja (28,6 por ciento por personas). Conclusiones: El diabético de 50 años y más en Cuba tiene baja prevalencia de maculopatía diabética, la cual se comporta de manera similar para la forma observable y para la remitible. La retinopatía no proliferativa moderada tiene mayor riesgo de afectación macular. La discapacidad visual por afectación macular en el diabético es baja, aunque la estrategia de atención oftalmológica en el diabético no alcanza los estándares necesarios de efectividad, relacionados con la cobertura del tratamiento con láser(AU)

ABSTRACT Objective: Determine the clinical and epidemiological characteristics of diabetic maculopathy in adults aged 50 years and over in Cuba. Methods: A descriptive cross-sectional epidemiological study was conducted based on the Rapid Assessment of Avoidable Blindness survey developed in Cuba in the year 2016, which included diabetic retinopathy with validation by the World Health Organization. Results: Prevalence of any maculopathy grade was 8.5 percent (6.1 to 10.8), whereas observable, referable maculopathy was 4.2 percent (2.2 to 6.0). Risk for maculopathy was higher in the female sex with 9.3 percent (6.6-12.9) and among diabetics from the 60-69 years age group with 9.2 percent (5.7-14.0). Risk increased in uncontrolled glycemia and when the evolution of the disease was 15 years and over. Association with observable retinopathy was 2.5 percent. Moderate visual disability due to maculopathy was 1.4 percent, while severe disability and blindness were 0.8 percent. Treatment coverage was low (28.6 percent per persons). Conclusion: Prevalence of maculopathy is low among diabetics aged 50 years and over in Cuba, with similar behavior in the observable and the referable variants. Moderate non-proliferative retinopathy shows a higher risk for macular damage. Visual disability due to macular damage is low among diabetics, though the ophthalmological care strategy for diabetics does not achieve the required effectiveness standards in terms of laser therapy coverage(AU)

Effect of conjugation methodology on the immunogenicity and protective efficacy of meningococcal group C polysaccharide-P64k protein conjugates.

Neisseria meningitidis serogroup C polysaccharide (CCPS) was conjugated to the carrier protein P64k using two different conjugation procedures, condensation mediated by carbodiimide with adipic acid dihydrazide as spacer and the reductive amination method. BALB/c mice were immunized with the resultant polysaccharide-protein conjugates and the immune response was evaluated. All conjugates assayed generated at least 10-fold higher antibody titers than the free polysaccharide. The reductive amination method rendered the best conjugate (CCPS-P64kR) that was able to elicit antibody titers statistically higher than the titer elicited by the plain CCPS (P<0.001). The sera of the group immunized with CCPS-P64kR showed a three-fold higher bactericidal response than the sera of the group immunized with the plain CCPS and they were able to protect against challenge with meningococci in the infant rat protection model. In addition, three different conjugates were obtained from polysaccharides with molecular relative sizes of 2000-4000 Da, 4000-10,000 Da or 10,000-50,000 Da, but no differences were detected in the immune response obtained against the three conjugates. Our experiments demonstrate that it is possible to generate a protective, T-cell-dependent response against CCPS using the P64k protein as carrier.

Discapacidad visual: Factor agravante de la discapacidad física en pacientes reumáticos. Presentación de un caso

Se realiza la presentación de caso de una Paciente, femenina de 53 años de edad, con antecedentes de artritis reumatoide desde hace 34 años tratada con esteroides en dosis pequeñas y moderadas, así como con los fármacos modificadores de la enfermedad con los que dispone el cuadro básico de medicamentos, solos o en combinación, actualmente con leflunomida. Padece así mismo de diabetes mellitus 3 años tratada con Insulina y de hipertensión arterial que es tratada con lmlodipino. Hace aproximadamente 3 años presenta disminución lenta y progresiva de la agudeza visual, que no resolvía con el uso de cristales correctores lo que asociado a su déficit motor y muscular debido a la artritis reumatoide, le impedía tener una vida con calidad, agravando su dependencia de otra persona para la realización de las actividades básicas de la vida diaria. Clasificada desde la Clinimetria: Capacidad funcional: Steinbrocker grado IV. HAQ-CU: 3. Se precisó el diagnóstico de catarata pre-senil y se decidió su tratamiento quirúrgico en aras de mejorar la calidad de vida de esta paciente

The incidence of visual incapacity in patients with rheumatic disease is a factor that increases the physical incapacity in these persons. We report the case of a 53 year old, female, from a rural area, with Antecedents of suffering from rheumatoid arthritis for 34 years and other diseases such as Hypertension and diabetes mellitus. She was treated with different medications such as anti-inflammatory steroids as well as the disease modifier drugs, insulin and Amlodipino. Around 3 years ago she had been having slow and progressive loss of vision which did not improve with the use of glasses. Then she was evaluated by the ophthalmologist and a surgical treatment for bilateral cataracts was indicated to improve her life quality. After surgery the patient had a good recovery

Uveítis. Un reto para el Reumatólogo

Las uveítis son un grupo heterogéneo de entidades clínicas, de muy diversas causas, que tienen en común la inflamación intraocular. Pueden ser la manifestación de una enfermedad generalizada ya establecida, ser un proceso limitado al globo ocular, o incluso ser el primer signo clínico de una entidad que se desarrollará con el tiempo. Por ello, el reumatólogo, con ayuda del examen oftalmológico, intentará buscar manifestaciones extraoculares específicas, para así solicitar las pruebas complementarias oportunas según su hipótesis diagnóstica.

The uveitis are a heterogeneous group of clinical entities, from very different causes, which have in common the intraocular inflammation. They can be the manifestation of disease widespread as established, be a process limited to the eyeball, or even be the first clinical sign of an entity that will develop over time. Therefore, rheumatologist, with the help of an eye examination, will attempt to search specific extraocular manifestations, for appropriate complementary tests according to their diagnostic hypothesis.

The enlargement of the hormone immune deprivation concept to the blocking of TGFalpha-autocrine loop: EGFR signaling inhibition.

Transforming growth factor alpha (TGFalpha) is a potent ligand of the epidermal growth factor receptor (EGFR). EGFR is frequently over-expressed in epithelial tumors and endogenous ligands, mostly TGFalpha, are frequently co-expressed with EGFR, potentially resulting in autocrine stimulation of tumor cell growth. Therefore, different therapeutic approaches aim for the inactivation of TGFalpha/EGF/EGFR signaling system, but no approach is based on TGFalpha as a target. The principal goal of this work was to assess the potential of an active specific immunotherapy approach to block the TGFalpha/EGFR autocrine loop. For the proof of the concept, a fusion protein between human TGFalpha (hTGFalpha) and P64k protein from Neisseria meningitidis was generated, and its immunogenicity characterized in a mouse model using different adjuvants. All immunogens were effective for the generation of specific humoral responses against hTGFalpha. The inmunodominant epitope of hTGFalpha when immunizing mice with the fusion protein involved the C-loop/C-terminal region. This region includes key residues for hTGFalpha binding to EGFR. The anti-hTGFalpha immune mice sera recognized the natural hTGFalpha precursor in A431 cells and hTGFalpha-transfected 3T3 fibroblasts as revealed by flow cytometry analysis and immunoblotting. They inhibited the binding of (125)I-TGFalpha to the EGFR, EGFR-autophosphorylation, and downstream activation of MAP kinases as well as proliferation of two EGFR-expressing human carcinoma cell lines. These data suggest that EGFR signaling activation by the hTGFalpha autocrine loop may be inhibited in vivo by induction of specifically blocking antibodies. The fusion protein reported in this paper could be a potential immunogen for the development of a new cancer vaccine.