Risk factors associated with antineoplastic chemotherapy-induced nausea and vomiting / Fatores de risco associados a náuseas e vômitos induzidos por quimioterapia antineoplásica

ABSTRACT OBJECTIVE: To estimate the incidence and to evaluate risk factors for antineoplastic nausea and vomiting with high and moderate emetogenic chemotherapy in adult patients in the first treatment cycle. METHODS: Prospective cohort study with follow-up of 269 adults during the first cycle of antineoplastic chemotherapy. The incidence of nausea and vomiting was evaluated in the acute phase (0-24 hours), in the late phase (24 hours-5th day) and in the total phase (0-5th day). RESULTS: In total, 152 patients underwent high emetogenic chemotherapy and 117 moderate emetogenic chemotherapy. The relative frequency of nausea was higher when compared with vomiting in the acute phase (p < 0.001) and in the late phase (p < 0.001). The risk factors identified were: age group ≤ 49 years (odds ratio = 0.47; 95%CI 0.23-0.95) and 50-64 years (odds ratio = 0.45; 95%CI 0.23-0.87), tobacco use (odds ratio = 0.35; 95%CI 0.14-0.88), and high emetogenic chemotherapy (odds ratio 0.55; 95%CI 0.31-0.95). CONCLUSION: The incidence of nausea was higher than that of vomiting, and adverse effects were more frequent in the late phase. The results suggest the risk factors for chemotherapy-induced nausea and vomiting are tobacco, age (young adults), and high emetogenic chemotherapy.

RESUMO OBJETIVO: Estimar a incidência e avaliar os fatores de risco para náuseas e vômitos induzidos por antineoplásicos com alto e moderado potencial emético em pacientes adultos, no primeiro ciclo de tratamento. MÉTODOS: Estudo de coorte prospectiva, com 269 adultos acompanhados durante o primeiro ciclo de quimioterapia antineoplásica. A incidência de náuseas e vômitos foi avaliada na fase aguda (0-24 horas), na fase tardia (24 horas-5° dia) e na fase total (0-5° dia). RESULTADOS: 152 pacientes foram submetidos a quimioterápico com alto potencial emético e 117 a moderado potencial emético. A frequência relativa de náuseas foi maior quando comparada à de vômitos na fase aguda (p < 0,001) e na fase tardia (p < 0,001). Os fatores de risco identificados foram: faixa etária ≤ 49 anos (odds ratio = 0,47; IC95% 0,23-0,95) e 50-64 anos (odds ratio = 0,45; IC95% 0,23-0,87), uso de tabaco (odds ratio = 0,35; IC95% 0,14-0,88) e alto potencial emético dos quimioterápicos (odds ratio 0,55; IC95% 0,31-0,95). CONCLUSÃO: A incidência de náuseas foi maior do que a de vômitos, e na fase tardia os efeitos adversos foram mais frequentes. Os resultados sugerem que os fatores de risco para náuseas e vômitos induzidos por quimioterapia são o tabaco, a idade (adultos jovens) e o alto potencial emético do quimioterápico.

Frecuencia y características del cáncer de vesícula biliar en un hospital de referencia al sur del Perú, 2009-2014: estudio descriptivo / Frequency and characteristics of gallbladder cancer at a referral hospital in southern Peru, 2009-2014: a descriptive study

