Associated factors to human papillomavirus vaccine adhesion in adult women: a cross-sectional study.

Background: The goal of human papillomavirus (HPV) vaccination is the decline of HPV related premalignant lesions, leading to prevention of cervical cancer. Vaccination against HPV is recommended until the age of 45 to prevent viral reinfections and reactivations. The aim of this study was to evaluate adhesion to HPV vaccination and their associated factors in adult women. Methods: Cross-sectional study in two tertiary hospitals, with a questionnaire distributed to women born between 1974 and 1992, from September till November 2019. Data collected included sociodemographic information, clinical information, knowledge about HPV, and the HPV vaccine and data regarding vaccine recommendation. Factors associated with vaccination were searched by bivariate and multivariate statistical analysis. Results: In 469 questionnaires, 25.4% (n = 119) women were vaccinated. The main reason for not vaccinating was the non-recommendation (n = 276; 70.2%). In bivariate analyses, vaccinated women were younger, predominantly not married, had higher educational level, and higher careers (P ≤ .001); an abnormal cytology, HPV infection or previous excision of the transformation zone were associated with a 3 to 4-fold increase in the odds of vaccination. Age, high-risk HPV infection, and knowing someone vaccinated remained factors independently associated with HPV vaccination in the multivariate analyses (P< .05). The recommendation of "vaccinate immediately" was independently associated with effectively doing it (P< .001). Conclusions: HPV vaccination is associated with vaccine recommendation, especially if it is recommended to do immediately. These results reinforce the need of health professionals to be aware of the impact that their recommendation has on adhesion to HPV vaccination.

Family Satisfaction With Critical Care: Before and After the COVID-19 Outbreak.

Introduction Family satisfaction with intensive care units (ICU) is recognized as a key component of the quality of care. As a result, family members are now more involved in the care process, and their needs are recognized throughout the ICU stay. The coronavirus disease 2019 (COVID-19) changed healthcare worldwide, due to the several restrictions imposed; the communication patterns changed drastically, and institutions were forced to adapt to create a balance between security and the needs of relatives. The aim of this study was to assess family members' satisfaction with the ICU and determine if the COVID-19 restructuring affected family satisfaction. Methods A prospective observational study was performed among the designated family members (DFM) of ICU patients over two time periods, a pre-pandemic period from December 2019 to February 2020 and a pandemic period from May 2020 to February 2021. The Family Satisfaction in the Intensive Care Unit 24 (FS-ICU 24) questionnaire, which was given to the DFM, was the instrument used to determine family satisfaction. Results The study involved 290 DFM, 175 during the pre-pandemic phase and 115 during the pandemic period. The overall and domain-specific family satisfaction scores were high (score > 80) in both the pre-pandemic and pandemic periods. The greatest satisfaction levels were related with symptom management and how nurses and doctors cared for the patient. No statistical differences were found between the two time periods. Lastly, a positive association between the two domains explored by FS-ICU 24, satisfaction with care and satisfaction with decision-making process, was verified in both time frames. Conclusion The data obtained revealed very good outcomes on the different FS-ICU 24 domains, in line with other studies in literature. No significant differences were found between the pre-pandemic and pandemic periods, suggesting that the measures implemented during the COVID-19 were successful. The importance of involving families in the decision-making process, providing them with accurate information, and active listening, as well as using better communication skills, is emphasized throughout all these results. The relevance of measuring family satisfaction should be brought to the attention of family members and healthcare professionals so that additional research may be conducted.

One Year of COVID-19 in Pregnancy: A National Wide Collaborative Study.

INTRODUCTION: Even though the risk of COVID-19 in pregnancy may be increased, large-scale studies are needed to better understand the impact of the infection in this population. The aim of this study is to describe obstetric complications and the rate of vertical transmission in pregnant women with SARS-CoV-2 infection. MATERIAL AND METHODS: Detected cases of SARS-CoV-2 infection in pregnancy were registered in Portuguese hospitals by obstetricians. Epidemiological, pregnancy and childbirth data were collected. RESULTS: There were 630 positive cases in 23 Portuguese maternity hospitals, most at term (87.9%) and asymptomatic (62.9%). The most frequent maternal comorbidity was obesity. The rates of preterm birth and small-to-gestational-age were 12.1% and 9.9%, respectively. In the third trimester, 2.9% of pregnant women required respiratory support. There were eight cases (1.5%) of fetal death, including two cases of vertical transmission. There were five cases of postpartum respiratory degradation, but no maternal deaths were recorded. The caesarean section rate was higher in the first than in the second wave (68.5% vs 31.5%). RT-PCR SARS-CoV-2 positivity among newborns was 1.3%. CONCLUSION: SARS-Cov-2 infection in pregnancy may carry increased risks for both pregnant women and the fetuses. Individualized surveillance and the prophylaxis of this population with vaccination. is recommended in these cases.

