The aim of the thesis is to describe and analyse how a group of women experience that their every-day lives are affected during and after primary breast cancer treatment. The thesis is a consecutive, longitudinal study that takes an explorative qualitative approach. Seventy-one women younger than 60 years of age with primary breast cancer were consecutively included in the study. The women were interviewed four or five times over a period of 4 to 6 years from end of radiotherapy. The analyses of the interviews were inspired by grounded theory and narrative analysis.  The thesis encompasses four papers. Paper I focused on the women’s contact with health care. The results of this study indicate that it is crucial for patients in a vulnerable situation to be admitted into a supportive system – ‘admitted into a helping plan’ – that, more or less explicitly, displays a well-thought-out plan of care. This is a process built on individual relationships with members of the health-care staff, but it ends up in a relationship to health care as a helping system, a ‘safe haven’ to attach to. Study II explored the women’s ideas about what motivated and discouraged their return to work. The results illustrate that the meaning of work fluctuates over time and that the processes of returning to work are conditioned by the patients’ individual life situations. Returning to work was regarded as an important part of the healing process because of how it generated and structured the women’s everyday lives. Returning to work meant demonstrating well-being and normalcy after breast cancer. Study III examined how life was lived and valued during and after treatment for breast cancer compared to pre-cancer life. The analysis showed that being afflicted with breast cancer was evaluated from a context of the women’s former everyday lives and stressed that how the women experienced breast cancer was a matter of personal circumstances. Study IV focused on how the women experienced and dealt with their altered bodies. The results showed that the women followed three different body-mind trajectories that depended to a significant extent on the severity of side effects and bodily alterations that resulted from their treatments. Being afflicted by breast cancer implies vulnerability and losses, but it can also involve benefits and provide new perspectives on life. How the overall breast cancer experience is valued seems to be very much a matter of circumstances in everyday life. This thesis highlights circumstances that focus in particular on contacts with health care, the body, the work situation, and the family situation.

The most useful drugs in the management of nephrotic syndrome are the corticosteroids. These drugs are as well known for their adverse effects as they are for their therapeutic advantages. The two most common paediatric side effects are suppression of linear growth and posterior subcapsular cataracts. Both of these untoward effects are insiduous and therefore less easily perceived. Although many workers have studied the growth inhibiting effects of the corticosteroids in the various diseases e.g. asthma, very little work was done to investigate these effects in patients with nephrotic syndrome. Furthermore, the Renal Clinic, King Edward VIII Hospital, Durban continues to use a daily regime of prednisone instead of the alternate day regime which is widely recommended to minimise growth retardation. This study was therefore undertaken to investigate the growth inhibiting effects of repeated courses of daily, high-dose prednisone in African and Indian children with nephrotic syndrome. All children with nephrotic syndrome with relevant data in their records and with no other chronic illness were selected from the Renal Clinic. Of the 125 selected, 87 children had been treated with prednisone for an average of 35,9 weeks and 38 had been treated symptomatically. The heights of those that received prednisone were measured at an averace of 77 weeks after completion of therapy. The mean height standard deviation score (SDS) of the treatment and control groups of Indian children were -1,06 and -0,92 respectively, both being between the 10th and 25th percentile, whilst the mean height SDS of the treatment and control groups of African children were -1,82 (just below the 5th percentile) and -1,77 (between the 5th and 10th percentile) respectively. From the results, it is evident that repeated courses of daily prednisone therapy, even when it exceeds 36 weeks, does not inhibit growth in both African and Indian children. Although there was no significant difference between the races and sexes with respect to growth and corticosteroid therapy, this study does confirm earlier reports that most of the African children with nephrotic syndrome had obvious glomerular lesions whilst most of the Indians had minimal change nephrotic syndrome. / Thesis (M.Med.)-University of Natal, Durban, 1986.

