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Original Article09-06-2024
Morbidity associated with emergency surgery versus scheduled surgery in patients with placenta accreta spectrum
- Juan José Saldarriaga-Hoyos
, - Daniela Sarria-Ortiz ,
- Valentina Galindo-Velasco ,
- Luisa Fernanda Rivera-Torres ,
- Albaro José Nieto-Calvache
Abstract
Original ArticleMorbidity associated with emergency surgery versus scheduled surgery in patients with placenta accreta spectrum
Revista Brasileira de Ginecologia e Obstetrícia. 2024;46:e-rbgo74
- Juan José Saldarriaga-Hoyos ,
- Daniela Sarria-Ortiz ,
- Valentina Galindo-Velasco ,
- Luisa Fernanda Rivera-Torres ,
- Albaro José Nieto-Calvache
Views158See moreAbstract
Objective
This study aims to evaluate the clinical outcomes of surgical management for placenta accreta spectrum in a Latin American reference hospital specializing in this condition. The evaluation involves a comparison between surgeries performed on an emergent and scheduled basis.
Methods
A retrospective cohort study was conducted on patients with placenta accreta spectrum who underwent surgery between January 2011 and November 2021 at a hospital in Colombia, using data from the institutional PAS registry. The study included patients with intraoperative and/or histological confirmation of PAS, regardless of prenatal suspicion. Clinical outcomes were compared between patients who had emergent surgeries and those who had scheduled surgeries. Descriptive analysis involved summary measures and the Shapiro-Wilk test for quantitative variables, with comparisons made using Pearson’s Chi-squared test and the Wilcoxon rank sum test, applying a significance level of 5%.
Results
A total of 113 patients were included, 84 (74.3%) of them underwent scheduled surgery, and 29 (25.6%) underwent emergency surgery. The emergency surgery group required more transfusions (72.4% vs 48.8%, p=0.047). Patients with intraoperative diagnosis of placenta accreta spectrum (21 women, 19.5%) had a greater volume of blood loss than patients taken into surgery with known presence of placenta accreta spectrum (3500 ml, IQR 1700 – 4000 vs 1700 ml, IQR 1195-2135. p <0.001).
Conclusion
Patients with placenta accreta spectrum undergoing emergency surgery require transfusions more frequently than those undergoing scheduled surgery
Views158
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 ArticleMorbidity associated with emergency surgery versus scheduled surgery in patients with placenta accreta spectrum
Revista Brasileira de Ginecologia e Obstetrícia. 2024;46:e-rbgo74
- Juan José Saldarriaga-Hoyos ,
- Daniela Sarria-Ortiz ,
- Valentina Galindo-Velasco ,
- Luisa Fernanda Rivera-Torres ,
- Albaro José Nieto-Calvache
Views158See moreAbstract
Objective
This study aims to evaluate the clinical outcomes of surgical management for placenta accreta spectrum in a Latin American reference hospital specializing in this condition. The evaluation involves a comparison between surgeries performed on an emergent and scheduled basis.
Methods
A retrospective cohort study was conducted on patients with placenta accreta spectrum who underwent surgery between January 2011 and November 2021 at a hospital in Colombia, using data from the institutional PAS registry. The study included patients with intraoperative and/or histological confirmation of PAS, regardless of prenatal suspicion. Clinical outcomes were compared between patients who had emergent surgeries and those who had scheduled surgeries. Descriptive analysis involved summary measures and the Shapiro-Wilk test for quantitative variables, with comparisons made using Pearson’s Chi-squared test and the Wilcoxon rank sum test, applying a significance level of 5%.
Results
A total of 113 patients were included, 84 (74.3%) of them underwent scheduled surgery, and 29 (25.6%) underwent emergency surgery. The emergency surgery group required more transfusions (72.4% vs 48.8%, p=0.047). Patients with intraoperative diagnosis of placenta accreta spectrum (21 women, 19.5%) had a greater volume of blood loss than patients taken into surgery with known presence of placenta accreta spectrum (3500 ml, IQR 1700 – 4000 vs 1700 ml, IQR 1195-2135. p <0.001).
