Disability after breast cancer surgery: Proposal of linkage between the International Classification of Functioning, Disability and Health and the Grocery Shelving Task Test.

PURPOSE: To link the concepts measured by the Grocery Shelving Task Test (GST) to the codes and qualifiers of the activity and participation component of the International Classification of Functioning, Disability and Health (ICF). METHODS: The linkage was performed by two professionals who applied the 10 standardized binding rules. The linking process was performed through the model of extraction and identification of the concepts that were found in each item of the GST Test. RESULTS: The GST test includes 1 domain of the activity and participation component (d4 mobility). The link with the qualifiers allowed quantifying the impairment of the limitations of activities in the postoperative period, being observed that 21.27% of the sample did not present any problem, 61.70% presented the qualifier "0.1" (mild problem), 8.50% had a moderate problem (qualifier '0.2') and 8.50% had a severe problem (qualifier '0.3'). No complete impairment was observed in any study participant. DISCUSSION: The linking of the GST to the ICF codes and qualifiers allowed quantifying the functional impairment in the postoperative period of breast cancer, allowing a comprehensive and standardized view, and being a guiding tool for treatment plans.

Thyroid function during the first year of use of the injectable contraceptive depot medroxyprogesterone acetate.

PURPOSE: The aim of the study was to evaluate thyroid function profile as a possible factor influencing weight and body composition variation in new users of depot medroxyprogesterone acetate (DMPA). MATERIALS AND METHODS: A prospective, non-randomised, comparative study was conducted at the University of Campinas, Brazil. Women aged 18-40 years with a body mass index (BMI) less than 30 kg/m2, normal oral glucose tolerance test, no known diseases, and using no medication, who opted to use DMPA were paired by age (±1 year) and BMI (±1 kg/m2) with women initiating copper intrauterine device (IUD) use. The main outcome measures were thyroid function profile, weight, and body composition, as measured by dual-energy X-ray absorptiometry. We used repeated measures ANOVA to perform comparisons between times and groups. RESULTS: We evaluated 28 DMPA users and 24 IUD users who completed the 12-month follow-up. We observed that FT4 levels were higher at 12 months (compared to baseline) in the DMPA group (p < .0001) and that FT4/FT3 ratio had increased in both groups. Additionally, at 12 months, total body mass had increased around 2 kg and lean mass increased in the DMPA group compared to the IUD group; there was also an increase in weight, BMI, total body mass, and fat mass when compared to baseline. CONCLUSIONS: No changes in thyroid function occurred that could explain the weight increase observed in DMPA users.

Vitamin D in Hashimoto's thyroiditis and its relationship with thyroid function and inflammatory status.

Several studies have shown the correlation between vitamin D [25(OH)D] deficiency and thyroid autoimmunity and reducing of thyroid autoantibodies in patients with normal levels of vitamin D combining with thyroid hormone replacement. However, other authors not agree with this association. It is still unclear whether the low 25(OH)D levels are the result of HT disease or a part of its cause. We studied 88 patients with HT regarding vitamin D status and thyroid autoimmunity markers as well as the relationship with cytokines produced by Th1, Th2, and Th17 cells compared with a control group of 71 euthyroid healthy subjects. The present study demonstrated that vitamin D concentrations were similar in patients HT and the control group. The reduction of free T4 levels was a predictor of vitamin D insufficiency for Hashimoto's thyroiditis, but not for the control group. Lower concentrations of TNF-α was a predictor of lower levels of vitamin D. Differences in the association between HT and vitamin D insufficiency remain unresolved in the literature. The thyroid hormone status would play a role in the maintenance of vitamin D sufficiency, and its immunomodulatory role would influence the presence of autoimmune thyroid disease. The positive correlation between free T4 and vitamin D concentrations suggests that adequate levothyroxine replacement in HT would be an essential factor in maintaining vitamin D at sufficient levels.

Evaluation of patients with head and neck cancer performing standard treatment in relation to body composition, resting metabolic rate, and inflammatory cytokines.

BACKGROUND: Squamous cell carcinoma of the head and neck (SCCHN) usually emerges as a set of signs and symptoms that, either alone or in combination with standard treatment, may lead to malnutrition and weight loss. METHODS: This study evaluated patients with SCCHN before day 0 and 30 days after the end of treatment, with/without tumor resection. Each individual patient underwent analyses of body composition and resting metabolic rate, as well as assessment of serum glucose, insulin, leptin, adiponectin, interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), IL-1ß, and insulin sensitivity. RESULTS: There was body mass loss during treatment and significant reduction in body fat and free fat mass. Early nutritional monitoring and tumor resection before treatment led to a better nutritional status and reduced inflammatory state. CONCLUSION: Early nutritional monitoring and resection of the tumor by surgery may be important factors for patients to better tolerate treatment.

