CLIPES MARCADORES TUMORAIS NO TRATAMENTO DO CÂNCER DE MAMA

Introduction: Breast cancer is a prevalent neoplasm among women globally, with significant advancements in diagnostic and therapeutic methods. Early detection and precise treatment are crucial for improving clinical outcomes and quality of life for patients. Objective: This study aims to comprehensively evaluate the effectiveness and limitations of tumor marker clips in breast cancer treatment, along with recent advances in the technique, contributing to an updated understanding of the role of these devices in clinical practice. Methodology: We conducted a systematic review of studies published between 2018 and 2024 that address the use of tumor marker clips in breast cancer. Ten articles were selected following rigorous inclusion criteria, considering relevance, methodology, and results. Results and Discussion: Tumor marker clips allow precise localization of tumors during breast-conserving surgeries and guide biopsy procedures, facilitating adjuvant radiotherapy planning. While they offer substantial benefits in reducing healthy tissue removal, their use faces challenges such as insertion complications and difficulties in localization in dense tissues. Conclusion: The integration of tumor marker clips in breast cancer management represents significant advancements, promoting a more personalized and effective treatment approach with potential positive impact on patient clinical outcomes.Introdução: O câncer de mama é uma neoplasia prevalente entre mulheres globalmente, com evolução significativa nos métodos diagnósticos e terapêuticos. A detecção precoce e o tratamento preciso são cruciais para melhorar os desfechos clínicos e a qualidade de vida das pacientes. Objetivo: Este estudo visa avaliar de forma abrangente a eficácia e as limitações dos clipes marcadores tumorais no tratamento do câncer de mama, além de analisar avanços recentes na técnica, contribuindo para a compreensão atualizada do papel desses dispositivos na prática clínica. Metodologia: Realizamos uma revisão sistemática de estudos publicados entre 2018 e 2024 que abordam o uso de clipes marcadores tumorais em câncer de mama. Foram selecionados 10 artigos após critérios rigorosos de inclusão, considerando a relevância, metodologia e resultados. Resultados e Discussão: Os clipes marcadores tumorais permitem uma localização precisa do tumor durante cirurgias conservadoras da mama e orientam procedimentos de biópsia, facilitando o planejamento da radioterapia adjuvante. Embora ofereçam benefícios substanciais na redução da remoção de tecido saudável, sua utilização enfrenta desafios como complicações durante a inserção e dificuldades de localização em tecidos densos. Conclusão: A integração dos clipes marcadores no manejo do câncer de mama representa avanços significativos, promovendo uma abordagem mais personalizada e eficaz no tratamento, com potencial impacto positivo nos desfechos clínicos das pacientes