Conclusion
Patients with placenta accreta spectrum undergoing emergency surgery require transfusions more frequently than those undergoing scheduled surgery
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. - Juan José Saldarriaga-Hoyos
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Original Article09-06-2024
Thinking on the purposes, roles and activities of networks for research on maternal and perinatal health: opinions of coordinators and members
Revista Brasileira de Ginecologia e Obstetrícia. 2024;46:e-rbgo75
Abstract
Original ArticleThinking on the purposes, roles and activities of networks for research on maternal and perinatal health: opinions of coordinators and members
Revista Brasileira de Ginecologia e Obstetrícia. 2024;46:e-rbgo75
Views133See moreAbstract
Objective
To identify the opinion of coordinators and members about the essential characteristics and to understand the research networks characteristics, to facilitate their implementation, sustainability and effectiveness so it can be replicated in low and middle-income countries.
Methods
A qualitative study using a semi-structured interview technique was conducted. We selected potential members, managers and participants of networks from publications identified in PubMed. After checking the FIGO congress program, we identified authors who were assigned as speakers at the event. An invitation was sent and interviews were scheduled.
Results
In total, eleven interviews were performed. Coordinators and members of networks have the same goal when they decide to participate in a network. In general, they cited that these individuals had to be committed, responsible and enthusiastic people. The network should be composed also of postgraduate students. A network should allow multi-leadership, co-responsibility, autonomy and empowerment of its members. Effective communication was mentioned as an important pillar for network maintenance. Another motivation is being an author or coauthor in publications. One way to maintain a network running is social or governmental commitment, after resources expire, studies continue.
Conclusion
Networks are different due to the social context where they are inserted, however, some characteristics are common to all of them, such as having engaged leaders. For an effective and sustainable network, commitment and motivation in a leader and members are more in need than financial resources. Ideally, to ensure the operation of the network, the institution where the leader is linked should support this network.
Views133This 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 ArticleThinking on the purposes, roles and activities of networks for research on maternal and perinatal health: opinions of coordinators and members
Revista Brasileira de Ginecologia e Obstetrícia. 2024;46:e-rbgo75
Views133See moreAbstract
Objective
To identify the opinion of coordinators and members about the essential characteristics and to understand the research networks characteristics, to facilitate their implementation, sustainability and effectiveness so it can be replicated in low and middle-income countries.
Methods
A qualitative study using a semi-structured interview technique was conducted. We selected potential members, managers and participants of networks from publications identified in PubMed. After checking the FIGO congress program, we identified authors who were assigned as speakers at the event. An invitation was sent and interviews were scheduled.
Results
In total, eleven interviews were performed. Coordinators and members of networks have the same goal when they decide to participate in a network. In general, they cited that these individuals had to be committed, responsible and enthusiastic people. The network should be composed also of postgraduate students. A network should allow multi-leadership, co-responsibility, autonomy and empowerment of its members. Effective communication was mentioned as an important pillar for network maintenance. Another motivation is being an author or coauthor in publications. One way to maintain a network running is social or governmental commitment, after resources expire, studies continue.
Conclusion
Networks are different due to the social context where they are inserted, however, some characteristics are common to all of them, such as having engaged leaders. For an effective and sustainable network, commitment and motivation in a leader and members are more in need than financial resources. Ideally, to ensure the operation of the network, the institution where the leader is linked should support this network.
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 Article09-06-2024
Immediate prepectoral versus submuscular breast reconstruction in nipple-sparing mastectomy: a retrospective cohort analysis
- Francisco Pimentel Cavalcante ,
- Ticiane Oliveira Lima ,
- Ryane Alcantara ,
- Amanda Cardoso ,
- Guilherme Novita , [ ... ],
- Eduardo Millen
Abstract
Original ArticleImmediate prepectoral versus submuscular breast reconstruction in nipple-sparing mastectomy: a retrospective cohort analysis
Revista Brasileira de Ginecologia e Obstetrícia. 2024;46:e-rbgo76
- Francisco Pimentel Cavalcante ,
- Ticiane Oliveira Lima ,
- Ryane Alcantara ,
- Amanda Cardoso ,
- Guilherme Novita ,
- Felipe Zerwes ,
- Eduardo Millen
Views273Abstract
Objective
To evaluate early complications in prepectoral breast reconstruction.
Methods
A retrospective cohort study including 180 consecutive cases of nipple-sparing mastectomy, comparing immediate breast reconstruction with subpectoral to prepectoral mammary implants in 2012-2022. Clinical and demographic characteristics and complications in the first three months following surgery were compared between the two techniques.
