Effectiveness of mat pilates on fatigue in women with breast cancer submitted to adjuvant radiotherapy: randomized controlled clinical trial.

PURPOSE: This clinical trial aimed to evaluate the influence of Mat Pilates and time on the change in fatigue scores in women with breast cancer undergoing adjuvant radiotherapy (RT). Additionally, assess the adherence and adverse effects of Mat Pilates sessions and the association of the level of physical activity with severe fatigue symptoms. METHODS: One hundred fifty-six patients with non-metastatic breast cancer were randomized to usual care or supervised Mat Pilates exercise. Fatigue and physical activity level were measured at baseline, end of RT, 30 days, 3 and 6 months after RT. The generalized estimating equation (GEE) with intention to treat was applied. RESULTS: A significant difference in the fatigue mean between the end of RT and the baseline was found in patients of both groups. There was no adverse effect with the practice of Mat Pilates, and it was analyzed the reduction of the symptom pain after the end of RT in women of intervention group compared to the control. There was no significant effect on fatigue between the groups. Patients with severe fatigue after 3 and 6 months of RT reported a significantly lower level of physical activity in the last periods. CONCLUSION: Fatigue levels increased at the end of RT but returned to baseline values after 6 months. A lower level of physical activity was associated with severe fatigue symptoms. Mat Pilates was safe for these women and reduced the symptom pain after treatment, but it did not successfully reduce fatigue during adjuvant RT. REGISTRATION: NCT03333993. November 7, 2017.  https://clinicaltrials.gov/ct2/show/NCT03333993?term=breast+cancer&cond=pilates&draw=2&rank=1 .

Gestational protein restriction alters early amygdala neurochemistry in male offspring.

BACKGROUND: Gestational protein intake restriction-induced long-lasting harmful outcomes in the offspring's organs and systems. However, few studies have focused on this event's impact on the brain's structures and neurochemical compounds. AIM: The present study investigated the effects on the amygdala neurochemical composition and neuronal structure in gestational protein-restricted male rats' offspring. METHODS: Dams were maintained on isocaloric standard rodent laboratory chow with regular protein [NP, 17%] or low protein content [LP, 6%]. Total cells were quantified using the Isotropic fractionator method, Neuronal 3D reconstruction, and dendritic tree analysis using the Golgi-Cox technique. Western blot and high-performance liquid chromatography performed neurochemical studies. RESULTS: The gestational low-protein feeding offspring showed a significant decrease in birth weight up to day 14, associated with unaltered brain weight in youth or adult progenies. The amygdala cell numbers were unchanged, and the dendrites length and dendritic ramifications 3D analysis in LP compared to age-matched NP progeny. However, the current study shows reduced amygdala content of norepinephrine, epinephrine, and dopamine in LP progeny. These offspring observed a significant reduction in the amygdala glucocorticoid (GR) and mineralocorticoid (MR) receptor protein levels. Also corticotrophin-releasing factor (CRF) amygdala protein content was reduced in 7 and 14-day-old LP rats. CONCLUSION: The observed amygdala neurochemical changes may represent adaptation during embryonic development in response to elevated fetal exposure to maternal corticosteroid levels. In this way, gestational malnutrition stress can alter the amygdala's neurochemical content and may contribute to known behavioral changes induced by gestational protein restriction.

Acompanhamento Fisioterapêutico após Tratamento Cirúrgico do Câncer de Mama por Teleconsulta: Percepção e Adesão das Pacientes / Physiotherapeutic Follow-up after Surgery for Breast Cancer Treatment by Telehealth: Patients' Perception and Adherence / Seguimiento Fisioterapéutico Posquirúrgico para el Tratamiento del Cáncer de Mama por Teleconsulta: Percepción y Adherencia de las Pacientes

Introdução: O serviço de fisioterapia do Hospital do Câncer III do Instituto Nacional de Câncer (HCIII/INCA) inseriu as teleconsultas em suas atividades assistenciais para o acompanhamento das pacientes submetidas ao tratamento cirúrgico do câncer de mama durante a pandemia. Objetivo: Avaliar a percepção das pacientes quanto aos atendimentos por teleconsulta no HCIII/INCA, além da compreensão e da adesão quanto às orientações fisioterapêuticas domiciliares no pós-operatório de câncer de mama. Método: Estudo observacional, de abordagem qualiquantitativa, no qual foram incluídas pacientes submetidas ao tratamento cirúrgico do câncer de mama, de março a maio de 2020, que realizaram teleconsultas com a fisioterapia. Foi utilizado um questionário com perguntas semiestruturadas e uma pergunta aberta sobre teleconsulta. Resultados: Foram incluídas 129 mulheres, 81,4% referiram conforto com as teleconsultas, 72,1% sentiram-se muito seguras e 71,3% sentiram-se satisfeitas com esse tipo de atendimento. Quanto às orientações fisioterapêuticas fornecidas, 89,1% das pacientes relataram que as entenderam e 66,7% que as seguiram totalmente; 63,6% realizaram os exercícios de membros superiores diariamente. Quanto à questão qualitativa, as pacientes relataram que a teleconsulta foi necessária, válida e importante por evitar a exposição ao vírus no período da pandemia, além de evitar os deslocamentos até a instituição, a economia de tempo e de dinheiro. Conclusão: A modalidade de teleconsulta nas avaliações da fisioterapia pós-cirurgia do câncer de mama geraram percepções de segurança, conforto e satisfação, tendo boa compreensão e adesão tanto das orientações fornecidas quanto da prática de exercícios domiciliares

