Comparative Analysis of the Quality of Life in the Pretreatment of Head and Neck Cancer Patients According to Tumor Site

Abstract Introduction Head and neck cancer (HNC) and its treatment can cause physical, psychological, and quality of life (QoL) damage, because it can disturb the physiology of eating, breathing, speaking, and compromise self-image. Objective To evaluate the QoL of the pretreatment of patients diagnosed with head and neck cancer according to the anatomical location of the tumor. Methods A descriptive, cross-sectional study was performed on a sample of 144 patients undergoing pretreatment for cancer from February 2017 to July 2019. The University of Washington QoL Questionnaire (version 4) was used to assess the QoL. The anatomical location data were obtained from medical records. The ANOVA test was used to compare the differences in QoL according to tumor location. Results A total of 144 participants were included, 66 (45.5%) of whom had the primary tumor located in the mouth. The median age of the patients was 62 years, with a higher prevalence of male (75.7%), Black (78.5%), single/divorced/widowed people (59%), and illiterates (32.6%); most of them were smokers (84.7%) and alcohol drinkers (79.2%). The mean QoL score was 830 for mouth cancer, 858 for pharynx cancer, and 891 for laryngeal cancer patients. Conclusion Based on the results of this study, it can be concluded that the QoL of patients with head and neck cancer was not influenced by tumor location. The most affected domains in the three groups were pain, appearance, chewing, swallowing, and speech (p < 0.05).

Comparative Analysis of the Quality of Life in the Pretreatment of Head and Neck Cancer Patients According to Tumor Site.

Introduction Head and neck cancer (HNC) and its treatment can cause physical, psychological, and quality of life (QoL) damage, because it can disturb the physiology of eating, breathing, speaking, and compromise self-image. Objective To evaluate the QoL of the pretreatment of patients diagnosed with head and neck cancer according to the anatomical location of the tumor. Methods A descriptive, cross-sectional study was performed on a sample of 144 patients undergoing pretreatment for cancer from February 2017 to July 2019. The University of Washington QoL Questionnaire (version 4) was used to assess the QoL. The anatomical location data were obtained from medical records. The ANOVA test was used to compare the differences in QoL according to tumor location. Results A total of 144 participants were included, 66 (45.5%) of whom had the primary tumor located in the mouth. The median age of the patients was 62 years, with a higher prevalence of male (75.7%), Black (78.5%), single/divorced/widowed people (59%), and illiterates (32.6%); most of them were smokers (84.7%) and alcohol drinkers (79.2%). The mean QoL score was 830 for mouth cancer, 858 for pharynx cancer, and 891 for laryngeal cancer patients. Conclusion Based on the results of this study, it can be concluded that the QoL of patients with head and neck cancer was not influenced by tumor location. The most affected domains in the three groups were pain, appearance, chewing, swallowing, and speech ( p < 0.05).

Nighttime salivary cortisol as a biomarker of stress and an indicator of worsening quality of life in patients with head and neck cancer: A cross-sectional study.

Background: Head and neck cancer (HNC) is a generic term defined on an anatomical-topographic basis to describe malignant tumors located in the oral cavity, pharynx, larynx, and thyroid. A situation commonly presented by individuals with cancer is stress, with evidence indicating a close relationship between stress, behavior, and the immune system with the development and progression of cancer. Aim: To assess the association between stress levels and quality of life among individuals with HNC. Methods: This was a cross-sectional study involving 72 HNC patients. The University of Washington Quality of Life Questionnaire was used to assess the quality of life, while the Perceived Stress Scale and salivary cortisol were used to evaluate stress levels. Results: A negative association was found between quality of life and stress levels as indicated by both the PSS and nighttime salivary cortisol. Nighttime salivary cortisol showed the best accuracy estimated by the area under the receiver operating characteristic curve, slightly better than that of PSS. Conclusion: Among the time points for saliva sampling, nighttime cortisol was found to have the best accuracy, which was similar to that of the PSS, for the detection of patients with the worst quality of life.