Introdução: Apesar do risco da COVID-19 na gravidez poder ser acrescido, são necessários estudos em larga escala para o melhor conhecimento do impacto desta infeção nesta população. O objetivo deste estudo é descrever as complicações obstétricas e a taxa de transmissão vertical em grávidas com infeção a SARS-CoV-2. Material e Métodos: Os casos conhecidos de infeção por SARS-CoV-2 na gravidez foram registados nos hospitais portugueses por obstetras. Foram recolhidos dados epidemiológicos, da gravidez e do parto. Resultados: Registaram-se 630 casos positivos em 23 maternidades portuguesas, a maioria no termo (87,9%) e assintomática (62,9%). A comorbilidade materna mais frequente foi a obesidade. A taxa de parto pré-termo e de leves para a idade gestacional foi de 12,1% e 9,9%, respectivamente. No terceiro trimestre, 2,9% das grávidas necessitaram de suporte respiratório. Verificou-se uma taxa de 1,5% de morte fetal, incluindo dois casos de transmissão vertical. Houve cinco casos de degradação respiratória no pós-parto, mas sem mortes maternas registadas. A taxa de cesarianas foi mais elevada na primeira do que na segunda vaga (68,5% vs 31,5%). A positividade do RT-PCR SARS-CoV-2 entre os recém-nascidos foi de 1,3%. Conclusão: A infeção pelo SARS-Cov-2 na gravidez pode acarretar riscos aumentados para as grávidas e fetos. Recomenda-se uma vigilância individualizada nestes casos e a profilaxia desta população com a vacinação.

Pelvic floor dysfunction after vaginal delivery: MOODS-a prospective study.

INTRODUCTION AND HYPOTHESIS: Labor is a known risk factor for pelvic floor dysfunction (PFD); however, the impact of operative vaginal delivery (OVD), particularly spatulas, remains unclear. The aim of this study was to compare postpartum PFD symptoms in women undergoing spontaneous vaginal delivery (SVD) and those undergoing OVD. METHODS: An observational prospective study (MOODS: Maternal-neonatal Outcomes in Operative Vaginal Delivery) was enrolled at Hospital de Braga from February to October 2018. All singleton term OVD (Thierry spatulas and vacuum extractor) and a convenience SVD sample were recruited, in a 2:1 ratio. To assess PFD symptoms Pelvic Floor Distress Inventory-20 (PFDI-20) was applied at 3, 6, and 12 months postpartum. The questionnaire is divided into three subscales: Urinary (UDI), Colorectal-Anal (CRADI), and Pelvic Organ Prolapse Distress Inventory (POPDI). RESULTS: Of the 304 women recruited, 207 were included, 34.3% with SVD and 65.7% with OVD. Thierry spatulas were used in 53.7% of women undergoing OVD. Frequency of nulliparous (p < 0.001), episiotomy (p < 0.001), neuraxial anesthesia (p < 0.001), postpartum pain (p = 0.001) and occiput-posterior fetal position (p < 0.001) were significantly higher in OVD. Second phase of labor duration was longer in OVD (p = 0.001). At 3 months postpartum, women undergoing OVD and spatula-assisted delivery had higher UDI score, POPDI score, and global score, with no differences at 6 months and 1 year. After controlling for confounding variables, OVD and spatulas were still associated with greater POPDI scores at 3 months postpartum. CONCLUSIONS: Operative vaginal delivery, particularly with spatulas, seems to be associated with a higher prevalence of early PFD symptoms, mainly regarding pelvic organ prolapse.

The Role of Operative Vaginal Delivery in Postpartum Sexual Dysfunction: MOODS - A Prospective Study.