INTRODUCCIÓN: El cáncer de vesícula biliar es una neoplasia poco común, y su frecuencia es variable en las regiones de Perú. OBJETIVO: Determinar la frecuencia y describir las características clínicas del cáncer de vesícula biliar en un hospital de referencia al sur de Perú. MÉTODOS: Estudiamos los informes de todas las muestras de colecistectomías realizadas entre los años 2009 y 2014, en el servicio de anatomía patológica del Hospital Regional Honorio Delgado. Además, revisamos las historias clínicas de los pacientes que tuvieran algún resultado compatible con cáncer de vesícula biliar. RESULTADOS: De 2991 colecistectomías, 75 (2,5%) tuvieron cáncer de vesícula biliar. El síntoma más frecuente en ambos grupos fue el dolor (96,7%), seguido de náusea (87,5%) y vómitos (65,0%). La mayoría de pacientes fueron mujeres (83,3%) mayores de 60 años (65,0%). El tipo histológico más frecuente fue el adenocarcinoma (80,0%). CONCLUSIÓN: La frecuencia de cáncer de vesícula biliar en un hospital de referencia del sur de Perú, es de 2,5% mayor a la reportada en otros estudios en las regiones centro y norte del país.

INTRODUCTION: Gallbladder cancer is a rare neoplasm, its frequency is variable in the regions of Peru. OBJECTIVE: To determine the frequency and describe the clinical characteristics of gallbladder cancer in southern Peru. METHODS: The reports of the anatomopathological department of the Honorio Delgado Regional Hospital were selected from all samples of cholecystectomies performed between 2009 and 2014 and those that had some result compatible with gallbladder cancer were looked for. Subsequently, the clinical histories were searched to obtain the characteristics of these patients. RESULTS: Of 2991 cholecystectomies, 75 (2.5%) had gall bladder cancer. The most frequent symptom in both groups was pain (96.7%), followed by nausea (87.5%) and vomiting (65.0%). The majority of patients were women (83.3%) older than 60 years (65.0%). The most frequent histological type was the adenocarcinoma (80.0%). CONCLUSION: The frequency of gallbladder cancer in a reference hospital in southern Peru is 2.51%, higher than that reported in other studies in the central and northern regions of Peru.

A nationwide study on the prevalence of functional gastrointestinal disorders in school-children / Prevalencia de desórdenes gastrointestinales funcionales en niños. Un estudio a nivel nacional

Abstract: Introduction: Functional gastrointestinal disorders (FGIDs) are highly prevalent worldwide and are thought to result from the interplay of multiple factors that can vary from region to region. Nationwide studies can help understand the regional epidemiology and the pathogenesis of FGIDs. The objectives of this study were to determine the prevalence of FGIDs in school-children of Colombia and assess associated factors. Methods: A cross-sectional study was carried out at twelve private and public schools in ten cities distributed through the four main geographic regions of Colombia. School-children completed a validated questionnaire to assess functional gastrointestinal disorders according to Rome III criteria. Demographic information and past medical and family history was obtained from the parents. Results: A total of 4394/5062 (86.8%) children participated in the study, with ages ranging from 8-18 years (mean = 11.9, SD = 2.3). The percentage of children with al least on FGID was 23.7%. Disorders of defecation were the most common category FGID (11.7%) followed by abdominal pain related-functional gastrointestinal disorders (10.4%). Children have increased odds of FGIDs if they have separated parents (OR 1.22, P=0.007), attend private school (OR 1.54, P<0.001), or have nausea (OR 3.16, P<0.001). Conclusions: This large epidemiological study of pediatric FGIDs is the first to evaluate a broad cross-section of children throughout a nation in the Americas. High prevalence of FGIDs and identified associations with their likelihood are relevant when providing medical care and when planning public health efforts.