Fundamentos teóricos para un estudio sobre la ludopatía / Theoretical foundations for a study on compulsive gambling

RESUMEN El presente texto hace referencia al uso de las nuevas tecnologías entre los adolescentes y jóvenes y al modo en que a nivel mundial llega a convertirse en una conducta adictiva, debido a su empleo inadecuado en esta población. Su objetivo está dirigido a fundamentar los elementos epistemológicos sobre la ludopatía para su atención. Se incursiona en cuestiones inherentes a las adicciones, la drogadicción y en particular sobre la ludopatía y sus consecuencias en los sujetos comprendidos entre las edades mencionadas. Este artículo constituye una salida del proyecto de investigación Sistema de estrategias educativas para la prevención de conductas adictivas en los adolescentes del área de salud Tula Aguilera, el cual gestiona el Centro para el Desarrollo de las Ciencias Sociales y Humanísticas en Salud, de la Universidad de Ciencias Médicas de Camagüey. El tipo de estudio es de carácter Investigación Desarrollo y se ejecutó en el período comprendido entre enero de 2017 y febrero de 2020.

ABSTRACT The present text makes reference to the use of the new technologies among the adolescents and young and to the way in that its inadequate employment at world level in the people, ends up becoming an addictive behavior. Their objective is directed to base the elements epistemológicos of the treatment of the ludopatía, from the school activity. This article constitutes an exit of the project of investigation System of educational strategies for the prevention of addictive behaviors in the adolescents of the area of health Tula Aerie, which negotiates the Center for the Development of the Social and Humanistic Sciences in Health, of the University of Medical Sciences of Camagüey. The study type is of character Investigation Development and it was executed in the period understood between January of 2017 and February of 2020.

Desarrollo socio sanitario de un asentamiento rural desde la perspectiva de las ciencias sociales / Social sanitary development of a rural establishment from the perspective of the social sciences

Se aplicó una intervención socio sanitaria en el asentamiento rural El León de Camagüey basada en los resultados de un estudio anterior, desde la comunicación social, educativa, así como aspectos socioculturales evaluados que permitieron la realización de este estudio. Su objetivo fue implementar una estrategia de intervención basada en acciones sociales y educativas colectadas en un manual que organizó contenidos de antropología socio cultural, psicología, sociología de la salud y trabajo social comunitario, la que fue conducida por profesionales de enfermería como prestadores, cuyo encargo social les asigna una mayor permanencia e intercambio con los pobladores, potenciándose el trabajo comunitario a partir de febrero de 2016,como etapa de sostenibilidad . La investigación constituyó un diseño mixto, con un estudio cuasi experimental sin grupo control (pre-post prueba) combinado con métodos cualitativos. La evaluación final efectuada en el periodo 2017-2018 exhibió modificaciones positivas en indicadores de las historias clínicas familiares de los pobladores, repercutiendo en el Análisis de la Situación de Salud, realizado en abril de 2018 y el entorno comunitario. Se demostró la importancia de la aplicación de la estrategia de intervención comunitaria desde las disciplinas de las ciencias sociales, por el personal de enfermería como agente de cambio de desarrollo local y protagonista de sostenibilidad(AU)

A social sanitary intervention was applied in the rural establishment El León of Camagüey, based on social and educational actions collected in a manual that organized social cultural anthropology contents, psychology, sociology of the health and community social work, which was led by infirmary professionals like lenders, whose social order assigns a major permanence and exchange of them with the settlers. The investigation constituted a mixed design, with a study quasi experimentally without control group (pre-post trial) combined with qualitative methods. The final evaluation carried out in the period 2017-2018 exhibited positive modifications in indicators of the familiar clinical history of the settlers, what reverberated in the Analysis of the Situation of Health, carried in April, 2018 and the community environment. It was demonstrated the importance of the application of the strategy of community intervention from the disciplines of the social sciences, by the infirmary personnel as change agent of local development and protagonist of sustainability(AU)