Introduction: The physiotherapy service at the Cancer Hospital III of the National Cancer Institute (HCIII/INCA) has included telehealth in its care activities for monitoring patients undergoing surgical treatment for breast cancer during the pandemic. Objective: To evaluate the perception of patients about telehealth at HCIII/INCA, in addition to understanding and adherence to home physiotherapeutic guidelines in the postoperative breast cancer period. Method: Observational, qualitative and quantitative approach study, which included patients who received surgical treatment for breast cancer from March to May 2020 and attended physiotherapy telehealth. A semi-structured questionnaire with an open question about telehealth was utilized. Results: 129 women were included, 81.4% reported comfort with telehealth, 72.1% felt very safe and 71.3% felt satisfied with this type of service. Regarding physiotherapeutic guidelines provided, 89.1% of the patients claimed they understood the content, 66.7% followed them completely and 63.6% performed daily upper limb exercises. In relation to the quality, the patients reported that telehealth was necessary, valid and important to avoid exposure to the virus during the pandemic, in addition to being cost-effective, time-saving and avoiding trips to the institution. Conclusion: The modality of telehealth as evaluated by physiotherapy after breast cancer surgery generated a feeling of security, comfort and satisfaction, with good understanding and adherence to the guidelines and practice of home exercises

Introducción: El servicio de fisioterapia del Hospital Oncológico III del Instituto Nacional del Cáncer (HCIII/INCA) ha incluido la teleconsulta en su actividad asistencial para el seguimiento de las pacientes sometidas a tratamiento quirúrgico por cáncer de mama durante la pandemia. Objetivo: Evaluar la percepción de las pacientes sobre la teleconsulta en el HCIII/INCA, además de su comprensión y adherencia a las pautas de fisioterapia domiciliaria en el posoperatorio de cáncer de mama. Método: Estudio observacional, con abordaje cualitativa y cuantitativa, que incluyó pacientes que se sometieron a tratamiento quirúrgico por cáncer de mama, de marzo a mayo de 2020, a quienes se les realizó teleconsultas con fisioterapia. Se utilizó un cuestionario con preguntas semiestructuradas y una pregunta abierta sobre teleconsulta. Resultados: Se incluyeron 129 mujeres, el 81,4% refirió comodidad con las teleconsultas, el 72,1% se sintió muy segura y el 71,3% se sintió satisfecha con este tipo de atención. En cuanto a las pautas fisioterapéuticas brindadas, el 89,1% de las pacientes reportó que las entendían y el 66,7% que las seguía completamente; el 63,6% realizaba ejercicios de miembros superiores diariamente. En cuanto a la pregunta cualitativa, las pacientes relataron que la teleconsulta fue necesaria, válida e importante para evitar la exposición al virus durante el período de pandemia, además de evitar desplazamientos a la institución, ahorrando tiempo y dinero. Conclusión: La modalidad de teleconsulta en las evaluaciones de fisioterapia después de la cirugía de cáncer de mama generó percepciones de seguridad, comodidad y satisfacción, con buena comprensión y adherencia tanto a las orientaciones brindadas como a la práctica de ejercicios domiciliarios

O parto vaginal e o corpo feminino no puerpério: Contribuições para a enfermagem obstétrica / El parto vaginal y el cuerpo femenino en la puerperia: Aportes a la enfermería obstétrica / Vaginal birth and the female body in the puerperum: Contributions to obstetric nursing

Objetivo: descrever os significados e os sentimentos da mulher após o parto vaginal e identificar como a atuação da enfermagem obstétrica pode contribuir para melhores experiências no puerpério. Método: Pesquisa fenomenológica heideggeriana com 14 mulheres que passaram pelo parto vaginal. Realizada entrevista aberta audiogravada, para a constituição da Unidade de Significação e da compreensão vaga e mediana. Resultado: O vivido e os sentimentos da mulher após o parto vaginal significaram: ter medo de fazer sexo, sentir dor na relação sexual, achar que não ia voltar a ser normal, sentir o corpo diferente de antes, achar que a relação sexual mudou, perder o desejo sexual. Conclusão: A atuação da enfermagem obstétrica é necessária para melhores desfechos frente ao medo e à adaptação da puérpera ao retorno da atividade sexual, pontuando ações simples para a sexualidade da puérpera/casal, como: cuidados de higiene, uso de lubrificantes e estímulo à retomada da intimidade sexual.(AU)

Objective: to describe the meanings and feelings of women after vaginal delivery and to identify how the performance of obstetric nursing can contribute to better experiences in the puerperium. Method: Heideggerian phenomenological research with 14 women who underwent vaginal delivery. An open audio-recorded interview was carried out, for the constitution of the Meaning Unit and vague and median understanding. Result: The experience and feelings of the woman after vaginal delivery meant: being afraid of having sex, feeling pain in sexual intercourse, thinking that it would not go back to being normal, feeling the body different from before, thinking that the sexual relationship has changed, lose sexual desire. Conclusion: The performance of obstetric nursing is necessary for better outcomes in the face of fear and the adaptation of the puerperal woman to the return of sexual activity, punctuating simple actions for the sexuality of the puerperal woman/couple, such as: hygiene care, use of lubricants and encouragement to resume of sexual intimacy.(AU)

