Women with breast cancer care at the public hospital of Macapá - Amapá: epidemiological and clinical aspects

Breast cancer is a disease of widespread epidemiology worldwide and is considered a serious public health problem. Although it is well established that early diagnosis and appropriate treatment interfere with mortality rates and cancer prevalence, few data are available on the descriptive epidemiology of breast cancer in Brazil and in the state of Amapá. The general objective of this dissertation work was to study the epidemiological and clinical aspects of breast cancer patients treated at the Dr. Alberto Lima Clinical Hospital (HCAL), from January 2012 to December 2017 in the city of Macapá, Amapá. Breast cancer cases were reviewed, with analysis of 194 medical records, and the following variables were studied: Annual frequency of breast tumor, age, education level, origin, location of breast lesion, histological type of cancer, age at first childbirth, Menarche and Menopause, breastfeeding time, alcohol intake, smoking, family history of breast cancer in first-degree relatives, clinical staging of the disease, immunohistochemical panel, type of surgical treatment, Chemotherapy, Radiotherapy, Hormone Therapy and Target Therapy " It was noted that the year 2017 had the highest number of diagnosed cases, the age group between 41-50 years was the most affected, women with low education (Elementary Level) and coming from the capital of Amapá. In these women, the most frequent characteristics were: Age at first birth between 13-20 years, Menarche between 10-13 years, Menopause 41-50 years with significant number of patients in Menácme (out of menopause), Breastfeeding time between 02 -22 and 23-42 months, both intervals with the same number of records; Most of them did not drink alcohol, were not smokers, and had no family history of first-degree relatives of breast cancer. In the studied cases, the most common localization of the breast lesion was the Lateral Upper Quadrant, the most diagnosed histological type was Invasive Ductal Carcinoma, with clinical stage IIA, Luminal A molecular subtype, Radiotherapy and Hormomyotherapy were performed most of the time, but Target Therapy was not prevalent

English

  Introduction: The early years of a child’s life are marked by a significant development, as well as high sensitivity to environmental influences such as poverty, housing, quality and family structure. Thus, the identification of environmental risk factors and delayed neurodevelopment, coupled with early intervention, are essential for an healthy development. Objective: To analyze the effect of environmental factors on the neuropsychomotor development of children in the Amazon community. Methods: This is a quantitative and qualitative study of analytical and cross-sectional approach with 50 children between 24 and 36 months of age, of both sexes, living in an Amazonian community. Two types of the socio-economic-environmental questionnaire were used; a) Infant/Toddler (IT) HOME Inventory to analyze the quality of the family environment; b) the Denver Screening Test II for screening neurodevelopment. Also, a descriptive analysis was performed using a calculation of means and standard deviations. Results: The study found that a significant majority of the children had normal neuropsychomotor development; however, children classified as delayed, the more significant impact variable in the development was the quality of the family environment, which in turn was influenced by the lower economic class, lack of water treatment, lack of electricity and external toilet. Conclusion: Environmental factors were not significant on the neuropsychomotor development of the local children of the Amazon community.   Introdução: É Os primeiros anos da vida de uma criança são marcados por um importante desenvolvimento, além da alta sensibilidade às influências ambientais, como condições de pobreza e moradia e qualidade e estrutura familiar. Desta forma, a identificação de fatores de riscos ambientais e atrasos do desenvolvimento neuropsicomotor, somada a intervenção precoce, são essenciais para um desenvolvimento saudável. Objetivo: Analisar o efeito dos fatores ambientais no desenvolvimento neuropsicomotor de crianças em comunidade Amazônica. Método: Estudo quali-quantitativo do tipo transversal e analítico, realizado com 50 crianças entre 24 e 36 meses de idade, de ambos os sexos, residindo em uma comunidade Amazônica. Foram utilizados um questionário socioeconômico-ambiental, o Infant/Toddler (IT) HOME Inventory, para analisar a qualidade do ambiente familiar e o Teste de Triagem de Denver II, para triagem do desenvolvimento neuropsicomotor, e a análise descritiva dos dados foi feita utilizando o cálculo das médias e desvios padrão. Resultados: O estudo constatou que a maioria significativa das crianças apresentou o desenvolvimento neuropsicomotor normal, no entanto, das crianças classificadas com atraso, a variável de maior impacto no desenvolvimento foi a qualidade do ambiente familiar, que por sua vez sofreu influência da classe econômica inferior, falta de tratamento da água, ausência de energia elétrica e banheiro tipo externo. Conclusão: Os fatores ambientais não foram significativos perante o esenvolvimento neuropsicomotor           das crianças ribeirinhas da comunidade amazônica.&nbsp

Women with breast cancer attended in public hospital from Macapá, Amapá: Risk factors

