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Original Article12-04-2024
Prognosis and cardiotoxicity associated to adjuvant trastuzumab for breast cancer: real world study in a public health system
- Ana Elisa Ribeiro da Silva Cabello
, - César Cabello ,
- Susana Oliveira Botelho Ramalho ,
- Otávio Rizzi Coelho ,
- Otávio Rizzi Coelho-Filho , [ … ],
- Luiz Carlos Zeferino
Views231
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract
Original ArticlePrognosis and cardiotoxicity associated to adjuvant trastuzumab for breast cancer: real world study in a public health system
Revista Brasileira de Ginecologia e Obstetrícia. 2024;46:e-rbgo93
- Ana Elisa Ribeiro da Silva Cabello ,
- César Cabello ,
- Susana Oliveira Botelho Ramalho ,
- Otávio Rizzi Coelho ,
- Otávio Rizzi Coelho-Filho ,
- Helymar da Costa Machado ,
- Délio Marques Conde ,
- Luiz Carlos Zeferino
Views231Abstract
Objective:
To analyze the prognosis of patients with breast cancer who developed trastuzumab-induced cardiotoxicity and to analyze factors associated with and resulting from cardiotoxicity.
Methods:
This was a retrospective cohort study that included 255 HER2-positive breast cancer patients who received adjuvant trastuzumab therapy. The inclusion criteria were a diagnosis of HER2-positive breast cancer and adjuvant trastuzumab therapy; disease stage I-III; <70 years; and a baseline echocardiogram showing a left ventricular ejection fraction (LVEF) ≥ 55%. The Kaplan-Meier method, the log-rank test, and the Cox proportional hazards model were used.
Results:
In all, 15.3% (39/255) of patients presented with cardiotoxicity. Treatment was suspended in 92.3% (36/39) of patients who presented with cardiotoxicity during trastuzumab treatment. The treatment was suspended in 46 of 255 patients and it was permanently interrupted in 84.8% (33/46) of these patients, with 84.8% (28/33) due to cardiotoxicity. Cardiotoxicity was not associated with disease-free survival (DFS) (hazard ratio (HR) = 1.48; 95% confidence interval (CI = 0.79-2.78) or overall survival (OS) (HR = 1.68; 95%CI= 0.83-3.41). Patients with clinical stage III and whom trastuzumab therapy was suspended (all causes) had worse DFS; (HR = 3.19; 95% CI=1.77-5.74) and (HR = 1.83; 95% CI=1.01-3.32) respectively. Those with clinical stage III and whom trastuzumab therapy was permanently interrupted had worse OS; (HR = 3.80; 95% CI =1.82-7.94), and (HR = 2,26; 95% CI =1.09-4.68 respectively.
Conclusion:
Cardiotoxicity was not associated with DFS or OS. Clinical stage III, Suspension and permanent interruption of treatment regardless of the cause were associated with worse DFS and OS in breast cancer patients.
Key-words Breast neoplasmsCardiotoxicityChemotherapyDisease-free survivalPrognosisTrastuzumabUnified Health SystemSee moreThis is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. - Ana Elisa Ribeiro da Silva Cabello
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Original Article12-04-2024
Prevalence and factors associated with non-alcoholic fatty liver disease among women with polycystic ovary syndrome
- Maria Elisa Franciscatto ,
- Juliana Bosso Taniguchi ,
- Raquel Wohlenberg ,
- Isadora Luísa Riedi ,
- Karen Oppermann
Views272This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract
Original ArticlePrevalence and factors associated with non-alcoholic fatty liver disease among women with polycystic ovary syndrome
Revista Brasileira de Ginecologia e Obstetrícia. 2024;46:e-rbgo81
- Maria Elisa Franciscatto ,
- Juliana Bosso Taniguchi ,
- Raquel Wohlenberg ,
- Isadora Luísa Riedi ,
- Karen Oppermann
Views272Abstract
Objective:
To verify the prevalence and factors associated with Non-Alcoholic Fatty Liver Disease (NAFLD) among women with Polycystic Ovary Syndrome (PCOS).
Methods:
A cross-sectional study was conducted with 53 patients with PCOS. The diagnosis of PCOS followed the Rotterdam criteria. The diagnosis of NAFLD was made through US showing hepatic steatosis, excluding significant alcohol consumption and chronic liver disease. The following variables were compared between the groups of women with and without NAFLD: age, race, anthropometric data, blood pressure levels, liver enzymes, glycemic and lipid profiles, total testosterone, presence of hirsutism, and metabolic syndrome (MS). Variables were compared between the groups using T-test, Mann-Whitney, and Chi-square tests.
Results:
Among 53 patients with PCOS, 50.9% had NAFLD. The NAFLD group had higher weight (p=0.003), BMI (p=0.001), waist circumference (p≤0.001), fasting glucose (p=0.021), HbA1C% (p=0.028), triglycerides (p=0.023), AST (p=0.004), ALT (p=0.001), higher prevalence of MS (p=0.004), and lower levels of HDL cholesterol (p=0.043). The other variables did not differ between the groups. Both groups were predominantly of caucasian race, and there was no significant difference in age.
