Early Free Range-of-Motion Upper Limb Exercises After Mastectomy and Immediate Implant-Based Reconstruction Are Safe and Beneficial: A Randomized Trial.

BACKGROUND: This study assessed the impact that free range-of-motion (ROM) upper limb exercises 15 or 30 days after mastectomy and immediate implant-based reconstruction has on surgical complications and kinetic-functional recovery. METHODS: This randomized clinical trial included 60 women who had breast cancer treated with mastectomy and immediate implant or tissue expander reconstruction. The patients initiated the exercises with shoulder ROM limited to 90° the day after surgery. After 2 weeks, the patients were randomized into two groups of 30 patients each: the "free-range group," which permitted shoulder range exercises until limited by pain or wound dehiscence, and the "limited-range group," which maintained shoulder movement restriction at 90° until 30 days after surgery, at which time they also were allowed to perform free-range exercises. The patients underwent evaluations preoperatively, then 7, 15, 30, 60, and 90 days after surgery. The primary outcomes were incidence and prevalence of dehiscence and seroma and incidence of infection and necrosis. The secondary outcomes were shoulder ROM, pain, and upper limb function. RESULTS: The two groups did not differ in terms of incidence and prevalence of postoperative complications. The patients with free upper limb exercise 15 days after surgery had less pain, greater shoulder amplitude, and better upper limb function than those who had movement restricted to 90° for 30 days. CONCLUSION: The postoperative protocol with free shoulder ROM on the 15th day after surgery is safe and beneficial in terms of kinetic-functional recovery and pain control for patients after mastectomy and immediate implant-based reconstruction. CLINICAL TRIALS REGISTER: NCT02480842.

Exercise Protocol With Limited Shoulder Range of Motion for 15 or 30 Days After Conservative Surgery for Breast Cancer With Oncoplastic Technique: A Randomized Clinical Trial.

OBJECTIVE: The objective is to evaluate the effect of limiting shoulder range of motion (ROM) for 15 or 30 days on surgical complications and on shoulder ROM, pain, and upper limb function of breast cancer patients following conservative oncoplastic surgery. MATERIALS AND METHODS: A randomized clinical trial was conducted with 60 women with breast cancer who underwent conservative oncoplastic surgery. The day after surgery, all patients started an exercise protocol with shoulder exercises limited to 90 degrees. Two weeks after surgery they were randomized into Free ROM Group (n=30) or Limited ROM Group (n=30). The Free ROM Group was allowed to perform shoulder exercises with unlimited ROM; the Limited ROM Group continued with shoulder movement restricted at 90 degrees until 30 days after surgery, at which time they were also allowed free ROM. The primary outcome was the incidence of postoperative complications (dehiscence, seroma, infection, and necrosis) and secondary outcomes were shoulder ROM, pain, and upper limb function. RESULTS: No difference in the incidence of postoperative scar complications between groups was noted. There was no difference between the groups in shoulder joint amplitude, pain, or upper limb function. CONCLUSIONS: The free ROM exercise protocol 15 days post surgery was safe concerning cicatricial complications.

An association study between the Val66Met polymorphism of the BDNF gene and postpartum depression.

Postpartum depression disorder (PPD) is a severe illness affecting around 15% of deliveries. Several evidences suggest that PPD is, at least, partially genetic determined. The gene encoding BDNF is a strong candidate for pathogenesis of PPD since that it has been observed decrease of serum BDNF in patients suffering from PPD. The gene encoding BDNF has a polymorphism (Val66Met) that alters the regulated protein secretion; the methionine variant being associated with insufficient secretion compared with the Valine variant. We hypothesized that BDNF gene Val66Met polymorphism could be associated with PPD. We assessed 227 subjects randomly selected who had delivery at a maternity hospital using EPDS. Differences in genotype frequency were calculated by chi (2) test. Logistic Regression Analyses was performed to verify the existence of interaction between biological, psychiatric and environmental variables and PPD. Difference between groups was tested with Student's t test. Tests were two-tailed and results significant when p < or = 0.05. No difference in BDNF genotype distribution was observed between the depressed and non-depressed women. Educational level, stress during pregnancy, bipolar disorder and anxiety was strongly associated with PPD. We were not able to show an association between BDNF polymorphisms and PPD. Further studies are necessary to both of confirm our results and improve validity of PPD diagnosis.

Diagnosis of Axillary Web Syndrome in Patients After Breast Cancer Surgery: Epidemiology, Risk Factors, and Clinical Aspects: A Prospective Study.