Resumen: Introducción: Los desórdenes gastrointestinales funcionales (DGF) son altamente prevalentes a nivel mundial. Se postula que estos desórdenes resultan del interjuego de múltiples factores que pueden variar regionalmente. Estudios a nivel nacional pueden ayudar a comprender la epidemiología regional y la patogénesis de los DGFs. Los objetivos del estudio fueron determinar la prevalencia de DGFs en escolares en Colombia y establecer los factores asociados. Métodos: Estudio de corte transversal realizado en 12 escuelas privadas y públicas en 10 ciudades de las cuatro regiones principales de Colombia. Niños de edad escolar completaron un cuestionario validado para diagnosticar DGFs de acuerdo con los criterios de Roma III. Información demográfica e historia personal y familiar fue obtenida de los padres. Resultados: Un total de 4394/5062 (86.8%) niños participaron en el estudio, rango de edad 8-18 años (promedio = 11.9, desviación estándar (DE) = 2.3). El 23.7% de los niños tuvieron al menos un DGF. Los desórdenes de la defecación fueron los más frecuentes (11.7%), seguidos por desórdenes funcionales de dolor (10.4%). Niños cuyos padres estaban separados (razón de momios (RM) 1.22, p= 0.007), cursaban en escuela privada (RM 1.54, p< 0.001) o reportaban náuseas (RM 3.16, p< 0.001) tuvieron mayor riesgo de DGFs. Conclusiones: Este estudio de DGF es el primero en evaluar un grupo numeroso de niños en diferentes regiones de un país americano. La alta prevalencia de DGFs y la identificación de asociaciones que aumentan el riesgo de desarrollar estos desórdenes son hallazgos relevantes para proveer cuidados médicos y planear estrategias de salud pública.

Incidence and management of chemotherapy-induced nausea and vomiting in women with breast cancer / Incidencia y gestión de náuseas y vómitos en tratamiento quimioterapico en mujeres con cáncer de mama / Ocorrência e manejo de náusea e vômito no tratamento quimioterápico em mulheres com câncer de mama

The objective of this study was to analyze the incidence of chemotherapy-induced nausea and vomiting in women with breast cancer and identify strategies used by them to control these signs and symptoms. Data for this cross-sectional study were collected through interviews during the last cycle of chemotherapy, between August 2011 and March 2012, in a university hospital in the State of São Paulo. The sample consisted of 22 women between the ages of 31 and 70, of whom 77.3% reported nausea and 50% vomiting during treatment. Regarding symptom management, 82% of the women reported having received some information centered on the use of prescribed medication. However, 27.3% did not know what medication they had taken. We concluded that there is a lack of systematic care and institutional protocol to guide professionals in providing standardized information to women so they can better control nausea and vomiting.

Este estudio objetivó analizar la incidencia de náuseas y vómitos en mujeres con cáncer de mama durante la quimioterapia, identificar el manejo utilizado para controlar estos signos y síntomas. Estudio transversal, cuyos datos fueron recolectados por medio de entrevistas en el último ciclo de quimioterapia entre agosto 2011 y marzo 2012 en un hospital universitario en el Estado de São Paulo. La muestra consistió de 22 mujeres, con edades entre 31 y 70 años, que el 77,3% reportó náuseas y el 50% vómitos durante el tratamiento. Cuanto al manejo, el 82% afirmó que habían recibido algún tipo de información centrada en el uso de la medicación prescrita, sin embargo, el 27,3% no supo responder cuál medicación fue utilizada. Se concluye que falta de sistematización de la atención y protocolo institucional para orientar profesionales para ofrecer información estandarizada, posibilitando el seguimiento de las mujeres para tener un mejor control de náuseas y vómitos.

Objetivou-se analisar a ocorrência de náusea e vômito em mulheres com câncer de mama durante a quimioterapia, e identificar o manejo utilizado para o controle desses sinais e sintomas. Pesquisa transversal, cujos dados foram coletados por meio de entrevista, no último ciclo de quimioterapia, entre agosto de 2011 e março de 2012 em um hospital universitário no interior do Estado de São Paulo. A amostra foi composta por 22 mulheres, com idade entre 31 e 70 anos, e 77,3% relataram náusea e 50% vômito, durante o tratamento. Quanto ao manejo, 82% delas afirmaram ter recebido algum tipo de informação que ficou centrada no uso da medicamento prescrito, entretanto, 27,3% não souberam responder qual medicamento usaram. Concluiu-se que há falta de sistematização da assistência e protocolo institucional que norteiem os profissionais a fornecer informações padronizadas, possibilitando o seguimento das mulheres, a fim de terem controle mais adequado da náusea e vômito.