Breast cancer is a disease of epidemiological concern worldwide, being considered a serious public health problem. Although it is well established that early diagnosis and adequate treatment interfere with mortality rates and the prevalence of cancer, few data are available regarding the descriptive epidemiology of breast cancer in Brazil, as well as in the various states of the federation, as is the State of Amapá. The general objective was to characterize the risk factors of breast cancer patients treated at Hospital de Clínicas Dr. Alberto Lima (HCAL) from January 2012 to December 2017 in the city of Macapá, Amapá. Cases of breast cancer were reviewed, with an analysis of 194 medical records, and the following variables were studied: age, education level, histological type of the neoplasia, age at first delivery, menarche and menopause, breastfeeding time, alcohol intake, smoking, family history of breast cancer in first-degree relatives. It was noted that the age group most affected was between 41-50 years old and with an education level of elementary education. In these women, the most frequent characteristics were: age at first delivery between 13-20 years, menarche between 10-13 years, menopause from 41-50 years with a significant number of patients at menace (outside menopause), breastfeeding time between 2-22 and 23-42 months, both intervals with the same number of records; most did not drink alcohol, were not smokers and had no family history of first-degree relatives of breast cancer. In the cases studied, the most frequently diagnosed histological type was invasive ductal carcinoma

Postural adjustments and kinematic index finger features in frail older adults under different equilibrium constraints

Background: Anticipatory postural adjustments (APAs) are significantly affected by age and may represent restrictions on functional independence. Previous studies in young adults have already highlighted that changing postural stability (i.e., seated vs. upright posture) affects the motor planning and APAs. In frail older adults (FOAs), the effect of these different conditions of postural stability have not yet been established, and the present study aimed to disentangle this issue. Methods: Participants executed an arm-pointing task to reach a diode immediately after it turned on, under different conditions of stability (seated with and without foot support and in an upright posture). A kinematic profile of the index finger and postural electromyographic data were registered in their dominant-side leg muscles: Tibialis anterior, soleus, rectus femoris, and semitendinosus. Results: The main finding of this study was that the adopted posture and body stabilization in FOAs did not reflect differences in APAs or kinematic features. In addition, they did not present an optimal APA, since postural muscles are recruited simultaneously with the deltoid. Conclusion: Thus, FOAs seem to use a single non-optimal motor plan to assist with task performance and counterbalance perturbation forces in which they present similar APAs and do not modify their kinematics features under different equilibrium constraints

Effects of environmental exposure to tobacco on modulation of color vision

The chronic use of cigarettes causes toxic and oxidative effects on the visual system, which can cause changes in color vision. Although there are studies on the harmful effects of tobacco in active smokers, the literature on secondhand/passive smokers (or environmental tobacco smoke) is still scarce. Therefore, the aim of this study was to investigate the ability of color vision in active and passive smokers. This is a cross-sectional observational study in which 103 individuals were divided pseudorandomly into 3 groups: control group (CG) n = 44 individuals (72 eyes), with a mean age of 28.65 ± 7.90; group of passive smokers (GPS) n = 28 (56 eyes), mean age 28.74 ± 9.42; group of active smokers (GAS) n = 31 (60 eyes), mean age 34.91 ± 11.30. The psychophysical evaluation of color vision was performed using the Ishihara pseudoisochromatic plates, the computer program of the Freiburg Visual Acuity & Contrast Test, version 3.7, and the desaturated Lanthony D15 ordering test. The results indicate that there was no correlation in GAS and GPS with age, time of exposure to tobacco and daily consumption. It was observed that both GAS and GPS showed changes in visual acuity (P <0.05), and only GPS showed changes in color vision (P <0.05); GFP showed a deficit in visual acuity and worse color vision when compared to GAS (P <0.05). These results are discussed in relation to the biochemical and pathophysiological effects that exposure to cigarettes may have on the visual system, which would explain the functional changes observed. We conclude that passive and active smokers have impaired color vision and that the psychophysical methods used in this study are effective for the subclinical tracking of changes in color vision

Deaths by COVID-19 in a hospital from a city from Legal Amazon region: what lessons could be learned?

