ABSTRACT
Introduction: Approximately 10% of breast cancer cases are attibutable to germinative mutations in susceptibility genes, including BRCA1, BRCA2 and others. The National Comprehensive Cancer Network (NCCN) recommends screening women with breast cancer for mutations in BRCA1/2 in defined scenarios. However, these genetic tests are unavailable at the Brazilian Public Health System (SUS). Objective: This study aimed to characterize women with breast cancer and define the criteria for performing BRCA1/2 test. Method: Quantitative, descriptive, analytic, and retrospective study. Medical records of women diagnosed by SUS with breast cancer between January 2016 and December 2018 were analyzed through the software JAMOVI (version 2.3 - 2022). Results: A total of 245 women were diagnosed. According to NCCN guidelines, 97 women met the criteria for performing BRCA1/2 test, with mean age of 47 years old, predominantly white (90,7%), with comorbidities (55.6%), premenopausal (59.8%), diagnosed in early stages 0 - IIb (68.2%) and 48.4% had familial history of breast cancer. Most frequent histology and molecular subtype was invasive ductal carcinoma (87.2%) and luminal type (59.8%). Conclusion: A significant number of women diagnosed by SUS had indication for BRCA1/2 test. These women are younger, had fewer comorbidities, not menopausal, and differ in terms of the molecular subtype when compared with those without indication for performing the test
Introdução: Aproximadamente 10% dos casos de câncer de mama são atribuíveis a mutações germinativas em genes de suscetibilidade, incluindo BRCA1 e BRCA2. A National Comprehensive Cancer Network (NCCN) recomenda a triagem de mulheres com câncer de mama para mutações em BRCA1/2 em cenários definidos. No entanto, esses testes genéticos não estão disponíveis no Sistema Único de Saúde (SUS). Objetivo: Caracterizar as mulheres com câncer de mama e definir os critérios para realização do teste BRCA1/2. Método: Estudo quantitativo, descritivo, analítico e retrospectivo. Foram analisadosprontuários de mulheres com diagnóstico de câncer de mama pelo SUS entre janeiro de 2016 e dezembro de 2018, por meio do software JAMOVI (versão 2.3 - 2022). Resultados: Foram diagnosticadas 245 mulheres. De acordo com as diretrizes da NCCN, 97 mulheres atenderam aos critérios para realizar o teste BRCA1/2, com idade média de 47 anos, predominantemente brancas (90,7%), com comorbidades (55,6%), na pré-menopausa (59,8%), diagnosticadas nos estágios iniciais 0 - IIb (68, 2%), e 48,4% tinham histórico familiar de câncer de mama. A histologia e o subtipo molecular mais frequentes foram carcinoma ductal invasivo (87,2%) e tipo luminal (59,8%). Conclusão: Considerando os critérios da NCCN, um número significativo de mulheres diagnosticadas pelo SUS teve indicação para realização do teste BRCA1/2. Essas mulheres são mais jovens, têm menos comorbidades, estão em período pré-menopausa mais frequentemente e diferem quanto ao subtipo molecular quando comparadas àquelas sem indicação de realização do exame. Palavras-chave: neoplasias da mama; neoplasias ovarianas; síndrome hereditária de câncer de mama e ovário; genes, BRCA1
Introducción: Aproximadamente el 10% de los casos de cáncer de mama son atribuibles a mutaciones germinales en genes de susceptibilidad, incluidos BRCA1 y BRCA2. La National Comprehensive Cancer Network (NCCN) recomienda la detección de mutaciones BRCA1/2 en mujeres con cáncer de mama en entornos definidos. Sin embargo, estas pruebas genéticas no están disponibles en el Sistema Único de Salud (SUS). Objetivo: Caracterizar mujeres con cáncer de mama y definir los criterios para la realización de la prueba BRCA1/2. Método: Estudio cuantitativo, descriptivo, analítico y retrospectivo. Las historias clínicas de las mujeres diagnosticadas con cáncer de mama entre enero de 2016 y diciembre de 2018, usuarias del SUS, fueron analizadas mediante el software JAMOVI (versión 2.3 - 2022). Resultados: 245 mujeres fueron diagnosticadas. Según las pautas de NCCN, 97 mujeres cumplieron con los criterios para someterse a la prueba BRCA1/2. Las mujeres con indicación para la prueba tenían un promedio de edad de 47 años, eran predominantemente blancas (90,7%), con comorbilidades (55,6%), premenopáusicas (59,8%), diagnosticadas en estadios tempranos 0 - IIb (68,2%) y 48,4% tenía antecedentes familiares de cáncer de mama. Los subtipos histológicos y moleculares más frecuentes fueron el carcinoma ductal invasivo (87,2%) y el tipo luminal (59,8%). Conclusión: Considerando los criterios de la NCCN, un número significativo de mujeres, usuarias del SUS, fueron designadas para hacer la prueba BRCA1/2. Estas mujeres son más jóvenes, tienen menos comorbilidades, están en el periodo de la premenopausia con mayor frecuencia y difieren en el subtipo molecular en comparación con aquellas sin orden de realizarse la prueba
