RESUMO
BACKGROUND: 5-Fluorouracil (5-FU) is essential in treating gastrointestinal cancers, but some patients show severe toxicity. The toxicity is exposure-related, which is linked to the enzyme dihydropyrimidine dehydrogenase (DPD) decoded by the DPYD gene. This study aimed to evaluate the possible toxicity related to 5-FU plasma levels, DPYD genotyping, and DPD phenotyping. METHODS: Forty-seven gastrointestinal cancer patients receiving 5-FU were included in this study. 5-FU plasma levels and DPD phenotyping were analyzed by UPLC-MS/MS. DPYD genotyping was also assessed. The Common Terminology Criteria for Adverse Events (CTCAE) was used to classify the toxicity. RESULTS: For hematological toxicity, 27.65% showed neutropenia, 78.72% anemia, and 29.78% thrombocytopenia. The area under the curve (AUC) of 5-FU calculated from the plasma was evaluated for three treatment cycles, and we observed that at the initial cycle, 48.93% were underexposed and 10.63% were overexposed, with a total of 59.56% of patients outside the therapeutic range. In the DPYD genotyping, 97.87% of patients had a wild-type genotype, and 2.12% had c.1236G>A mutation (E412E, rs56038477). A total of 82.97% of patients showed a phenotype compatible with normal DPD activity. CONCLUSION: These findings suggest that the evaluation of DPYD genotyping and DPD phenotyping in the Brazilian population still requires further study. Moreover, the analysis of the plasma AUC of 5-FU could contribute to clinical routine, being a very useful tool, especially for identifying patients outside the therapeutic range and thus guiding more individualized doses, or even in the intervention of possible toxicities related to overexposure.
RESUMO
RESUMO Introdução: As lesões de manguito rotador são uma das principais causas de incapacitação da prática de exercícios físicos e de ausência no trabalho. A população acometida por essa patologia apresenta diferentes perfis. Exames de imagem são recursos de elevada relevância no diagnóstico dessas lesões, sendo a ressonância magnética extensamente utilizada como ferramenta diagnóstica, por ser capaz de detectar com eficiência características morfológicas da ruptura do tendão. Este estudo teve como objetivo estimar a prevalência e as características das lesões de manguito rotador em exames de ressonância magnética de ombro realizados em uma clínica ortopédica. Métodos: Foi realizado um estudo observacional com delineamento transversal, que analisou 292 laudos de ressonância magnética de ombro de pacientes com idade entre 18 e 65 anos, realizados entre julho de 2016 e junho de 2017. O nível de significância estabelecido foi de 5% (p < 0,05). Resultados. Observou-se prevalência de 91,1% de lesões de manguito rotador nos laudos analisados, sendo o supraespinhal acometido em 89,7% destes. A média de idade dos pacientes com lesão de manguito rotador foi superior à dos pacientes sem lesão. Alterações degenerativas acromioclaviculares, presença de líquido na bursa e tendinopatia da cabe- ça longa do bíceps apresentaram correlação com as lesões de manguito. Conclusão: Concluiu-se que as lesões do manguito rotador apresentaram alta prevalência, em especial as do músculo supraespinhal. Envelhecimento e achados associados nos laudos de imagem tiveram correlação com o surgimento dos diferentes tipos de lesão do manguito. PALAVRA-CHAVE: Manguito rotador, tendinopatia, imagem por ressonância magnética
ABSTRACT Introduction: Rotator cuff injuries are one of the main causes of disability from physical exercise and absence from work. The population affected by this pathology has different profiles. Imaging scans are highly relevant resources in the diagnosis of these injuries, and magnetic resonance is extensively used as a diagnostic tool, as it is capable of efficiently detecting morphological characteristics of tendon rupture. This study aimed to estimate the prevalence and characteristics of rotator cuff injuries in MRI scans of the shoulder performed in an orthopedic clinic. Methods: An observational, cross-sectional study was carried out, which analyzed 292 shoulder MRI reports of patients aged between 18 and 65 years, carried out between July 2016 and June 2017. The level of significance established was 5% (p < 0.05). Results. There was a prevalence of 91.1% of rotator cuff injuries in the analyzed reports, with the supraspinatus being affected in 89.7% of these. The mean age of patients with rotator cuff injuries was higher than that of patients without injuries. Acromioclavicular degenerative changes, presence of fluid in the bursa, and tendinopathy of the long head of the biceps correlated with cuff injuries. Conclusion: It was concluded that rotator cuff injuries had a high prevalence, especially those of the supraspinatus muscle. Aging and associated findings in the imaging reports were correlated with the appearance of different types of cuff injuries. KEYWORDS: Rotator cuff, tendinopathy, magnetic resonance imaging