Outcome of Patients With Breast Cancer Treated in a Private Health Care Institution in Brazil.

PURPOSE: Middle-income countries like Brazil often have a dichotomous health care system in which patients may be treated in either public or private institutions that differ substantially in terms of level of access to diagnostic and therapeutic procedures. PATIENTS AND METHODS: This was a prospective, observational study to assess real-world data in 1,230 female patients with breast cancer who were treated in a private health care institution between 2012 and 2016 in Brazil. RESULTS: Breast cancer in these patients mostly was diagnosed at early (79.0% stages I or II) or locally advanced (16.1% stage III) stages. The primary tumor was resected in 89.0% of cases, most often through breast-conserving surgery (55.1%). Patients with locally advanced disease received more aggressive therapy (eg, higher rates of mastectomy, axillary dissection and chemotherapy use) than patients with early-stage disease. The estimated 2-year overall survival (OS) was 95.3%. Survival was significantly longer among patients with stage I or II disease (2-year OS, 97.9% and 97.5%, respectively) than those with stage III or IV disease (89.4% and 69.5%, respectively; P < .01). Tumor grade was also correlated with OS in the overall cohort ( P = .05); triple-negative status was only prognostic for patients with stage III disease ( P < .01). CONCLUSION: The data provided aid understanding of the current scenario of breast cancer presentation and treatment in the Brazilian private health care system and may serve as a foundation to guide resource allocation. Our results reinforce the need to pursue adequate access to cancer care in low- and middle-income countries to optimize patient outcome.

Resposta cronotrópica ao teste anaeróbio máximo de corrida - MART / Chronotropic response to maximal anaerobic running test - MART

INTRODUÇÃO: A frequência cardíaca (FC) no teste anaeróbio máximo de corrida (MART) expressa o comportamento autonômico cardíaco em exercício. Ainda não foi investigado se tais respostas cronotrópicas apresentam associação com o desempenho aeróbio e anaeróbio. OBJETIVOS: Descrever a resposta cronotrópica cardíaca durante o MART nos segundos iniciais de estímulo (FC ON) e de recuperação (FC OFF) e estabelecer a associação entre as variáveis cronotrópicas com o desempenho aeróbio e anaeróbio. MÉTODOS: Foram voluntários 13 homens assintomáticos e fisicamente ativos, com 25,1 ± 4,9 anos, 76,8 ± 12,5 kg, 178,4 ± 9,0 cm e 50,6 ± 4,1 mL×kg‑1×min‑1. Na primeira visita, após a anamnese e medidas antropométricas, foi realizado um teste cardiopulmonar de exercício (TCPE) com monitoração direta dos gases expirados. Na segunda visita, foi feita uma familiarização ao MART e na terceira, o teste de MART conduzido até a exaustão. RESULTADOS: A FC de recuperação (58 ± 20 bpm) comparada à FC de pico alcançada no primeiro e no último estágio de MART (39 ± 14 bpm) apresentou maior inclinação, resultando em maior amplitude de variação ao longo do teste, caracterizando diferenças significativas (P = 0,0017). A FC ON apresentou entre o momento inicial, meio e final do MART diferenças significativas (inicial versus final, p = 0,007). Para FC OFF foram encontradas diferenças significativas do início com o meio (p = 0,035) e do início com o final (p = 0,005) do teste. As correlações entre as variáveis cronotrópicas e de desempenho não apresentaram significância estatística (P < 0,05), assim como com as variáveis de desempenho. CONCLUSÃO: O MART parece ser um modelo de sobrecargas fisiológicas adequado para investigação da modulação autonômica cardíaca. Observou-se atuação do sistema parassimpático mesmo em cargas supramáximas até o final do teste.

INTRODUCTION: Heart rate (HR) in maximal anaerobic running test (MART) expresses the cardiac autonomic behavior in exercise. It has not been investigated whether such responses are associated with chronotropic aerobic and anaerobic performance. OBJECTIVE: To describe the cardiac chronotropic response during the MART in seconds of stimulation (HR ON) and recovery (HR OFF), and establish the association between chronotropic variables with aerobic and anaerobic performance. METHODS: Thirteen male volunteers were asymptomatic and physically active, with 25.1 ± 4.9 years, 76.8 ± 12.5 kg, 178.4 cm and 50.6 ± 9.0 ± 4.1 mL×kg-1×min-1. On the first visit after the interview and anthropometric measurements, we performed a cardiopulmonary exercise testing (TCPE) with direct monitoring of expired gases. The second visit was carried to familiarize the MART and the third, the test was performed until exhaustion MART. RESULTS: Heart rate recovery (58 ± 20 bpm) compared to the peak HR achieved in the first and last stage of MART (39 ± 14 bpm) had a higher slope, resulting in greater range of variation over the test, characterizing differences (P = 0.0017). The HR ON presented between the time the initial, middle and end of the MART significant differences (start versus final, p = 0.007). To HR OFF significant differences were found starting with the middle (p = 0.035) and the starting to the final (p = 0.005) test. The chronotropic correlations between variables, including decrease in HR, and TCPE performance were not statistically significant (P < 0.05), as nor as the performance variables. CONCLUSION: The MART model seems to be a physiological overload suitable for investigation of cardiac autonomic modulation. There was action of the parasympathetic system even in supramaximal loads by the end of the test.