Results
The prepectoral technique was used in 22 cases (12.2%) and the subpectoral in 158 (87.8%). Median age was higher in the prepectoral group (47 versus 43.8 years; p=0.038), as was body mass index (25.1 versus 23.8; p=0.002) and implant volume (447.5 versus 409 cc; p=0.001). The prepectoral technique was more associated with an inframammary fold (IMF) incision (19 cases, 86.4% versus 85, 53.8%) than with periareolar incisions (3 cases, 13.6% versus 73, 46.2%); (p=0.004). All cases in the prepectoral group underwent direct-to-implant reconstruction compared to 54 cases (34.2%) in the subpectoral group. Thirty-eight complications were recorded: 36 (22.8%) in the subpectoral group and 2 (9.1%) in the prepectoral group (p=0.24). Necrosis of the nipple-areola complex/skin flap occurred in 27 patients (17.1%) in the subpectoral group (prepectoral group: no cases; p=0.04). The groups were comparable regarding dehiscence, seroma, infection, and hematoma. Reconstruction failed in one case per group (p=0.230). In the multivariate analysis, IMF incision was associated with the prepectoral group (aOR: 34.72; 95%CI: 2.84-424.63).
Conclusion
The incidence of early complications was comparable between the two techniques and compatible with previous reports. The clinical and demographic characteristics differed between the techniques. Randomized clinical trials are required.
Key-words Breast implantationBreast implantsBreast neoplasmsMammaplastyMastectomyNipplesPectoralis musclesSurgical procedures, operativeSee moreViews273This 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 ArticleImmediate prepectoral versus submuscular breast reconstruction in nipple-sparing mastectomy: a retrospective cohort analysis
Revista Brasileira de Ginecologia e Obstetrícia. 2024;46:e-rbgo76
- Francisco Pimentel Cavalcante ,
- Ticiane Oliveira Lima ,
- Ryane Alcantara ,
- Amanda Cardoso ,
- Guilherme Novita ,
- Felipe Zerwes ,
- Eduardo Millen
Views273Abstract
Objective
To evaluate early complications in prepectoral breast reconstruction.
Methods
A retrospective cohort study including 180 consecutive cases of nipple-sparing mastectomy, comparing immediate breast reconstruction with subpectoral to prepectoral mammary implants in 2012-2022. Clinical and demographic characteristics and complications in the first three months following surgery were compared between the two techniques.
Results
The prepectoral technique was used in 22 cases (12.2%) and the subpectoral in 158 (87.8%). Median age was higher in the prepectoral group (47 versus 43.8 years; p=0.038), as was body mass index (25.1 versus 23.8; p=0.002) and implant volume (447.5 versus 409 cc; p=0.001). The prepectoral technique was more associated with an inframammary fold (IMF) incision (19 cases, 86.4% versus 85, 53.8%) than with periareolar incisions (3 cases, 13.6% versus 73, 46.2%); (p=0.004). All cases in the prepectoral group underwent direct-to-implant reconstruction compared to 54 cases (34.2%) in the subpectoral group. Thirty-eight complications were recorded: 36 (22.8%) in the subpectoral group and 2 (9.1%) in the prepectoral group (p=0.24). Necrosis of the nipple-areola complex/skin flap occurred in 27 patients (17.1%) in the subpectoral group (prepectoral group: no cases; p=0.04). The groups were comparable regarding dehiscence, seroma, infection, and hematoma. Reconstruction failed in one case per group (p=0.230). In the multivariate analysis, IMF incision was associated with the prepectoral group (aOR: 34.72; 95%CI: 2.84-424.63).
Conclusion
The incidence of early complications was comparable between the two techniques and compatible with previous reports. The clinical and demographic characteristics differed between the techniques. Randomized clinical trials are required.
Key-words Breast implantationBreast implantsBreast neoplasmsMammaplastyMastectomyNipplesPectoralis musclesSurgical procedures, operativeSee 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. - Francisco Pimentel Cavalcante
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Original Article07-26-2024
Maintaining accuracy and expanding access: evaluating the efficacy of the Botucatu Abbreviated Breast MRI Protocol
- Eduardo Carvalho Pessoa ,
- Thais Paiva Moares ,
- Heverton Leal Ernesto de Amorim ,
- Henrique Lima Couto ,
- Joelcio Francisco Abbade , [ ... ],
- Eliana Aguiar Petri Nahas
Abstract
Original ArticleMaintaining accuracy and expanding access: evaluating the efficacy of the Botucatu Abbreviated Breast MRI Protocol
Revista Brasileira de Ginecologia e Obstetrícia. 2024;46:e-rbgo55
- Eduardo Carvalho Pessoa ,
- Thais Paiva Moares ,
- Heverton Leal Ernesto de Amorim ,
- Henrique Lima Couto ,
- Joelcio Francisco Abbade ,
- Suzana Shinomia ,
- Carla Priscila Kamiya Carvalho Pessoa ,
- Eliana Aguiar Petri Nahas
Views157See moreAbstract
Objective
Our study evaluated the effectiveness of the Botucatu Abbreviated Protocol in breast magnetic resonance imaging (MRI) within Brazil’s public healthcare system, focusing on its impact on patient access to MRI exams.