Determinación de la concentración plasmática de proteína C reactiva en pacientes con diferentes formas clínicas de la enfermedad de Chagas / Determining the C-reactive protein level in patients with different clinical forms of Chagas disease

La enfermedad de Chagas (EC) es una infección causada por Trypanosoma cruzi que aún hoy constituye un problema de salud en los países en desarrollo de Sudamérica y causa trastornos de la conducción e insuficiencia cardiaca crónica. En este trabajo, el Grupo de Estudios de Enfermedad de Chagas del Hospital de la Universidad Estatal de Campinas ha analizado a 136 individuos para investigar la relación entre insuficiencia cardiaca crónica y concentración sérica de proteína C reactiva (PCR). La PCR estratificada según diferentes apariciones clínicas de la EC reveló que los pacientes con cardiopatía grave y cardiopatía no chagásica tenían estadísticamente concentraciones de PCR mayores que los otros grupos de control y cardiopatía leve (p < 0,05), incluso estratificando por edad ( < 40 y ≥ 40 años). Hubo una correlación lineal positiva entre edad y PCR, de manera que cuanto mayores los individuos, más altos los valores de PCR. Estos datos refuerzan la asociación entre inflamación crónica y aparición de insuficiencia cardiaca. Aunque la elevaciones de PCR no están exclusivamente relacionadas con la EC, serían un marcador asequible de la evolución de la EC hacia fases avanzadas (AU)

Chagas disease is caused by Trypanosoma cruzi and remains a health problem in the developing countries of South America. The condition leads to cardiac conduction disturbances and chronic heart failure. In this study, 136 individuals were evaluated by the Chagas Disease Study Group of the Hospital de la Universidad Estatal de Campinas in Brazil to determine the relationship between chronic heart failure and the serum C-reactive protein (CRP) level. When patients were stratified according to the different clinical presentations of Chagas disease, it was found that the CRP levels in those with severe heart disease and non-Chagasic cardiopathy were significantly higher than in controls or those with mild heart disease (P < .05), even when participants were stratified by age (i.e. <40 and 8805 40 years there was a direct linear correlation between age crp level such that the older individual higher these data provide further evidence for an association chronic inflammation development of heart failure although elevations are not exclusively related to chagas disease may be useful marker progression more advanced phase (AU)

GLP-1 and adiponectin: effect of weight loss after dietary restriction and gastric bypass in morbidly obese patients with normal and abnormal glucose metabolism.

BACKGROUND: It has been proposed that there is improvement in glucose and insulin metabolism after weight loss in patients who underwent diet restriction and bariatric surgery. METHODS: Eleven normal glucose tolerant (NGT) morbidly obese patients [body mass index (BMI), 46.1+/-2.27 g/m2] and eight abnormal glucose metabolism (AGM) obese patients (BMI, 51.20 kg/m2) were submitted to diet-restriction and bariatric surgery. Prospective study on weight loss changes, over the glucose, insulin metabolism, glucagon-like peptide-1 (GLP-1), and adiponectin levels were evaluated by oral glucose tolerance test during three periods: T1 (first evaluation), T2 (pre-surgery), and T3 (9 months after surgery). RESULTS: Insulin levels improved after surgery. T1 was 131.1+/-17.60 pmol/l in the NGT group and 197.57+/-57.94 pmol/l in the AGM group, and T3 was 72.48+/-3.67 pmol/l in the NGT group and 61.2+/-9.33 pmol/l in the AGM group. The major reduction was at the first hour of the glucose load as well as fasting levels. At 9 months after surgery (T3), GLP-1 levels at 30 and 60 min had significantly increased in both groups. It was observed that the AGM group had higher levels of GLP-1 at 30 min (34.06+/-6.18 pmol/l) when compared to the NGT group (22.69+/-4.04 pmol/l). Homeostasis model assessment of insulin resistance from the NGT and AGM groups had a significant reduction at periods T3 in relation to T1 and T2. Adiponectin levels had increased concentration in both groups before and after surgical weight loss. However, it did not have any statistical difference between periods T1 vs. T2. CONCLUSIONS: Weight loss by surgery leads to improvement in the metabolism of carbohydrates in relation to sensitivity to the insulin, contributing to the reduction of type 2 diabetes incidence. This improvement also was expressed by the improvement of the levels of adiponectin and GLP-1.