Cirurgia paliativa do ombro em paralisia obstétrica do plexo braquial

A paralisia obstétrica do plexo braquial é rara originando disfunção grave e défice marcado da rotação externa e da abdução do ombro. Reviram-se retrospectivamente 11 casos de paralisia obstétrica do plexo braquial (sete com paralisia alta e quatro com paralisia completa) tratados cirurgicamente pela técnica de L’Épiscopo modificada por Hoffer. Estes resultados foram padronizados segundo o tipo de lesão (grupo A – lesão alta; grupo B – lesão completa) e a idade (grupo I ≤ 4 anos; grupo II > 4 anos). O seguimento médio foi de 35 meses. A idade média aquando da cirurgia era de 6,5 anos (r= 2–11). Todos, excepto um, apresentaram melhoria funcional, com aumento da pontuação média de Mallet de 4,6 pontos. Os dois subtipos de paralisia tiveram pontuação média de Mallet sobreponível (grupo A – 4.6; grupo B – 4.7); a idade aquando da cirurgia não influenciou o resultado clínico (pontuação média (grupo I) – 4.8; (grupo II) – 4.4). Não foram registadas complicações. A técnica de L’Épiscopo modificada por Hoffer é eficaz no tratamento paliativo do ombro em paralisia obstétrica do plexo braquial, permitindo recuperação da abdução e rotação externa do ombro. Está indicada em paralisias altas e completas, quando associada a outras cirurgias de recuperação da função do cotovelo, punho e/ou mão. Idade superior a 4 anos não contra-indica a cirurgia desde que sejam excluídas alterações da articulação glenoumeral.

Endothelial damage is aggravated in acute GvHD and could predict its development

The aim of the present study was to explore whether there is enhanced endothelial dysfunction in patients developing acute GvHD (aGvHD) after allogeneic hematopoietic cell transplantation (allo-HCT) and to identify biomarkers with predictive and/or diagnostic value. In in vitro experiments, endothelial cells (ECs) were exposed to serum from patients with (aGvHD, n=31) and without (NoGvHD, n=13) aGvHD, to evaluate changes in surface adhesion receptors, the reactivity of the extracellular matrix by measuring the presence of Von Willebrand factor (VWF) and platelet adhesion, and the activation of intracellular signaling proteins. Plasma levels of VWF, ADAMTS-13, TNF receptor 1 (TNFR1), soluble vascular cell adhesion molecule 1 and soluble intercellular adhesion molecule 1 were also measured. In vitro results showed a more marked proinflammatory and prothrombotic phenotype in ECs in association with aGvHD. Regarding circulating biomarkers, levels of VWF and TNFR1 above an optimal cutoff score, taken independently or combined, at day 7 after allo-HCT, would be able to positively predict that around 90% of patients will develop aGvHD. Our results demonstrate that endothelial damage is aggravated in those allo-HCT recipients developing aGvHD, and that VWF and TNFR1 are promising predictive aGvHD biomarkers. These findings could contribute to improve the understanding of the pathophysiology of aGvHD.

Age of blood and survival after massive transfusion

BACKGROUND

Massive transfusion is the clinical scenario where the presumed adverse effects of stored blood are expected to be more evident because the whole patient's blood volume is replaced by stored blood.

OBJECTIVE

To analyse the association between age of transfused red blood cells (RBC) and survival in massively transfused patients.

METHODS

In this retrospective study, clinical and transfusion data of all consecutive patients massively transfused between 2008 and 2014 in a large, tertiary-care hospital were electronically extracted from the Transfusion Service database and the patients' electronic medical records. Prognostic factors for in-hospital mortality were investigated by multivariate logistic regression.

RESULTS

A total of 689 consecutive patients were analysed (median age: 61 years; 65% males) and 272 died in-hospital. Projected mortality at 2, 30, and 90 days was 21%, 35% and 45%, respectively. The odds ratio (OR) for in-hospital mortality among patients who survived after the 2nd day increased with patient age (OR: 1.037, 95% CI: 1.021-1.054; per year P<0.001), with the number of RBC unit transfused in the first 48hours (OR: 1.060; 95% CI: 1.038-1.020 per unit; P<0.001), and the percentage of such RBC stored for more than 28 days (1.010, 95% CI: 1.005-1.018 per percent point; P=0.01).

CONCLUSION

Mortality after massive transfusion was associated with a higher proportion of old RBCs transfused in the first 48hours. Other factors associated with poor prognosis were older patient's age and larger volumes of transfused RBCs.

Fatigue and return-to-work in cancer patients: Association with work ability and quality of life

Introduction

Fatigue is a common and debilitating problem in cancer survivors. Research show that this symptom endures even in disease-free patients affecting quality of life. Returning to work is physically and emotionally demanding for this population and fatigue levels seems to predict the time taken to return to work and the ability of the worker.

Objective

Our main objective was to explore the direct effect of the fatigue on work ability and quality of life of professionally active cancer survivors. Aims Fatigue levels, work ability and overall quality of life of survivors group were compared with a sample of individuals without cancer history. Relationship between fatigue symptoms and work ability and quality of life were examined within of the survivors group.

Methods

This cross-sectional study included 57 cancer survivors and 57 controls (n = 114) and data was collected from two Central Hospitals of Portugal. Participants completed the Functional Assessment of Chronic Illness Therapy-Fatigue, the Work Ability Index and the Functional Assessment of Cancer Therapy-General.

Results

Cancer survivors reported higher levels of fatigue than controls and worse work ability and quality of life (P < .001). Controlling the effect of the age and gender, fatigue of the cancer survivors group influenced negatively their overall quality of life (β= –.315, P= .013, R2= .143) but not their work ability.

Conclusions

Although the fatigue has not affected directly the work ability of the cancer survivors, two years or more after the conclusion of the treatments, this symptom has a significant effect on the quality of life.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

(Re)examining the Factorial sstructure of the Generalized Anxiety Disorder-7 in a College Students Sample

Introduction

Generalized anxiety in young adults during college career is a serious public-health problem that untreated has a chronic course. Research has shown that the self-report questionnaire generalized anxiety disorder-7 (GAD-7) is a reliable and valid measure to assess generalized anxiety symptoms severity in heterogeneous psychiatric samples. However, GAD-7 is not available for non-clinical populations and their factor structure has not been re-examined.

Objectives

Our objective was to examine factor structure and measurement invariance of the GAD-7 among college students testing two alternatives models.

Aims

The original model fit of single-factor was compared to two-factor model that considered in comprehensive approach of generalized anxiety the assessment of cognitive-emotional nature and somatic symptoms.

Methods

In this cross-sectional study the GAD-7 was administrated to college students (n = 1031) recruited in the six schools which compose the Polytechnic Institute of Coimbra, Portugal. Confirmatory factor analysis was used testing two models.

Results

Among college students, 32.8% reported significant generalized anxiety symptoms. The original unidimensional structure of GAD-7 was confirmed but the two-factor model comprising cognitive–emotional and somatic factors presented better fit to the data (χ2(1) = 21.01, P < 0001). This latent factor were positively associated (r = 0.51, P < 0.001) and presented a good internal consistency (α = 0.85 and α = 0.86 for cognitive-emotional and somatic items, respectively). The invariance factor of two-factor model across gender was also confirmed.

Conclusions

Results indicate that within college communities the GAD-7 integrates two stable generalized anxiety factors related but independent structure. The GAD-7 can be an adequate measure to detected generalized anxiety symptoms in this population.

Disclosure of interest

The authors have not supplied their declaration of competing interest.