Objetivo: describir los significados y sentimientos de las mujeres después del parto vaginal e identificar cómo la actuación de la enfermería obstétrica puede contribuir para mejores experiencias en el puerperio. Método: Investigación fenomenológica heideggeriana con 14 mujeres que tuvieron parto vaginal. Se realizó una entrevista abierta grabada en audio, para la constitución de la Unidad de Significado y comprensión vaga y mediana. Resultado: La experiencia y sentimientos de la mujer después del parto vaginal significó: tener miedo de tener relaciones sexuales, sentir dolor en las relaciones sexuales, pensar que no volvería a ser normal, sentir el cuerpo diferente al anterior, pensar que la relación sexual ha cambia, pierde el deseo sexual. Conclusión: La actuación de enfermería obstétrica es necesaria para mejores resultados frente al miedo y la adaptación de la puérpera al retorno de la actividad sexual, puntuando acciones simples para la sexualidad de la puérpera/pareja, tales como: cuidado de la higiene, uso de lubricantes y estímulo a la reanudación de la intimidad sexual.(AU)

Impact on fatigue of different types of physical exercise during adjuvant chemotherapy and radiotherapy in breast cancer: systematic review and meta-analysis.

BACKGROUND: Physical exercise in women with breast cancer has shown benefits in reducing fatigue levels during adjuvant radiotherapy and chemotherapy. However, it is not well understood which type of exercise is more effective. OBJECTIVE: Assess the impact of different types of physical exercises on fatigue and which is the most effective in reducing this adverse effect during adjuvant treatment in breast cancer. METHODS: The inclusion criteria were randomized clinical trials of physical exercise in women diagnosed with breast cancer in stages I to IV, above 18 years, evaluating fatigue using validated questionnaires. The meta-analysis pooled results by standardized mean difference (SMD). RESULTS: A total of 20 randomized clinical trials involving 1793 participants revealed that the practice of physical exercise was statistically effective in reducing fatigue (SMD = - 0.46; 95% CI: - 0.66, - 0.27). Our analysis of subgroups suggests that the supervised combination of resistance training (RT) with aerobic training (AT) is the most effective physical exercise to reduce fatigue (SMD = - 1.13; 95% CI: - 2.09, - 0.17). The supervised RT was more effective (SMD = - 0.30; 95% CI: - 0.46, - 0.15) than supervised AT or mind-body techniques. It was observed that only during chemotherapy, women with breast cancer in the intervention groups showed a significant reduction in fatigue (SMD = - 0.38; 95% CI: - 0.55 to - 0.20). CONCLUSION: Physical exercise during adjuvant chemotherapy and/or radiotherapy in women with breast cancer can be considered beneficial in reducing fatigue, especially for women undergoing chemotherapy and for supervised training of resistance or combined RT and AT.

Axillary surgical approach in T1-T2N0M0 clinical breast cancer staging: Survival in a women's hospital cohort in Rio de Janeiro

The concerns regarding the prognosis and quality of life of patients with early breast cancer staging without lymph node involvement have increased, especially with regard to the axillary surgical approach. The aim of the present study was to determine overall survival and disease-free survival according to the axillary surgical approach. Methods: Retrospective cohort study of 827 women with clinical T1-T2N0M0 diagnosis attended at the Cancer Hospital III of the Brazilian National Cancer Institute, from January 2007 to December 2009, with a follow-up period of 60 months. Data were obtained from the Hospital Registry of Cancer through the medical records. Results: 683 women underwent sentinel lymph node biopsy and 144 underwent sentinel lymph node biopsy followed by axillary lymphadenectomy. After 5 years of follow-up, considering adjustment, it was observed overall survival (96.2% vs 93.6%; HR 0.98; 95%CI 0.42­2.29) and disease-free survival (93.7% vs 91.2%; HR 0.78; 95%CI 0.39­1.48) similar among patients undergoing either one or the other approach. In patients with micrometastasis, both overall (93.3%) and diseasefree survival (100%) were higher in women who underwent only sentinel lymph node biopsy compared to those who underwent this procedure followed by axillary lymphadenectomy (OS: 87.5%; DFS: 90,7%), albeit not statistically significant.

O Uso da Bandagem Compressiva no Pós-Operatório Imediato Não Está Associado à Dor Aguda Pós-Mastectomia / Use of Compression Bandage in the Immediate Postoperative Period is Not Associated with Post-Mastectomy Acute Pain / El Uso de Vendaje Compresivo en el Postoperatorio Inmediato No se Asocia con Dolor Agudo tras Mastectomía

Introdução: A bandagem cinesiológica é um tratamento não farmacológico de baixo custo, simples e de fácil aplicação, que tem como função atuar na redução da dor, no edema local e na melhora da atividade muscular. Objetivo: Avaliar a associação entre o uso da bandagem compressiva na ocorrência de dor pós-operatória em mulheres submetidas à mastectomia no Hospital do Câncer III do Instituto Nacional de Câncer (HC III/INCA). Método: Ensaio clínico randomizado com 106 mulheres submetidas à mastectomia entre março e novembro de 2021. As pacientes, após sorteio, foram designadas para um grupo controle de cuidados de rotina da instituição e para um grupo intervenção, em que foi acrescida, aos cuidados de rotina, a aplicação da bandagem compressiva na região do plastrão no primeiro dia (D1) do pós-operatório. Foram avaliadas dor, parestesia, amplitude de movimento e síndrome da rede axilar no D1, na primeira semana (D7) e no primeiro mês (D30) após a cirurgia. Resultados: Os dois grupos foram similares com relação aos dados demográficos e clínicos. Não houve diferença significativa na presença de dor no local da aplicação (nas avaliações D7 e D30) sendo 24,1% e 27,8% para o grupo da bandagem compressiva (p=0,102) e 11,8% e 17,6% para o grupo controle (p=0,217). Não houve diferença estatisticamente significativa para qualquer desfecho avaliado. Conclusão: O uso da bandagem compressiva no pós-operatório imediato não esteve associado à dor e a outras complicações nas avaliações de sete e 30 dias de pós-operatório de mastectomias