Desarrollo socio sanitario de un asentamiento rural desde la perspectiva de las ciencias sociales / Social sanitary development of a rural establishment from the perspective of the social sciences

RESUMEN Se aplicó una intervención socio sanitaria en el asentamiento rural El León de Camagüey basada en los resultados de un estudio anterior, desde la comunicación social, educativa, así como aspectos socioculturales evaluados que permitieron la realización de este estudio. Su objetivo fue implementar una estrategia de intervención basada en acciones sociales y educativas colectadas en un manual que organizó contenidos de antropología socio cultural, psicología, sociología de la salud y trabajo social comunitario, la que fue conducida por profesionales de enfermería como prestadores, cuyo encargo social les asigna una mayor permanencia e intercambio con los pobladores, potenciándose el trabajo comunitario a partir de febrero de 2016,como etapa de sostenibilidad . La investigación constituyó un diseño mixto, con un estudio cuasi experimental sin grupo control (pre-post prueba) combinado con métodos cualitativos. La evaluación final efectuada en el periodo 2017-2018 exhibió modificaciones positivas en indicadores de las historias clínicas familiares de los pobladores, repercutiendo en el Análisis de la Situación de Salud, realizado en abril de 2018 y el entorno comunitario. Se demostró la importancia de la aplicación de la estrategia de intervención comunitaria desde las disciplinas de las ciencias sociales, por el personal de enfermería como agente de cambio de desarrollo local y protagonista de sostenibilidad.

ABSTRACT A social sanitary intervention was applied in the rural establishment El León of Camagüey, based on social and educational actions collected in a manual that organized social cultural anthropology contents, psychology, sociology of the health and community social work, which was led by infirmary professionals like lenders, whose social order assigns a major permanence and exchange of them with the settlers. The investigation constituted a mixed design, with a study quasi experimentally without control group (pre-post trial) combined with qualitative methods. The final evaluation carried out in the period 2017-2018 exhibited positive modifications in indicators of the familiar clinical history of the settlers, what reverberated in the Analysis of the Situation of Health, carried in April, 2018 and the community environment. It was demonstrated the importance of the application of the strategy of community intervention from the disciplines of the social sciences, by the infirmary personnel as change agent of local development and protagonist of sustainability.

Urinary tract infection in non-hospitalized patients with cirrhosis and no symptoms of urinary tract infection: a case series study

Bacterial infections are important factors in decompensation, and they increase the mortality rate of patients with liver cirrhosis. The most common infections among these patients are spontaneous bacterial peritonitis, pneumonia, skin infections and urinary tract infections (UTI). This transversal study evaluated the frequency of UTI in non-hospitalized patients with cirrhosis followed in a hepatology outpatient unit. Patients with clinical, laboratorial, echographic and/or histological diagnosis of cirrhosis were evaluated from April 2002 to August 2004. Patients who accepted participating in this study were submitted to clinical evaluation and the following laboratorial examinations: urine analysis, urine culture, blood culture and hepatic function tests. Patients with symptoms of UTI, diabetis, prostatic disease were excluded. Eighty-two patients with cirrhosis were studied. Their mean age was 51 years (SD = 11); 73 percent were male. Hepatitis C virus was the main etiology in 45 percent of the cases. The Child-Pugh B functional class was observed in 52 percent of the cases. Urine cultures were positive in 4.9 percent of these patients. In this study of non-hospitalized cirrhotic patients, with no symptoms of UTI, the frequency of urinary tract infection was approximately 5 percent. The bacteria found were E. coli and Klebsiella pneumonia. We conclude that it is necessary to screen for UTI in such patients.

Anti-Golgi complex antibodies during pegylated-interferon therapy for hepatitis C.