BACKGROUND: Childbirth brings many changes to women's life and sexual health. The influence of operative vaginal delivery on sexual function has produced inconsistent results. AIM: To evaluate the effects of mode of vaginal delivery (spontaneous or operative) in postpartum sexual function. METHODS: Descriptive prospective study (MOODS- Maternal-neonatal Outcomes in Operative Vaginal Delivery) including 304 women who had a singleton term vaginal delivery (operative or spontaneous in a relation 2:1). Women were invited to answer a questionnaire at 3, 6 months and 1 year postpartum. OUTCOMES MEASUREMENT: A validated questionnaire was applied, the Female Sexual Function Index (FSFI) Score, to evaluate effects of operative delivery on sexual health. Sexual dysfunction was defined by FSFI score <26.55. RESULTS: 211 women answered at least one questionnaire. Overall rate of sexual dysfunction was 62%, 43% and 48% at 3, 6 and 12 months respectively. At 3 months, total FSFI score was significantly lower in operative vaginal delivery group (mean±SD, 21.3±8.6 vs 24.9±7.9, P = 0.015). Arousal (P = 0.028), orgasm (P = 0.029), satisfaction (P = 0.015) and pain (P = 0.007) FSFI domains were also significantly inferior. At this time, 44% women in spontaneous delivery group and 70% in operative delivery group had sexual dysfunction (P = 0.0002). At 6 months, there were no differences in FSFI scores according the type of delivery. At 12 months, total FSFI score was similar in both groups, but pain domain was significantly lower in operative delivery (P = 0.004). Considering type of instrument (Thierry's Spatulas or Kiwi Vacuum), no differences were found regarding episiotomy, perineal trauma, obstetric anal sphincter injury or postpartum complications. FSFI scores did not differ between the two instruments at any time point. A logistic regression showed that, when controlled for perineal trauma, mode of delivery was independently associated with sexual dysfunction at 3 months (P = 0.02). CLINICAL IMPLICATIONS: Clinicians should assess women's sexual health during pregnancy and postpartum period in order to enhance their wellbeing. STRENGTHS/LIMITATIONS: Strengths include its prospective design, standardized questionnaire and the new perspectives about a different obstetrical instrument (Thierry's spatulas). Limitations include the absence of pre-pregnancy sexual function data and considerable drop-out rate. CONCLUSION: Sexual dysfunction affects a great proportion of newly mothers and in postpartum period mode of delivery and perineal trauma seem to play an important role. Although there was a progressive reduction over time, prevalence of sexual dysfunction at 6 months and 1 year postpartum was still considerable. The type of obstetrical instrument does not seem to influence short or long-term sexual function. de Sousa NQ, Borges AC, Sarabando R, et al. The Role of Operative Vaginal Delivery in Postpartum Sexual Dysfunction: MOODS - A Prospective Study. J Sex Med 2021;18:1075-1082.

Effect of laying on of hands as a complementary therapy for pain and functioning in older women with knee osteoarthritis: A randomized controlled clinical trial.

AIM: To assess the effects of laying on of hands (LooH) as a complementary therapy to kinesiotherapy, on pain, joint stiffness, and functional capacity of older women with knee osteoarthritis (KOA) compared to a control group. METHODS: In this randomized controlled clinical trial, participants were assigned into 3 groups: LooH with a spiritual component ("Spiritist passe" Group - SPG), LooH without a spiritual component (LooH Group - LHG), and a control group receiving no complementary intervention (Control Group - CG). Patients were assessed at baseline, 8 weeks, and 16 weeks. Primary outcomes were joint stiffness and functional capacity (Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC]), and pain (WOMAC and visual analog scale). Secondary outcomes were anxiety, depression, mobility, and quality of life. Differences between groups were evaluated using an intention-to-treat approach. RESULTS: A total of 120 women (mean age = 69.2 ± 5.2 years) with KOA were randomized (40 participants per group). At 8 weeks, SPG differed significantly from the LHG for WOMAC Functional Status (between-group difference in the change = 0.97; 95% CI: 0.35 to 1.59, P = .001); Anxiety levels (between-group difference in the change = 1.38; 95% CI: 0.11 to 2.65, P = .027); and also from the CG for all outcomes with exception of WOMAC Stiffness. After 16 weeks, SPG differed significantly from the LHG only for WOMAC Functional Status (between-group difference in the change = 0.92; 95% CI: 0.32 to 1.52, P = .001]) and also from the CG for all outcomes with exception of WOMAC Stiffness and timed up-and-go. CONCLUSION: Our results suggest that LooH with a "spiritual component" may promote better long-term functional outcomes than both LooH without a "spiritual component" and a control group without LooH.