Methods
This retrospective study involved 197 breast MRI exams of female patients over 18 years with histological breast carcinoma diagnosis, conducted at Hospital das Clínicas de Botucatu - UNESP between 2014 and 2018. Two experienced examiners prospectively and blindly analyzed the exams using an Integrated Picture Archiving and Communication System (PACS). They first evaluated the Botucatu Abbreviated Protocol, created from sequences of the complete protocol (PC), and after an average interval of 30 days, they reassessed the same 197 exams with the complete protocol. Dynamic and morphological characteristics of lesions were assessed according to BI-RADS 5th edition criteria. The study also analyzed the average number of monthly exams before and after the implementation of Botucatu Abbreviated Protocol.
Results
The Botucatu Abbreviated Protocol showed high sensitivity (99% and 96%) and specificity (90.9% and 96%). There was a significant increase in the average monthly MRI exams from 6.62 to 23.8 post-implementation.
Conclusion
The Botucatu Abbreviated Protocol proved effective in maintaining diagnostic accuracy and improving accessibility to breast MRI exams, particularly in the public healthcare setting.
Views157This 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 ArticleMaintaining accuracy and expanding access: evaluating the efficacy of the Botucatu Abbreviated Breast MRI Protocol
Revista Brasileira de Ginecologia e Obstetrícia. 2024;46:e-rbgo55
- Eduardo Carvalho Pessoa ,
- Thais Paiva Moares ,
- Heverton Leal Ernesto de Amorim ,
- Henrique Lima Couto ,
- Joelcio Francisco Abbade ,
- Suzana Shinomia ,
- Carla Priscila Kamiya Carvalho Pessoa ,
- Eliana Aguiar Petri Nahas
Views157See moreAbstract
Objective
Our study evaluated the effectiveness of the Botucatu Abbreviated Protocol in breast magnetic resonance imaging (MRI) within Brazil’s public healthcare system, focusing on its impact on patient access to MRI exams.
Methods
This retrospective study involved 197 breast MRI exams of female patients over 18 years with histological breast carcinoma diagnosis, conducted at Hospital das Clínicas de Botucatu - UNESP between 2014 and 2018. Two experienced examiners prospectively and blindly analyzed the exams using an Integrated Picture Archiving and Communication System (PACS). They first evaluated the Botucatu Abbreviated Protocol, created from sequences of the complete protocol (PC), and after an average interval of 30 days, they reassessed the same 197 exams with the complete protocol. Dynamic and morphological characteristics of lesions were assessed according to BI-RADS 5th edition criteria. The study also analyzed the average number of monthly exams before and after the implementation of Botucatu Abbreviated Protocol.
Results
The Botucatu Abbreviated Protocol showed high sensitivity (99% and 96%) and specificity (90.9% and 96%). There was a significant increase in the average monthly MRI exams from 6.62 to 23.8 post-implementation.
Conclusion
The Botucatu Abbreviated Protocol proved effective in maintaining diagnostic accuracy and improving accessibility to breast MRI exams, particularly in the public healthcare setting.
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. - Eduardo Carvalho Pessoa
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Original Article07-26-2024
Validation and cultural translation for the Brazilian Portuguese version of the Estro-Androgenic- Symptom Questionnaire in Women
- Cássia Raquel Teatin Juliato ,
- Ana Aline Coelho Oswaldo ,
- Camila Carvalho de Araújo ,
- Marina Rotoli ,
- Lúcia Costa-Paiva , [ ... ],
- Luiz Gustavo Oliveira Brito
Abstract
Original ArticleValidation and cultural translation for the Brazilian Portuguese version of the Estro-Androgenic- Symptom Questionnaire in Women
Revista Brasileira de Ginecologia e Obstetrícia. 2024;46:e-rbgo56
- Cássia Raquel Teatin Juliato ,
- Ana Aline Coelho Oswaldo ,
- Camila Carvalho de Araújo ,
- Marina Rotoli ,
- Lúcia Costa-Paiva ,
- Rossella Nappi ,
- Luiz Gustavo Oliveira Brito
Views169Abstract
Objective
This study aimed to translate and validate the Estro-Androgenic-Symptom Questionnaire in Women (EASQ-W) into Brazilian Portuguese language, as we hypothesized that this tool would be consistent for addressing the specific context of hormonal symptoms in menopause.
