Prejudice impairing quality of life in sickle cell disease patients in a developing country: faces of suffering

ABSTRACT Introduction: The perception of prejudice against, and stigmatization of, sickle cell disease (SCD) leads the patient to perceive a different treatment, due to the disease stigma and maybe related to a worse quality of life (QoL). Objectives: Describe and evaluate the perception of the prejudice against the disease and its impact on the quality of life of patients with sickle cell disease. Methods: This is a cross-sectional study conducted between March 2019 and February 2020, with patients diagnosed with SCD. Patients were questioned about the perception of prejudice in any kind of situation, choosing between "Yes" or "No", not differentiating situations related to prejudice. To assess the QoL and impact of the disease, the volunteers answered a version of the SF-36 questionnaire translated and validated into Brazilian Portuguese. Results: In this study, 113 patients with SCD were followed up, 92% were classified as HbSS and the rest, divided between HbSC and HbS-β-0. Regarding the SF-36, the worst scores were in the summary of the physical components (mean 48.19 ± 21.51) and the physical aspect had the lowest mean (30.75 ± €42.65). When questioned if they had already perceived any kind of prejudice, including the SCD, 32.74% answered "Yes". For this comparison, there was a significant difference in the summary of the physical and mental components, with worse QoL for those who had already suffered prejudice. Conclusion: Patients diagnosed with SCD who reported perception of prejudice had statistically significant worse QoL, revealing the negative impact, that might lead to sadness and social isolation.

Análise de prontuários de pacientes com câncer de mama em tratamento com bisfosfonatos: fator de risco para manifestações orais e osteonecrose induzida / Analysis of medical records of patients with breast cancer on treatment with bisphosphonates: risk factor for oral manifestations and induced osteonecrosis

JUSTIFICATIVA E OBJETIVOS: A terapêutica do câncer de mama (CM) merece ser avaliada com cuidado antes de ser prescrita, pois dentre as opções, existem os bisfosfonatos que mostram relação com a indução a osteonecrose dos maxilares.O objetivo deste estudo foi verificar o uso de bisfosfonato na terapêutica anticâncer e a sua relação com osteonecrose induzida através da análise de prontuários de portadoras do câncer de mama. MÉTODOS: Estudo longitudinal com dados coletados de pacientes que com diagnóstico de câncer de mama entre 2007 e 2008, internadas no Hospital Aldenora Belo, referência neste tipo de tratamento em São Luis/MA, usuárias de bisfosfonato há mais de um ano, sendo a amostra formada por 31 mulheres.RESULTADOS: Das 31 pacientes em tratamento que compuseram a amostra (20,6%), 3 (1,99%) vieram a óbito, 13 (8,63%) desistiram e 15 (9,96%) continuaram, com maioria pertencentes a faixa etária superior aos 40 anos e usuárias de pamidronato por via venosa, sendo, este dois fatores, por si só, fatores de risco.Observou-se apenas um caso de destruição óssea craniofacial com comprovada associação entre idade e uso prolongado do fármaco.CONCLUSÃO: Constatou-se que o pamidronato nunca é o fármaco de primeira escolha, seus efeitos colaterais são significantes.Quanto à osteonecrose induzida, não há nenhum caso confirmado nos prontuários, visto que o diagnóstico é complexo (acompanhamento clínico e radiográfico) além do Cirurgião Dentista não fazer parte da equipe multidisciplinar do hospital.

BACKGROUND AND OBJECTIVES: The treatment of breast cancer (BC) must be carefully evaluated before being prescribed, since there are, among the options, bisphosphonates that show a relation with the induction of osteonecrosis of the jaw. The aim of this study was to investigate the use of bisphosphonates in anticancer therapy, and its relationship to induced osteonecrosis by analyzing medical records of patients with breast cancer. METHODS: A longitudinal study with data collected from patients diagnosed with breast cancer between 2007 and 2008, admitted at Hospital Aldenora Belo, a reference in this type of treatment in the city of São Luis, in the state of Maranhão,who were bisphosphonate users for over a year, with the sample being comprised of 31 women. RESULTS: Of the 31 patients treated in the sample (20.6%), 3 (1.99%) died, 13 (8.63%) quit and 15 (9.96%) continued, with most of them aged over 40 years, and users of intravenous pamidronate, these two factors alone being risk factors. There was one case of craniofacial bone destruction with proven association with age and prolonged use of the drug. CONCLUSION: It was found that pamidronate is never the first-choice drug, its side effects are significant. Regarding induced osteonecrosis, there is no confirmed case in the records, since the diagnosis is complex (clinical and radiographic monitoring) and also because the Dentist is not part of the multidisciplinary team at the hospital.