BACKGROUND/AIM: Pegylated interferon (Peg-IFN) plus ribavirin is the standard therapy for hepatitis C. Peg-IFN has several antiviral mechanisms, but its role in hepatitis C treatment seems to be related to its immunomodulatory effect. Ribavirin, an antiviral agent, potentiates IFN activity when added to it. Both drugs are associated with adverse reactions of different magnitudes. Autoimmune phenomena have been reported with this treatment. In this paper, we describe cases of ALT/GGT flares during Peg-IFN plus ribavirin treatment, which related to the appearance of anti-Golgi antibody and disease progress. METHODS: We investigated three patients with hepatitis C and severe ALT/GGT flares during Peg-IFN and ribavirin treatment coinciding with anti-Golgi complex antibody as the only marker of autoimmunity. We then reviewed the medical files and tested anti-Golgi antibody in stored sera from 25 patients treated with conventional IFN and in 14 patients treated with Peg-IFN. RESULTS: The three patients were male, over 45 years of age; all were relapsers and non-responders. Anti-Golgi antibody was positive during treatment coinciding with ALT/GGT flares but with hepatitis C virus (HCV)-RNA negativity, disappearing after stopping treatment, with normalization of ALT/AST levels. One patient had progression of fibrosis from F2 to F3 despite negativity of HCV-RNA. In the last group, only two patients treated with Peg-IFN experienced ALT/GGT flares but without anti-Golgi antibody CONCLUSIONS: The presence of anti-Golgi complex antibody could be a marker of a temporary autoimmune phenomenon and progressive disease.

Peripheral insulin resistance during treatment of chronic hepatitis C with peguilated interferon plus ribavirin.

UNLABELLED: Patients with hepatitis C virus (HCV) infection present higher risk of developing type-2 diabetes mellitus (DM). However, the mechanism of this association and the role of antiviral treatment are still unclear. The objective of this study was to investigate the relationship between the use of peguilated interferon and the development of insulin resistance (IR) in these patients. METHODS: HOMA index was evaluated in 30 HCV-infected patients just before and during the first 6 months of treatment with peguilated interferon plus ribavirin. Anthropometrical parameters and glucose/cholesterol profile were also monitored. RESULTS: No changes in HOMA after 6 months of treatment were observed. Glucose levels decreased but not significantly (P = 0.059). Patients with higher HOMA index after 6 months of treatment also presented higher aminotransferase levels (P = 0.03), higher fat index on computed tomography (P = 0.011), longer time of exposure to the virus (P = 0.021), and a positive smoking history when compared to non-insulin resistant patients (P = 0.045). There was no influence of fibrosis stage on liver biopsy in the insulin-resistance development. CONCLUSIONS: No changes in the IR were observed after 6 months of treatment. Insulin resistance is related to the abdominal fat and anthropometrical parameters rather than to the antiviral treatment.

Urinary tract infection in non-hospitalized patients with cirrhosis and no symptoms of urinary tract infection: a case series study.

Bacterial infections are important factors in decompensation, and they increase the mortality rate of patients with liver cirrhosis. The most common infections among these patients are spontaneous bacterial peritonitis, pneumonia, skin infections and urinary tract infections (UTI). This transversal study evaluated the frequency of UTI in non-hospitalized patients with cirrhosis followed in a hepatology outpatient unit. Patients with clinical, laboratorial, echographic and/or histological diagnosis of cirrhosis were evaluated from April 2002 to August 2004. Patients who accepted participating in this study were submitted to clinical evaluation and the following laboratorial examinations: urine analysis, urine culture, blood culture and hepatic function tests. Patients with symptoms of UTI, diabetis, prostatic disease were excluded. Eighty-two patients with cirrhosis were studied. Their mean age was 51 years (SD = 11); 73% were male. Hepatitis C virus was the main etiology in 45% of the cases. The Child-Pugh B functional class was observed in 52% of the cases. Urine cultures were positive in 4.9% of these patients. In this study of non-hospitalized cirrhotic patients, with no symptoms of UTI, the frequency of urinary tract infection was approximately 5%. The bacteria found were E. coli and Klebsiella pneumonia. We conclude that it is necessary to screen for UTI in such patients.