Objetivo: Descrever a epidemiologia de mortes por COVID-19 em um hospital na região da Amazônia em um período de 64 dias, que corresponde à curva de crescimento da primeira onda da pandemia de COVID-19 em 2020. Métodos: Os dados foram obtidos de 152 óbitos registrados em prontuários de adultos e idosos hospitalizados. Os dados foram também comparados com o número de óbitos em anos anteriores, no mesmo período estudado, de forma a avaliar o impacto da pandemia neste hospital. O estudo também avalia o impacto das transferências intra-hospitalares, contabilizando o número de vezes que os pacientes que faleceram realizaram transferências entre setores do hospital. Resultados: No período analisado, houve aumento de óbitos em relação aos anos anteriores. A maioria dos pacientes mortos era do sexo masculino, com idade entre 34 e 96 anos. Os óbitos foram associados a comorbidades como hipertensão arterial, diabetes mellitus e doença renal. A infecção por SARS-CoV-2 foi confirmada em 91 casos. Entre eles, 15 indivíduos foram internados sem condições relacionadas à infecção por SARS-CoV-2; eles tiveram um número três vezes maior de transferências hospitalares do que aqueles admitidos com sintomas de infecção por SARS-CoV-2. Dezesseis pacientes com infecção por SARS-CoV-2 desenvolveram sintomas respiratórios logo após a hospitalização. O exame diagnóstico para infecção por SARS-CoV-2 foi realizado em média 4 (± 6) dias após o início dos sintomas e 6 (± 6) dias após a admissão, e o tempo médio do início dos sintomas respiratórios até o óbito foi de 4 ( ± 6) dias. Conclusões: Esses dados sugerem alta presença de infecção hospitalar por SARS-CoV-2 na região amazônica brasileira, o que pode estar relacionado ao número de transferências setoriais, demora na confirmação do diagnóstico e falta de manejo. Relatamos um grave problema de saúde pública, pois demonstra a fragilidade das instituições de saúde no ambiente hospitalar.Objectives: Describe the epidemiology of COVID-19 deaths within a hospital in the Amazon region in a period of 64 days, which corresponds to the growth curve of the COVID-19 first-wave pandemic in 2020. Methods: The data were obtained from medical records of 152 deaths registered for adults and elderly hospitalized. The data were also compared with the number of deaths in previous years during the same period studied to assess the impact of the pandemic on this hospital. The study also assesses the impact of intra-hospital transfers, accounting for the number of times patients who died performed transfers between sectors of the hospital. Results: During the period analyzed, there was an increase in deaths compared to the previous years. The majority of dead patients were male, aged between 34 and 96 years. The deaths were associated comorbidities such as arterial hypertension, diabetes mellitus, and kidney disease. The SARS-CoV-2 infection was confirmed in 91 cases. Among them, 15 individuals were admitted without conditions related to SARS-CoV-2 infection; they had a three-fold higher number of hospital transfers than those admitted with SARS-CoV-2 infection symptoms. Sixteen patients with SARS-CoV-2 infection developed respiratory symptoms just after hospitalization. The diagnostic exam for SARS-CoV-2 infection was performed on average 4 (± 6) days after the onset of symptoms and 6 (± 6) days after admission, and the average time from the onset of respiratory symptoms to death was 4 (± 6) days. Conclusions: These data suggest the high presence of hospital infection by SARS-CoV-2 in the Brazilian Amazon region, which may be related to the number of sectorial transfers, delay in confirming the diagnosis, and lack of management. We report a serious public health problem, as it demonstrates the fragility of healthcare institutions in the hospital environment

Visual dysfunction of type I and VI mucopolysaccharidosis patients evaluated with visual evoked cortical potential

Purpose: To evaluate the visual system of patients suffering from type I or VI mucopolysaccharidosis (MPS) by recording the visual evoked cortical potential (VECP). Methods: Two patients with MPS VI and 2 patients with MPS I were tested before and after enzyme replacement therapy (ERT). A control group of 20 subjects was tested for statistical comparison. VECP was elicited by monocular stimulation with 1-Hz phase-reversal checkerboard patterns at 0.5 and 2 cycles per degree and with 16° of visual field. In all patients, both eyes were tested. VECP amplitude and latency were measured and compared with tolerance limits obtained from controls. Results: MPS I and VI patients have a severe visual impairment that can be quantified by measuring VECPs. Even after several weeks of ERT, the visual impairment remained unaltered, indicating that the treatment had no significant influence on the visual conditions of MPS patients. Visual responses to high spatial frequencies were more deeply impaired than responses to low spatial frequencies. This can be explained by the kind of damage in the visual system that preferentially targets the eye optics. Conclusion: VECPs can be used to monitor the degree of visual impairment of MPS patients and to check ERT efficacy

Psychophysical Evaluation of Visual Functions of Ex-Alcoholic Subjects After Prolonged Abstinence

Chronic alcohol abuse can lead to a brain damages, and the health status of alcoholics even after a long-term alcohol abstinence is a public health concern. The present study investigated the color vision and spatial luminance contrast sensitivity of a group of 17 ex-alcoholics (46.3 ± 6.7 years old) in long-term alcohol abstinence after having been previously under alcohol dependence for many years. We also investigated the association of impaired psychophysical performance in different tests we applied. The mean time of alcohol consumption was 16.9 ± 5.1 years and the mean abstinence period was 12.4 ± 8.5 years. Achromatic vision of all subjects was evaluated using spatial luminance contrast sensitivity function (CSF) test and color vision was evaluated using Mollon–Reffin color discrimination test (MR) and the Farnsworth–Munsell 100 hue arrangement test (FM100). Relative to controls, the spatial luminance contrast sensitivity was lower in 10/17 of the ex-alcoholic subjects. In the color vision tests, 11/16 ex-alcoholic subjects had impaired results compared to controls in the FM100 test and 13/14 subjects had color vision deficits measured in the MR test. Fourteen subjects performed all visual tests, three subjects had impaired results for all tests, seven subjects had impaired results in two tests, three subjects had visual deficit in one test, and one had normal results for all tests. The results showed the existence of functional deficits in achromatic and chromatic vision of subjects with history of chronic alcoholism after long abstinence. Most subjects had altered result in more than one test, especially in the color vision tests. The present investigation suggests that the damage in visual functions produced by abusive alcohol consumption is not reversed after long term alcohol abstinence