[Truncated abstract] The prinicipal aim of this thesis was to explore the relationship between 3rd generation cephalosporin antibiotics and hospital-acquired Clostridium difficile-associated diarrhoea (CDAD). This antibiotic class has been implicated in the aetiology of CDAD; therefore restriction of these antibiotics via antibiotic policies represents a potential strategy for prevention and control of CDAD. Successful control of CDAD in hospitals translates to improved quality of care for patients, and a reduction of pressure on hospital resources. Therefore, the objectives of this study were to determine whether 3rd generation cephalosporins were related to CDAD, to evaluate the effect of changes to antibiotic policy on the incidence of CDAD, and to determine the impact of CDAD on patient length of stay and hospital costs. The study was conducted in Sir Charles Gairdner Hospital (SCGH), a public teaching hospital located in Perth, the capital city of the state of Western Australia. Evidence for an association between 3rd generation cephalosporins and CDAD was obtained from studies of ecologic- and individual-level data. A time series analysis of the relationship between monthly consumption of 3rd generation cephalosporins and the incidence of CDAD in SCGH was undertaken covering the period 1994 to 2000. The results demonstrated a positive relationship between the use of 3rd generation cephalosporins and CDAD. A matched case-control study that involved 193 adult inpatients diagnosed with CDAD and 386 adult inpatients without CDAD, selected from the period 1996 to 2000, was conducted. Information was collected on exposure to 3rd generation cephalosporin antibiotics during hospitalisation, as well as exposure to other antibiotics and medications, procedures, and comorbidities. Results from conditional logistic regression analyses found CDAD cases were six times more likely to be exposed to 3rd generation cephalosporins during their admission, prior to the onset of diarrhoea, than controls (adjusted odds ratio [OR] = 6.17, 95% confidence interval [CI] = 1.56-24.37). Approximately one third of CDAD in the study population could be attributed to 3rd generation cephalosporins. CDAD cases were also four times more likely to have been exposed to either amoxicillin-clavulanate or ticarcillin-clavulanate (adjusted OR=4.23, 95% CI=1.81-9.93). In October 1998, an antibiotic policy was introduced at SCGH that restricted the use of ceftriaxone, the 3rd generation cephalosporin most commonly used by the hospital. During 1999 and 2000, the incidence of CDAD halved as ceftriaxone consumption fell in response to this policy. The effect of this policy was demonstrated in the time series model; during the post-policy period the relationship between ceftriaxone and CDAD that was evident prior to the policy was cancelled out. From the individual-level data, obtained from the case-control study, a reduction in the prevalence of exposure to 3rd generation cephalosporins from 11% to 1% accounted for a 30% reduction in the incidence of CDAD. Data from the case-control study was also used to analyse the independent contribution of CDAD to length of stay and admission costs using multiple linear regression

Hipodermóclise (HDC) é uma importante técnica alternativa para a administração de medicamentos e fluidos pela via subcutânea. É usada com frequência para o controle dos sintomas em pacientes em cuidados paliativos com dificuldade de acesso venoso e que são incapazes de tolerar medicação oral. No entanto, raros estudos abordaram o uso da HDC de uma forma global, para reposição hidroeletrolítica e terapia medicamentosa, tanto na forma contínua quanto intermitente, observando detalhes e complicações do seu uso. Os objetivos deste estudo incluíram caracterizar o uso da HDC para administração de medicamentos, soluções e eletrólitos e avaliar as possíveis complicações locais, identificando também outros fatores que influenciam sua ocorrência. Estudo observacional prospectivo com coleta de dados em prontuário e acompanhamento diário de pacientes internados com câncer avançado, da equipe de Cuidados Paliativos do Instituto do Câncer do Estado de São Paulo (ICESP) em uso de HDC, verificando local de punção, medicamentos administrados e possíveis complicações, acompanhando os detalhes de seu uso. A análise estatística não-paramétrica e método de regressão logística foram realizados. Foram acompanhados 99 pacientes com 243 punções, das quais 166 (68,3%) em coxa e 46 (18,9%) em abdome. Os medicamentos mais utilizados foram morfina em 122 (50,2%) punções, seguido de dipirona em 118 (48,6%) e dexametasona em 86 (35,4%). A solução mais prescrita foi a glicofisiológica em 38 (15,6%) punções, pelo seu aporte calórico. 13,6% das punções (33 de 243) tiveram complicações, sendo apenas seis casos maiores (edema). Complicações ocorreram mais frequentemente até o segundo dia da punção e foram associadas com o número (p=0,007) e o volume (p=0,042) de medicamentos administrados e também com a solução glicofisiológica (p=0,003) e os eletrólitos cloreto de potássio (p=0,037) e cloreto de sódio (p=0,013). Este estudo permitiu o conhecimento de fatores associados a complicações e propõe algumas recomendações, como: individualização da terapia, especialmente relacionada com o volume de escolha, número de medicamentos administrados e evitar a adição de eletrólitos na solução glicofisiológica / Hypodermoclysis (HDC) is an important alternative technique for the administration of drugs and fluids into the subcutaneous tissue. It is frequently used for symptom