Andreza Carvalho Rabelo Mendonça

Hipoestesia, dor e incapacidade no membro superior após radioterapia adjuvante no tratamento para câncer de mama

BACKGROUND AND OBJECTIVES: Surgery and radiotherapy (RT) may induce upper limb (UP) pain, functional disorder and daily life activities impairment. This study aimed at evaluating and comparing superficial sensitivity (SS) on the dermatome corresponding to the intercostobrachial sensory nerve (ICBN), pain and disability of UL ipsilateral to surgery before and after adjuvant RT. METHOD: Twenty females submitted to surgery including axillary lymphadenectomy (AL) were evaluated before and immediately after adjuvant RT (25-30 sessions). The following tools were used to evaluate SS, pain and disability: esthesiometry, McGill Pain Questionnaire (MPQ), Pain Rating Index and shoulder disability (SPADI). Two measures were obtained from MPQ: number of words chosen (NWC) and pain rating index (PRI). Wilcoxon Signed Rank Test for paired samples was used for intragroup comparison, considering significant p < 0.05. RESULTS: There has been significant SS decrease after RT by increased esthesiometer pressure from 1.9 ± 0.2 to 2.8 ± 0.2 (p = 0.004) indicating hypoesthesia. There has been no difference in contralateral UL. NWC and PRI scores have significantly increased (p = 0.005 and p = 0.006) after RT. There has been significant total SPADI score increase after RT (p = 0.0001), with increased disability from 24.6 ± 5.7 to 39.2 ± 5.7 (p = 0.001) and pain from 26.3 ± 6.4 to 48.4 ± 7.1 (p = 0.001). CONCLUSION: Hypoesthesia was identified in the ICBN pathway, in addition to UL pain and disability after adjuvant RT.

Comparison of the placebo effect between different non-penetrating acupuncture devices and real acupuncture in healthy subjects: a randomized clinical trial

BackgroundSeveral studies have used placebo acupuncture methods in recent years as a way for blinding therapeutic effect of acupuncture, however placebo method selection has not followed enough methodological criteria to the point of stabilishing a consensus of what should be the best method to be used. This study aimed to evaluate the effectiveness of three different placebo acupuncture methods for blinding applied in healthy subjects.MethodsThis study was approved by the Ethics Committee of the Federal University of Sergipe with the number 47193015.5.0000.5546 and all individuals participating in the study signed a free and informed consent. For this study, 321 healthy volunteers were randomly divided into seven groups using the abdominal point stomach (ST) 25 and seven groups using the lumbar point bladder (Bl) 52 for stimulation. For real acupuncture procedure, three different methods of placebo acupuncture plus a mix between real acupuncture and placebo applied in the same individual, totaling fourteen groups in this study. Outcome assessments were performed before and immediately after applying the technique. Investigator who assessed variables had no knowledgement about the method was applied. Identification, weight and height were measured before puncture by using. At the end, subjects were asked if they believed they were receiving real or placebo acupuncture.ResultsThere was no significant difference between groups for the perception about the type o stimulation (wheter real or placebo puncture). Percentage of subjects who reported to have received real acupuncture in the abdominal point was 69.56% in real group, 86.95% in group Park Sham, 82.60% in needle + foam, 91.30% in insertion and removal, 78.26% in real + Park Sham, 86.36% in real + needle and foam, 86.95% in real + insertion and removal, and for the lumbar point was 86.36% in real group, 86.95% in group Park Sham, 69.56% in needle + foam, 72% in insertion and removal, 86.95% in real + Park Sham, 81.81% in real + needle and foam and 78.26% in real + insertion and removal.ConclusionAll placebo acupuncture methods proposed in this study were equally effective for bliding the study participants using either abdominal or lumbar acupoints, and none of the placebo methods presented benefit compared to the other to be used in future clinical trials.Ethics CommitteeFederal University of Sergipe (UFS), number of approval: 47193015.5.0000.5546Trial registrationensaiosclinicos.gov.br RBR-3w2p32 Registered in 28th January 2016.