DOENÇA DE GAUCHER E A DIFICULDADE EM SEU DIAGNÓSTICO

Gaucher Disease is a rare metabolic disorder caused by the deficiency of the enzyme glucocerebrosidase, leading to the accumulation of glucocerebroside in organs such as the spleen, liver, bone marrow, and central nervous system. Early identification of GD is challenging due to nonspecific symptoms and a lack of awareness among healthcare professionals. This study aims to understand the factors influencing the diagnosis of this disease, providing practical recommendations to improve both diagnosis and clinical outcomes. The study evaluated the effectiveness of diagnostic methods for GD and explored recent advances in early detection and disease management using a multidimensional approach, including a literature review, analysis of clinical data from patients diagnosed between 2014 and 2024, and an evaluation of technological innovations in the field. The literature review and clinical data analysis revealed that type 1 GD is the most prevalent, particularly among Ashkenazi Jews, often presenting with hepatosplenomegaly. The study highlighted the importance of enzyme replacement therapy (ERT) in managing GD, significantly improving clinical symptoms. Recent technological advances, such as new genotyping techniques and neonatal screening, have the potential to revolutionize the diagnosis of GD. However, the centralization of healthcare services and the lack of awareness about the disease remain significant challenges. Despite advances in understanding and detecting GD, the clinical complexity and variability of presentations continue to pose significant challenges. Investing in continuing education in genetics for healthcare professionals and decentralizing genetic services are essential to optimize early identification and appropriate treatment, resulting in better clinical outcomes for patients with GD.A Doença de Gaucher é uma desordem metabólica rara causada pela deficiência da enzima glucocerebrosidase, resultando no acúmulo de glucocerebrosídeo em órgãos como baço, fígado, medula óssea e sistema nervoso central. A identificação precoce da DG é desafiadora devido aos sintomas inespecíficos e à falta de conhecimento sobre a doença entre os profissionais de saúde. O objetivo deste estudo, permeia compreender os fatores que influenciam no diagnóstico dessa doença, fornecendo recomendações práticas para o aprimoramento tanto do diagnóstico quanto desfechos clínicos. Este estudo avaliou a eficácia dos métodos diagnósticos da DG e explorou avanços recentes na detecção precoce e gestão da doença, utilizando uma abordagem multidimensional que incluiu revisão da literatura, análise de dados clínicos de pacientes diagnosticados entre 2014 e 2024, e avaliação de inovações tecnológicas na área. A revisão da literatura e a análise de dados clínicos revelaram que a DG tipo 1 é a mais prevalente, especialmente entre judeus Ashkenazi, apresentando-se frequentemente com hepatoesplenomegalia. O estudo destacou a importância da terapia de reposição enzimática (TRE) na gestão da DG, melhorando significativamente os sintomas clínicos. Avanços tecnológicos recentes, como novas técnicas de genotipagem e triagem neonatal, têm potencial para revolucionar o diagnóstico da DG. No entanto, a centralização dos serviços de saúde e a falta de conhecimento sobre a doença continuam sendo desafios significativos. Apesar dos avanços no entendimento e na detecção da DG, a complexidade clínica e a variabilidade das apresentações continuam a representar desafios significativos. Investir na educação continuada em genética para profissionais de saúde e descentralizar os serviços de genética são essenciais para otimizar a identificação precoce e o tratamento adequado, resultando em melhores desfechos clínicos para os pacientes com DG

Prevalência do infarto agudo do miocárdio em mulheres e fatores de risco associados