Introduction: Kinesiological bandage is a low-cost, simple and easy-to-apply non-pharmacological treatment that aims to reduce pain, local edema and improvement of muscle activity. Objective: To evaluate the association between the use of compressive bandage in the occurrence of postoperative pain in women undergoing mastectomy at Cancer Hospital III of the National Cancer Institute (HC III/INCA). Method: One hundred and six women who underwent mastectomy between March and November 2021 participated of this randomized clinical trial. The patients were randomly assigned to a routine care group at the institution and an intervention group, in which the application of a compressive bandage in the breast plastron in the first postoperative day (D1) was added to the routine care. Pain, paresthesia, range of motion and axillary web syndrome were evaluated on the D1, the first week (D7) and the first month (D30) after surgery. Results: The two groups were similar with respect to demographic and clinical data. There was no significant difference in the presence of local pain (at D7 and D30) in 24.1% and 27.8% for the compressive bandage group (p=0.102) and 11.8% and 17.6% for the control group (p=0.217). There were no other statistically significant differences for any outcome assessed. Conclusion: The use of compressive bandage in the immediate postoperative period was not associated with pain and other complications in the 7th and 30th days after mastectomies

Introducción: El vendaje kinesiológico es un tratamiento no farmacológico de bajo costo, sencillo y fácil de aplicar, cuya función es disminuir el dolor, el edema local y mejorar la actividad muscular. Objetivo: Evaluar la asociación entre el uso de vendaje compresivo y la aparición de dolor posoperatorio en mujeres sometidas a mastectomía en el Hospital del Cáncer III del Instituto Nacional del Cáncer (HC III/INCA). Método: Ciento seis mujeres sometidas a mastectomía entre marzo y noviembre de 2021 participaron en este ensayo clínico aleatorizado. Los pacientes fueron asignados aleatoriamente a un grupo de atención de rutina en la institución y a un grupo de intervención, en los que se agregó a la atención de rutina la aplicación de un vendaje compresivo en la región del plastrón en el primer día (D1) del postoperatorio. El dolor, las parestesias, el rango de movimiento y el síndrome de red axilar se evaluaron el D1, la primera semana (D7) y el primer mes (D30) después de la cirugía. Resultados: Los dos grupos fueron similares con respecto a los datos demográficos y clínicos. No hubo diferencia significativa en la presencia de dolor en el sitio de aplicación (en las evaluaciones D7 y D30) con 24,1% y 27,8% para el grupo de vendaje compresivo (p=0,102) y 11,8% y 17,6% para el grupo control (p=0,217). No hubo diferencias estadísticamente significativas para ninguno de los resultados evaluados. Conclusión: El uso de vendaje compresivo en el posoperatorio inmediato, no se asoció con dolor y otras complicaciones en las evaluaciones de 7 y 30 días después de mastectomías

Naïve hepatitis B e antigen-negative chronic hepatitis B patients are at risk of carotid atherosclerosis: A prospective study.

BACKGROUND: There is an increased risk of atherosclerosis in patients with chronic hepatitis C or human immunodeficiency virus, but there is scarce data on hepatitis B virus infection. The hypothesis of this study is that hepatitis B virus infection increases the risk of carotid plaques and subclinical atherosclerosis in naïve hepatitis B e antigen (HBeAg) negative subjects. AIM: To assess the rate of carotid plaques and subclinical atherosclerosis in naïve HBeAg negative subjects in comparison with a cohort of healthy controls. METHODS: Prospective case-control collaborative study conducted in two tertiary hospitals. Four hundred and two subjects prospectively recruited at the outpatient clinic were included from May 2016 to April 2017: 201 naïve HBeAg-negative hepatitis B virus-infected [49 chronic hepatitis B (CHB) and 152 inactive carriers(ICs)] and 201 healthy controls. Anthropomorphic and metabolic measures, liver stiffness and carotid Doppler ultrasound were performed. Subclinical atherosclerosis was established on an intima-media thickness increase of ≥1.2 mm and/or the presence of carotid plaques. Normally distributed quantitative variables were compared with the Student t test and those with a non-normal distribution with the Mann-Whitney U test. Categorical variables were compared between groups using the χ 2 or Fisher exact test. RESULTS: Carotid plaques were found more often in CHB (32.7%) than ICs (17.1%) or controls (18.4%) (P = 0.048). Subclinical atherosclerosis was also increased in CHB (40.8%) vsICs (19.1%) or controls (19.4%) (P = 0.003). No differences in the risk of atherosclerosis were observed between controls and ICs. The factors independently associated with the presence of carotid plaques were age [odds ratio(OR) 1.43, P < 0.001] and CHB (OR 1.18, P = 0.004) and for subclinical atherosclerosis, age (OR 1.45, P < 0.001), CHB (OR 1.23, P < 0.001) and diabetes (OR 1.13, P = 0.028). In the subset of young subjects (< 50 years), carotid plaques (12.5% vs 1.1%, P = 0.027) and subclinical atherosclerosis (12.5% vs 2.2%, P = 0.058) were more frequent among CHB than ICs. CONCLUSION: Untreated HBeAg-negative CHB is an independent risk factor for carotid plaques and subclinical atherosclerosis, while ICs present a similar risk to controls.