Female urinary incontinence: quality of life comparison on reproductive age and postmenopausal period

Introduction: urinary incontinence (UI) is defined as any involuntary leakage of urine and their symptoms can affect womens quality of life (QoL). Objectives: to compare incontinent womens QoLin reproductive age (G1) with those in post menopausal period(G2). Material and methods: a descriptive and retrospective study involved 86 women with UI complaints. Clinical, sociodemographic, obstetrical and gynecological antecedents were collected. Pelvic floor evaluation was conducted by digital palpation and QoL was evaluated by Kings Health Questionnaire (KHQ). Mann-Whitney and t Student test were used to compare QoL domains. Results: 36 women in reproductive age (G1) 42.9 (± 7,4) years and 50 women in postmenopausal period (G2) 61,6 (± 9,3) years were assessed. The G2 showed significantly more nocturia (p = 0,0057), urge incontinence (p = 0,0061) and enuresis (0,0021) symptoms, whereas in G1 bladder pain and voiding difficulties were more significant. KHQ domains showed statistical differences in: general health perception (G1 26,4 ± 16,8 versus G2 38,0 ± 16.2; p = 0,0019) and emotions (G1 15,1 ± 31,3 versus G2 38,9 ± 37,5; p = 0,0051). Conclusion: UI affects negatively QoLin women. Women on postmenopausal period showed higher impact on the QoLdomains related to general health perception and emotions.

Effect of radiotherapy on pulmonary function and fatigue of women undergoing treatment for breast cancer

El presente estudio comparo la funcion pulmonar y la fatiga de mujeres antes y despues de la radioterapia (RT) como ayudante para el tratamiento del cancer de mama, y se correlaciono la funcion pulmonar con la dosis de radiacion y fatiga. Fue realizado un estudio observacional longitudinal involucrando 20 mujeres. La funcion pulmonar fue evaluada por espirometria (ClementClarke®) y manovacuometria (GlobalMed®, modelo MVD 300) y, la fatiga fue evaluada por la Functional Assessment of Cancer Therapy Fatigue (FACT-F). Todas las evaluaciones fueron realizadas antes de la primera sesion y una semana despues del termino de la RT. Para el analisis estadistico fueron utilizados los tests Wilcoxon Signed Rank Test y correlacion de Spearman, adoptando un nivel de significancia p<0,05. En la espirometria, se encontro reduccion significativa de la capacidad vital forzada (23,52%), del volumen espiratorio forzado en el primer segundo (26,23%) y del peak de flujo espiratorio (10,12%) (p=0,001). Las presiones espiratorias e inspiratorias maximas tambien disminuyeron significativamente (25,45 y 32,92%, respectivamente). Se observo disminucion significativa del bienestar fisico y del bienestar funcional, y un aumento significativo de la fatiga en el FACT-F (p=0,001). No fueron observadas correlaciones entre las variables de la funcion pulmonar con la dosis de radiacion y fatiga. En corto plazo, la RT promueve la reduccion de la funcion pulmonar, pero los valores son considerados similares a los normales. Se observo aumento significativo de la fatiga y disminucion de los puntajes en los dominios de bienestar fisico y funcional.

Fatores materno-infantis associados à diástase dos músculos retos do abdome no puerpério imediato

Objectives: to compare the distance between the rectus abdominis muscles (RAM) and the prevalence of separation of the rectus abdominis muscle (SRAM) in the supra- and infra-umbilical regions of primiparous and multiparous women during immediate post-partum and to identify associated factors relating to mother and child. Methods: a cross-sectional study was carried out with 115 primiparous and 154 multiparous women. The SRAM was measured 4.5 cm above and below the umbilical scar and was correlated with maternal age, body mass index (BMI), gestational age, weight, height, and the circumference of the head and thorax of the newborn. Students t test, Pearsons correlation, the chi-squared test and multiple logistic regression, p<0.05, were used to analyze the data. Results: the distance between the supra-umbilical RAMs was 3.04 (±1.68) and 3.35 (±1.19) cm in the primiparous and multiparous women. The prevalence of supra-umbilical SRAM was 74.8% and 76.6% and that of infra-umbilical SRAM 40.0% and 54.5%. In both groups a positive correlation was found between the distance between the supra-umbilical RAM, the age of the mother, BMI and infra-umbilical RAM. The BMI and weight of the newborn were the factors associated with supra-umbilical SRAM in primiparous women and maternal age was the associated factor among multiparous women. Conclusions: irrespective of parity, the distance between the RAM and the prevalence of SRAM were greater in the supra-umbilical region and correlated with the age of the mother, BMI and infra-umbilical SRAM. Among primiparous women the associated factors were BMI and weight of the newborn and among multiparous women, the age of the mother alone.