Methods
In a cross-sectional study, a total of 119 women with Genitourinary Syndrome of Menopause (GSM) and 119 climacteric women without GSM were included. The EASQ-W was translated, and its psychometric properties were rigorously examined. Participants completed questionnaires covering sociodemographic details, the EASQ-W, and the Menopause Rating Scale (MRS). A subgroup of 173 women was re-invited after 4 weeks for test-retest analysis of the EASQ-W. Additionally, the responsiveness of the questionnaire was evaluated in 30 women who underwent oral hormonal treatment.
Results
The internal consistency of the EASQ-W was found to be satisfactory in both GSM and control groups (Cronbach’s alpha ≥ 0.70). Notably, a floor effect was observed in both groups; however, a ceiling effect was only evident in the sexual domain of the GSM group. Construct validity was established by comparing the EASQ-W with the MRS, yielding statistically significant correlations (0.33831-0.64580, p < 0.001). The test-retest reliability over a 4-week period was demonstrated to be satisfactory in both the GSM and control groups (ICC 0.787-0.977). Furthermore, the EASQ-W exhibited appropriate responsiveness to oral hormonal treatment (p < 0.001).
Conclusion
This study successfully translated and validated the Estro-Androgenic-Symptom Questionnaire in Women (EASQ-W) into Brazilian Portuguese, with satisfactory internal consistency, test-retest reliability, and construct validity.
Key-words AndrogenEASQ-WEstrogenMenopauseSigns and symptomssurveys and questionnairesValidation studiesSee moreViews169This 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 ArticleValidation and cultural translation for the Brazilian Portuguese version of the Estro-Androgenic- Symptom Questionnaire in Women
Revista Brasileira de Ginecologia e Obstetrícia. 2024;46:e-rbgo56
- Cássia Raquel Teatin Juliato ,
- Ana Aline Coelho Oswaldo ,
- Camila Carvalho de Araújo ,
- Marina Rotoli ,
- Lúcia Costa-Paiva ,
- Rossella Nappi ,
- Luiz Gustavo Oliveira Brito
Views169Abstract
Objective
This study aimed to translate and validate the Estro-Androgenic-Symptom Questionnaire in Women (EASQ-W) into Brazilian Portuguese language, as we hypothesized that this tool would be consistent for addressing the specific context of hormonal symptoms in menopause.
Methods
In a cross-sectional study, a total of 119 women with Genitourinary Syndrome of Menopause (GSM) and 119 climacteric women without GSM were included. The EASQ-W was translated, and its psychometric properties were rigorously examined. Participants completed questionnaires covering sociodemographic details, the EASQ-W, and the Menopause Rating Scale (MRS). A subgroup of 173 women was re-invited after 4 weeks for test-retest analysis of the EASQ-W. Additionally, the responsiveness of the questionnaire was evaluated in 30 women who underwent oral hormonal treatment.
Results
The internal consistency of the EASQ-W was found to be satisfactory in both GSM and control groups (Cronbach’s alpha ≥ 0.70). Notably, a floor effect was observed in both groups; however, a ceiling effect was only evident in the sexual domain of the GSM group. Construct validity was established by comparing the EASQ-W with the MRS, yielding statistically significant correlations (0.33831-0.64580, p < 0.001). The test-retest reliability over a 4-week period was demonstrated to be satisfactory in both the GSM and control groups (ICC 0.787-0.977). Furthermore, the EASQ-W exhibited appropriate responsiveness to oral hormonal treatment (p < 0.001).
Conclusion
This study successfully translated and validated the Estro-Androgenic-Symptom Questionnaire in Women (EASQ-W) into Brazilian Portuguese, with satisfactory internal consistency, test-retest reliability, and construct validity.
