Anxious Personality and Breast Cancer: Possible Negative Impact on Quality of Life After Breast-Conserving Therapy

Background Quality of Life (QoL) is an important outcome measure in oncology. To assess the influence of surgical treatment and personality on QoL in women with breast cancer, a longitudinal prospective cohort study was done. Methods Women (n = 222) completed questionnaires concerning QoL (WHOQOL 100) and personality (NEO-FFI and STAI) prior to the diagnosis of breast cancer and 1, 3, 6, and 12 months after diagnosis and treatment. One hundred five women were treated with breast-conserving therapy (BCT) and 117 women underwent mastectomy (MTC). Results The two treatment groups did not differ on overall QoL. At all measurement times the influence of trait anxiety on overall QoL was substantial in the BCT group. Women with a high score on trait anxiety were seven times more likely to have a low overall QoL 1 year after BCT. In the MTC group overall QoL was influenced mainly by neuroticism. Conclusions Personality, especially trait anxiety and neuroticism, determined patients' overall QoL scores. Women with an anxious personality fared worse concerning QoL after breast conserving therap

Transcranial endovascular obliteration of intracranial arteriovenous dural fistulae

We present a female patient with left eye hiperemia at 8 months. There was no prior history of trauma neither other complaints or symptons associated. The neurologic examination was normal except for marked hiperemia at left eye. There was no bruit. The CT scan revealed tortuous and dilated vascular structures at cortical surface of left temporal lobe. The digital subtraction angiography (DSA) revealed dural fistulae (DF) of the cavernous sinus type IV, with reflux through the superficial middle cerebral vein (SMCV) and venous ectasia, without drainage through superior oftalmic vein (SOV). Since there was no conventional endovascular access to the fistula, catetherization of SMCV by direct puncture and endovascular treatment was proposed. The procedure was performed under general anesthesia and the cranial drainage was completely excluded. The drainage became through the SOV and a small fistular component remained. One week later the treatment was completed, with obliteration of arterial afferents and functional exclusion of the DF.Escola Paulista Med, UNIFESP, Neurovasc Sector, BR-04023 Sao Paulo, BrazilEscola Paulista Med, UNIFESP, Neurovasc Sector, BR-04023 Sao Paulo, BrazilWeb of Scienc

Portuguese-Brazilian evidence-based guideline on the management of hyperglycemia in type 2 diabetes mellitus

Background: In current management of type 2 diabetes (T2DM), cardiovascular and renal prevention have become important targets to be achieved. In this context, a joint panel of four endocrinology societies from Brazil and Portugal was established to develop an evidence-based guideline for treatment of hyperglycemia in T2DM. Methods: MEDLINE (via PubMed) was searched for randomized clinical trials, meta-analyses, and observational studies related to diabetes treatment. When there was insufficient high-quality evidence, expert opinion was sought. Updated positions on treatment of T2DM patients with heart failure (HF), atherosclerotic CV disease (ASCVD), chronic kidney disease (CKD), and patients with no vascular complications were developed. The degree of recommendation and the level of evidence were determined using predefined criteria. Results and conclusions: In non-pregnant adults, the recommended HbA1c target is below 7%. Higher levels are recommended in frail older adults and patients at higher risk of hypoglycemia. Lifestyle modification is recommended at all phases of treatment. Metformin is the first choice when HbA1c is 6.5-7.5%. When HbA1c is 7.5-9.0%, dual therapy with metformin plus an SGLT2i and/or GLP-1RA (first-line antidiabetic agents, AD1) is recommended due to cardiovascular and renal benefits. If an AD1 is unaffordable, other antidiabetic drugs (AD) may be used. Triple or quadruple therapy should be considered when HbA1c remains above target. In patients with clinical or subclinical atherosclerosis, the combination of one AD1 plus metformin is the recommended first-line therapy to reduce cardiovascular events and improve blood glucose control. In stable heart failure with low ejection fraction ( 30 mL/min/1.73 m2, metformin plus an SGLT-2i is recommended to reduce cardiovascular mortality and heart failure hospitalizations and improve blood glucose control. In patients with diabetes-associated chronic kidney disease (CKD) (eGFR 30-60 mL/min/1.73 m2 or eGFR 30-90 mL/min/1.73 m2 with albuminuria > 30 mg/g), the combination of metformin and an SGLT2i is recommended to attenuate loss of renal function, reduce albuminuria and improve blood glucose control. In patients with severe renal failure, insulin-based therapy is recommended to improve blood glucose control. Alternatively, GLP-1RA, DPP4i, gliclazide MR and pioglitazone may be considered to reduce albuminuria. In conclusion, the current evidence supports individualizing anti-hyperglycemic treatment for T2DM.This article publication was funded by Sociedade Brasileira de Diabetes (SBD)