OBJECTIVES: Axillary web syndrome (AWS) is a complication after breast cancer surgery associated with the axillary approach. We defined a diagnosis tool as well as evaluated cord frequency, characteristics, and risk factors. METHODS: A prospective cohort study of 173 women followed-up at Breast Diseases Division of Universidade Federal de São Paulo between July 2014 and September 2015 was established as an evaluation protocol to diagnose AWS. Sociodemographic status, anthropometric values, range of motion, comorbidities, pain, cord frequency, and characteristics (localization, number, palpable, and/or visible) among other data were collected at different time points before and after surgery. RESULTS: The majority of the cords appeared by the seventh day (66.1%), and the total incidence of the cords was 90.9% at the 180th day. The axilla was the place for 80% of the occurrence of AWS, and >70% of the cords were palpable. Flexion and abduction of the shoulder showed reduced range of motion. Pain was present in 39.7% of the patients. Lymphadenectomy as well as hypertension were associated with increased risk of cord development; diabetes was associated with a decreased risk. CONCLUSIONS: The evaluation protocol applied here showed a high incidence of AWS, with palpable cords more frequent than visible ones. The significance of hypertension and diabetes mellitus as risk factors for cord development in AWS should be evaluated in future studies. The evaluation protocol developed in this study seems to be of great importance for early detection of AWS and could also be valuable for future treatment planning.

The role of BDNF genetic polymorphisms in bipolar disorder with psychiatric comorbidities.

BACKGROUND: Bipolar disorder (BD) is a complex disorder where genetic factors play a major role in its etiology. Probably, no other axis I diagnosis has a co-morbidity prevalence as high as BD. Since BDNF is involved in different ways in various psychiatric disorders we hypothesized that its genetic polymorphisms could be associated with the co-morbidity phenomenon in BD. METHODS: We studied 320 subjects (160 BD patients and 160 healthy controls). Genotyping was performed using made-to-order TaqMan genotyping assays (rs4923463, rs6265, rs2049045, and rs7103411). Statistical analyses were performed using UNPHASED version 3.0.12 and Haploview 4.1. RESULTS: No genotypic, allelic or haplotype differences were found between bipolar patients and healthy controls. Concerning exclusively the rs4923463 (G/G) there was a significant association with alcoholism (p=0.009), smoking (p=0.006) and violent suicide attempt (p=0.03). We further found that the G-G haplotype (rs4923463-rs2049045) (adjusted p=0.029) and the G-T haplotype (rs4923463-rs7103411) (adjusted p=0.029) were significantly more frequent in the group with alcoholism co-morbidity when compared with the group without this co-morbidity. LIMITATIONS: Sample size and retrospective assessment of suicide behavior and psychiatric comorbidities. CONCLUSIONS: The results obtained in our study indicate that BDNF variants may confer susceptibility to additional psychiatric diagnosis in BD.

Edinburgh Postnatal Depression Scale for screening in the public health system.

OBJECTIVE: To evaluate the utilization of the Edinburgh Postnatal Depression Scale as a screening tool in the public health system. METHODS: The Scale was administered between the 40th and 90th day after delivery to 245 mothers whose delivery occurred at a private maternity hospital located in the municipality of Belo Horizonte, Southeastern Brazil, from 2005 to 2006. All participants were submitted to a structured psychiatric interview (Mini-Plus 5.0), used as gold standard for postpartum depression diagnosis. The scale's sensitivity and specificity were calculated, and the receiver operating characteristic (ROC) curve was used to find the best cut-off point. Student's t test was employed to compare numeric variables and chi-square was used for the categorical variables. Reliability was calculated by Cronbach's coefficient á of internal consistency. RESULTS: Postpartum depression was diagnosed in 66 women (26.9% of the total sample). No differences were found between women with and without postpartum depression concerning age, level of schooling, number of prior deliveries, and marital status. Using 10 as the cut-off point, the scale's sensibility was 86.4, the specificity was 91.1, and the positive predictive value, 0.78. CONCLUSIONS: The psychometric properties of the Scale characterize it as a good screening tool for postpartum depression and its disseminated use in Sistema Unico de Saúde (SUS - National Health System) could have positive impacts, with a significant increase in the recognition, diagnosis and treatment of postpartum depression.