Key-words AndrogenEASQ-WEstrogenMenopauseSigns and symptomssurveys and questionnairesValidation studiesSee 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. - Cássia Raquel Teatin Juliato
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Original Article07-26-2024
Real-world data on adjuvant capecitabine after standard neoadjuvant chemotherapy for triple negative breast cancer
- Maria Fernanda Imperio Pereira ,
- Isabela Panzeri Carlotti Buzatto ,
- Hélio Humberto Angotti Carrara ,
- Fabiana de Oliveira Buono ,
- Jurandyr Moreira de Andrade , [ ... ],
- Daniel Guimarães Tiezzi
Abstract
Original ArticleReal-world data on adjuvant capecitabine after standard neoadjuvant chemotherapy for triple negative breast cancer
Revista Brasileira de Ginecologia e Obstetrícia. 2024;46:e-rbgo29
- Maria Fernanda Imperio Pereira ,
- Isabela Panzeri Carlotti Buzatto ,
- Hélio Humberto Angotti Carrara ,
- Fabiana de Oliveira Buono ,
- Jurandyr Moreira de Andrade ,
- Leonardo Fleury Orlandini ,
- Daniel Guimarães Tiezzi
Views186Abstract
Objective
Neoadjuvant chemotherapy (NACT) has become the standard of care for patients with triple-negative breast cancer (TNBC) with tumors > 1 cm or positive axillary nodes. Pathologic complete response (pCR) has been used as an endpoint to select patients for treatment scaling. This study aimed to examine the benefit of adding adjuvant capecitabine for TNBC patients who did not achieve pCR after standard NACT in a real-world scenario.
Methods
This retrospective cohort study included all patients with TNBC who underwent NACT between 2010 and 2020. Clinicopathological data were obtained from the patient records. Univariate and multivariate analyses were conducted at the 5 years follow-up period.
Results
We included 153 patients, more than half of whom had stage III (58.2%) and high-grade tumors (60.8%). The overall pCR rate was 34.6%, and 41% of the patients with residual disease received adjuvant capecitabine. Disease-specific survival (DSS) among the patients who achieved pCR was significantly higher (p<0.0001). Residual disease after NACT was associated with detrimental effects on DSS. In this cohort, we did not observe any survival benefit of adding adjuvant capecitabine for patients with TNBC subjected to NACT who did not achieve pCR (p=0.52).
Conclusion
Our study failed to demonstrate a survival benefit of extended capecitabine therapy in patients with TNBC with residual disease after NACT. More studies are warranted to better understand the indication of systemic treatment escalation in this scenario.
Key-words Breast neoplasmsCapecitabine/therapeutic useNeoadjuvant therapyTriple-negative breast neoplasmsSee moreViews186This 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 ArticleReal-world data on adjuvant capecitabine after standard neoadjuvant chemotherapy for triple negative breast cancer
Revista Brasileira de Ginecologia e Obstetrícia. 2024;46:e-rbgo29
- Maria Fernanda Imperio Pereira ,
- Isabela Panzeri Carlotti Buzatto ,
- Hélio Humberto Angotti Carrara ,
- Fabiana de Oliveira Buono ,
- Jurandyr Moreira de Andrade ,
- Leonardo Fleury Orlandini ,
- Daniel Guimarães Tiezzi
Views186Abstract
Objective
Neoadjuvant chemotherapy (NACT) has become the standard of care for patients with triple-negative breast cancer (TNBC) with tumors > 1 cm or positive axillary nodes. Pathologic complete response (pCR) has been used as an endpoint to select patients for treatment scaling. This study aimed to examine the benefit of adding adjuvant capecitabine for TNBC patients who did not achieve pCR after standard NACT in a real-world scenario.
Methods
This retrospective cohort study included all patients with TNBC who underwent NACT between 2010 and 2020. Clinicopathological data were obtained from the patient records. Univariate and multivariate analyses were conducted at the 5 years follow-up period.
Results
We included 153 patients, more than half of whom had stage III (58.2%) and high-grade tumors (60.8%). The overall pCR rate was 34.6%, and 41% of the patients with residual disease received adjuvant capecitabine. Disease-specific survival (DSS) among the patients who achieved pCR was significantly higher (p<0.0001). Residual disease after NACT was associated with detrimental effects on DSS. In this cohort, we did not observe any survival benefit of adding adjuvant capecitabine for patients with TNBC subjected to NACT who did not achieve pCR (p=0.52).