Subject(s)
Humans , Female , Ovarian Neoplasms , Breast Neoplasms , Genes, BRCA1 , Hereditary Breast and Ovarian Cancer SyndromeABSTRACT
ABSTRACT BACKGROUND AND OBJECTIVES: To pursue safer and more effective treatments for rheumatoid arthritis, the effect of dexamethasone treatment (DEX, 0.25mg/kg) combined with transcranial direct current stimulation (tDCS) in the behavior and neurochemical parameters of arthritic rats was evaluated. METHODS: Thirty-six Wistar rats were divided into four groups: control+DEX (CTRL+DEX), arthritis+DEX (RA+DEX), arthritis+DEX+sham-tDCS (RA+DEX+sham-tDCS) and arthritis+DEX+tDCS (RA+DEX+tDCS). The arthritic model (RA) was induced by complete Freund's adjuvant (CFA) paw administration. Paw edema and mechanical allodynia were assessed by plethysmometer and von Frey apparatus, respectively. Fourteen days after the CFA injection, rats received the treatment for eight days (DEX and/or tDCS). Behavioral parameters were measured with the Open-Field test. ELISA was used to evaluate hippocampal and spinal cord tumor necrosis factor (TNF-α) levels, cerebral cortex and brainstem BDNF levels. RESULTS: In pre-treatment measurements, arthritic rats presented an increase in joint swelling and mechanical allodynia when compared to the control group, confirming chronic pain establishment. A slight antinociceptive effect of dexamethasone combined with tDCS in the pain model was observed. The pain model significantly induced an increase in the grooming behavior and a reduction in the spinal cord and hippocampal TNF-α levels; these effects were reverted in the sham- and active-tDCS-treated rats. However, no effects of DEX or tDCS were observed in the BDNF levels in the cerebral cortex and brainstem. CONCLUSION: Despite the small effect observed, tDCS treatment cannot be discarded as a non-pharmacological adjuvant technique for inflammatory chronic pain treatment.
RESUMO JUSTIFICATIVA E OBJETIVOS: Para investigar métodos mais seguros e eficazes para o manejo da artrite reumatoide, avaliou-se o efeito do tratamento com dexametasona (DEX, 0,25mg/kg) combinado com estimulação transcraniana por corrente contínua (ETCC) sobre parâmetros comportamentais e bioquímicos de ratos submetidos a um modelo de artrite reumatoide. MÉTODOS: Trinta e seis ratos Wistar foram alocados em 4 grupos: controle+DEX (CTRL+DEX), artrite+DEX (AR+DEX), artrite+DEX+sham-ETCC (AR+DEX+sham-ETCC) e artrite+DEX+ETCC (AR+DEX+ETCC). O modelo de artrite foi induzido pela administração de complete Freund's adjuvant (CFA) na pata. Edema na pata e a alodínia mecânica foram avaliadas por pletismômetro e teste de von Frey, respectivamente. 14 dias após injeção de CFA, ratos foram tratados por 8 dias (DEX e/ou ETCC). Atividade locomotora foi avaliada pelo teste do campo aberto. TNF-alfa (hipocampo e medula espinal) e BDNF (córtex e tronco) foram mensurados por ELISA. RESULTADOS: Nas medições pré-tratamento, ratos com artrite exibiram aumento de o inchaço articular e alodínia mecânica comparados ao grupo controle, confirmando o estabelecimento de modelo de dor crônica. Também se observou discreto efeito antinociceptivo da dexametasona combinada com ETCC no modelo de artrite. O modelo de dor induziu um aumento no comportamento de grooming e reduziu os níveis de TNF-alfa no hipocampo; estes efeitos foram revertidos nos grupos sham- e ETCC ativo. Entretanto, não foram observados efeitos da DEX ou ETCC nos níveis de BDNF no córtex cerebral ou no tronco encefálico. CONCLUSÃO: Apesar dos discretos efeitos observados, não se pode descartar a ETCC como uma abordagem terapêutica não farmacológica para o manejo da dor crônica inflamatória na artrite reumatoide.