Right ventricular diameter predicts all-cause mortality in heart failure with preserved ejection fraction.

Left ventricular ejection fraction (EF) is helpful to differentiate heart failure (HF) phenotype in clinical practice. The aim of the study was to identify simple echocardiographic predictors of post-discharge all-cause mortality in hospitalized HF patients. Patients with acute HF (75 ± 9.8 years), classified in preserved (≥ 50%) and reduced (< 50%) EF (HFpEF and HFrEF, respectively), were enrolled. The mean follow-up period was of 25.4 months. Patients definitively analyzed were 135. At multivariate Cox model, right ventricular diameter (RVd), inferior vena cava diameter (IVCd) and blood urea nitrogen (BUN) resulted to be significantly associated with all-cause mortality in HFpEF (HR 2.4, p = 0.04; HR 1.06, p = 0.02; HR 1.02, p = 0.01), whereas, left atrial volume (LAV) was significantly associated with mortality in HFrEF (HR 1.06, p = 0.006). Excluding LAV from the model, only COPD remained an independent predictor of all-cause mortality (HR 2.15, p = 0.04) in HFrEF. At Kaplan-Meier analysis, no differences of survival between HFrEF and HFpEF were found, however, significantly increased all-cause mortality for higher values of basal-RVd, BUN, and IVCd (log-rank p = 0.0065, 0.0063, 0.0005) in HFpEF, and for COPD and higher LAV (log-rank p = 0.0046, p = 0.033) in HFrEF. These data are indicative that in patients hospitalized with HF, EF is not a suitable predictor of long-term all-cause mortality, whereas, right ventricular volumetric remodeling and IVCd have a prognostic role in HFpEF as well as LAV in HFrEF. Our study suggests that besides EF, other echocardiographic parameters are helpful to optimize the phenotyping and prognostic stratification of HF.

Inflammation and Aortic Pulse Wave Velocity: A Multicenter Longitudinal Study in Patients With Inflammatory Bowel Disease.

Background Inflammatory bowel disease ( IBD ) is characterized by a low prevalence of traditional risk factors, an increased aortic pulse-wave velocity ( aPWV ), and an excess of cardiovascular events. We have previously hypothesized that the cardiovascular risk excess reported in these patients could be explained by chronic inflammation. Here, we tested the hypothesis that chronic inflammation is responsible for the increased aPWV previously reported in IBD patients and that anti-TNFa (anti-tumor necrosis factor-alpha) therapy reduce aPWV in these patients. Methods and Results This was a multicenter longitudinal study. We enrolled 334 patients: 82 patients with ulcerative colitis, 85 patients with Crohn disease, and 167 healthy control subjects matched for age, sex, and mean blood pressure, from 3 centers in Europe, and followed them for 4 years (range, 2.5-5.7 years). At baseline, IBD patients had higher aPWV than controls. IBD patients in remission and those treated with anti-TNFa during follow-up experienced an aortic destiffening, whereas aPWV increased in those with active disease and those treated with salicylates ( P=0.01). Disease duration ( P=0.02) was associated with aortic stiffening as was, in patients with ulcerative colitis, high-sensitivity C-reactive protein during follow-up ( P=0.02). All these results were confirmed after adjustment for major confounders. Finally, the duration of anti-TNFa therapy was not associated with the magnitude of the reduction in aPWV at the end of follow-up ( P=0.85). Conclusions Long-term anti-TNFa therapy reduces aPWV , an established surrogate measure of cardiovascular risk, in patients with IBD . This suggests that effective control of inflammation may reduce cardiovascular risk in these patients.

Axillary surgery in breast cancer: acute postoperative complications in a hospital cohort of women of Rio de Janeiro, Brazil / Abordagem cirúrgica axilar no câncer de mama: complicações pós-operatórias agudas em uma coorte hospitalar de mulheres do Rio de Janeiro

Objective: To analyze the incidence of early postoperative complications in women with breast cancer according to the axillary surgery. Methods: An observational study of a cohort of women diagnosed with T1-T2N0M0 clinical stage breast cancer attended at the Brazilian National Cancer Institute from January 2007 to December 2009. The outcome was defined as postsurgical complications in the affected upper limb, such as: axillary web syndrome, winged scapula, paraesthesia and surgical wound, seroma and wound infection. The incidence of simple complications was estimated. The crude and adjusted Odds Ratios, with their respective 95% confidence intervals, were estimated by Multiple Logistic Regression analysis. Results: The incidence of postoperative complications was significantly lower in sentinel lymph node biopsy (axillary web syndrome: 6.0%; paraesthesia: 45.2%; winged scapula: 9.1%; seroma: 28.5%; wound infection: 3.8%) than in axillary lymphadenectomy (axillary web syndrome: 22.5%; paraesthesia: 89.8%; winged scapula: 50.0%; seroma: 69.4%; wound infection: 12.9%). Compared to those who underwent axillary lymphadenectomy, the risk of postoperative complications in those in whom sentinel lymph node biopsy was performed was significantly lower. Conclusion: The sentinel lymph node biopsy technique was an independent protective factor for acute postoperative complications when compared to axillary lymphadenectomy