Conclusion:
The prevalence of NAFLD among patients with PCOS was 50.9%. Metabolic and hepatic enzyme abnormalities were more prevalent in this group compared to the group without the disease. Obesity tripled the prevalence of NAFLD.
Key-words Alcohol drinkingHyperandrogenismmetabolic syndromenon-alcoholic fatty liver diseaseObesityPolycystic ovary syndromeWaist circumferenceSee moreThis is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. - Maria Elisa Franciscatto
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Original Article12-04-2024
Clinical, histopathological and immunohistochemical analysis of vulvar squamous cell carcinoma
Revista Brasileira de Ginecologia e Obstetrícia. 2024;46:e-rbgo91
Views207This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract
Original ArticleClinical, histopathological and immunohistochemical analysis of vulvar squamous cell carcinoma
Revista Brasileira de Ginecologia e Obstetrícia. 2024;46:e-rbgo91
Views207See moreAbstract
Objective:
The average age of patients with vulvar squamous cell carcinoma (SCC) has been reported to have declined. Human papilloma virus (HPV)-related lesions have been shown to be associated with the expression of the immunohistochemical (IHC) marker p16. Non-HPV-related tumors have been characterized by p53 abnormal expression and PDL1 expression. We aimed to evaluate the correlation between these markers and vulvar SCC and to relate it to the clinical and pathological characteristics.
Methods:
Histopathologic assessments and IHC analyses of p16, p53, and PDL1 were performed in 41 samples of vulvar SCC collected between 2016 and 2021. The data were correlated with clinical and pathological characteristics of the patients.
Results:
The mean age of the patients was 72.1 years. Positive p16 and PDL1 staining was detected in 24.4% and 17.1% of the samples, respectively. p53 expression was negative in 19.5% of the samples, whereas it was overexpressed in 24.4%. p16-positive tumors showed a smaller depth of invasion (DOI) (p = 0.014), while tumors with p53 abnormal expression showed greater DOI (p = 0.041). PDL1 expression was correlated with increased number of inflammatory cells (p = 0.055). In addition, lesions with lymphovascular space invasion were p16-negative.
Conclusion:
In our sample, regarding to the SCC incidence the patients’ mean age did not change. The expression of p16 was inversely correlated with p53 results. Tumors with p53 abnormal expression and absence of p16 showed a greater DOI. Our data suggest an association between PDL1 expression and increased inflammatory infiltrates in vulvar SCC.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. -
Review Article12-04-2024
Zuranolone for postpartum depression: a systematic review and meta-analysis of two randomized studies
Revista Brasileira de Ginecologia e Obstetrícia. 2024;46:e-rbgo79
Views290This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract
Review ArticleZuranolone for postpartum depression: a systematic review and meta-analysis of two randomized studies
Revista Brasileira de Ginecologia e Obstetrícia. 2024;46:e-rbgo79
Views290See moreAbstract
Objective:
To evaluate the maternal outcomes in women with postpartum depression using zuranolone, the first oral medication indicated to treat postpartum depression.
Methods:
We conducted a systematic search in September 2023, on Pubmed, Embase and Cochrane Trials. We included randomized controlled trials comparing the effectiveness and safety of zuranolone versus placebo in women with postpartum depression. No time or language restrictions were applied. 297 results were retrieved, of which 11 papers were selected and fully reviewed by two authors. Review Manager 5 was used for statistical analysis and Cochrane Risk-of-bias tool for randomized trials was applied for quality assessment.
Results:
We included 2 studies, with 346 women, of whom 174 (50.2%) were treated with zuranolone. Zuranolone was significantly associated to an improvement of Clinical Global Impression response rate; Hamilton Depression Rating Scale 15 days and 45-day remission, 3-day, 15-day, and 45-day symptom remission, and reduction in the dose of antidepressants. As for safety outcomes, it was noticed that zuranolone increases sedation risk, which can be dose related. No significant differences were found for other adverse events.