Freqüência e implicaçöes dos auto-anticorpos em hepatites agudas virais / Frequency and implications of autoantibodies in acute viral hepatitis

Existem interaçöes entre viroses hepatotrópicas e o sistema imunológico do hospedeiro que podem influenciar na patogenicidade da agressäo hepática. O objetivo deste trabalho foi investigar a freqüência de auto-anticorpos na fase aguda da hepatite viral, sua relaçäo com atividade bioquímica, gravidade da doença e cronicidade. Foram estudados 156 pacientes com hepatite aguda viral de 1992 a 2000. Destes, 32 por cento tiveram infecçäo por vírus A, 31 por cento por vírus B, 8 por cento por vírus C, 3 por cento tiveram hepatite E e 24 por cento näo A-E. Na fase aguda, 20,5 por cento apresentaram FAN e 14,8 por cento antimúsculo liso positivos. Na convalescença, 6,4 por cento persistiram com FAN e 3,9 por cento com antimúsculo liso positivos. Pacientes que persistiam com anticorpos detectáveis näo apresentavam níveis de transaminases e bilirrubinas significativamente diferentes daqueles com auto-anticorpos negativos. Concluindo, os anticorpos que aparecem na fase inicial da infecçäo säo transitórios e näo têm implicaçäo prognóstica

[Frequency and implications of autoantibodies in acute viral hepatitis]. / Freqüência e implicações dos auto-anticorpos em hepatites agudas virais.

There are interactions between hepatotropic viruses and the host immune system, which could contribute to liver damage in viral hepatitis. The aim of this study was to investigate the frequency of autoantibodies in patients with acute viral hepatitis and their relationship with biochemical activity, severity of acute illness and chronicity rate. From 1992 to 2000, 156 patients with acute viral hepatitis were enrolled in a prospective study. Among these, hepatitis A was detected in 32%, hepatitis B in 31%, hepatitis C in 8%, hepatitis E in 3% and 24% were considered non A-E hepatitis. During the acute phase, 20.5% of patients presented ANA and 14.8% anti-smooth muscle antibody positive. During convalescence, 6.4% of patients showed ANA and 3.9% anti-smooth muscle positive. Comparison between autoantibodies-positive and negative groups showed no differences regarding ALT and bilirubin levels. In conclusion, autoantibodies can occur in acute viral hepatitis but there are no prognostic consequences.

A baixa qualidade do soro caseiro em Salvador, Brasil

Durante o ano de 1988 foi realizada uma campanha de âmbito nacional com o objetivo de informar a população brasileira sobre o preparo e utilização do soro caseiro (solução sal/açúcar para reidratação oral). A campanha foi intensivamente divulgada pelos meios de comunicação de massa. Este estudo preliminar avaliou a qualidade do soro caseiro preparado por 23 mães de crianças internadas num hospital pediátrico de Salvador, Bahia. Catorze (60,9) dentre as 23 mães prepararam soluções, contendo concentrações de Na na faixa de 30-80mmol/L, recomendada pela Organização Mundial da Saúde. Onze (47,8) soluções continham glicose dentro da faixa recomendada de 30-112 mmol/L. Apenas 6 (26) das 23 mães prepararam soluções com concentrações adequadas de Na e glicose simultaneamente e, destas, somente 3 (13) apresentavam, também, balanço adequado das concentrações dos eletrólitos. Características potencialmente iatrogênicas devido a elevadas concentrações de Na e glicose foram encontrados em 30,4 e em 43,5 das soluções, respectivamente. Os resultados revelam grande dificuldade das mães em preparar o soro caseiro com características adequadas para sua utilização numa campanha de controle da diarréia