Conclusion
Our study failed to demonstrate a survival benefit of extended capecitabine therapy in patients with TNBC with residual disease after NACT. More studies are warranted to better understand the indication of systemic treatment escalation in this scenario.
Key-words Breast neoplasmsCapecitabine/therapeutic useNeoadjuvant therapyTriple-negative breast neoplasmsSee 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 Fernanda Imperio Pereira
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Original Article07-26-2024
Mid-pregnancy circulating cytokine levels, placental efficiency and their relationship with preterm birth
- Carlos Grandi ,
- Karina Bezerra Salomão ,
- Stella Felippe de Freitas ,
- Paulo Ricardo Higassiaraguti Rocha ,
- Ricardo de Carvalho Cavalli , [ ... ],
- Viviane Cunha Cardoso
Abstract
Original ArticleMid-pregnancy circulating cytokine levels, placental efficiency and their relationship with preterm birth
Revista Brasileira de Ginecologia e Obstetrícia. 2024;46:e-rbgo58
- Carlos Grandi ,
- Karina Bezerra Salomão ,
- Stella Felippe de Freitas ,
- Paulo Ricardo Higassiaraguti Rocha ,
- Ricardo de Carvalho Cavalli ,
- Viviane Cunha Cardoso
Views189See moreAbstract
Objective
To assess a panel of cytokines and placental insufficiency with the risk of preterm delivery (PTD).
Methods
Nested case-control study into the BRISA birth cohort. Eighty-two mother-infant-placenta pairs were selected at 20+0 to 25+6 weeks. Circulating biomarker levels were performed using Luminex flowmetric xMAP technology. Cytokines classified as Th1, Th2 or Th17 and other biomarkers were selected. The ratio between birth weight and placental weight (BW/PW) was used as a proxy for placental efficiency. Spearman correlation, univariate analyses and logistic regression models were calculated. Sensitivity, specificity, positive and negative likelihood ratios were calculated using the Receiver Operating Characteristic curve.
Results
Mean gestational age was 250 days, 14,6% were small for gestational age, 4,8% large for gestational age and 13,4% stunted. Placental efficiency was higher for term newborns (p<0,001), and 18/22 (81%) preterm biomarker values were higher than the control group. Th1 cytokines were highly correlated, while the weakest correlation was observed in other biomarkers. Less education was associated with a higher risk of PTD (p = 0.046), while there was no appreciable difference in the risk of PTD for placental insufficiency. Biomarkers showed negligible adjusted OR of PTD (0.90 to 1.02). IL-6, IL-8, IL-1β, TNFβ, IL-4, IL-13, GCSF, MIP1A, VEGF, EGF, and FGF2 presented a higher sensitivity ranging from 75.56% to 91.11%.
Conclusion
IL-8, IL-12p40, IL-4, IL-13, GCSF, MIP1B, and GMSF in asymptomatic pregnant women were associated with PTD. This finding suggests an activation of maternal inflammatory response.
Views189This 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 ArticleMid-pregnancy circulating cytokine levels, placental efficiency and their relationship with preterm birth
Revista Brasileira de Ginecologia e Obstetrícia. 2024;46:e-rbgo58
- Carlos Grandi ,
- Karina Bezerra Salomão ,
- Stella Felippe de Freitas ,
- Paulo Ricardo Higassiaraguti Rocha ,
- Ricardo de Carvalho Cavalli ,
- Viviane Cunha Cardoso
Views189See moreAbstract
Objective
To assess a panel of cytokines and placental insufficiency with the risk of preterm delivery (PTD).
Methods
Nested case-control study into the BRISA birth cohort. Eighty-two mother-infant-placenta pairs were selected at 20+0 to 25+6 weeks. Circulating biomarker levels were performed using Luminex flowmetric xMAP technology. Cytokines classified as Th1, Th2 or Th17 and other biomarkers were selected. The ratio between birth weight and placental weight (BW/PW) was used as a proxy for placental efficiency. Spearman correlation, univariate analyses and logistic regression models were calculated. Sensitivity, specificity, positive and negative likelihood ratios were calculated using the Receiver Operating Characteristic curve.