ABSTRACT
Introduction: The transcranial direct current stimulation (tDCS) is a non-invasive technique, which induces neuroplastic changes in the central nervous system of animals and humans. Furthermore, tDCS has been suggested as a therapeutic tool for pain management. The aim of this study was to standardize a non-invasive tDCS technique indexed by the nociceptive response of rats submitted to different conditions necessary to the tDCS application. Method: 60-day-old male Wistar rats (n=65), divided into 6 groups: control(C); non-active sham (NAS); active-sham (AS); active-sham restrained (ASR); non-active sham restrained (NASR); active tDCS treatment. Animals received treatment during 30 seconds (sham-active) or 20 minutes (restraint and tDCS)/8 days. Nociceptive threshold was assessed by Hot Plate test at baseline, immediately and 24h after the first session, immediately and 24h after the last session. Variance analysis of repeated measurements followed by Bonferroni was performed for intra-group comparison. Results: Physical restraint and 30 seconds stimulation (sham-tDCS) increased pain sensitivity (P≤0.05), and tDCS treatment was able to prevent the thermal hyperalgesia. Our original tDCS montage is similar to that used in the procedure with humans, because it is not an invasive technique. The electrodes are positioned on the head, and the animals are immobilized during the 20-minute treatment. As this procedure could involve behavior and neurochemical alterations due to stress induced by restriction (thus, it creates a research bias), we hypothesized that a 30-second electrical stimulus application (sham-tDCS) and the physical restriction used during tDCS treatment might alter nociceptive response in rats. Conclusion: There are methodological limitations in the present tDCS-technique. Although active-tDCS treatment is able to prevent these harmful effects, interference of these factors has to be considered during the results' analysis. Future adaptations of the tDCS-technique in rats are required to evaluate its therapeutic effects (AU)
Subject(s)
Rats , Pain Measurement/methods , Transcranial Direct Current Stimulation/methods , Chronic Pain/therapy , Models, Animal , Nociception , Rats, Wistar , Restraint, Physical , Time FactorsABSTRACT
Objective: To determine the effects of acute and chronic administration of methylprednisolone on oxidative stress, as quantified by measuring lipid peroxidation (LPO) and total reactive antioxidant potential (TRAP), in rat lungs. Methods: Forty Wistar rats were divided into four groups: acute treatment, comprising rats receiving a single injection of methylprednisolone (50 mg/kg i.p.); acute control, comprising rats i.p. injected with saline; chronic treatment, comprising rats receiving methylprednisolone in drinking water (6 mg/kg per day for 30 days); and chronic control, comprising rats receiving normal drinking water. Results: The levels of TRAP were significantly higher in the acute treatment group rats than in the acute control rats, suggesting an improvement in the pulmonary defenses of the former. The levels of lung LPO were significantly higher in the chronic treatment group rats than in the chronic control rats, indicating oxidative damage in the lung tissue of the former. Conclusions: Our results suggest that the acute use of corticosteroids is beneficial to lung tissue, whereas their chronic use is not. The chronic use of methylprednisolone appears to increase lung LPO levels. .
Objetivo: Determinar os efeitos da administração aguda e crônica de metilprednisolona no estresse oxidativo, por meio da quantificação da peroxidação lipídica (POL) e do potencial antioxidante reativo total (PART), em pulmões de ratos. Métodos: Quarenta ratos Wistar foram divididos em quatro grupos: tratamento agudo, com ratos recebendo uma dose única de metilprednisolona (50 mg/kg i.p.); controle agudo, com ratos recebendo injeção unida de salina; tratamento crônico, com ratos recebendo metilprednisolona v.o. na água do bebedouro (6 mg/kg por dia durante 30 dias; e controle crônico, com ratos recebendo água de bebedouro normal). Resultados: Os níveis de PART foram significativamente maiores no grupo tratamento agudo que no grupo controle agudo, sugerindo uma melhora do sistema de defesa pulmonar. Os níveis de POL foram significativamente maiores no grupo tratamento crônico que no grupo controle crônico, indicando dano oxidativo no tecido pulmonar. Conclusões: Nossos resultados sugerem que o uso agudo de corticoides foi benéfico aos tecidos pulmonares, enquanto seu uso crônico não o foi. O uso crônico de metilprednisolona parece aumentar os níveis pulmonares da POL. .