This article aims to analyze the risk factors associated with acute myocardial infarction in women. The study is an Integrative Literature Review based on a retrospective cross-sectional study of a descriptive nature and a qualitative data approach. The research was carried out in six stages: elaboration of the research question; search and sampling – establishment of inclusion and exclusion criteria; data extraction; evaluation and critical analysis of the data obtained; analysis and synthesis of studies with interpretation of results; presentation of the review. For the guiding research question, the PICO strategy was considered. The selection of articles was made in the databases PubMed, Medical Literature Analysis and Retrievel System Online (MedLine), Science Direct and Latin American and Caribbean Literature in Health Sciences (Lilacs). In the search strategy, combinations of descriptors were considered according to the indications of each database, namely the Health Sciences Descriptors (DeCS) of the Virtual Health Library (VHL) and Medical Subject Headings (MeSH). The most prevalent risk factors associated with acute myocardial infarction in women are: advanced age, hormone replacement therapy, use of oral contraceptives, genetic predisposition and emotional overload. Therefore, it is important to encourage health education related to search strategies aimed at early diagnosis of this clinical condition in females. Targeted anamnesis is essential for the aforementioned condition in order to obtain a good prognosis.Este artículo tiene como objetivo analizar los factores de riesgo asociados al infarto agudo de miocardio en la mujer. El estudio es una Revisión Integrativa de la Literatura basada en un estudio transversal retrospectivo de carácter descriptivo y enfoque de datos cualitativos. La investigación se desarrolló en seis etapas: elaboración de la pregunta de investigación; búsqueda y muestreo – establecimiento de criterios de inclusión y exclusión; extracción de datos; evaluación y análisis crítico de los datos obtenidos; análisis y síntesis de estudios con interpretación de resultados; presentación de la reseña. Para la pregunta rectora de la investigación se consideró la estrategia PICO. La selección de artículos se realizó en las bases de datos PubMed, Medical Literature Analysis and Retrievel System Online (MedLine), Science Direct y Latin American and Caribbean Literature in Health Sciences (Lilacs). En la estrategia de búsqueda se consideraron combinaciones de descriptores según las indicaciones de cada base de datos, concretamente los Descriptores en Ciencias de la Salud (DeCS) de la Biblioteca Virtual en Salud (BVS) y los Medical Subject Headings (MeSH). Los factores de riesgo más prevalentes asociados al infarto agudo de miocardio en la mujer son: edad avanzada, terapia de reemplazo hormonal, uso de anticonceptivos orales, predisposición genética y sobrecarga emocional. Por lo tanto, es importante incentivar la educación en salud relacionada con estrategias de búsqueda encaminadas al diagnóstico precoz de esta condición clínica en el sexo femenino. La anamnesis dirigida es fundamental para obtener un buen pronóstico de la enfermedad antes mencionada.Este artigo tem por objetivo analisar os fatores de risco associados ao infarto agudo do miocárdio em mulheres. O estudo se trata de uma Revisão Integrativa de Literatura baseada em um estudo transversal retrospectivo de caráter descritivo e abordagem qualitativa dos dados. A pesquisa foi realizada em seis etapas: elaboração da questão de pesquisa; busca e amostragem – estabelecimento de critérios de inclusão e exclusão; extração de dados; avaliação e análise crítica dos dados obtidos; análise e síntese dos estudos com interpretação dos resultados; apresentação da revisão. Para a questão norteadora da pesquisa, foi considerada a estratégia PICO. A seleção dos artigos foi feita nas bases de dados PubMed, Medical Literature Analysis and Retrievel System Online (MedLine), Science Direct e Literatura Latino-Americana e do Caribe em Ciências da Saúde (Lilacs). Na estratégia de busca foram consideradas combinações de descritores conforme as indicações de cada base de dados, sendo eles os Descritores em Ciências da Saúde (DeCS) da  Biblioteca Virtual em Saúde (BVS) e Medical Subject Headings (MeSH). Os fatores de risco mais prevalentes associados ao infarto agudo do miocárdio em mulheres são: idade avançada, terapia de reposição hormonal, uso de anticoncepcionais orais, predisposição genética e sobrecarga emocional. Dessa forma, é importante o estímulo da educação em saúde relacionada a estratégias de busca que visem o diagnóstico precoce dessa condição clínica no sexo feminino. A anamnese direcionada é fundamental para o quadro supracitado a fim de se obter bom prognóstico

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

Gene expression of the immunoinflammatory and immunological status of obese dogs before and after weight loss.

Obesity is characterized by a low degree of chronic inflammation state that, along with metabolic modifications, promotes important changes in the animal's organism. Adipose tissue actively participates in inflammation and immunity, and several defense cells of the organism may, therefore, be involved in the diversity found between obese and ideal weight individuals. Studies regarding this subject have shown immune cell changes in humans and rats, however, the literature is scarce in relation to dogs. Thus, the present study aimed to evaluate the gene expression profile of immunoinflammatory response and the lymphoproliferation of obese dogs before and after weight loss. Eight female dogs, neutered, of different breeds, aged between 1 and 8 years (4.74±3.19), obese, with body condition score (BCS) of 9 out of a 9-point scale and body composition determined by the deuterium isotope dilution method were included. The obese dogs were enrolled in a weight loss program and after losing 20% of their initial weight became a second experimental group. A third experimental group consisted of eight female dogs, neutered, aged between 1 and 8 years (3.11±0.78) and with ideal BCS (5 out of a 9-point scale). Gene expression of immunoinflammatory cytokines (resistin, leptin, adiponectin, TNF-α, IL-6, IL-8, and IL-10) was assessed by qRT-PCR and immunity was assessed by lymphoproliferative response using the flow cytometry technique. The data that presented normal distribution was evaluated by analysis of variance by the PROC MIXED of the SAS and when differences were detected, these were compared by the Tukey test. Regarding the gene expression data, the procedure PROC GLIMMIX was adopted and the methodology of generalized linear model was used, in which the Gama distribution proved to be adequate. Values of p<0.05 were considered significant. The mean weight loss period of the animals included in the study was 194.25 ± 28.31 days and the mean weekly weight loss rate was 1.02 ± 0.82%. The average fat mass, both in percentage (P<0.001) and in kilograms (P = 0.012), was higher in the obese group (40.88%; 8.91kg), returning to normal and without difference between the control group (19.16%; 3.01kg) and after weight loss (22.10%; 4.11kg). The weight loss program resulted in an increase in percentage of lean body mass (P = 0.001), 55.50% in obese animals vs 77.90% in obese dogs after weight loss, the latter with no difference when compared to the control group (80.84%). The obese group presented increased gene expression of resistin and IL-8 in relation to the weight loss group (P = 0.002). In adiponectin, the obese group presented increased mRNA gene expression when compared to the weight loss group (P = 0.003). The evaluation of lymphocyte proliferation showed differences between the group of obese animals before and after weight loss (P = 0.004). Weight loss resulted in an increase in the lymphoproliferation rate (18.48%) compared to obese dogs at the beginning of the study (10.71%). These results indicate that weight loss modulates the immunoinflammatory response of obese dogs and may present important benefits to health and longevity of dogs