Efecto de la radioterapia en la función pulmonar y en la fatiga de mujeres en tratamiento para el cáncer de mama

El presente estudio comparo la funcion pulmonar y la fatiga de mujeres antes y despues de la radioterapia (RT) como ayudante para el tratamiento del cancer de mama, y se correlaciono la funcion pulmonar con la dosis de radiacion y fatiga. Fue realizado un estudio observacional longitudinal involucrando 20 mujeres. La funcion pulmonar fue evaluada por espirometria (ClementClarke®) y manovacuometria (GlobalMed®, modelo MVD 300) y, la fatiga fue evaluada por la Functional Assessment of Cancer Therapy Fatigue (FACT-F). Todas las evaluaciones fueron realizadas antes de la primera sesion y una semana despues del termino de la RT. Para el analisis estadistico fueron utilizados los tests Wilcoxon Signed Rank Test y correlacion de Spearman, adoptando un nivel de significancia p<0,05. En la espirometria, se encontro reduccion significativa de la capacidad vital forzada (23,52%), del volumen espiratorio forzado en el primer segundo (26,23%) y del peak de flujo espiratorio (10,12%) (p=0,001). Las presiones espiratorias e inspiratorias maximas tambien disminuyeron significativamente (25,45 y 32,92%, respectivamente). Se observo disminucion significativa del bienestar fisico y del bienestar funcional, y un aumento significativo de la fatiga en el FACT-F (p=0,001). No fueron observadas correlaciones entre las variables de la funcion pulmonar con la dosis de radiacion y fatiga. En corto plazo, la RT promueve la reduccion de la funcion pulmonar, pero los valores son considerados similares a los normales. Se observo aumento significativo de la fatiga y disminucion de los puntajes en los dominios de bienestar fisico y funcional.

Comparação da qualidade de vida após a cirurgia para câncer de mama associada ou não à radioterapia adjuvante

O tratamento cirurgico e adjuvante do câncer de mama muitas vezes e indispensavel, mas pode trazer complicacoes funcionais. Da mesma forma, o emprego da radioterapia (RT) pode causar efeitos adversos e prejuizo na qualidade de vida (QV). O objetivo do estudo foi avaliar e comparar a QV de mulheres submetidas a cirurgia para o câncer de mama que realizaram ou nao RT adjuvante. Foram incluidas 28 mulheres alocadas em dois grupos: grupo radioterapia (GRT) e grupo controle (GC). O GRT foi investigado antes e apos a RT e o GC somente em um momento. Foi aplicado na forma de entrevista o questionario da European Organization for Research and Treatment of Cancer (EORTC), o Quality of Life Questionnaire C-30 (QLQ-C30) e o Breast Cancer Module (BR-23), especifico para câncer de mama. Para a comparacao entre grupos foi utilizado o teste de Mann Whitney e intragrupo o Wilcoxon Signed Rank Test, adotando significância p<0,05. Observou-se piora da QV no item funcao fisica e desempenho funcional da escala de funcoes em ambos os grupos (p=0,00 e p= 0,02) e do item fadiga na escala de sintomas na analise final do GRT quando comparado com o GC (p=0,03). Nos demais itens nao foram encontradas diferencas significativas. Na analise dos escores do BR-23 verificou-se diferenca nos sintomas no braco na comparacao inicial e final do GRT com o GC (p=0,02 e p=0,02). Dessa forma, o emprego da RT adjuvante pode comprometer a QV destas mulheres, especialmente com relacao a funcao fisica, desempenho funcional e fadiga.