Epidemiological aspects of immediate postoperative pain in a tertiary hospital / Aspectos epidemiológicos da dor imediata pós-operatória em um hospital terciário

ABSTRACT BACKGROUND AND OBJECTIVES: Pain is a predominant symptom in the postoperative period and expected in any surgical service, being considered as a worldwide problem. Therefore, the aim of this study was to describe and analyze its epidemiological aspects, intensity, and predictors, for better management and predictability. METHODS: This is a quantitative, retrospective and cross-sectional observational study, carried out in a tertiary hospital at Londrina-PR, in which medical records of post-surgical patients who responded to pain scales during their stay in the post-anesthetic recovery room were analyzed. RESULTS: This study found that females are more likely to have postoperative pain and that younger patients are more susceptible, although not significantly. Mild pain predominated at rates greater than 60%, in which spinal blocks and gynecological/obstetric procedures were the most prevalent, in contrast to severe pain, which obtained higher percentages when general anesthesia and orthopedic surgeries were performed. In addition, an equation for predicting severe pain in the immediate postoperative period was obtained, based on the chosen anesthesia and the patient's age. CONCLUSION: Less intense postoperative pain was more prevalent than other intensities, with anesthesia and the type of surgery being possible predictive factors, even if the harbinger of its severity was based on age and the anesthetic method.

RESUMO JUSTIFICATIVA E OBJETIVOS: A dor é um sintoma predominante no pós-operatório e é esperada em qualquer serviço cirúrgico, sendo considerada um problema mundial. Portanto, o objetivo deste estudo foi descrever e analisar seus aspectos epidemiológicos, intensidade e preditores, tendo em vista um melhor manejo e previsibilidade. MÉTODOS: Estudo observacional quantitativo, retrospectivo e transversal, realizado em um hospital terciário no município de Londrina-PR, em que foram analisados prontuários de pacientes pós-cirúrgicos que responderam às escalas de dor durante permanência na sala de recuperação pós-anestésica. RESULTADOS: Esta pesquisa constatou que o sexo feminino possui maior tendência em ter dor pós-operatória e que pacientes mais jovens são os mais suscetíveis, apesar de não apresentarem grande significância. A dor leve predominou com taxas superiores a 60%, sendo que bloqueios espinhais e procedimentos ginecológicos/obstétricos foram os mais prevalentes, em contraste com a dor intensa, que obteve maiores percentuais quando realizadas anestesia geral e cirurgias ortopédicas. Além disso, obteve-se uma equação preditora de dores intensas no pós-operatório imediato, baseada no tipo de anestesia e na idade do paciente. CONCLUSÃO: A dor pós-operatória de menor intensidade foi mais prevalente que as outras intensidades, sendo a anestesia empregada e o tipo de cirurgia possíveis fatores preditores, mesmo que o prenúncio de sua severidade fosse baseado na idade e no método anestésico.

Comparative analysis: QOL in breast cancer patients before and during the COVID-19 pandemic

Introduction: The 2019 outbreak of coronavirus disease (COVID-19) posed unprecedented challenges of emotional matter for women diagnosed with breast cancer. This research aimed to compare the quality of life of patients who were diagnosed with breast cancer from 2014 to 2019, and patients who were diagnosed during the COVID-19 pandemic, from January to August 2020. Methods: A cross-sectional study was performed, including patients with breast cancer, associated or not with chronic pathologies, with no psychiatric disorders, aged over 18 years. The questionnaire developed by the European Organisation for Research and Treatment of Cancer (EORTC-C30) version 3.0 was used for the comparative analysis of quality of life. The study population consisted of 185 women, of which 43.2% (n = 80) were previously diagnosed and 56.7% (n = 105) were diagnosed during the pandemic, with a median age of 45 years (IQ = 15). Results: The EORTC-C30 quality of life score remained the same for both groups (33.33; 33.33). There was a decrease in the scores on the emotional (58; 50) and physical (60; 40) scales of patients diagnosed during the pandemic. Conclusions: Future longitudinal research should contribute to the understanding of the long-term effects of COVID-19 on the psychological health of patients with breast cancer.