Apert syndrome: prenatal diagnosis challenge.

Apert syndrome is a rare genetic disorder that manifests as craniosynostosis, craniofacial and limb dysmorphic features. Mutations in fibroblast growth factor receptor 2 (FGFR2) gene account for almost all cases. Given the impact it can have throughout life, prenatal management becomes a challenge. A healthy 33-year-old woman, gravida 4, para 0, was referred to routine ultrasound at 22 weeks of gestation. Atypical cranial morphology with prominent forehead, ocular proptosis, hypertelorism and mitten hands were detected. Genetic investigation revealed an FGFR2 gene mutation (c.755C>G(p.Ser252Trp)), confirming the diagnosis. Magnetic resonance showed brachycephaly, turricephaly and cortical malformation. Following counselling, parents requested medical termination of pregnancy. Macroscopic features were consistent with ultrasound findings. This case emphasises the importance of early diagnosis to provide the best family counselling and prenatal management. A multidisciplinary team, consisting of an obstetrician with ultrasonography experience, a medical geneticist and a fetal pathologist, should conduct these cases.

Pelvic pain in young girls: not only dysmenorrhoea!

Imperforate hymen is the most frequent cause of haematocolpos, although it is a rare malformation (1:2000). We present two cases of young girls with cyclic abdominal pain and urinary symptoms. At gynaecological examination, they all presented imperforate hymen and ultrasound revealed significant vaginal distension. X-shaped hymenectomy was performed in all patients. The later the diagnosis of imperforate hymen, the higher the risk of complications like haematometra, haematosalpinx, haemoperitoneum and infections such as tubo-ovarian abscesses, peritonitis and endometriosis (retrograde menstruation theory).

Use of etonogestrel implant beyond approved duration: prolonged contraceptive effectiveness.

BACKGROUND: The subdermal etonogestrel contraceptive implant has a current approved duration of 3 years. There is, however, recent and strong evidence of its effectiveness for 2 additional years during which no pregnancies were documented. CASE: We report a case of a 28-year-old woman who had an etonogestrel implant inserted 4 years earlier and wished to get pregnant. The implant was, however, deep in the triceps muscle and could not easily be removed. Her serum levels of etonogestrel remained positive even 6 years after insertion. As infertility investigation revealed endometriosis and bilateral tubal obstruction she was referred for assisted reproduction. Despite obtaining oocytes during an ovarian stimulation cycle, the endometrium was never above 4 mm, precluding embryo transfer. It was decided to remove the implant in order to improve endometrial conditions, after which the patient achieved pregnancy. CONCLUSION: This case report suggests that the etonogestrel implant is effective for even longer than the most recent studies have shown.

Transfusion management for patients taking an anti-CD38 monoclonal antibody.

INTRODUCTION: Pre-transfusion tests, essential for the release of blood components, may be affected by drugs. Monoclonal antibodies represent a class of medications increasingly used in the clinical practice, with anti-CD38 monoclonal antibodies (daratumumab) being a promising resource in the treatment of refractory myeloma. This monoclonal antibody recognizes CD38 in myeloma cells and interferes with pre-transfusion tests by causing panreactivity in indirect antiglobulin tests thereby clinically masking alloantibodies. Dithiothreitol is a reagent that breaks disulfide bonds and effectively destroys antigenic sites for CD38 on red blood cells. This study reports the immunohematological findings of pre-transfusion tests of patients with multiple myeloma receiving daratumumab and on solutions to prevent the interference of this monoclonal antibody. METHODS: Serum samples from five patients on anti-CD38 monoclonal antibody treatment were evaluated. Tests performed included ABO/RhD typing, indirect antiglobulin test, direct antiglobulin test and eluate test. A daily evaluation was performed to determine the shelf life of dithiothreitol-treated red blood cells when stored in Alsever's solution. RESULTS: No interference in the ABO/RhD typing results was noted but in all samples, a panreactivity was observed in indirect antiglobulin tests. Regarding the direct antiglobulin test, two samples presented positive results but negative eluates. In all samples, treatment of reagent red blood cells with 0.2M dithiothreitol offset interference by anti-CD38 monoclonal antibodies. Dithiothreitol-treated red blood cells stored in Alsever's solution were stable for up to 15 days. CONCLUSION: Treatment of reagent red blood cells with dithiothreitol can be efficient and accessible to offset the interference of the anti-CD38 drug in pre-transfusion tests. The number of costly serological workups can be reduced by having stored dithiothreitol red blood cells with this proving to be a useful reagent for investigating anti-CD38.