Características demográficas e psicossociais associadas à depressão pós-parto em uma amostra de Belo Horizonte / Demographic and psychosocial characteristics associated with postpartum depression in a sample from Belo Horizonte

INTRODUÇÃO: A depressão pós-parto (DPP) tem sido alvo de inúmeras investigações científicas devido à sua alta prevalência e gravidade e também por suas repercussões negativas na puérpera e na criança. OBJETIVO:Comparar mulheres com e sem DPP em um grupo de puérperas selecionadas aleatoriamente a partir dos partos ocorridos em uma maternidade de Belo Horizonte (MG). MÉTODOS: Selecionamos 245 mulheres que tiveram parto em uma maternidade de Belo Horizonte. Aplicamos uma entrevista semiestruturada para a obtenção de dados psicossociais e demográficos e uma entrevista estruturada (Mini Neuropsychiatric Interview, MINI-Plus) para o diagnóstico de depressão maior segundo critérios do Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV). RESULTADOS:26,9 por cento das mulheres tinham diagnóstico de DPP. Não encontramos diferenças entre as características sociodemográficas das mulheres com (n = 66, 26,9 por cento) e sem diagnóstico de DPP (n = 179, 73,1 por cento). Entretanto, diversas variáveis clínicas e psicossociais se mostraram significativamente diferentes entre os dois grupos, tais como história de depressão, vivência de estresse ou presença de sintomas depressivos ou ansiosos durante a gravidez, ocorrência de complicações maternas ou na criança no pós-parto e insuficiência de suporte nos cuidados pós-natais. CONCLUSÃO: A identificação de fatores associados à DPP é importante para a compreensão de sua etiopatogenia e para o estabelecimento de estratégias de prevenção e tratamento precoce dessa grave doença.

INTRODUCTION: Postpartum depression has been the object of extensive research both because of its high prevalence and its repercussions on the mother and the infant. OBJECTIVE:To compare women with and without depression in a sample of postpartum women randomly selected at a maternity in the city of Belo Horizonte, Brazil. METHODS: A total of 245 women who gave birth at a private maternity hospital in Belo Horizonte were selected. A semi-structured interview was used for the collection of psychosocial and demographic data. Diagnosis of major depression was established using and a structured interview (Mini Neuropsychiatric Interview, MINI-Plus), based on criteria set forth in the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV). RESULTS: Of the total sample, 26.9 percent had a diagnosis of postpartum depression. No differences were observed in the social and demographic characteristics of depressed women (n = 66, 26,9 percent) and of those without depression (n = 179, 73,1 percent). Nevertheless, several clinical and psychosocial variables showed significant differences between the groups and were therefore associated with postpartum depression, namely previous history of depression, presence of stress or depressive/anxiety symptoms during pregnancy, postpartum complications affecting the mother or the infant, and lack of support and care in the postpartum period. CONCLUSION: The identification of factors associated with postpartum depression is important for an improved understanding of the pathophysiology of this disease and for the establishment of strategies aimed at prevention and early diagnosis.

Escala de Depressão Pós-natal de Edimburgo para triagem no sistema público de saúde / Escala de Depresión Post-natal de Edimburgo para tamizage en el sistema público de salud / Edinburgh Postnatal Depression Scale for screening in the public health system

OBJETIVO: Avaliar a utilização da Escala de Depressão Pós-natal de Edimburgo como instrumento de triagem no sistema público de saúde. MÉTODOS: A Escala foi administrada entre o 40º e 90º dia do pós-parto, a 245 mulheres que tiveram parto em uma maternidade privada no município de Belo Horizonte (MG), entre 2005 e 2006. As participantes foram submetidas a uma entrevista psiquiátrica estruturada (Mini-Plus 5.0) utilizada como padrão-ouro para diagnóstico de depressão. Foram calculadas sensibilidade e especificidade da escala e utilizou-se a curva ROC para achar o melhor ponto de corte. Foi utilizado o teste t de Student para comparação das variáveis numéricas e o qui-quadrado para as variáveis categóricas. A confiabilidade foi aferida pelo coeficiente de consistência interna á de Cronbach. RESULTADOS: Foram diagnosticadas 66 mulheres com o quadro depressivo pós-parto (26,9 por cento da amostra). Não houve diferença entre as mulheres com e sem depressão pós-parto em relação à idade, escolaridade, número de partos anteriores e estado civil. Utilizando-se o ponto de corte de 10, a sensibilidade da escala foi 86,4, a especificidade 91,1 e o valor preditivo positivo 0,78. CONCLUSÕES: As propriedades psicométricas da Escala a caracterizam como um bom instrumento de triagem da depressão pós-parto e seu uso disseminado no Sistema Único de Saúde poderia repercutir positivamente com aumento significativo na taxa de reconhecimento, diagnóstico, e tratamento da depressão pós parto.

Alteraçöes psíquicas durante o climatério / Psychic alterations in the perimenopause

A mulher no período do climatério apresenta com freqüência sintomatologia psíquica. A etiologia destas alteraçöes é multifatorial e envolve fatores biológicos e psicossociais. O tratamento, desta forma, deve levar em consideraçäo estes possíveis fatores etiológicos, o que implica no uso de terapia de reposiçäo hormonal, psicofármacos, e/ou psicoterapia. Este artigo visa destacar a importância dos sintomas psíquicos durante o climatério, assim como os possíveis tratamentos a serem empregados