Objetivo: Analisar a incidência de complicações pós-operatórias precoces em mulheres com câncer de mama de acordo com a cirurgia axilar. Métodos: Estudo observacional de uma coorte de mulheres diagnosticadas com câncer de mama em estágio clínico T1-T2N0M0 atendidas no Instituto Nacional de Câncer do Brasil de janeiro de 2007 a dezembro de 2009. O desfecho foi definido como complicações pós-cirúrgicas no membro superior afetado, tais como: síndrome da rede axilar, escápula alada, parestesia e ferida cirúrgica, seroma e infecção da ferida. A incidência de complicações simples foi estimada. Os Odds Ratios bruto e ajustado, com seus respectivos intervalos de confiança de 95%, foram estimados por análise de Regressão Logística Múltipla. Resultados: A incidência de complicações pós-operatórias foi significativamente menor na biópsia de linfonodo sentinela (síndrome da rede axilar: 6,0%; parestesia: 45,2%; escápula alada: 9,1%; seroma: 28,5%; infecção da ferida: 3,8%) do que na linfadenectomia axilar (síndrome da rede axilar: 22,5%; parestesia: 89,8%; escápula alada: 50,0%; seroma: 69,4%; infecção da ferida: 12,9%). Em comparação com aqueles que foram submetidos a linfadenectomia axilar, o risco de complicações pós-operatórias naqueles nos quais a biópsia de linfonodo sentinela foi realizada foi significativamente menor. Conclusão: A técnica de biópsia de linfonodo sentinela foi um fator de proteção independente para complicações pós-operatórias quando comparadas à linfadenectomia axilar

Hepatitis C virus eradication by direct-acting antiviral agents improves carotid atherosclerosis in patients with severe liver fibrosis.

BACKGROUND AND AIMS: Recent studies suggest an association between hepatitis C virus (HCV) infection and cardiovascular damage, including carotid atherosclerosis, with a possible effect of HCV clearance on cardiovascular outcomes. We aimed to examine whether HCV eradication by direct-acting antiviral agents (DAA) improves carotid atherosclerosis in HCV-infected patients with advanced fibrosis/compensated cirrhosis. MATERIALS AND METHODS: One hundred eighty-two consecutive patients with HCV and advanced fibrosis or compensated cirrhosis were evaluated. All patients underwent DAA-based antiviral therapy according to AISF/EASL guidelines. Intima-media thickness (IMT), carotid thickening (IMT ≥1 mm) and carotid plaques, defined as focal thickening of ≥1.5 mm at the level of the common carotid, were evaluated by ultrasonography (US) at baseline and 9-12 months after the end of therapy. Fifty-six percent of patients were male, mean age 63.1 ±â€¯10.4 years, and 65.9% had compensated cirrhosis. One in five had diabetes, 14.3% were obese, 41.8% had arterial hypertension and 35.2% were smokers. At baseline, mean IMT was 0.94 ±â€¯0.29 mm, 42.8% had IMT ≥1 mm, and 42.8% had carotid plaques. RESULTS: All patients achieved a 12-week sustained virological response. IMT significantly decreased from baseline to follow-up (0.94 ±â€¯0.29 mm vs. 0.81 ±â€¯0.27, p <0.001). Consistently, a significant reduction in the prevalence of patients with carotid thickening from baseline to follow-up was observed (42.8% vs. 17%, p <0.001), while no changes were reported for carotid plaques (42.8% vs. 47.8%, p = 0.34). These results were confirmed in subgroups of patients stratified for cardiovascular risk factors and liver disease severity. CONCLUSION: HCV eradication by DAA improves carotid atherosclerosis in patients with severe fibrosis with or without additional metabolic risk factors. The impact of this improvement in the atherosclerotic burden in terms of reduction of major cardiovascular outcomes is worth investigating in the long term. LAY SUMMARY: Hepatitis C virus eradication by direct-acting antiviral agents improves carotid atherosclerosis in patients with advanced fibrosis/compensated cirrhosis. The improvement in intima-media thickness and carotid thickening was confirmed after stratification for severity of liver disease and cardiovascular risk factors. Hepatitis C virus eradication by direct-acting antiviral agents also lead to improvement in glucose homeostasis and increased cholesterol levels.

Percepção das Mulheres sobre sua Funcionalidade e Qualidade de Vida após Mastectomia / Women Perception of their Functionality and Quality of Life after Mastectomy / Percepción de las Mujeres sobre su Funcionalidad y Calidad de Vida después Mastectomía

Introdução: No Brasil, o diagnóstico do câncer de mama ocorre geralmente em fase avançada, culminando com tratamentos mais agressivos que levam a maiores sequelas funcionais e psicológicas, que interferem negativamente na qualidade de vida. Objetivo: Compreender e descrever a percepção das pacientes sobre o impacto do tratamento oncológico e a contribuição da fisioterapia na recuperação da sua qualidade de vida e funcionalidade. Método: Trata-se de um estudo qualitativo no qual foram incluídas 29 mulheres submetidas à mastectomia radical modificada, que apresentaram restrição da amplitude de movimento de membro superior. As pacientes realizaram dez atendimentos fisioterapêuticos e, ao final, foram submetidas a entrevistas semiestruturadas, categorizadas em relação aos efeitos do tratamento oncológico, limitações pós-cirúrgicas, conceito de qualidade de vida e impacto do tratamento fisioterapêutico no retorno às atividades de vida diária. Resultados: Após o tratamento, as pacientes relataram melhora da capacidade funcional, emocional e autoestima, possibilitando sua reinserção social e retorno às atividades de vida diária. Conclusão: Por meio dos relatos, foi possível concluir que a reabilitação promoveu resultados positivos na qualidade de vida e funcionalidade e ter uma percepção mais ampla sobre o impacto do adoecimento e do tratamento oncológico no cotidiano dessas mulheres, subsidiando assim caminhos para o aperfeiçoamento do cuidado fisioterapêutico a essa população.