Inulin Induces IL-10 Secretion and Increased FOXP3 Gene Expression in Human Peripheral Blood Mononuclear Cells

ABSTRACT Inulin is an effective prebiotic and its potential in modulating systemic immunity have been proposed. A subpopulation of T cells, named T regulatory cells (Tregs), expressing the Forkhead boxP3 transcription factor are key mediators of peripheral tolerance and suppress undesirable immune responses. These Tregs can be induced by cytokine transforming growth factor beta (TGF-β) and interleukin 10 (IL-10). This work aimed to evaluate inulin effects on human peripheral blood mononuclear cells (PBMC) in vitro. PBMC were incubated with inulin, and the expression of TGF-(1, FOXP3 and IL-10 was analyzed. Increased supernatant IL-10 levels were observed in PBMC of inulin-treated group (p=0.03). Moreover, FOXP3 gene expression was 7.6 fold higher in inulin-treated PBMC, whereas a trend in TGF-β1 expression was detected (p=0.055). These data suggest that inulin induces an immunosuppressive environment in cultured PBMC by promoting FOXP3 gene expression and IL-10 secretion. These studies offer prospects for further fundamental research in this field.

Involvement of transforming growth factor beta-1 (TGFβ1) cytokine and FOXP3 transcription factor genetic polymorphisms in hematological malignancies

Hematological malignancies (HM) are a group of neoplastic diseases that arise from hematologic cell lineages. Transforming growth factor beta 1 (TGFβ1) is shown to negatively regulate normal and malignant hematopoiesis and, in immunological context, to promote T cell exhaustion and generation of regulatory T cells, which are shown to be deleterious in cancer, by the induction of transcription factor FOXP3 expression. The present study aimed to evaluate TGFB1 exon-1 rs1800470 and FOXP3 intron-1 rs2232365 polymorphisms in relation to HM susceptibility. DNA was extracted from blood samples of 43 HM patients and 142 neoplasia-free individuals and polymorphisms were analyzed by allelic-specific PCR. Association analysis was assessed by the Odds Ratio (OR) with significance level of 5%. Regarding FOXP3 polymorphism, no significant differences were observed in genotype or allele distribution among the patients and controls. However, there was a positive association between TGFB1 TT genotype and HM susceptibility (OR = 4.07; CI95% = 1.94 - 8.52). In the combined analysis, a positive association was also observed for TGFB1 TT and FOXP3 GG genotypes (OR = 4.00; CI95% = 1.54 - 10.41) in relation to HM susceptibility. Our results indicated promising new markers to be further investigated in hematological malignancies.

Protein Expression and Codon 72 Polymorphism of TP53 Gene in Triple Negative Breast Cancer

A subgroup of tumor that has received attention is triple-negative breast cancer (TNBC), which presents phenotype of negative estrogen receptor, negative progesterone receptor and has no overexpression of HER2. TP53 acts as a tumor suppressor limiting the proliferation of damaged cells. A polymorphic site (rs1042522) of TP53 encodes either an arginine or a proline amino acid, but its biological significance remains unclear. This study aimed to investigate this variant and its expression in search for a possible involvement in TNBC susceptibility and clinical outcome. Genetic polymorphism was evaluated in 50 patients and 115 controls by PCR based methodology and immunohistochemistry was done with monoclonal antibody. Case-control study showed no positive or negative association (OR= 0.95; CI95%= 0.48-1.89). Comparison of genotypes and clinical outcome showed no significant results. Despite most of patients presented p53 positive staining by immunohistochemistry, there was no significant association in relation to prognostic parameters. Results demonstrated a lack of association between codon 72 polymorphism, susceptibility and prognosis of TNBC. Immunohistochemistry analysis should be done more carefully, since most of the patients had the somatic mutation of p53, which could be an indicator of prognostic value in TNBC.

TT virus in peripheral blood cells from patients with human papillomavirus (HPV): investigating association with cervical carcinoma

Torque Teno Virus (TTV) presence was investigated in peripheral blood of 117 brazilian women by nested polymerase chain reaction. TTV DNA was observed in 18.6% of healthy donors and in 24.32% Human Papillomavirus (HPV) patients. TTV presence was also investigated in the HPV positive group for comparison between the cervical cancer and noncancerous patients. TTV DNA prevalence was significantly higher among the HPV positive patients with cervical cancer (57.14%) than in HPV noncancerous patients (16.67%). Thus, the presence of TTV infection could be a risk factor for cancer development in the patients presenting HPV-TTV coinfection. Further studies are required to clarify the TTV influence in HPV pathogenesis.

