ABSTRACT
AIMS: The proinflammatory cytokine tumor necrosis factor-alpha (TNF-α) is an essential component in the host immune response to infection, and it has been reported to be an important mediator in severe periportal fibrosis (PPF). We hypothesized that the (-G308A) polymorphism of the TNF-α gene is associated with the severity of PPF and that these polymorphisms influence TNF-α expression. METHODS: In this cross-sectional study, we genotyped these polymorphisms within the TNF-α gene in 256 Brazilian subjects infected with Schistosoma mansoni, with different patterns of PPF. RESULTS: The genotype (-308) AA was associated with a significant increase in the risk to advanced PPF (OR = 4.60; p = 0.009). In addition, median levels of TNF-α were higher in patients with moderate to advanced PPF, compared with mild fibrosis (20 and 17.3 pg/mL, respectively; p = 0.040). There was no association between average serum levels of TNF-α and (-G308A) TNF-α polymorphism. CONCLUSIONS: Our results suggest the (-308) AA genotype may be a risk factor for severity in advanced PPF, in this Brazilian population, and could potentially be used to predict the severity of advanced PPF in schistosomiasis.
Subject(s)
Schistosomiasis mansoni/genetics , Tumor Necrosis Factor-alpha/genetics , Adult , Aged , Brazil , Cross-Sectional Studies , Female , Fibrosis , Genotype , Humans , Liver Cirrhosis/pathology , Male , Middle Aged , Polymorphism, Single Nucleotide/genetics , Risk Factors , Schistosomiasis/genetics , Schistosomiasis mansoni/blood , Schistosomiasis mansoni/metabolism , Tumor Necrosis Factor-alpha/blood , Tumor Necrosis Factor-alpha/metabolism , Young AdultABSTRACT
Objective: To perform a descriptive analysis of the physical and clinical profile of women after a mastectomy, as well as to verify the functionality of the ipsilateral upper limb after surgery and to evaluate which quality of life questionnaire domains have repercussions on the functional capacity of this part of the body. Methods: Cross-sectional descriptive study, performed at the Centro de Oncologia Dr. Muccini, in Petrolina (Pernambuco, Brazil), with the participation of 53 patients. We used the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire to evaluate the functionality of the ipsilateral upper limb after surgery, and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC-QLQ-C30) and its breast cancer specific module (EORTC-QLQ-BR23) to measure quality of life. Results: The symptoms had a significant impact on the function of the patients' upper limbs. Statistically significant correlations (p<0.05) were observed between the total DASH score and the symptoms (r=0.451 in the QLQ-C30 and r=0.535 in the QLQ-BR23) and the functionality (r=-0.488 and r=-0.448), which were negative. There was also a statistically significant association (p=0.001) between limitation in activities of daily living (ADLs) and the subjective presence of lymphedema. Conclusion: The sensory alterations resulting from a mastectomy are the main factors responsible for the development of modifications that affect the functionality of the ipsilateral upper limb after surgery. The subjective sensation of lymphedema was associated with limitations in the ADLs and with a decrease in the arm's functional capacity.
Objetivo: Realizar a análise descritiva do perfil físico e clínico de mulheres após mastectomia, além de verificar a funcionalidade do membro superior homolateral à cirurgia e avaliar quais os domínios do questionário de qualidade de vida têm repercussões na capacidade funcional desse segmento corporal. Métodos: Estudo descritivo de corte transversal, realizado no Centro de Oncologia Dr. Muccini, em Petrolina (PE), com a participação de 53 pacientes. A funcionalidade do membro superior homolateral à cirurgia foi mensurada por meio do questionário Disability of the Arm, Shoulder and Hand (DASH) e a qualidade de vida por meio do European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC-QLQ-C30) e seu módulo específico para câncer de mama (EORTC-QLQ-BR23). Resultados: A sintomatologia teve impacto importante na função dos membros superiores das pacientes, uma vez que foram verificadas correlações estatisticamente significativas (p<0,05) entre o escore total do DASH com a sintomatologia (r=0,451 no QLQ-C30 e r=0,535 no QLQ-BR23) e a funcionalidade (r=-0,488 e r=-0,448), sendo estas negativas. Foi também verificada associação estatisticamente significante (p=0,001) entre limitação nas atividades da vida diária (AVDs) e presença subjetiva de linfedema. Conclusão: As alterações sensitivas decorrentes da mastectomia são as principais responsáveis pelo desenvolvimento de modificações que afetam a funcionalidade do membro superior homolateral à cirurgia. A sensação subjetiva de linfedema teve associação com limitações nas AVDs e redução da capacidade funcional do braço.