control in palliative care patients, with difficult venous access and unable to tolerate oral medications. However, few studies address the use of HDC as a whole to fluid replacement and drug therapy, both continuous and intermittent mode, observing details and complications of its use. The objectives of this study included characterizing the use of HDC to administer drugs, solutions and electrolytes and to evaluate possible local complications also identifying other factors influencing their occurrence. Prospective observational study with data collection in medical records and daily monitoring of advanced cancer inpatients of the palliative care team of São Paulo State Cancer Institute (ICESP) in use of HDC, checking infusion site, administered drugs and possible complications, following the details of its use. Non-parametrical statistical analysis and logistic regression were performed. Were followed 99 patients with 243 infusion sites, which 166 (68.3%) in the thigh and 46 (18.9%) in the abdomen. The most commonly used drugs were morphine in 122 (50.2%) infusion sites, followed by dipyrone in 118 (48.6%) and dexamethasone in 86 (35.4%). The most prescribed solution was dextrose 5%/0,9% saline in 38 (15.6%) infusion sites because of its caloric intake. 13.6% of punctures (33 of 243) had complications, only six larger cases (edema). Complications occurred mainly up to the second day of the infusion sites and were associated with the number (p=0,007) and volume (p=0,042) of drugs used as also with 5% dextrose/0.9% saline solution (p=0,003) and NaCl (p=0,037) and KCl (p=0,013) electrolytes. This study has allowed the knowledge of factors associated with complications and proposes some recommendations as: individualization of therapy especially related to the volume of choice, number of drugs administered, and avoid adding electrolytes to the 5% dextrose/0.9% saline solution

Diarrhoea, particularly infectious diarrhoea, in children below five years of age is recognised as one of the leading cause of morbidity and mortality throughout the world. This is especially true in residential areas of developing countries where there is substandard sanitation and overcrowding which are reservoirs for farther transmission. Shigellosis is endemic in developing countries and in Sub-Saharan Africa, including South Africa, a region where unique geographic, economic, political, sociocultural, and personal factors interact to create distinctive continuing challenges to prevention and control. Our study was undertaken to establish baseline information on incidences of Shigella, its serotype and resistant pattern of isolates from human faeces from residents of Johannesburg, South Africa. All stools received from January to April 2013 from the private health care system were cultured on standard media for isolation of Shigella and confirmed by standard biochemical reactions and serological method. Antibiotic sensitivity test was determined by the agar diffusion method. 11009 stool samples were assayed from patients aged between 22 days to 94 years with a 110 Shigella isolates yield, of which 47 (43%) were S. flexneri, 61 (55%) S. sonnei and 1 (1%) of S. dysentriae and S. boydii respectively. Majority of patients 76 (69%) were children between < 1 to 5 years old followed by those between 6 to 10 years 13(12%). Of the four species isolated from children of up to 10 years old, S. sonnie was confirmed in 52 cases (59%) and S. flexneri in 36 cases (41%). A total of 53 (48%) males and 57 (52%) females were infected. However, a hundred per cent susceptibility to ciprofloxacin and ceftriaxone but high levels of resistance to Co-trimoxazole (83%), tetracycline (72%), and ampicillin (26%) was noted. From the 110 isolates, 96 (87%) were resistant to one or more drugs while 14 (13%) were fully susceptible. These results show that S. sonnei followed by S. flexneri as predominating aetiology of shigellosis and Ceftriaxone and ciprofloxacin as effective drugs against all four Shigella species. / Health Studies / M. Sc. (Life Sciences)

Abstract The introduction of physiologically and therapeutically effective drugs in anaesthetic treatment has meant a significant change. Their discovery has thus contributed to a minimisation of their negative effects on a living organism. As a result, anaesthesiology has become more controllable and safer. These new drugs translate into more comfort for the patient in the course of anaesthesiology as well as his or her rapid recovery resulting in a shorter period of hospitalisation. The research of new physiologically and therapeutically effective substances is a pre-requisition of a potential higher standard of medical care. Older substances, e.g. Alkuronium and Gallamin, which, due to their undesirable effects, have come out of use, have lost their significance. Nowadays, these substances have been generally replaced by substances with an intermedial effect, e.g. Rokuronium and Cisatrakurium, which, compared with Alkuronium and Gallamin, show a minimum of undesirable effects. One of the foremost objectives of the current pharmaceutical research is to find a replacement of Sukcinylcholin, which, in spite of its known side effects, has had a non-substitutable position in urgent intubation. As a result, its use is limited to out-patient application and a certain selection of patient categories. Let us hope that we shall see a replacement of Sukcinylcholin being introduced in treatment in the near future. This would mean a final solution of problems arising from its side effects limiting its scope of application.