Subject(s)
Animals , Male , Glucocorticoids/administration & dosage , Lung/drug effects , Methylprednisolone/administration & dosage , Oxidative Stress/drug effects , Antioxidant Response Elements , Disease Models, Animal , Lipid Peroxidation , Lung/metabolism , Rats, WistarABSTRACT
Aims: Morphine treatment in early life is a practice widely used in paediatric intensive care units. However, the consequences of this treatment on behavioural responses throughout life have been poorly studied. It is well known that behavioural symptoms after morphine exposure are presumed to depend on certain changes in the dopaminergic system, and there is a strong evidence of the involvement of D2 receptor. In this way, our objective was to evaluate whether 5 μg morphine administration, once daily for 7 days in 8-day-old rats (P8), alters exploratory and anxiolitic-like behaviours over short- (P16) and medium-term (P30) periods in the open-field (OF) and elevated-plus maze (EPM) tests, and to verify the involvement of the D2 receptor in the behaviour changes. Place of Study: All experiments were performed at Animal Experimentation Unit of Hospital de Clínicas de Porto Alegre. The experimental protocol was approved by the Institutional Committee for Animal Care and Use (GPPG-HCPA protocol No: 08345). Methodology: Wistar rats with 8-day-old (P8) received 5 μg of morphine administration, once daily for 7 days. The exploratory and anxiolitic-like behavious were analyzed in P16 and P30 by OF and EPM tests. At the ages where we observed significant differences in behaviour responses in both tests, the control and morphine groups were subdivided into three groups, each one designed to evaluate the effect of 0.2 mg/kg, 0.5 mg/kg or vehicle of i.p. administration of a dopamine D2 antagonist receptor (Haloperidol). Results: At short-term (P16) morphine group showed an increase in grooming, as well increase in exploratory behaviours at P30 in the OF test. In addition, anxiolytic-like behaviours were observed in the morphine group, such as increase of percentage of open arms behaviours and non-protected head dipping at medium-term in the EPM test. At the ages at which differences in behaviours were observed, both groups (control and morphine) received D2 antagonist receptor (haloperidol) 30 min before each test. All behaviours changes seen in the morphine group at P30 were totally reversed by haloperidol administration. Conclusion: Our findings demonstrate that morphine treatment in neonate period promotes behavioural changes in OF and EPM at P16 and P30. However, only alterations observed at P30 depend, at least in part, of dopaminergic system, particularly of the D2 receptor.
ABSTRACT
Realizou-se um estudo transversal, com a população idosa moradora nas zonas rural e urbana caracterizando a prevalência de morbidades e sintomas. Entrevistou-se 229 idosos, com média de idade de 72,3 anos, 57,2% residem na zona urbana, 56,3% são do sexo feminino. As morbidades mais relatadas por residentes da zona urbana foram: insônia (37,7%), ansiedade (32,1%), depressão (26,7%); e na rural, diabetes (13,3%). Nesta, a Doença de Alzheimer foi mais prevalente em idosos que utilizam agrotóxicos (21,7%). Os sintomas mais prevalentes por moradores da zona urbana foram: tosse/coriza e visão alterada (41,2%), alergia/coceira (11,4%). Na rural, boca seca (25,4%), visão alterada (35,6%) e dor nas pernas (66,1%) que também foram mais prevalentes em quem utilizava agrotóxicos. O uso de Equipamentos de Proteção Individual de forma incompleta foi de 85,4% e 45,1% descartam as embalagens de forma inadequada. Há a necessidade de desenvolvimento de programas de saúde pública que auxiliem na promoção de saúde do idoso, e que considere a possível exposição dessa população a agrotóxicos com um determinante em saúde.
A cross-sectional study was conducted with the elderly population in rural and urban areas characterized by the prevalence of morbidity and symptoms, and 229 elderly people were interviewed. The average age was 72.3, of which 57.2% lived in the rural zone and 56.3% were female. The morbidities most reported were insomnia (37.7%), anxiety (32.1%), depression (26.7%), and in the rural zone it was diabetes (13.3%). In this zone, Alzheimer´s disease was more prevalent among the elderly who handled pesticides (21.7%). The most prevalent symptoms among urban zone residents were: cough/runny nose and sight alterations (41.2%), allergy/itching (11.4%). In the rural zone, dry mouth (25.4%), sight alterations (35.6%) and leg pain (66.1%) were also more prevalent among those who used pesticides. The inadequate use of Individual Protection Equipment was 85.4%, and 45.1% also disposed of pesticide packaging inappropriately. The setting up of public health programs is necessary to promote health among the elderly and the potential exposure to pesticides for this population should be seen as a health risk determinant.