Detection of GBV-C/HGV RNA in cervico-vaginal smears from healthy individuals

The purpose of the present study was to evaluate the sexual transmission of GBV-C/HGV, through RNA detection in cervicovaginal smears. Therefore the GBV-C/HGV RNA in cervicovaginal smears from apparently healthy women was investigated using routine proceedings for prophylactic screening to cervical cancer. GBV-C/HGV RNA was detected by reverse transcriptase and polymerase chain reaction (RT-PCR). Only one woman presented co-infection with human papilloma virus (HPV). The GBV-C/HGV RNA was detected in 13/73 (17.57 percent) healthy women and it's prevalence in participating women between 28-43 years old was 53.85 percent. No association was found with GBV-C/HGV for the age of first sexual intercourse and number of pregnancies. In GBV-C/HGV RNA positive women, 69.23 percent were married. In conclusion, the present findings show that cervical and vaginal specimens could contain the GBV-C/HGV RNA.

O objetivo do presente estudo foi avaliar a transmissão sexual de GBV-C/HBV, através da detecção do RNA viral em raspados cérvico-vaginais. Portanto, a presença do RNA GBV-C/HGV foi investigada em raspados cérvico-vaginais em mulheres aparentemente saudáveis que realizaram exames preventivos para câncer cervical. GBV-C/HGV RNA foi detectado por reação de transcriptase reversa e reação em cadeia da polimerase (RT-PCR). Apenas uma mulher apresentou a co-infecção com o papiloma vírus humano (HPV). O RNA GBV-C/HGV foi detectado em 13/73 (17,57 por cento) mulheres saudáveis e sua prevalência entre participantes da idade de 28-43 anos foi de 53,85 por cento. Não foi observada relação entre a presença do RNA GBV-C/HGV com a idade de primeira relação sexual, nem com o número de gestações. Entre as mulheres que apresentavam o RNA viral, 69,23 por cento eram casadas. O presente estudo demonstrou que secreções cérvico-vaginais podem conter o RNA viral GBV-C/HBV.

Aspectos patológicos, imunológicos e propriedades moleculares do TT vírus / Pathological and immunological aspects and molecular properties of TT virus

O TT vírus (TTV) foi primeiramente descrito no Japão, em 1997, por T. Nishizawa, no soro de pacientes com hepatite, pós-transfusão, não-A-G. Tem sido intensivamente investigado, desde então, como uma possível adicão à lista dos vírus indutores de hepatite. O TTV é um vírus DNA não-envelopado, de fita simples. Uma considerável variabilidade genética tem sido demonstrada por parte do TTV, o que tem levado pesquisadores a agrupar isolados do vírus em inúmeros genótipos e subtipos. No entanto a significância clínica da infeccão por TTV permanece desconhecida. Ele é freqüentemente detectado em fluidos corporais e seu componente mais bem elucidado atualmente é o genoma. Conhecimentos relacionados ao TTV têm aumentado constantemente, porém vários aspectos fundamentais permanecem obscuros. Esta revisão apresenta algumas das propriedades moleculares do TT vírus.

Detecção do RNA HGV/GBV-C em indivíduos saudáveis não portadores de HBV, HIV-1/2 e HCV / Detection of HGV/GBV - CRNA in healthy individuals non Carrier of HBV, HIV-1/2 and HCV

O vírus da hepatite G (HGV ou GBV-C) é um membro da família Flaviviridae. Baseado no perfil clínico e epidemiológico, este vírus pode ser adquirido principalmente por trnasmissão parenteral, por meio de sangue contaminado. Nós investigamos a presença do RNA do GBV -C/HGV em amostras de sangue periférico de doadores normais na ausência de marcadores como antígenos de superfície do HBV (HBsAg), anticorpos anti HBc (anti-HBc), anticorpos anti-HCV e anticorpos anti -HIV-1/HIV-2 0 RNA GBV-C foi detectado por reação de transcriptase reversa e reação em cadeia catalisada pela polimerase (RT-PCR). Foram analisadas 50 amostras de plasma e identificados 6 (12 por cento) amostras positivas para o RNA do GBV-C. A presença de RNA GBV-C na ausência de hepatite B e C em doadores saudáveis pode indicar que este vírus é capaz de transmissão independente e não contribui para doença hepática