The impact of a breast cancer diagnosis on marital outcomes and factors associated with divorce and separation.

Objective: To analyze marital outcomes, divorce or separation, and its association with demographic, socioeconomic, and clinicopathological factors among breast cancer (BC) survivors after 2-years of diagnosis. Methods: We performed a retrospective analysis of marital status at baseline and at years 1 and 2 of follow-up of women aged ≥ 18 years diagnosed with invasive BC participating in the AMAZONA III (GBECAM0115) study. The BC diagnosis occurred between January 2016 and March 2018 at 23 institutions in Brazil. Results: Of the 2974 women enrolled in AMAZONA III, 599 were married or living under common law at baseline. Divorce or separation occurred in 35 (5.8%) patients at 2 years of follow-up. In the multivariate analysis, public health insurance coverage was associated with a higher risk of marital status change (8.25% vs. 2.79%, RR 3.09, 95% CI 1.39 - 7.03, p = 0.007). Women who underwent mastectomy, adenomastectomy or skin-sparing mastectomy were associated with a higher risk of divorce or separation (8.1% vs. 4.49%, RR 1.97, 95 CI 1.04 - 3.72, p = 0.0366) than those who underwent breast-conserving surgery. Conclusion: Women covered by the public health system and those who underwent mastectomy, adenomastectomy or skin-sparing mastectomy were associated with a higher risk of divorce or separation. This evidence further supports the idea that long-term marital stability is associated with a complex interplay between socioeconomic conditions and stressors, such as BC diagnosis and treatment. ClinicalTrials Registration: NCT02663973.

Manejo inicial da neutropenia febril em pacientes com neoplasias malignas / The initial approach to febrile neutropenia in patients with malignancies

Febre, durante a neutropenia induzida pela quimioterapia em pacientes com neoplasias malignas, pode ser o único indício de uma infecção grave vigente, pois os sinais e os sintomas de inflamação podem estar mascarados. Por esse motivo, médicos, especialmente os que trabalham em pronto atendimento, devem ter conhecimento dos protocolos atualizados, a fim de diagnosticar e tratar precocemente pacientes com neutropenia febril, evitando, assim, um desfecho letal em um curto período de tempo.

Fever during chemotherapy-induced neutropenia in patients with malignancies, may be the only indication of a severe infection current, since the signs and symptoms of inflammation may be masked. For this reason, physicians, especially those working in emergency room must be aware of the updated guidelines in order to early diagnose and treat patients with febrile neutropenia, thus avoiding a lethal outcome in a short period of time.

O manejo das reações agudas em quimioterapia / Management of acute reactions in chemotherapy

As reações agudas são eventos imprevisíveis que podem ocorrer na administração de dose terapêutica de qualquer medicação. Os quimioterápicos são drogas potencialmente responsáveis por estas reações. Torna-se importante que o profissional de saúde saiba reconhecer, avaliar e agir prontamente frente a estas situações.

The acute reactions are unpredictable events that may occur in the therapeutic dose of any drug. Chemotherapy is potentially responsible for these reactions. It is important that health professionals learn to recognize, evaluate and act promptly addressing these situations.

Cardioembolic sources in stroke patients in South of Brazil.

Background. Stroke is a leading cause of mortality and disability in Brazil and around the world. Cardioembolism is responsible for nearly 30% of the origins of ischemic stroke. Methods. We analyzed data of 256 patients with cardioembolic ischemic stroke (according to TOAST classification) who were admitted into the Hospital São Lucas-PUCRS from October 2011 to January 2014. The cardioembolic subtype was divided into six subgroups: arrhythmias, valvular heart disease, coronary artery disease, cardiomyopathy, septal abnormalities, and intracardiac injuries. The prevalence of the most important cardiovascular risk factors and medications in use for prevention of systemic embolism by the time of hospital admission was analyzed in each patient. Results. Among 256 patients aged 60.2 +/- 6.9 years, 132 males, arrhythmias were the most common cause of cardioembolism corresponding to 50.7%, followed by valvular heart disease (17.5%) and coronary artery disease (16%). Hypertension (61.7%) and dyslipidemia (43.7%) were the most common risk factors. Less than 50% of patients with arrhythmias were using oral anticoagulants. Conclusions. Identifying the prevalence of cardioembolic stroke sources subgroups has become an increasingly important role since the introduction of new oral anticoagulants. In this study, arrhythmias (especially atrial fibrillation) were the main cause of cardioembolism.