Concomitant Functional Gastrointestinal Symptoms Influence Psychological Status in Korean Migraine Patients

BACKGROUND/AIMS: Migraine is frequently accompanied by symptoms consistent with functional gastrointestinal disorders (FGIDs). This study evaluated the prevalence of functional gastrointestinal symptoms and assessed the symptoms' relationship with the concomitant functional symptoms of anxiety, depression, and headache-related disability. METHODS: This prospective study included 109 patients with migraine who were recruited from a headache clinic at a teaching hospital. The participants completed a self-administered survey that collected information on headache characteristics, functional gastrointestinal symptoms (using Rome III criteria to classify FGID), anxiety, depression, and headache-related disability. RESULTS: In total, 71% of patients met the Rome III criteria for at least one FGID. In patients with FGID, irritable bowel syndrome was the most common symptom (40.4%), followed by nausea and vomiting syndrome (24.8%) and functional dyspepsia (23.9%). Depression and anxiety scores were significantly higher in patients meeting the criteria for any FGID. The number of the symptoms consistent with FGID in individual patients correlated positively with depression and anxiety. CONCLUSIONS: FGID symptoms defined by the Rome III criteria are highly prevalent in migraine. These symptoms correlate with psychological comorbidities, such as depression and anxiety.

The Prevalence of Gastrointestinal Symptoms in Patients with Non-Insulin Dependent Diabetes Mellitus

BACKGROUND/AIMS: Gastrointestinal (GI) symptoms are common among patients with non-insulin dependent diabetes mellitus (NIDDM). Our aim was to investigate the frequency of chronic GI symptoms in Korean patients with NIDDM. METHODS: A cross-sectional survey, using a reliable and valid questionnaire, was performed in diabetes clinics from seven hospitals of the Catholic University of Korea. RESULTS: A total of 608 patients (249 males and 359 females, mean age 53.7+/-10.9 years) were investigated. The frequencies of weekly heartburn and acid regurgitation (esophageal symptoms) were 7.1% (95% confidence interval [CI], 5.0 to 9.2) and 4.4% (95% CI, 2.8 to 6.1), respectively. The frequency of dyspepsia was 13.2% (95% CI, 10.5 to 15.8). The frequencies of constipation and diarrhea were 15.0% (95% CI, 12.2 to 18.0) and 5.3% (95% CI, 3.5 to 7.1), respectively. Nausea and the use of manual maneuvers to facilitate defecation were more prevalent in women than in men. Constipation and fecal incontinence were more common in diabetes patients with long duration (>10 years). Fecal incontinence and using laxatives were more frequent in the complicated diabetes group. Using laxatives was more frequent in the uncontrolled diabetes group. CONCLUSIONS: Two-thirds of diabetic patients experienced GI symptoms. The prevalence of GI symptoms was more common in patients who had diabetic complications and a long duration of diabetes.

Escala para medir la calidad de la recuperación postanestésica desde la perspectiva del usuario / A scale for measuring the quality of post-anaesthetic recovery from the user's point of view

Objetivo: Desarrollar una escala válida para medir la calidad de recuperación postanestésica desde la perspectiva de los pacientes (CdR). Métodos Se realizó en sujetos programados para cirugía electiva con clasificación ASA I o II. Lugar: Hospital San Juan de Dios de Bogotá, Clínica de Salud Sexual y Reproductiva Profamilia y Clínica Carlos Lleras del Seguro Social. Se realizó en cinco fases: I. Entrevistas semiestructuradas para conocer las diferentes categorías e ítem de calidad referidos por los pacientes (n=30); II. Categorización y análisis de contenidos para conocer los ítem relevantes (n=42); III. Validación de apariencia (n=20). IV. Diseño y validación de la escala, CdR (n=283): Análisis de factores principales, rotación varimax. La consistencia interna se evaluó con el coeficiente Alpha de Cronbach. La validación de criterio, concurrente y discriminante se hizo utilizando estadística no paramétrica; V. Evaluación de reproducibilidad de la escala (n=100), mediante el coeficiente de concordancia de Kendal. Resultados CdR se construyó en español colombiano, con 14 ítems y 3 dominios, calidad general (8 ítems), sala de recuperación (5 ítems) y dolor (1 ítems). Mostró buena consistencia interna (Cronbach = 0.8783). CdR se correlacionó positivamente (rho spearman0.39) con 3 de 5 escalas. Discriminó diferencias por sexo, tipo de cirugía, sitio quirúrgico y tipo de anestesia (Ji2 y K. Wallis, p<0.05). Tuvo buena reproducibilidad (Kendal=0,6378, p=0,033). Conclusión CdR es la primera escala válida para medir la calidad de la recuperación postanestésica, construida sólo desde la perspectiva de los pacientes.

