Délio Marques Conde

Refining breast cancer risk estimation in carriers of pathogenic BRCA2 variants

Background and Objective: Around 6% of female breast cancer (BC) cases are attributed to an inherited predisposition. Of the genes associated with an increased risk of BC, CHEK2 stands out as one of those most commonly identified. This review discusses various aspects of the association between the CHEK2 pathogenic variants (PVs) and BC. Methods: This narrative review involved a comprehensive search of the literature in the PubMed, Embase, Google Scholar and the Latin American and the Caribbean Literature on Health Sciences (LILACS) databases. Original articles, reviews, meta-analyses, medical society consensuses and guidelines published in English were included. Key Content and Findings: This review highlights the complexity and challenges involved in managing CHEK2 PV carriers. When assessing the risk of BC in these individuals, family history and the type of mutation (either missense or protein-truncating) are relevant factors, emphasizing the need for personalized risk assessments. Few studies involving large cohorts and focusing on different outcomes were identified, specifically in CHEK2 PV carriers. Consequently, further studies with CHEK2 PV carriers are required that take genetic diversity into consideration, since the available data originate predominantly from cohorts with European ancestry. Conclusions: This review provides up-to-date evidence on the association between CHEK2 PVs and BC and its implications for the counseling and management of carriers.

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 […] Abstract 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 […]

Objective: The aim of this study was to present a new technique for hybrid marking of non-palpable breast lesions and in vivo evaluation of surgical margins, called Fluorescence and Seed for Hybrid Intraoperative Evaluation. Methods: Seven women with non-palpable breast lesions and suspected or confirmed malignancy underwent prior iodine-125 seed implantation and peripheral intravenous administration of indocyanine green 30 min before surgery. A hybrid gamma probe with an optonuclear probe was used to detect gamma radiation in the lesions and, sequentially, the fluorescence mode, in the same lesion and its margins, after its removal. Results: This method distinguished, in real time, one benign and six malignant lesions, guiding the removal, identifying the remaining neoplastic area in the surgical bed, and allowing its intraoperative enlargement. Conclusion: This pilot study evaluates the feasibility of this new technique in identifying the primary lesion and controlling surgical margins using hybrid technology.

Objective: To understand the meaning of chronic pelvic pain from the perspective of diagnosed women and analyze the determining factors for outpatient discharge. Methods: This is qualitative research, using strategic social research as its theoretical methodological framework. 14 women participated in the study, seven of whom were undergoing outpatient follow-up and seven who were discharged from the gynecology outpatient clinic of a university hospital in the city of Goiânia, Goiás, Brazil. Semi-structured interviews were carried out with guiding questions. The analysis of results was based on the thematic modality of content analysis, according to Bardin. Results: Data analysis culminated in three thematic categories: “Before the pain”, “Living with the pain” and “Treating the pain”. Parental emotional abandonment, grief, disagreement with parents and childhood difficulties were prominent before the onset of pain. The onset of pain was related to the birth of children, menarche, surgeries and family conflicts. Living with pain promoted great suffering, fear, harm to relationships and work activity. The improvement in emotional state and financial conditions, the resolution of marital conflicts, the opportunity to express oneself and talk to other patients, the use of medication and some surgical procedures were decisive for pain control and outpatient discharge. Conclusion: Chronic pelvic pain was related to socioeconomic, emotional and physical suffering. The resolution of these aspects contributed to outpatient discharge.

Resumo Objetivo Compreender o significado da dor pélvica crônica sob a ótica das mulheres diagnosticadas e analisar os fatores determinantes para a alta ambulatorial. Métodos Pesquisa de natureza qualitativa, tendo como referencial teórico metodológico a Pesquisa Social do tipo Estratégica. Participaram do estudo 14 mulheres, sendo sete em seguimento ambulatorial e sete que receberam alta, no ambulatório de ginecologia de um hospital universitário no município de Goiânia, Goiás, Brasil. Foram realizadas entrevistas semiestruturadas, com questões norteadoras. A análise dos resultados

Chronic pelvic pain (CPP) in women is a highly prevalent condition worldwide and requires multimodal treatment. Adverse childhood experiences have been associated with CPP in women, while allodynia and poor outcomes have been linked to pain catastrophizing in these patients. Pain perception has been associated with parenting style during childhood. The objective of this study was to investigate the association between parenting style, pain catastrophizing, anxiety, depression and CPP in women. A case–control study was conducted between May 2018 and August 2021 with 123 women with CPP and 123 pain-free controls. Questionnaires were used to collect participants’ data. The association between parenting style and CPP was assessed using multiple logistic regression, with odds ratios (OR) and 95% confidence intervals (CI) being calculated. The correlation between catastrophizing, pain intensity, pain duration, anxiety, depression, and parenting style in women with CPP was assessed using Spearman’s rank correlation coefficient (r). A higher frequency of low maternal care (60.7% versus 45.2%; p = 0.026), anxiety (79.7% versus 56.9%; p < 0.001), depression (73.2% versus 56.1%; p = 0.008) and physical violence (31.7% versus 14.6%; p = 0.003) was found in the CPP group compared to the controls. There was no association between parenting style and CPP in the adjusted analysis. A positive correlation was found between catastrophizing and pain intensity (r = 0.342; p < 0.001), anxiety (r = 0.271; p = 0.002), depression (r = 0.272; p = 0.002), and maternal overprotection (r = 0.185; p = 0.046). A negative correlation was found between anxiety and maternal (r = −0.184; p = 0.047) and paternal (r = −0.286; p = 0.006) care and between depression and maternal (r = −0.219; p = 0.018) and paternal (r = −0.234; p = 0.026) care. The present results suggest a significant but weak association of parenting style with pain catastrophizing, the mental health of women with CPP, and the way in which they experience pain.