Trata-se de um ensaio clínico com três Grupos. Avaliaram-se os efeitos da intervenção \"Treinamento, Avaliação e Registro Sistematizado de Dor\" sobre a intensidade da dor, o consumo suplementar de morfina, o tratamento de efeitos colaterais e a satisfação com a analgesia dos doentes, no pós-operatório de cirurgia cardíaca. Foram estudados 182 doentes, no Grupo I (GI, N=55), Grupo II (GII, N=66) e Grupo III (GIII, N=61). Todos receberam a mesma orientação pré-operatória e submeteram-se ao mesmo protocolo medicamentoso para o controle de dor e dos efeitos colaterais. No GI a equipe de enfermagem não recebeu Treinamento e realizou a avaliação da dor conforme rotina da instituição. Nos GII e GIII toda a equipe de enfermagem participou do Curso de Capacitação Sobre a Dor e Seu Controle (Treinamento). No GII a equipe de enfermagem utilizou a Ficha Sistematizada sobre Dor e seu Controle, a cada duas horas. No GIII a equipe de enfermagem não utilizou esta Ficha. Os doentes dos três Grupos também foram avaliados pela pesquisadora nas primeiras 30 horas, a cada 6 horas (6 Momentos). Os resultados foram analisados pelos testes de Kruskal-Wallis, Dunn, Friedman, Qui-quadrado e Verossimilhança. O nível de significância adotado foi de 5%. Os Grupos foram semelhantes quanto à idade, sexo, escolaridade, tipo de cirurgia, tipo de dreno e estado físico. A dor ao repouso e à tosse foi menos intensa no GII. Ao repouso observou-se diferença no Momento 2 (p=0,012) e à tosse, nos Momentos 2, 3, 4 e 6 (p=0,021, p=0,005, p=0,048 e p=0,001, respectivamente). Na dor à inspiração profunda não houve diferença intergrupos. No GII observou-se maior uso de morfina suplementar (p=0,002), maior número de doentes recebendo morfina (p=0,002) e maior média na relação dose de morfina/doente (p=0,022). O GI foi o que menos recebeu antiemético (p=0,019, Momento 2) mas teve a maior ocorrência de náusea e vômito (p=0,032, Momento 6). Prurido ocorreu somente uma vez e não houve depressão respiratória. A satisfação com a analgesia foi mais elevada no GII nos Momentos 2 e 3 (p=0,001 e p=0,012). O Treinamento associado à Ficha Sistematizada sobre a Dor e seu Controle incitou os enfermeiros a intervirem mais vezes para o ajuste da analgesia, melhorou o controle da dor e a satisfação dos doentes com a analgesia. Mostrou-se a melhor opção para o controle da dor no pós-operatório de cirurgia cardíaca / This paper reports on a clinical trial with three Groups. The effects of the intervention \"Training, Assessment and Registration of Pain\" on pain intensity, supplementary consumption of morphine, treatment of side effects, and satisfaction with analgesia among patients in post-operative cardiac surgery. The sample were studied 182 patients, in Group I (GI, N=55), Group II (GII, N=66) and Group III (GIII, N=61). All received the same pre-operative guidelines and submitted themselves to the same medication protocol for the control of pain and its side effects. In GI, the nursing team did not receive the Training, and carried out the pain assessment according to the routine practice of the institution. In GII and GIII, all the nursing team took part in the Curso de Capacitação Sobre a Dor e Seu Controle (Training Course on Pain and its Control). In GII the nursing team used the Ficha Sistematizada sobre Dor e seu Controle (Systematized Record of Pain and its Control) every two hours. In GIII the nursing team did not use this Record. The patients in the three Groups were assessed by the researcher every 6 hours, for the first 30 hours (6 separate moments). The results were analyzed by the Kruskal-Wallis, Dunn, Friedman, Qui-quadrado and Verossimilhança tests. The level of significance adopted was 5%. The Groups were similar, in terms of age, sex, level of education, type of surgery, type of drainage and physical state. The pain in rest and when coughing were less intense in GII. For pain in rest, a difference was observed in Moment 2 (p=0.012) and when coughing, in Moments 2, 3, 4 and 6 (p=0.021, p=0.005, p=0.048 and p=0.001, respectively). For pain on deep inspiration, there was no difference between the groups. In GII, greater use of supplementary morphine was observed (p=0.002), with a higher number of patients receiving morphine (p=0.002), and a higher average ratio of morphine dose to patient (p=0.022). GI was the group which received the least antiemetic (p=0.019, Moment 2) but had the highest occurrence of nausea and vomiting (p=0,032, Moment 6). Pruritis occurred only once, and there was no respiratory depression. Satisfaction with the analgesia was higher in GII in Moments 2 and 3 (p=0.001 and p=0.012). The Training, together with the Systematized Record of Pain and its Control led the nurses to intervene more often in adjusting the analgesia, which improved the pain control and the satisfaction of the patients with the analgesia. This proved to be the best option for the control of post-operative pain following cardiac surgery

No Brasil, o Sistema de Saúde é Universalista, com o tratamento integral gratuito ao paciente com câncer, cujo direito é assegurado por Lei e regulamentado pelo Ministério da Saúde / Instituto Nacional de Câncer José Alencar Gomes da Silva (INCA), por meio de Decreto Presidencial e Portarias. A habilitação e credenciamento de Hospitais em Unidades ou Centros de Alta Complexidade em Oncologia segue critérios rígidos, que determina como sendo obrigatória a presença do Cirurgião-Dentista na equipe multiprofissional e multidisciplinar na oncoterapia. O tratamento odontológico é compulsório e imprescindível na terapia antineoplásica, para prevenir e tratar as complicações orais: hemorragia, infecção, mucosite oral, xerostomia, cárie de radiação, trismo, alterações periodontais, osteonecrose avascular, osteorradionecrose; que podem levar à interrupção da oncoterapia, acarretando um aumento considerável nos custos da terapia implementada, a piora da qualidade de vida, e em alguns casos, podendo levar o paciente a óbito. O protocolo de cuidados orais na oncoterapia é normatizado e padronizado pelo INCA. Desta forma, foi realizado estudo do tratamento odontológico em pacientes com diagnóstico de câncer atendidos no Serviço de Odontologia Oncológica do UNACON do Hospital Geral de Palmas/Tocantins, no período de abril de 2011 a dezembro de 2016. Os dados foram obtidos de forma individualizada e estruturados segundo Variáveis Demográficas (VD), Procedimento Odontológico (PO), Procedimento Odontológico por Dente (POD) e Outras Variáveis de Interesse (OVI). O impacto financeiro de PO e POD foi avaliado pela comparação entre a tabela SIGTAP do Sistema Único de Saúde (SUS) e a tabela VRPO/SOESP (Valores Referenciais para Procedimentos Odontológicos/Sindicato dos Odontologistas do Estado de São Paulo). A maior incidência de pacientes foi observada na 5ª década de vida, com tendência à proporção homem/mulher de 1:1. Foram realizados 910 procedimentos preventivos/profilaxia/atividade educativa; 1826 raspagens supra e subgengival e aplicação tópica de flúor por hemiarcada; 932 restaurações de uma e duas faces com resina fotopolimerizável; 909 exodontias; 2746 sessões de laserterapia de baixa potência. O impacto financeiro mostrou uma defasagem significativa da Tabela SIGTAP/SUS. O estudo realizado revela a importância de uma base de dados estruturada para o registro do tratamento odontológico realizado em pacientes com diagnóstico de câncer atendidos no Sistema Único de Saúde; para que com isso seja possível fomentar, nos Sistemas de Saúde no Mundo, a elaboração e padronização de protocolo de cuidados orais na terapia antineoplásica, e o planejamento dos recursos humanos e financeiros destinados ao tratamento odontológico nos pacientes oncológicos. / In Brazil, the Health System is Universalist, with free comprehensive treatment for the cancer patient, whose right is guaranteed by Law and regulated by the Ministry of Health / National Cancer Institute José Alencar Gomes da Silva (INCA), through a Presidential Decree and Ordinances. The accreditation of Hospitals in Units or Centers of High Complexity in Oncology follows rigid criteria, which determines as mandatory the presence of the Dentist in the multiprofessional and multidisciplinary team in oncotherapy. Dental treatment is compulsory and essential in antineoplastic therapy to prevent and treat oral complications: hemorrhage, infection, oral mucositis, xerostomia, radiation caries, trismus, periodontal changes, avascular osteonecrosis, osteorradionecrosis; which can lead to interruption of oncotherapy, leading to a considerable increase in the costs of the therapy implemented, worsening of quality of life, and in some cases, leading to death. The protocol of oral care in oncotherapy is standardized by INCA. In this way, a study of the dental treatment was carried out in patients diagnosed with cancer attended at the UNACON Oncological Dentistry Service of the General Hospital of Palmas / Tocantins, from april 2011 to december 2016. Data were obtained individually and structured according to Demographics Variables (VD), Dental Procedure (PO), Dental Procedure by Tooth (POD) and Other Variables of Interest (OVI). The financial impact of PO and POD was evaluated by comparing the SIGTAP table of the Unified Health System (SUS) and the VRPO / SOESP table (Reference Values for Dental Procedures / Union of Dental Practitioners of the State of São Paulo). The highest incidence of patients was observed in the 5th decade of life, with a tendency to male to female ratios of 1: 1. Nine hundred and ten (910) preventive procedures / prophylaxis / educational activity were carried out; 1826 supra and subgingival scaling and topical application of fluoride by hemiarcate; 932 single and double sided restorations with photopolymerizable resin; 909 exodontia; 2746 sessions of low power laser therapy. The financial impact showed a significant lag in the SIGTAP / SUS Table. The study reveals the importance of a structured database for the registry of dental treatment performed in patients diagnosed with cancer treated in the Unified Health System; so that it is possible to promote, in the World Health Systems, the elaboration and standardization of oral care protocol in antineoplastic therapy, and the planning of human and financial resources for dental treatment in cancer patients.

OBJETIVOS: Evidências consistentes sugerem que a quimioterapia (QT) sistêmica para o tratamento do câncer pode apresentar efeitos deletérios na cognição levando a prejuízos de memória, atenção, velocidade de processamento e função executiva. A maioria dos estudos anteriores, entretanto, foi realizada em mulheres com câncer de mama, o que levanta a possibilidade de que o déficit possa ter sido causado por alterações hormonais e/ou menopausa precoce induzidas pela QT. Pouco se sabe sobre a toxicidade da QT na cognição de pacientes portadores de câncer coloretal (CCR). O objetivo do estudo foi avaliar os efeitos cognitivos da QT adjuvante baseada em fluorouracil (5FU) associado ou não a oxaliplatina (FLOX) em pacientes portadores de CCR estádios II e III , em comparação a indivíduos com câncer de cólon estádio II de baixo risco não submetidos à QT. METODOLOGIA: Estudo de coorte prospectivo, não intervencionista, unicêntrico, onde os pacientes com CCR foram submetidos a uma avaliação neuropsicológica detalhada, além da avaliação de queixas subjetivas de memória e de sintomas depressivos antes do início da quimioterapia (t1) e após 12 meses de seguimento (t2). Avaliamos ainda o papel da apoliproteína E como preditor de risco para disfunção cognitiva e a presença de lesão de substância branca por ressonância magnética (RM) de crânio. RESULTADOS: Num período de 2 anos, de dezembro de 2012 a dezembro de 2014, 85 pacientes foram recrutados e completaram a avaliação inicial (t1): 26 no grupo controle (sem quimioterapia= QT-) e 59 no grupo casos (quimioterapia= QT+). Dentre os 85 pacientes que participaram da avaliação inicial, 16 foram excluídos da análise do desfecho principal. A maioria dos pacientes era do sexo masculino (60,3%), idosos com idade média de 62,5 anos (DP 9,4) e escolaridade média de 7,6 anos (DP 3,7). Considerando o desfecho primário do escore composto global e também os domínios cognitivos de memória e atenção, não econtramos diferença significativa de desempenho no t1 e t2 entre os grupos. Com relação a função executiva, os pacientes que realizaram QT apresentaram melhor desempenho no t1, entretanto, evoluíram com maior declínio e pior desempenho que os controles no t2 