Subject(s)
Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Geriatrics , Rural Health , Urban Health , Brazil/epidemiology , Cross-Sectional Studies , Pesticides/poisoning , PrevalenceABSTRACT
The scope of this study was to investigate the in-house stock of medication in communities served by the Family Health Strategy (FHS) in a city located in the south of Brazil. A sample of 10% of households in five FHS areas was studied. Data were collected by Community Healthcare Workers using the adapted Fernandes questionnaire (2000). The mean age of the interviewees was 42 years and of the residents was 16 years, 51% of which were female. Low income (1 to 3 minimum wages) was observed (69.1%), and low education levels (0 to 4 years of study) (42%). Of the households visited 98.7% had at least one medication in stock. In 533 of the storage places located, 43.5% of such places were exposed to heat, 39.6% were exposed to humidity and 16.51% to light. Of the 2,717 medicines found, 6.9% were past the validity date, 35.3% were not in the secondary wrapping and 67.9% were without the patient information leaflet. Analgesics were the most common medications in in-house stock (21%). This study revealed the need for a multi-professional team to promote health and the rationalization of in-house stock since the Community Healthcare Worker is an indispensable professional to promote the rational use of medication.
O objetivo deste estudo foi avaliar o estoque domiciliar de medicamentos em comunidades atendidas pela Estratégia de Saúde da Família (ESF) em município localizado no Sul do Brasil. Foram amostrados 10% dos domicílios de cinco ESF. Os dados foram coletados por Agentes Comunitários de Saúde (ACS) através de questionário adaptado. A idade média dos entrevistados foi de 42 anos e dos moradores foi de 16 anos, destes 51% eram mulheres. Foi observada renda de 1 a 3 salários mínimos (69,1%), e escolaridade de 0 a 4 anos de estudo (42%). Dos domicílios visitados, 98,7% apresentavam pelo menos um medicamento estocado. Dos 533 lugares de guarda averiguados, 43,5% estava exposto ao calor, 39,6% a umidade, 16,5% a luz. Dos 2.717 medicamentos encontrados, 6,9% estavam vencidos, 35,3% não estavam dentro da embalagem secundária, quando esta se aplica, 67,9% não continham a presença de bula. Os fármacos analgésicos foram os mais prevalentes no estoque (21%). Os resultados nos levam a concluir que há necessidade de equipe multiprofissional para a promoção de saúde e a racionalização dos estoques domiciliares de medicamentos, sendo que o ACS é um profissional indispensável para a promoção do uso racional de medicamentos.
Subject(s)
Adult , Female , Humans , Male , Community Health Services , Community Health Workers , Drug Utilization/standards , Family Health , Brazil , Drug Storage , Family CharacteristicsABSTRACT
Pharmaceutical assistance concerns actions developed by the pharmacist and other professionals with the purpose of promoting, protecting and restoring health. Medications are an essential tool in this process that focuses on the access to, and the rational use of, drugs. This study is aimed at evaluating the Pharmaceutical Assistance provided by Municipal Health Offices in the Taquari Valley, Rio Grande do Sul. For this purpose, 2,794 users of public pharmacies were interviewed and data was analyzed using descriptive statistics. The users of the public pharmacies were mainly female and individuals with low educational level and income. On average, 2.41 drugs were prescribed per medical prescription and 1.72 of these were procured. Out of the total medicines prescribed, 76.5 percent were listed in the municipal standard drug list (SDL). Medication was prescribed by its generic name in 81.8 percent of the prescriptions. Antibiotics and injections were prescribed in 11.9 percent and 4.0 percent of the prescriptions, respectively. Users' access to information is partial, which can impair adherence to the treatment. Thus, it is possible to conclude that review of the service is necessary for it to be effective.
A Assistência Farmacêutica se preocupa com ações desenvolvidas pelo farmacêutico ou outros profissionais com o propósito de promover, proteger e restaurar a saúde. Medicamentos são ferramentas essenciais nesse processo, que se concentra no acesso e no uso racional de fármacos. Este estudo objetivou a avaliação da Assitência Farmacêutica suprida pela Secretaria Municipal da Saúde no Vale do Taquari, no Rio Grande do Sul. Com esse propósito, 2.794 usuários das farmácias públicas foram entrevistados e analisaram-se os dados usando estatística descritiva. Os usuários das farmácias públicas eram, principalmente, mulheres e indivíduos com baixo nível educacional e financeiro. Na média, 2,41 fármacos eram prescritos por prescrição médica e 1,72 destes foram obtidos. Do total de medicamentos prescritos, 76,5 por cento estava inscritos na lista de medicamentos padrão do município (SDL). A medicação foi prescrita pelo nome genérico em 81,8 por cento dos casos. Antibióticos e injeções foram prescritas em 11,9 por cento e 4,0 por cento das prescrições, respectivamente. O acesso dos usuários à informação é parcial, o que pode prejudicar a adesão ao tratamento. Dessa forma, é possível concluir que a revisão do serviço é necessária para que seja eficaz.