Chronic pelvic pain (CPP) affects a significant proportion of women worldwide And has a negative impact on several aspects of these women’s lives including mental health, work, relationships and sexual function, among others. This set of factors ultimately reflects negatively on quality Of life. The physiopathology of CPP is complex and remains to be fully clarified; however, recent advances have increased understanding of the mechanisms involved in chronic pain in general, and more specifically, CPP. Nonetheless, even when a detailed clinical history is obtained, meticulous physical examination is performed and imaging resources are appropriately used, the organic cause of the pain may still fail to be identified in a substantial number of women with CPP. Management of CPP may therefore be challenging. This narrative review was aimed at adding to the available literature on the subject, presenting and discussing the principal characteristics of CPP in women. The paper highlights gaps in the literature while providing the most up-to-date evidence associated with the physiopathology and classification of pain, its diagnosis and treatment. In addition, current challenges in the management of women with CPP are discussed.

Objective. To investigate the association between parental bonding styles and anxiety, depression, suicidal ideation, and self‐efficacy beliefs in undergraduate medical students. Methods. A cross‐sectional, self‐administered survey involving 315 Brazilian medical students was conducted online. The Parental Bonding Instrument (PBI), the Generalized Anxiety Disorder‐7 (GAD‐7) scale, the 9‐item Patient Health Questionnaire (PHQ‐9), the Suicidal Behaviors Questionnaire‐Revised (SBQ‐R), and the general self‐efficacy (GSE) scale were used. The internal consistency of the instruments used in the study was analyzed using Cronbach’s alpha. Multiple logistic regression models were applied, and the odds ratios (OR) and respective 95% confidence intervals (CI) were calculated to determine the association between parental bonding styles and anxiety, depression, suicidal ideation, and general self‐efficacy beliefs. Results. In the analysis adjusted for sociodemographic variables, maternal affectionless control was associated with a greater risk of anxiety (OR = 2.48; 95% CI: 1.15‐5.33), depression (OR = 7.54; 95% CI: 3.20‐17.78), suicidal ideation (OR = 3.62; 95% CI: 1.58‐8.27), and low self‐efficacy (OR = 3.81; 95% CI: 1.76‐8.25), while maternal neglectful parenting was associated with depression (OR = 3.24; 95% CI: 1.17‐8.96) and paternal affectionate constraint with suicidal ideation (OR = 3.09; 95% CI: 1.36‐7.02). Conclusions. These findings showed dysfunctional parenting styles to be associated with mental illnesses and low self‐efficacy in Brazilian undergraduate medical students. This should be taken into consideration when treating medical students with mental disorders.

Chronic post-surgical pain (CPSP) is one of the post-surgical complications of a Cesarean section. Despite the high rates of Cesarean section worldwide, the incidence of CPSP and the risk factors for this condition remain relatively unknown. The objective of this study was to calculate the incidence of CPSP in women submitted to Cesarean section and to analyze the associated risk factors. A prospective cohort of 621 women undergoing Cesarean section was recruited preoperatively. Potential presurgical (sociodemographic, clinical and lifestyle-related characteristics) and post-surgical risk factors (the presence and intensity of pain) risk factors were analyzed. Pain was measured at 24 hours and 7, 30, 60 and 90 days after surgery. Following discharge from hospital, data were collected by telephone. The outcome measure was self-reported pain three months after a Cesarean section. The risk factors for chronic pain were analyzed using the log-binomial regression model (a generalized linear model). A total of 462 women were successfully contacted 90 days following surgery. The incidence of CPSP was 25.5% (95%CI: 21.8–29.7). Risk factors included presurgical anxiety (adjusted relative risk [RR] 1.03; 95%CI: 1.01–1.05), smoking (adjusted RR 2.22; 95%CI: 1.27–3.88) and severe pain in the early postoperative period (adjusted RR 2.79; 95%CI: 1.29–6.00). One in four women submitted to Cesarean section may develop CPSP; however, the risk factors identified here are modifiable and preventable. Preventive strategies directed towards controlling anxiety, reducing smoking during pregnancy and managing pain soon after hospital discharge are recommended.