após ajuste para idade, sexo, escolaridade e sintomas depressivos no baseline (beta -1,80; 95%CI -3,50; -0,11, p=0,04). Um subgrupo de 32 pacientes foram submetidos a RM de crânio que não mostrou alterações significativas de substância branca pela técnica de imagem de tensor de difusão (DTI) no seguimento. A presença do alelo ?4 da apolipoproteína E não foi diferente entre os grupos. CONCLUSÃO: Pacientes portadores de câncer colorretal que receberam quimioterapia adjuvante com esquema FLOX apresentaram declínio no desempenho cognitivo no domínio função executiva em comparação a pacientes com doença localizada que não receberam QT após 12 meses de seguimento / PURPOSE: Cognitive dysfunction may occur after chemotherapy in cancer survivors, especially in those that received chemotherapy for breast cancer. The frequency and to which extent such toxicity develops in colorectal cancer (CRC) survivors is unknown. This prospective study evaluated the effects of adjuvant chemotherapy on the cognitive performance of patients with localized CRC in comparison with a control group who did not receive chemotherapy. METHODS: Consecutive patients with localized stages II and III CRC completed neuropsychological assessments, self-reported cognitive complaints questionnaires, and depressive symptoms evaluation before starting fluoropyrimidine-based adjuvant chemotherapy (t1) and after 12 months (t2). Control group was assessed at matching intervals. Blood was collected for apolipoprotein E (APOE) genotyping. Clinical and demographic data were also collected. Diffusion tensor imaging (DTI) data was acquired from a subset of participants at both time-points. RESULTS: From December 2012 to December 2014, 137 patients were approached and 85 patients were recruited: 59 received chemotherapy (CTh+) and 26 did not (CTh-), based on standard recommendation for adjuvant therapy for CRC. The mean age was 62.5 years (SD 9.4), 60% were male, and the mean years of education was 7.6 (SD 3.7). No difference was found on global composite score (p=0.38), attention (p= 0.84) or memory (p= 0.97) between the two groups during the followup (mean 375 days, SD 29). However there was a significant difference on executive function domain, after adjustment for age, sex, education, and depressive symptoms at baseline (beta - 1.80; 95%CI -3.50; -0.11, p=0.04), suggesting worse performance for the CTh+ group. In 32 patients who underwent MRI, there was no significant differences for all DTI indices in any white matter regions between CTh+ and CTh- groups during follow-up. APOE polymorphisms were not predictive of cognitive dysfunction. CONCLUSION: After adjusting for confounding factors, patients with CRC who received adjuvant fluorouracil with or without oxaliplatin presented cognitive decline on executive function after 12 months in comparison with patients with localized disease that did not receive chemotherapy

INTRODUÇÃO: O polivinilpirrolidona-iodo (PVP-I) tópico vem sendo descrito como um agente esclerosante para pleurodese de fácil obtenção, baixo custo e com boa eficácia. Apesar disso, sua segurança ainda não foi estudada de maneira sistemática e alguns autores apresentam restrições ao seu uso por relatos de determinados eventos adversos. OBJETIVOS: descrever a ocorrência de eventos adversos sérios e comuns à pleurodese com PVP-I tópico. Avaliar se existe relação de dose-dependência na ocorrência dos eventos adversos; a efetividade clínica e a qualidade de vida dos pacientes. MÉTODOS: ensaio clínico envolvendo pacientes submetidos a pleurodese com PVP-I tópico, randomizados em dois grupos: grupo 1 com PVP-I tópico a 1% e grupo 2 com PVP-I tópico a 2%. A análise de segurança foi baseada na ocorrência de eventos adversos, graduados de acordo com o Common Terminology Criteria for Adverse Events. Foram realizadas avaliações clínicas e exames complementares no pré-operatório e em vários momentos do seguimento pós-operatório. Os dados clínicos avaliados foram dor, dispnéia, temperatura, pressão arterial, freqüência cardíaca, saturação de oxigênio e acuidade visual. Exames complementares envolveram hemograma, função renal, hepática e tireoidiana, eletrocardiograma