Diagnóstico clínico versus autópsia / Clinical diagnosis versus autopsy

Para determinar a exatidào do diagnóstico clínico da causa básica de óbitos, analisaram-se os registros de 910 autópsias realizadas em um hospital universitário de Salvador, Bahia, Brasil. Em 31 casos encontraram-se incorrecôes nos diagnósticos clínicos. Entre 1970 e 1982 as taxas globais de erro diagnóstico mantiveram-se bastante estáveis, sendo mais elevadas para os pacientes mais idosos. Dos 263 óbitos por càncer, 36 porcent foram diagnosticados incorrectamente e várias patologias consideradas relativamente fáceis de diagnosticar, nem sempre foram identificadas corretamente. A causa da morte foi incorrectamente diagnosticada em vários óbitos decorrentes de enfermidades tais como: hipertensào arterial, doencas crônicas de obstrucào pulmonar, pneumonia/bronconeumonia e esquistossomose. Alèm de suas implicacôes médicas diretas, erros diagnósticos da magnitude que se observaram neste e em outros estudos, comprometem seriamente a qualidade das estatísticas vitais e de sua utilidade para melhorar a saúde pública

Diagnóstico clínico versus autópsia / Clinical diagnosis versus autopsy

Para determinar a exatidão do diagnóstico clínico da causa básica de óbitos, analisaram-se os registros de 910 autópsias realizadas em um hospital universitário de Salvador, Bahia, Brasil. Em 31 casos encontraram-se incorrecões nos diagnósticos clínicos. Entre 1970 e 1982 as taxas globais de erro diagnóstico mantiveram-se bastante estáveis, sendo mais elevadas para os pacientes mais idosos. Dos 263 óbitos por cãncer, 36 porcent foram diagnosticados incorrectamente e várias patologias consideradas relativamente fáceis de diagnosticar, nem sempre foram identificadas corretamente. A causa da morte foi incorrectamente diagnosticada em vários óbitos decorrentes de enfermidades tais como: hipertensão arterial, doencas crñicas de obstrucão pulmonar, pneumonia/bronconeumonia e esquistossomose. Alèm de suas implicacões médicas diretas, erros diagnósticos da magnitude que se observaram neste e em outros estudos, comprometem seriamente a qualidade das estatísticas vitais e de sua utilidade para melhorar a saúde pública

Clinical diagnosis versus autopsy

Records from 910 autopsies performed at a university hospital in Salvador, Bahia, Brazil, were examined in order to assess the accuracy of clinical diagnoses of the patients' underlying causes of death. This study found inaccurate clinical diagnoses in 31 per cent of the cases. The overall rate of diagnostic error appeared to remain fairly stable from 1970 to 1982 being highest for older patients. Thirthy-six percent of the 263 cancer deaths were incorrectly diagnosed, and a number of pathologies considered relatively easy to diagnose were not always correctly identified. Quite aside from their direct medical implications, diagnostic errors of the magnitude observed in this and other studies seriosly jeopardize the quality of vital statistics and such statistics' usefulness for improving public health

Clinical diagnosis versus autopsy

Records from 910 autopsies performed at a university hospital in Salvador, Bahia, Brazil, were examined in order to assess the accuracy of clinical diagnoses of the patients' underlying causes of death. This study found inaccurate clinical diagnoses in 31 per cent of the cases. The overall rate of diagnostic error appeared to remain fairly stable from 1970 to 1982 being highest for older patients. Thirthy-six percent of the 263 cancer deaths were incorrectly diagnosed, and a number of pathologies considered relatively easy to diagnose were not always correctly identified. Quite aside from their direct medical implications, diagnostic errors of the magnitude observed in this and other studies seriosly jeopardize the quality of vital statistics and such statistics' usefulness for improving public health

Disponible en Portugues en: Bol. Oficina Sanit. Panam 110(3):213-18, 1991