Results
Mean gestational age was 250 days, 14,6% were small for gestational age, 4,8% large for gestational age and 13,4% stunted. Placental efficiency was higher for term newborns (p<0,001), and 18/22 (81%) preterm biomarker values were higher than the control group. Th1 cytokines were highly correlated, while the weakest correlation was observed in other biomarkers. Less education was associated with a higher risk of PTD (p = 0.046), while there was no appreciable difference in the risk of PTD for placental insufficiency. Biomarkers showed negligible adjusted OR of PTD (0.90 to 1.02). IL-6, IL-8, IL-1β, TNFβ, IL-4, IL-13, GCSF, MIP1A, VEGF, EGF, and FGF2 presented a higher sensitivity ranging from 75.56% to 91.11%.
Conclusion
IL-8, IL-12p40, IL-4, IL-13, GCSF, MIP1B, and GMSF in asymptomatic pregnant women were associated with PTD. This finding suggests an activation of maternal inflammatory response.
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. - Carlos Grandi
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Original Article07-26-2024
Factors associated with exclusive breastfeeding in “Near Miss” neonates in Brazil
Revista Brasileira de Ginecologia e Obstetrícia. 2024;46:e-rbgo59
Abstract
Original ArticleFactors associated with exclusive breastfeeding in “Near Miss” neonates in Brazil
Revista Brasileira de Ginecologia e Obstetrícia. 2024;46:e-rbgo59
Views135See moreAbstract
Objective
To assess the association between sociodemographic and perinatal factors and hospital practices to encourage exclusive breastfeeding in near miss neonates in maternity hospitals.
Methods
This is a prospective cohort of live births from the survey “To be born in Brazil” conducted between 2011 and 2012. The weighted number of newborns who met the neonatal near miss criteria was 832. Exclusive breastfeeding at hospital discharge and 45 days after delivery were dependent variables of the study. The sociodemographic and perinatal factors of the puerperal women and hospital practices to encourage breastfeeding were independent variables. The data were analyzed with Poisson regression and set with p value<0.05. Is exclusive breastfeeding in neonatal near misses associated with factors related to sociodemographic conditions, maternal characteristics and the organization of health services?
Results
Data from 498 women and their children were analyzed. Mothers with incomplete primary education were more likely (36%) to have exclusive breastfeeding (RR: 1.36; 95% CI: 1.06-1.74) at discharge. Women who did not offer the breast to the newborn in the joint accommodation (65%) were less likely to be breastfeeding exclusively (RR: 0.65; 95% CI: 0.56-0.75) at discharge. Variables that increased the probability of exclusive breastfeeding after 45 days of delivery were primiparity (RR: 1.36; 95% CI: 1.08-1.69) and having the newborn in the delivery room (RR: 1.90; 95% CI: 1.12-3.24).
Conclusion
Exclusive breastfeeding in neonatal near misses was associated with maternal characteristics and important hospital practices, such as being breastfed in the joint accommodation and the newborn being in the mother’s lap in the delivery room.
Views135This 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 ArticleFactors associated with exclusive breastfeeding in “Near Miss” neonates in Brazil
Revista Brasileira de Ginecologia e Obstetrícia. 2024;46:e-rbgo59
Views135See moreAbstract
Objective
To assess the association between sociodemographic and perinatal factors and hospital practices to encourage exclusive breastfeeding in near miss neonates in maternity hospitals.
Methods
This is a prospective cohort of live births from the survey “To be born in Brazil” conducted between 2011 and 2012. The weighted number of newborns who met the neonatal near miss criteria was 832. Exclusive breastfeeding at hospital discharge and 45 days after delivery were dependent variables of the study. The sociodemographic and perinatal factors of the puerperal women and hospital practices to encourage breastfeeding were independent variables. The data were analyzed with Poisson regression and set with p value<0.05. Is exclusive breastfeeding in neonatal near misses associated with factors related to sociodemographic conditions, maternal characteristics and the organization of health services?
Results
Data from 498 women and their children were analyzed. Mothers with incomplete primary education were more likely (36%) to have exclusive breastfeeding (RR: 1.36; 95% CI: 1.06-1.74) at discharge. Women who did not offer the breast to the newborn in the joint accommodation (65%) were less likely to be breastfeeding exclusively (RR: 0.65; 95% CI: 0.56-0.75) at discharge. Variables that increased the probability of exclusive breastfeeding after 45 days of delivery were primiparity (RR: 1.36; 95% CI: 1.08-1.69) and having the newborn in the delivery room (RR: 1.90; 95% CI: 1.12-3.24).
Conclusion
Exclusive breastfeeding in neonatal near misses was associated with maternal characteristics and important hospital practices, such as being breastfed in the joint accommodation and the newborn being in the mother’s lap in the delivery room.
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.
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