Is paclitaxel less cardiotoxic in the treatment of breast cancer before or after doxorubicin? / Qual estratégia terapêutica é menos cardiotóxica no tratamento do câncer de mama: uso de paclitaxel antes ou depois da doxorrubicina?

Background: The combination of doxorubicin (DOX) with paclitaxel (PTX) effectively treats breast cancer (BC). However, DOX-associated cardiotoxicity (CTX) is aggravated by the use of PTX. Consensus is lacking about which drug sequence involves the most CTX. Objectives: To evaluate whether DOX followed by PXT or the reverse sequence has the greatest cardiotoxic potential in the treatment of BC. Methods: Prospective study of women with primary BC who received four cycles of DOX and 12 infusions of PTX. Participants were divided into Group 1 (G1; PXT before DOX) and Group 2 (G2; DOX before PXT) at the discretion of the oncologist. CTX was defined as an absolute reduction in left ventricular ejection fraction (LVEF) > 10% to a value <53%. Patients underwentclinical evaluations and echocardiography before treatment (Phase 1) and one year after treatment (Phase 2). Results: Sixty-nine women were evaluated: 19 in G1 and 50 in G2. The groups had similar clinical characteristics. The doses of radiation, DOX, and PTX used were similar. Eight (11.6%) patients developed CTX: two (10.5%) in G1 and six (12.0%) in G2 (p=0.62). The mean LVEF was similar between groups in Phase 1 (G1=65.1±3.5%; G2=65.2±3.9%; p=0.96), with a significant reduction noted after one year in both groups: G1=61.4±8.1% (p=0.021) and G2=60.8±7.6% (p<0,001). Although lower, mean LVEF remained similar between groups after Phase 2 (p=0.79). Conclusions: In women with BC who underwent chemotherapy, the incidence of CTX at the end of the first year of treatment was similar regardless of whether DOX was used before or after PTX. (AU)

[Factors associated with voice disorders among women teachers]. / Fatores associados a alterações vocais em professoras.

This study aimed to identify risk factors for voice disorders (hoarseness in the previous six months as an initial manifestation, and vocal cord nodules as a more severe manifestation of overt disease) among teachers. The cross-sectional study included 747 women teachers from elementary and middle schools in the public school system in Vitória da Conquista, Bahia State, Brazil. Data were collected using a self-applied, standardized questionnaire. Hoarseness in the previous six months was reported by 59.2% of teachers and vocal cord nodules by 12.9%. Logistic regression techniques showed that hoarseness was statistically associated with > 24 classroom hours per week, work in more than one school, and having to make an effort to speak. Vocal cord nodules were associated with working > 5 years as a teacher, work in more than one school, working at another job besides teaching, and having to make an effort to speak. In conclusion, voice disorders are frequent among schoolteachers and are associated with multiple occupational risk factors, besides purely biological ones.

Fatores associados a alterações vocais em professoras / Factors associated with voice disorders among women teachers

Objetivou-se identificar fatores associados a alterações vocais (rouquidão nos últimos seis meses, como uma manifestação inicial, e calo nas cordas vocais, como uma manifestação mais severa, de doença já instalada) entre professoras. Um estudo epidemiológico de corte transversal investigou 747 professoras da rede municipal de ensino de Vitória da Conquista, Bahia, Brasil, coletando dados num formulário padronizado, auto-aplicado. A queixa de rouquidão nos últimos seis meses foi referida por 59,2 por cento das professoras e a do diagnóstico médico de calo nas cordas vocais, por 12,9 por cento. Técnicas de regressão logística revelaram que rouquidão nos últimos seis meses estava estatisticamente associada a trabalhar > 24 horas em sala de aula, trabalhar em mais de uma escola e fazer força para falar. A queixa de calo nas cordas vocais estava associada a trabalhar > 5 anos como docente, trabalhar em mais de uma escola, trabalhar em outra atividade além da docência e fazer força para falar. Conclui-se que alterações vocais são freqüentes nesta população e estão associadas a múltiplos fatores ocupacionais, além daqueles de cunho fundamentalmente biológico.

This study aimed to identify risk factors for voice disorders (hoarseness in the previous six months as an initial manifestation, and vocal cord nodules as a more severe manifestation of overt disease) among teachers. The cross-sectional study included 747 women teachers from elementary and middle schools in the public school system in Vitória da Conquista, Bahia State, Brazil. Data were collected using a self-applied, standardized questionnaire. Hoarseness in the previous six months was reported by 59.2 percent of teachers and vocal cord nodules by 12.9 percent. Logistic regression techniques showed that hoarseness was statistically associated with > 24 classroom hours per week, work in more than one school, and having to make an effort to speak. Vocal cord nodules were associated with working > 5 years as a teacher, work in more than one school, working at another job besides teaching, and having to make an effort to speak. In conclusion, voice disorders are frequent among schoolteachers and are associated with multiple occupational risk factors, besides purely biological ones.

Doenças ocupacionais em professores atendidos pelo Centro de Estudos da Saúde do Trabalhador (CESAT) / Occupational diseases of teachers attended at the Center for Studies on Workers' Health

As relações entre as condições de trabalho e a saúde de professores têm merecido vários estudos, recentemente. Contudo, são raros os trabalhos baseados em diagnósticos de doenças ocupacionais. Este trabalho buscou identificar as doenças ocupacionais diagnosticadas mais freqüentemente nos atendimentos realizados a professores pelo Centro de Estudos da Saúde do Trabalhador (CESAT) de Salvador, Bahia. Foi realizado um estudo descritivo de série de casos com base em dados secundários. A população-alvo foi formada por todos os professores atendidos pelo CESAT de 1991 a 2001. Foram calculadas a proporção de professores com doença ocupacional entre os atendidos e as proporções de algumas doenças ocupacionais específicas. Foram analisados os dados referentes a 235 professores. A média de idade foi de 42 anos, com predominância do sexo feminino (97por cento). Do total, 66por cento dos professores atendidos receberam diagnóstico de doença ocupacional. As doenças mais freqüentes foram: doenças da laringe e das cordas vocais, síndrome do túnel do carpo, síndrome do manguito rotatório, epicondilites, bursites do ombro, tendinites, rinites, sinusites e faringites crônicas e alérgicas.