Transfusion management for patients taking an anti-CD38 monoclonal antibody

Abstract Introduction: Pre-transfusion tests, essential for the release of blood components, may be affected by drugs. Monoclonal antibodies represent a class of medications increasingly used in the clinical practice, with anti-CD38 monoclonal antibodies (daratumumab) being a promising resource in the treatment of refractory myeloma. This monoclonal antibody recognizes CD38 in myeloma cells and interferes with pre-transfusion tests by causing panreactivity in indirect antiglobulin tests thereby clinically masking alloantibodies. Dithiothreitol is a reagent that breaks disulfide bonds and effectively destroys antigenic sites for CD38 on red blood cells. This study reports the immunohematological findings of pre-transfusion tests of patients with multiple myeloma receiving daratumumab and on solutions to prevent the interference of this monoclonal antibody. Methods: Serum samples from five patients on anti-CD38 monoclonal antibody treatment were evaluated. Tests performed included ABO/RhD typing, indirect antiglobulin test, direct antiglobulin test and eluate test. A daily evaluation was performed to determine the shelf life of dithiothreitol-treated red blood cells when stored in Alsever's solution. Results: No interference in the ABO/RhD typing results was noted but in all samples, a panreactivity was observed in indirect antiglobulin tests. Regarding the direct antiglobulin test, two samples presented positive results but negative eluates. In all samples, treatment of reagent red blood cells with 0.2 M dithiothreitol offset interference by anti-CD38 monoclonal antibodies. Dithiothreitol-treated red blood cells stored in Alsever's solution were stable for up to 15 days. Conclusion: Treatment of reagent red blood cells with dithiothreitol can be efficient and accessible to offset the interference of the anti-CD38 drug in pre-transfusion tests. The number of costly serological workups can be reduced by having stored dithiothreitol red blood cells with this proving to be a useful reagent for investigating anti-CD38.

Locally advanced hypopharyngeal squamous cell carcinoma: single-institution outcomes in a cohort of patients curatively treated either with or without larynx preservation.

OBJECTIVE: The present study was aimed at describing a single-institution experience in the curative treatment of patients diagnosed with locally advanced hypopharyngeal squamous cell carcinoma. MATERIALS AND METHODS: Data concerning all patients treated for locally advanced hypopharyngeal squamous cell carcinoma between January 2006 and June 2012 were reviewed. RESULTS: A total of 144 patients were included in the present study. The median follow-up period was 36.6 months. Median survival was 26 months, and 2-year and 5-year overall survival rates were, 51% and 30.5%, respectively. Median recurrence-free survival was 18 months and 2-year and 5-year recurrence-free survival rates were 42.8% and 28.5%, respectively. CONCLUSION: The outcomes in the present series are in line with the literature.

Locally advanced hypopharyngeal squamous cell carcinoma: single-institution outcomes in a cohort of patients curatively treated either with or without larynx preservation / Carcinoma espinocelular da hipofaringe: resultados de uma instituição numa coorte de doentes tratados com intenção curativa com ou sem preservação da laringe

Abstract Objective: The present study was aimed at describing a single-institution experience in the curative treatment of patients diagnosed with locally advanced hypopharyngeal squamous cell carcinoma. Materials and Methods: Data concerning all patients treated for locally advanced hypopharyngeal squamous cell carcinoma between January 2006 and June 2012 were reviewed. Results: A total of 144 patients were included in the present study. The median follow-up period was 36.6 months. Median survival was 26 months, and 2-year and 5-year overall survival rates were, 51% and 30.5%, respectively. Median recurrence-free survival was 18 months and 2-year and 5-year recurrence-free survival rates were 42.8% and 28.5%, respectively. Conclusion: The outcomes in the present series are in line with the literature.

Resumo Objetivo: O objetivo deste estudo é descrever a experiência de uma instituição no tratamento com intenção curativa de doentes diagnosticados com carcinoma espinocelular da hipofaringe localmente avançado. Materiais e Métodos: Os dados relativos aos doentes portadores de carcinoma espinocelular da hipofaringe localmente avançado tratados entre janeiro de 2006 e junho de 2012 foram revistos. Resultados: Foram incluídos 144 doentes. O tempo mediano de seguimento foi 36,6 meses. A sobrevivência mediana, aos 2 anos e aos 5 anos foi 26 meses, 51% e 30,5%, respectivamente. A sobrevivência livre de recorrência mediana, aos 2 anos e aos 5 anos foi 18 meses, 42,8% e 28,5%, respectivamente. Conclusão: Os resultados encontrados na nossa série estão em acordo com a literatura.