e radiografia de tórax. A efetividade clínica foi determinada pela necessidade de procedimentos adicionais após a pleurodese e a qualidade de vida através de questionário específico. RESULTADOS: foram avaliados 60 pacientes, 30 em cada grupo. Predominou o sexo feminino, em 55 pacientes. A média de idade foi de 55,9 ± 11,7 anos. A etiologia mais comum do derrame pleural foi neoplasia de mama em 43 pacientes, seguida por neoplasia pulmonar e de ovário. Foram encontrados 47 eventos adversos sérios relacionados ao procedimento distribuídos em 34 pacientes nos primeiros 30 dias de avaliação. Foram eles: dor, em onze pacientes, hipertensão em dez, empiema em um, hiponatremia em oito pacientes, elevação da fosfatase alcalina, transaminase oxalacética e transaminase pirúvica em dez, três e um pacientes respectivamente e hipocalemia em um paciente. A taxa de sucesso foi de 96% e não houve mudança na qualidade de vida após o procedimento. Na comparação dos grupos não se observou diferença estatística em relação aos dados avaliados. CONCLUSÕES: Os eventos adversos sérios mais esperados após a realização de pleurodese com PVP-I tópico são dor, hipertensão e alguns distúrbios metabólicos. A pleurodese com PVP-I tópico mostrou ser um procedimento eficaz, mas não ofereceu melhora na qualidade de vida dos pacientes. Não se observou relação de dose-dependência na ocorrência dos eventos adversos e na eficácia do procedimento / BACKGROUND: Iodopovidone has been described as a sclerosing agent easily obtained, inexpensive and with good results. Despite this, its safety has not been systematically evaluated and some authors have restrictions to its use because of reports of some adverse events related. OBJECTIVE: To describe the occurrence of common and serious adverse events after iodopovidone pleurodesis. Second endpoints were to describe dose-dependent relation to adverse events, procedure efficacy and patient\'s quality of life. METHODS: clinical trial including patients with recurrent malignant pleural effusion, undergone to pleurodesis, randomized into two groups: group 1 received 1% iodopovidone and group 2 received 2% Iodopovidone. We sought adverse events systematically with clinical and complementary evaluations since before pleurodesis and on several times postoperative. Clinical evaluation involved pain analog scale, dyspnea scale, oxygen saturation, heart frequency, arterial blood pressure, body temperature and visual acuity. Complementary evaluation was done by electrocardiogram, chest x-ray and laboratory tests (hemogram, renal function, liver function and thyroid function). All adverse events were graduated according to the Common Terminology Criteria for Adverse Events (CTCAEV). Efficacy was considered when the patients did not need further pleural procedure after pleurodesis and quality of life analysis was determined by questionnaire. RESULTS: Sixty patients were enrolled, thirty in each group, 55 females and 5 males. Mean age was 55,9 ± 11,7. The mainly etiology of malignant pleural effusion was breast cancer, in 43 patients, followed by lung cancer and ovarian tumor. We found 47 serious adverse events, possibly related to iodopovidone pleurodesis that occurred in 34 patients on 30 days follow-up. Most frequent clinical adverse events of these were pain, eleven patients, hypertension, ten and empyema in one patients. Serious metabolic events founded were hyponatremia in eight patients, alkaline phosphatase, alanine aminotransferase and aspartate aminotransferase increased in ten, three and one patients respectively and hypokalemia in one patient. Success rate occurred in 96%. We didn\'t find change on quality of life after pleurodesis. We found no difference in patient\'s demographical data, occurrence of adverse events, efficacy and quality of life between groups. CONCLUSIONS: Observed common and serious adverse events related to iodopovidone pleurodesis were pain, hypertension, and some metabolic alterations. We found good efficacy for iodopovidone pleurodesis, but no significant change in patient\'s quality of life after procedure. This report does not suggest dose-dependent relation for the occurrence of adverse events