Introduction: In Brazil, the breast cancer diagnosis usually occurs an advanced stage, culminating in more aggressive treatments that lead to greater functional and psychological sequelae that interfere negatively in the quality of life. Objective: This study aimed to understand and describe the patients' perception about the impact of cancer treatment and the contribution of physiotherapy to recovery their quality of life and functionality. Method: It ́s a qualitative study with twenty-nine women, underwent modified radical mastectomy and who presented a restriction of the range of motion of the upper limb. The patients underwent ten physiotherapeutic sessions and, in the end, they were submitted to semi-structured interviews, categorized in relation to the effects of oncological treatment, post-surgical limitations, concept of quality of life and impact of physical therapy on return to daily activities of daily living. Results: After the treatment, the patients reported functional, emotional and self-esteem improvement, allowing their social reinsertion and return activities of daily living. Conclusion: Through the reports, it was possible to conclude that the rehabilitation promoted positive results in the quality of life and functionality and we could have a broader perception about the impact of the illness and oncological treatment in the daily life of these women, thus subsidizing ways to improve the physiotherapeutic care to this population.

Introducción: En Brasil, el diagnóstico del cancro de mama ocurre generalmente, en fase avanzada, culminando con tratamientos más agresivos que llevan a mayores secuelas funcionales y psicológicas que interfieren negativamente en la calidad de vida. Objetivo: Comprender y describir la percepción de las pacientes sobre el impacto del tratamiento oncológico y la contribución de la fisioterapia en la mejora de su calidad de vida y funcionalidad. Método: Se trata de un estudio cualitativo en el que se incluyeron 29 mujeres, sometidas a la mastectomía radical modificada, que presentaron restricción de la amplitud de movimiento de miembro superior. Las pacientes realizaron diez atendimientos fisioterapéuticos y, al final, fueron sometidas a entrevistas semiestructuradas, categorizadas en relación a los efectos del tratamiento oncológico, limitaciones postquirúrgicas, concepto de calidad de vida e impacto del tratamiento fisioterapéutico en el retorno a las actividades de vida diaria. Resultados: Después del tratamiento, las pacientes reportaron mejoría de la capacidad funcional, emocional y autoestima, posibilitando su reinserción social, retorno a las actividades de vida diaria. Conclusión: Por medio de los relatos, fue posible concluir que la rehabilitación tuvo resultados positivos en la calidad de vida y funcionalidad y tener una percepción más amplia sobre el impacto de la enfermedad y del tratamiento oncológico en el cotidiano de esas mujeres, subsidiando así caminos para perfeccionar el cuidado fisioterapéutico a esta población.

Increased expression of markers of early atherosclerosis in patients with inflammatory bowel disease.

BACKGROUND & AIMS: Recent studies documented an increased cardiovascular risk in patients with inflammatory bowel disease (IBD). Our study aimed at investigating the prevalence of intima-media thickness (IMT) of the carotid arteries and the arterial stiffness indices as markers of early atherosclerosis in young IBD patients. METHODS: We recruited 68 consecutive IBD patients, and 38 matched healthy controls less than 45years old (median age 31.6±8.1years). Clinical and demographic features, cardiovascular risk factors, history of cardiovascular events, concomitant therapies were registered on a dedicate database. Carotid IMT was evaluated by using high resolution B-mode ultrasonography. Arterial stiffness was assessed by measurement of carotid-femoral Pulse Wave Velocity (PWV) and Augmentation Index (AIx). RESULTS: Total cholesterol (P<0.013) and LDL-cholesterol (P<0.019) levels were significantly lower in IBD patients compared to controls. Carotid IMT was higher in IBD than in controls (P<0.047), but there was no statistically significant difference among Crohn's Disease (CD) and Ulcerative Colitis (UC) patients. Moreover, PWV and AIx were significantly higher in patients as compared to controls (P<0.006 and P<0.004 respectively). No medication seemed to affect vascular measurements, though stiffness parameters were significantly higher in patients treated with 5-ASA (11.9 (9.7) vs 18.2 (10.2), P<0.021), suggesting a lack of efficacy of 5-ASA in protecting IBD patients from early atherogenesis. CONCLUSIONS: Young IBD patients show an increase in subclinical markers of atherosclerosis. Future studies need to address whether these markers result in an increased risk of cardiovascular events in these patient.

The Presence of White Matter Lesions Is Associated With the Fibrosis Severity of Nonalcoholic Fatty Liver Disease.