Evidências científicas brasileiras sobre gangrena de Fournier / Brazilian scientific evidence on Fournier’s gangrene / Evidencias científicas brasileñas acerca de la gangrena de Fournier

Objetivou-se descrever os registros científicos brasileiros publicados nos últimos vinte anos acerca da gangrena de Fournier. Trata-se de uma revisão integrativa realizada por intermédio de incursões nas bases LILACS, MEDLINE, BDENF e Coleciona SUS com o descritor “Gangrena de Fournier”. Foram selecionados os textos publicados entre janeiro de 1994 e julho de 2014, em português e disponíveis gratuitamente online. De acordo com os 14 artigos encontrados, os principais sintomas da gangrena de Fournier incluem desconforto com sensações dolorosas, febre elevada, edema, mal estar e sudorese. Na maior parte dos casos são observados eritema e formação de bolhas, evoluindo para uma ferida. O quadro clínico auxilia na seleção da terapêutica antimicrobiana empírica antes mesmo do resultado da cultura. Conclui-se que o diagnóstico precoce e o tratamento adequado e agressivo são determinantes no prognóstico do paciente. Ainda há escassez de produções científicas brasileiras com alto poder de evidência sobre o tema.

The objective of this study was to describe the Brazilian scientific reports published over the past twenty years on Fournier’sgangrene. It is an integrative review conducted through incursions in the LILACS, MEDLINE, BDENF and Coleciona SUS databaseswith the descriptor ‘Fournier’s Gangrene’. Texts published between January 1994 and July 2014, in Portuguese, andfreely available online were selected. According to the 14 articles found, the main symptoms of Fournier’s gangrene includediscomfort with painful sensations, high fever, edema, malaise, and sweating. In most cases erythema and blistering areobserved, evolving into a wound. The clinical profile assists in the selection of empirical antimicrobial therapy even beforethe culture results. It was concluded that early diagnosis and appropriate and aggressive treatment are crucial in patientprognosis. There is still a shortage of Brazilian scientific production with a high power of evidence on the subject.

El objetivo fue describir producciones brasileñas publicadas en los últimos veinte años acerca de la gangrena de Fournier.Revisión integradora realizada en las bases de datos LILACS, MEDLINE, BDENF y Colecciona SUS, con el descriptor “Gangrenade Fournier”. Se seleccionaron textos publicados entre enero de 1994 y julio de 2014, en portugués y disponiblesgratuitamente en Internet. Según los 14 artículos encontrados, los principales síntomas de la gangrena de Fournier incluyenmalestar, con sensaciones dolorosas, fiebre alta, edema, malestar general, sudoración. En la mayor parte de los casos, sonobservados eritema y formación de bollas, surgiéndose una herida. El cuadro clínico ayuda en la selección de la terapia antimicrobianaempírica antes del resultado de la cultura. En conclusión, el diagnóstico precoz y el tratamiento apropiado yagresivo son cruciales en el pronóstico del paciente. Aún, hay escasez de producciones científicas brasileñas con gran poderde evidencia sobre el tema.

Breast cancer local recurrence under the form of inflammatory carcinoma, treated with concurrent radiation and chemotherapy, a case report.

The authors present a case report of a patient with breast cancer diagnosed in 2005, treated with conservative surgery, adjuvant chemotherapy and radiotherapy, followed by hormonal therapy until 2010, who relapsed under the form of inflammatory breast cancer in 2011. After tumor progression detected during primary systemic therapy, a concurrent radiation and radiosensitizing chemotherapy were proposed. There was a significant clinical response to this treatment, enabling curative chance with total mastectomy. The histological examination of the breast and regional lymph nodes revealed a complete response, since there was no evidence of residual tumor. There are few reports concerning concurrent radiotherapy and chemotherapy in locally advanced breast cancer, but it could be a suitable "loco regional rescue therapy" to further reduce tumor progression and allow curative surgery. Study of this treatment strategy in randomized clinical trials is warranted.

EEG theta and alpha reactivity on opening the eyes in the diagnosis of Alzheimer's disease.