Objective: Developing a valid scale for measuring the quality of post-anaesthetic recovery (QoR) from the patientsÆ point of view. Methods ASA I or II scheduled surgical patients were selected. Setting: Hospital San Juan de Dios, Bogotá, ProfamiliaÆs Sexual and Reproductive Health Clinic and Social SecurityÆs Clínica Carlos Lleras. Five phases: semi-structured interviews for establishing different quality categories and items referred by patients (n=30); content analysis and categorisation to establish relevant items (n=42); facial validity (n=20); scale design and validation, QoR (n=283): main factor analysis, varimax rotation CronbachÆs alpha coefficient was used for testing internal consistency. Concurrent and discriminating criteria were validated by using non-parametrical statistics]; and reproducibility (n=100), tested by KendalÆs concordance coefficient. Results The QoR was constructed in Colombian Spanish with 14 items and 3 domains, general quality (8 items), recovery room (5 items) and pain (one item). The QoR showed good internal consistency (Cronbach = 0.8783). The QoR positively correlated (SpearmanÆs rho0.39) with 3 out of 5 scales and found differences by gender, kind of surgery, surgical site and kind of anaesthesia (Ji2 and K. Wallis, p<0.05). The QoR had good reproducibility (Kendal=0.6378, p=0.0335). Conclusion The QoR is the first valid scale constructed from the patientÆs point of view for measuring the quality of post-anaesthetic recovery.

Efficacy of prophylactic ondansetron in Thai patients undergoing gastrointestinal tract surgery.

Postoperative nausea and vomiting (PONV) although frequently is considered a minor postoperative complication, it may be greatly trouble some especially in ambulatory surgical patients. This study was performed to compare the efficacy and safety of a single intravenous bolus dose of ondansetron 4 mg with the placebo in the prevention of PONV and to assess the safety and tolerability in Thai patients. By using the randomized, double-blind, placebo controlled study design, we enrolled 82 Thai male and female patients, ASA physical status I or II, between the ages of 12 and 75 year undergoing gastrointestinal tract surgery with general anesthesia in the study. A single intravenous bolus dose of ondansetron 4 mg or a single dose of placebo was administered immediately prior to the induction of the anesthesia. The patients were followed for 24 hours to assess PONV and adverse events. We found that intravenous ondansetron 4 mg seemed to be effective and safe in the prevention of PONV especially in female patients (P = 0.037) based on clinical observation. However there was no statistical significance between groups. None of the patients in both groups had any adverse events. In addition, there was no significant difference between preoperative and postoperative abnormalities of liver enzymes. Also we had found no difference in patient satisfaction between two groups.

Postoperative nausea vomiting (PONV): influence of bowel manipulation during intraabdominal surgery.

This study does not confirm the hypothesis that "bowel manipulation during intraabdominal surgery may release 5 HT3 to stimulate the vomiting center via the vagus nerve". Thus routine prophylactic use of 5 HT3 receptor antagonist is probably not necessary, especially in Thai patients whose PONV is not distinct both in incidence and intensity of emesis.