We tested whether nonalcoholic fatty liver disease (NAFLD) and/or its histological severity are associated with vascular white matter lesions (WML) in patients with biopsy-proven NAFLD and in non-NAFLD controls. Data were recorded in 79 consecutive biopsy-proven NAFLD, and in 82 controls with normal ALT and no history of chronic liver diseases, without ultrasonographic evidence of steatosis and liver stiffness value <6 KPa. All subjects underwent magnetic resonance assessment and WML were classified according to the Fazekas score as absent (0/III), or present (mild I/III; moderate II/III, and severe I/III). For the purpose of analyses, all controls were considered without NASH and without F2-F4 liver fibrosis. WML were found in 26.7% of the entire cohort (43/161), of moderate-severe grade in only 6 cases. The prevalence was similar in NAFLD versus no-NAFLD (29.1% vs 24.3%; P = 0.49), but higher in NASH vs no-NASH (37.7% vs 21.2%, P = 0.02) and F2-F4 vs F0-F1 fibrosis (47.3% vs 20.3%, P = 0.001). In both the entire cohort and in NAFLD, only female gender (OR 4.37, 95% CI: 1.79-10.6, P = 0.001; and OR 5.21, 95% CI: 1.39-19.6, P = 0.01), age > 45 years (OR 3.09, 95% CI: 1.06-9.06, P = 0.03; and OR 11.1, 95% CI: 1.14-108.7, P = 0.03), and F2-F4 fibrosis (OR 3.36, 95% CI: 1.29-8.73, P = 0.01; and OR 5.34, 95% CI: 1.40-20.3, P = 0.01) were independently associated with WML (mostly of mild grade) by multivariate analysis. Among NAFLD, the prevalence of WML progressively increased from patients without (1/18; 5.5%), or with 1 (1/17, 5.8%), to those with 2 (9/30; 30%) and further to those with 3 (12/14; 85.7%) risk factors. The presence of WML is not associated with NAFLD, but with metabolic diseases in general, and fibrosis severity of NAFLD. Clinical implications of this issue need to be assessed by longitudinal studies.

Atenção fisioterapêutica no controle do linfedema secundário ao tratamento do câncer de mama: rotina do Hospital do Câncer III/Instituto Nacional de Câncer / Care physical therapy in control of secondary lymphedema treatment of breast cancer: routine Cancer Hospital III/National Cancer Institute

O câncer de mama é o tipo de neoplasia mais incidente na população eminina brasileira. Devido ao diagnóstico ainda ser realizado em estadiamentos avançados, os tratamentos precisam ser mais agressivos, o que aumenta o risco de morbidades. Dentre essas complicações, a mais frequente é o linfedema, caracterizado por insuficiência do sistema linfático decorrente da obstrução causada pelo tratamento. É uma afecção crônica que pode evoluir com importantes alterações físicas e psicossociais, afetando a qualidade de vida dessas pessoas. A fisioterapia dispõe de diferentes condutas que podem ser aplicadas em todas as fases do tratamento oncológico, potencializando as ações de prevenção primária, secundária e terciária do linfedema. O objetivo deste artigo foi divulgar ascondutas adotadas no Serviço de Fisioterapia do Hospital do Câncer III, do Instituto Nacional de Câncer (INCA), para prevenção, diagnóstico e tratamento do linfedema de membros superiores em pacientes submetidas ao tratamento para o câncer de mama. Por meio desta divulgação, uscamosproporcionar um objeto de discussão entre os profissionais de saúde dos diferentes níveis de atenção, com o intuito de colaborar para o controle do linfedema secundário ao câncer de mama.

Breast cancer is the most frequent type of cancer among women in Brazil. Because the diagnosis is still held in advanced staging, treatments need to be more aggressive, which increases the risk of morbidity. Among these complications, the most prevalent is the lymphedema, characterized by failure of the lymphatic system resulting from the obstruction caused by the treatment of breast cancer. It is a chronic disease that can evolve with significant physical changes and psychosocial affecting the quality of life of these people. Physical therapy has different behaviors that can be implemented at all stages of cancer treatment, boosting shares of primary, secondary and tertiary prevention of lymphedema. The aim of this paper is to disseminate the approaches adopted in the Department of Physical Therapy of Cancer Hospital III, in the National Cancer Institute, for prevention, diagnosis and treatment of lymphedema of the upper limbs in patients undergoing treatment for breast cancer. Through this publication, we seek to provide a subject of discussion among health professionals of different levels of care, with the goal of collaborating to control lymphedema secondary to breast cancer.

Bed-side inferior vena cava diameter and mean arterial pressure predict long-term mortality in hospitalized patients with heart failure: 36 months of follow-up.

BACKGROUND: In discharged patients with heart failure (HF), diverse conditions can intervene to worsen outcome. We would investigate whether such factors present on hospital admission can affect long-term mortality in subjects hospitalized for acute HF. METHODS: One hundred twenty-three consecutive patients hospitalized for acute HF (mean age 74.8 years; 57% female) were recruited and followed for 36 months after hospitalization. RESULTS: At multivariate Cox model, only inferior vena cava (IVC) diameter and mean arterial pressure (MAP) registered bed-side on admission, resulted, after correction for all confounders factors, the sole factors significantly associated with a higher risk of all-cause mortality in long-term (HR 1.06, p=0.0057; HR 0.97, p=0.0218; respectively). Study population was subdivided according to median values of IVC diameter (23 mm) and MAP (93.3 mm Hg). The Kaplan­Meier curve showed that HF patients with both IVC ≥ 23 mm and MAP b93.3 mm Hg on admission had reduced probability of survival free from all-cause death (log rank p = 0.0070 and log rank p = 0.0028, respectively). CONCLUSIONS: In patients hospitalized for acute HF, IVC diameter, measured by hand-carried ultrasound (HCU), and MAP detected on admission are strong predictors of long-term all-cause mortality. The data suggest the need for a careful clinical-therapeutic surveillance on these patients during the post-discharge period. IVC diameter and MAP can be utilized as parameters to stratify prognosis on admission and to be supervised during follow-up.