Impact of an inpatient multidisciplinary glucose control management program

ABSTRACT Objective: Glycemic control has been increasingly recognized as a critical element in inpatient care, but optimal management of blood glucose in the hospital setting remains challenging. The aims of this study were to describe and evaluate the impact of the implementation of an inpatient multidisciplinary glucose control management program on glucose control in hospitalized patients. Materials and methods: Retrospective analysis of medical records and glucose monitoring data obtained by point- of-care testing (POCT) in hospitalized patients before (May 2014) and after (June 2015 and May 2017) the implementation of the program. Results: We analyzed 6888, 7290, and 7669 POCTs from 389, 545, and 475 patients in May 2014, June 2015, and May 2017, respectively. Hyperglycemia (≥ 180 mg/ dL) occurred in 23.5%, 19.6%, and 19.3% POCTs in May 2014, June 2015, and May/2017, respectively (p < 0.001), while severe hyperglycemia (≥ 300 mg/dL) was observed in 2.5%, 2.2%, and 1.8% of them, respectively (p = 0.003). Hyperglycemia (≥ 180 mg/dL) reduced significantly from May 2014 to June 2015 (16.3%, p < 0.001) and from May 2014 to May 2017 (178%, p < 0.001). No significant changes occurred in hypoglycemic parameters. Conclusions: The implementation of an inpatient multidisciplinary glucose control management program led to significant reductions in hyperglycemic events. The key elements for this achievement were the development of institutional inpatient glycemic control protocols, establishment of a multidisciplinary team, and continuing educational programs for hospital personnel. Altogether, these actions resulted in improvements in care processes, patient safety, and clinical outcomes of hospitalized patients

Frequency of low adherence and related factors in older adults treated in Ponto dos Volantes, in the Jequitinhonha Valley

OBJECTIVE: To evaluate adherence to medication treatment and possible associated factors in elderly patients interviewed during medical appointments in primary care units. METHOD: This was a cross-sectional, population-based study of 57 older patients aged 60 to 99 years living in the municipality of Ponto dos Volantes, state of Minas Gerais, including rural and urban areas. Data were collected during medical appointments, using a structured electronic script. The association between the parameters and the level of adherence to treatment was assessed using the \u3c72 test, with a 95% confidence interval. RESULTS: Among the elderly patients interviewed, 45 (78.9%) responded about adherence to treatment. Of these, 11 (24.4%) were included in the low adherence group. None “ of the parameters evaluated showed a statistically significant association with the classification of drug adherence. CONCLUSION: The present study identified that 1 in every 4 patients had low adherence to drug treatment. Among the variables studied, notably sex, age, schooling, number of comorbidities, number of medications, and income, no statistically significant relationship was observed.</p