The objective of this study was to evaluate the contribution of EEG theta and alpha reactivity on opening the eyes, in the diagnosis of slight and moderate Alzheimer's disease (AD). Thirty four patients with AD and a control group of 30 individuals were studied, all being assessed using a neurological evaluation, CERAD neuropsychological battery (consortium to establish a registry for Alzheimer's disease), incorporating the Mini Mental State Examination (MMSE), Clinical Dementia Rating (CDR) and a qEEG analysis of the absolute band power at rest, with the eyes both open and closed. The theta and alpha reactivity indices were calculated on opening the eyes, defined from the relationship between the absolute powers in the respective bands in the periods with the eyes open and with them closed, the quotient of the relationship between the alpha and theta indices, the alpha/theta ratio, was also calculated. Multiple regression models were used to determine the accuracy in discriminating between the AD and control groups. A regression model using only cognitive data provided an accuracy of 92.2%, whereas a regression model combining cognitive data and qEEG measurements provided an accuracy of 95.3% in the classification between AD and the controls. The variable for the qEEG was the left hemisphere alpha/theta index, since the other parameters were shown to be inferior with respect to the clinical data in the regression analysis. The integrated study of the theta and alpha reactivity indices on opening the eyes and the alpha/theta index, was shown to be a useful approach in qEEG in the evaluation of AD and should be evaluated with larger samples and with other data analysis methods, with the aim of increasing the accuracy.

Comparação da aptidão física relacionada à saúde de adultos de diferentes faixas etárias / Comparison of the health related physical fitness of adults of differents ages

O objetivo deste estudo foi investigar as possíveis diferenças nos níveis de aptidão física relacionada à saúde(AFRS) em homens e mulheres de diferentes faixas etárias. Fizeram parte da amostra 326 sujeitos (132 homens e 194 mulheres), não-praticantes de exercícios físicos regulares, que foram separados, de acordo com o sexo, em três grupos etários: 20-29 anos (G1), 30-39 anos (G2) e 40-49 anos (G3). Todos os sujeitos foram submetidos a medidas antropométricas e de desempenho motor (flexibilidade, resistência/força muscular e aptidão cardiorrespiratória). A análise estatística incluiu o teste de Levene para verificação da homogeneidade das variâncias, estatística descritiva, ANOVA de um fator (faixa etária) e o teste de Bonferroni. O nível de significância adotado foi de P<0,05. Os melhores níveis de aptidão física, tanto nos homens quanto nas mulheres, foram observados nos sujeitos mais jovens (G1), enquanto que os piores níveis foram encontrados nos sujeitos de idade mais avançada (G3). A variação da gordura corporal relativa do G1 para o G3 foi mais acentuada nos homens (34%) do que nas mulheres (16%). Em relação ao desempenho motor, as maiores diferenças percentuais entre G1 e G3 foram identificadas no teste abdominal modificado (39% vs. 22% para homens e mulheres, respectivamente) e flexão e extensão de braço (31% vs. 24% para homens e mulheres, respectivamente). Os resultados sugerem que existe uma tendência natural de redução dos níveis de AFRS com o avançar da idade, em indivíduos não praticantes de exercícios físicos regulares...

The objective of this study was to investigate possible differences in the levels of health related physical fi tnessof men and women of different ages. The sample comprised 326 people (132 men and 194 women) who did not perform regular physical exercise, and who were separated for analysis by sex and into three age groups: 20-29 years (G1), 30-39 years (G2) and 40-49 years (G3). All subjects underwent anthropometric measurements and motor performance testing(fl exibility, muscle resistance/strength and cardiorespiratory fi tness). Statistical analysis employed the Levene test to verify the homogeneity of variation, descriptive statistics, single factor ANOVA (age group) and the Bonferroni test. The signifi cancelevel adopted was p<0.05. The best levels of physical fi tness were observed among the youngest subjects (G1), irrespective of sex, while the worst fi tness levels were detected in the oldest subjects (G3). The variation in body fat from G1 to G3 was more accentuated among the men (34%) than among the women (16%). With relation to motor performance, the greatest percentage differences between G1 and G3 were detected by either modifi ed abdominal test (39% and 22%, for men andwomen respectively) and the arm fl exion and extension test (31% and 24%, for men and women respectively. The results suggest that among individuals who do not regularly practice physical exercise there is a natural tendency for health relatedphysical fi tness to reduce as age increases...