Respostas hemodinâmicas a um protocolo de treinamento isométrico de preensão manual / Hemodynamic responses to an isometric handgrip training protocol / Respuestas hemodinámicas a un protocolo de entrenamiento isométrico de prensión manual

FUNDAMENTO: No passado, os exercícios isométricos foram proscritos para cardiopatas. Contudo, evidências recentes sugerem que um protocolo de treinamento isométrico de preensão manual (PTIM) - quatro séries de dois minutos a 30 por cento da força máxima - provoca efeitos favoráveis sobre a modulação autonômica e reduz os níveis de pressão arterial sistólica (PAS) e diastólica (PAD) de repouso. OBJETIVO: Visando obter subsídios para uma ampla aplicabilidade clínica, quantificamos as principais respostas hemodinâmicas durante uma sessão de PTIM em pacientes de um programa de exercício supervisionado. MÉTODOS: Quarenta e um pacientes (36 homens) realizaram o PTIM com medidas da frequência cardíaca (FC) e da PA antes, durante cada uma das duas séries feitas com o braço esquerdo e um minuto após a finalização. As medidas foram colhidas mediante um sinal de eletrocardiograma em um tensiômetro oscilométrico digital Tango+, previamente validado para condições de exercício físico. RESULTADOS: PTIM foi adequadamente realizado e sem a ocorrência de reações clínicas adversas. Observou-se um pequeno aumento dos níveis de PAS e de PAD, respectivamente, 16 e 7 mm Hg (p < 0,05) e um incremento ainda menor da FC - 3 bpm - (p < 0,05), quando compararam-se os dados obtidos aos 80 segundos da última série com os de pré-exercício. Um minuto pós-esforço, os valores de FC, de PAS e PAD já haviam praticamente retornado aos níveis iniciais. CONCLUSÃO: PTIM foi bem tolerado por pacientes em programas de exercício, gerando uma repercussão hemodinâmica transiente e modesta, sem induzir a rápida inativação vagal cardíaca característica dos exercícios dinâmicos e curtos.

BACKGROUND: In the past, isometric exercises were proscribed for heart disease. However, recent evidence suggests that an isometric handgrip training (IHT) protocol - four sets of two minutes at 30 percent of maximum strength - produces favorable effects on the autonomic modulation and reduces resting systolic (SBP) and diastolic (DBP) blood pressure. OBJECTIVE: Aiming at obtaining support for broad clinical applicability, we quantified the main hemodynamic responses during an IHT session in patients from a supervised physical exercise program. METHODS: Forty-one patients (36 men) underwent the IHT with measurements of heart rate (HR) and BP before, during each of the two series performed with the left arm and one minute after completion. Measurements were obtained by an electrocardiogram signal in a digital Tango + oscillometric tensiometer, previously validated for physical exercise conditions. RESULTS: The IHT was appropriately carried out, with no clinical adverse reactions. There was a small increase in SBP and DBP levels, respectively, of 16 and 7 mmHg (p <0.05) and an even smaller increase in HR - 3 bpm - (p <0.05) when we compared the data obtained at 80 seconds of the last series with the pre-exercise CONCLUSION: IHT was well tolerated by patients undergoing exercise programs, resulting in a transient and modest hemodynamic effect, without inducing rapid cardiac vagal inactivation, characteristic of dynamic and short exercises.

Hemodynamic responses to an isometric handgrip training protocol.

BACKGROUND: In the past, isometric exercises were proscribed for heart disease. However, recent evidence suggests that an isometric handgrip training (IHT) protocol - four sets of two minutes at 30% of maximum strength - produces favorable effects on the autonomic modulation and reduces resting systolic (SBP) and diastolic (DBP) blood pressure. OBJECTIVE: Aiming at obtaining support for broad clinical applicability, we quantified the main hemodynamic responses during an IHT session in patients from a supervised physical exercise program. METHODS: Forty-one patients (36 men) underwent the IHT with measurements of heart rate (HR) and BP before, during each of the two series performed with the left arm and one minute after completion. Measurements were obtained by an electrocardiogram signal in a digital Tango + oscillometric tensiometer, previously validated for physical exercise conditions. RESULTS: The IHT was appropriately carried out, with no clinical adverse reactions. There was a small increase in SBP and DBP levels, respectively, of 16 and 7 mmHg (p <0.05) and an even smaller increase in HR - 3 bpm - (p <0.05) when we compared the data obtained at 80 seconds of the last series with the pre-exercise CONCLUSION: IHT was well tolerated by patients undergoing exercise programs, resulting in a transient and modest hemodynamic effect, without inducing rapid cardiac vagal inactivation, characteristic of dynamic and short exercises.