Conclusion:
These findings suggest that zuranolone might present a safe and effective medication for out-of-hospital treatment of PPD. Sedation effects need to be further assessed.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. -
FEBRASGO POSITION STATEMENT11-25-2024
Nonclassic congenital adrenal hyperplasia due to 21-hydroxylase deficiency in women: diagnosis and treatment: Number 11 – 2024
- Andrea Prestes Nácul ,
- Ana Carolina Japur Sá Rosa e Silva ,
- Daniela Angerame Yela ,
- Sebastião Freitas de Medeiros ,
- José Maria Soares Júnior , [ … ],
- Cristina Laguna Benetti-Pinto
Views188This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract
FEBRASGO POSITION STATEMENTNonclassic congenital adrenal hyperplasia due to 21-hydroxylase deficiency in women: diagnosis and treatment: Number 11 – 2024
Revista Brasileira de Ginecologia e Obstetrícia. 2024;46:e-FPS11
- Andrea Prestes Nácul ,
- Ana Carolina Japur Sá Rosa e Silva ,
- Daniela Angerame Yela ,
- Sebastião Freitas de Medeiros ,
- José Maria Soares Júnior ,
- Gabriela Pravatta Rezende Antoniassi ,
- Lia Cruz da Costa Damásio ,
- Técia Maria de Oliveira Maranhão ,
- Gustavo Arantes Rosa Maciel ,
- Cristina Laguna Benetti-Pinto
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. - Andrea Prestes Nácul
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FEBRASGO POSITION STATEMENT11-14-2024
Challenges and strategies in adolescent vaccination: Number 12 – 2024
Revista Brasileira de Ginecologia e Obstetrícia. 2024;46:e-FPS12
Views174This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract
FEBRASGO POSITION STATEMENTChallenges and strategies in adolescent vaccination: Number 12 – 2024
Revista Brasileira de Ginecologia e Obstetrícia. 2024;46:e-FPS12
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. -
Original Article10-23-2024
Nipple-sparing mastectomy in young versus elderly patients
- Antônio Luiz Frasson ,
- Isabela Miranda ,
- Betina Vollbrecht ,
- Carolina Malhone ,
- Ana Beatriz Falcone , [ … ],
- Martina Lichtenfels
Views167This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract
Original ArticleNipple-sparing mastectomy in young versus elderly patients
Revista Brasileira de Ginecologia e Obstetrícia. 2024;46:e-rbgo90
- Antônio Luiz Frasson ,
- Isabela Miranda ,
- Betina Vollbrecht ,
- Carolina Malhone ,
- Ana Beatriz Falcone ,
- Fernanda Barbosa ,
- Francisco Pimentel Cavalcante ,
- Martina Lichtenfels
Views167See moreAbstract
Objective:
In this study, we compared indications and outcomes of 115 young (< 40 years) versus 40 elderly (> 60 years) patients undergoing nipple-sparing mastectomy (NSM) as risk-reducing surgery or for breast cancer (BC) treatment.
Methods:
Between January 2004 and December 2018, young and elderly patients undergoing NSM with complete data from at least 6 months of follow-up were included.
Results:
BC treatment was the main indication for NSM, observed in 85(73.9%) young versus 33(82.5%) elderly patients, followed by risk-reducing surgery in 30(26.1%) young versus 7(17.5%) elderly patients. Complication rates did not differ between the age groups. At a median follow-up of 43 months, the overall recurrence rate was higher in the younger cohort (p = 0.04). However, when stratified into local, locoregional, contralateral, and distant metastasis, no statistical difference was observed. During the follow-up, only 2(1.7%) young patients died.
Conclusion:
Our findings elucidate a higher recurrence rate of breast cancer in younger patients undergoing NSM, which may correlate with the fact that age is an independent prognostic factor. High overall survival and low complication rates were evidenced in the two groups showing the safety of NSM for young and elderly patients.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. - Antônio Luiz Frasson
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Original Article10-23-2024
Access and adequacy of antenatal care in a city in Brazil during two phases of the COVID-19 pandemic
- Nicole Zazula Beatrici ,
- Roxana Knobel ,
- Mariana Schmidt Vieira ,
- Iago Felipe Alexandrini ,
- Alberto Trapani Júnior , [ … ],
- Carla Betina Andreucci
Abstract
Original ArticleAccess and adequacy of antenatal care in a city in Brazil during two phases of the COVID-19 pandemic
Revista Brasileira de Ginecologia e Obstetrícia. 2024;46:e-rbgo87
- Nicole Zazula Beatrici ,
- Roxana Knobel ,
- Mariana Schmidt Vieira ,
- Iago Felipe Alexandrini ,
- Alberto Trapani Júnior ,
- Carla Betina Andreucci
Views202Abstract
Objective:
To compare access and suitability of antenatal care between years 2020 and 2022 among postpartum individuals at a Hospital in Florianopolis, and evaluate factors associated with antenatal suitability.
Methods:
Observational, cross-sectional, and quantitative study carried out in 2022. Collected data were compared with the database of a previous similar study carried out in the same setting in 2020. Data were extracted from medical records and prenatal booklets, in addition to a face-to-face questionnaire. Adequacy was measured using the Carvalho and Novaes index and health access was qualitatively evaluated. Socio-demographic and antenatal variables were analyzed. A statistical significance level of 0.05 was considered. Open-ended questions were categorized for analysis.
Results:
395 postpartum individuals were included. Antenatal care was adequate for 48.6% in 2020 and 69.1% in 2022. Among the barriers to access, 56% reported difficulty in scheduling appointments and/or exams and 23% complained of reduced healthcare staff due to strikes, COVID-19, among others. Adequate antenatal care was associated with being pregnant in 2022, being referred to high-risk units (PNAR), and not reporting difficulties in access. Also, it was associated with twice the chance of investigation for gestational diabetes (GDM) and syphilis.
Conclusion:
The 2022 post-vaccination period showed higher antenatal adequacy. The main difficulty for postpartum individuals was scheduling appointments and/or exams. Having antenatal care in 2022, no reports of difficulty in access, and follow-up at a high-risk unit were associated with antenatal adequacy.
Key-words COVID-19Delivery of health careDiabetesGestationalpandemicsPostpartum periodPregnancyPrenatal caresurveys and questionnairesVaccinationSee moreThis is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. - Nicole Zazula Beatrici
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