This study aimed to quantify the average survival time of cancer patients once terminal sedation was started until death and identify potential variables that may influence their survival time on sedation. This is a retrospective cohort analysis of all consecutive terminal cancer patients who died after starting terminal sedation at public tertiary Brazilian Hospital. A total of 532 cancer patients died in Hospital Estadual Mário Covas during this period and 181 out of them who received terminal sedation were included in this analysis. The median survival was 27 h. By multivariate analysis, increase in the dose of sedative drug during sedation (odds ratio 1.576, 95% CI 1.113-2.232), use of opioids alone for sedation (odds ratio 1.438, 95% CI 1.046-1.977) and dyspnoea as cause of sedation (odds ratio 1.564 95% CI 1.045-2.341) were independent risk factors for a shorter survival time after starting terminal sedation. Sedated, terminal cancer patients usually live about 1 day. We identified risk factors for a shorter sedation period. This study is limited by its retrospective design and by the frequent use of opioids as the main sedative medications. Prospective studies must be carried out in order to validate these data.
As malformações congênitas, deformidades e anomalias cromossômicas são qualquer tipo alteração da estrutura anatômica normal, presente ao nascimento. Resultam em defeitos na estrutura, forma e/ou função de órgãos, células ou componentes celulares presentes antes do nascimento e surgidas em qualquer fase do desenvolvimento fetal, e estima-se que cerca de 3% dos recém-nascidos tenham uma grande anomalia. Diante da relevância que as patologias associadas às malformações congênitas apresentam, é importante realizar estudo epidemiológico sobre malformações congênitas, deformidades e anomalias cromossômicas, no Nordeste do Brasil, de 2014-2018, para que se conheça a realidade da nossa região frente ao problema de saúde pública que tais patologias configuram. Assim, o objetivo deste estudo foi estudar as malformações congênitas no Nordeste do Brasil de 2014-2018.Foi realizado estudo epidemiológico, com dados secundários oriundos do Sistema de Informação do SUS-DATASUS. Os dados foram tabulados em planilhas Excel® e submetidos à análise estatística através do Programa Bioestat 5.3, no qual foram realizadas a estatística descritiva e análise de variância, considerando-se o nível de significância de 95%(p<0.05). Ocorreram no período em estudo n=98310 internações por malformações congênitas. Dentre os Estados, destacou-se a Bahia (n=26550). Quanto à faixa etária os menores de 1 ano foram mais atingidos (n=26258). Quanto ao sexo, houve predomínio no sexo masculino (n=55700). A raça parda foi mais afetada (n=41927) e as malformações do aparelho circulatório foram mais frequentes (21,4%). A mortalidade por malformações congênitas foi de n=2822, mais frequentes em < 1 ano (n=2149) e dentre os Estados, houve mais óbitos na Bahia (n=603 óbitos). Considera-se que ocorreu um grande número de internações por malformações congênitas no Nordeste brasileiro, bem como ocorreram óbitos por tais patologias, mais frequentes em menores de 1 ano. A realização de estudos epidemiológicos, podem subsidiar melhorias na fundamentação de políticas públicas visando melhorias no que se refere à prevenção, diagnóstico e tratamento de tais patologias.
e20653 Background: In practice it is common to start terminal sedation for patients with advanced cancer who develop physical discomfort not amenable to be treated by other means. We aimed at quantifying the average survival time of terminal cancer patients once sedation was started until death and identify potential variables that may influence their survival time on sedation. Methods: This is a retrospective cohort analysis of all consecutive terminal cancer patients who died after starting terminal sedation at public tertiary brazilian Hospital during 2 years (January 2005 to January 2007). Results: 532 cancer patients died in Hospital Estadual Mário Covas during this period and 181 out of them who received terminal sedation were included in this analysis. The median survival was 27 hours. By multivariate analysis, increase in the dose of sedative drug during sedation (Odds Ratio 1.576, 95% CI 1.113–2.232); use of opioids alone for sedation (Odds Ratio 1.438, 95% CI 1.046–1.977); and dyspnea as cause of sedation (Odds Ratio 1.564 95% CI 1.045–2.341) were independent risk factors for a shorter survival time after starting terminal sedation. Conclusions: Sedated, terminal cancer patients usually live about one day. We identified risk factors for a shorter sedation period. This study is limited by its retrospective design and by the frequent use of opioids as the main sedative medications. Prospective studies must be carried out in order to validate these data in settings in which non-opiods are the main sedative medications. No significant financial relationships to disclose.
A previously healthy 13-year-old boy, 2 weeks prior to the presentation, developed diarrhea (3 watery stools per day non-mucoid/bloody), vomiting, and fever, was diagnosed with acute gastroenteritis and prescribed with probiotics. These symptoms resolved, but after 1 week fever recurred. Moreover, patient developed abdominal pain, located to the right upper quadrant, radiation to the right iliac fossa, variable intensity, and no specific relation to food intake. Pain in the right shoulder was also mentioned. The patient continued to worsen clinically with progressive anorexia, lethargy, and 5 kg weight loss which prompted presentation to the pediatric emergency department. He had no respiratory and urinary symptoms. There was no recent travel history or animal exposure. The patient denied either consumption of undercooked food or unbottled water.On physical examination, he was markedly pale. His abdomen was soft with diffuse mild tenderness, more significant on the right quadrants. There was no rebound tenderness located at the McBurney point. No organomegalies were found. The remaining physical examination was normal.Initial laboratory test results revealed the following: hemoglobin level, 11.2 g/dL; white blood cell count, 27.14 × 10 9 /L (77% neutrophils, 10% lymphocytes); platelet count, 425 × 10 9 /L; C-reactive protein level was 22.19 mg/dL; hepatic enzymes levels were high: aspartate aminotransferase, 94 U/L and alanine aminotransferase, 130 U/L. Gamma-glutamyl transferase level was 161 U/L, alkaline phosphatase level was 324 U/L, and lactate dehydrogenase level was 569 U/L. Coagulation tests were unremarkable. Blood and urine cultures were performed.A chest radiograph showed a small right-sided pleural effusion. Abdominal ultrasound demonstrated a
The deletion of the long arm of chromosome 4 is rare, presenting with a variable phenotype depending on the chromosomic area affected. A term newborn with prenatal diagnosis of anhydramnios, dysplastic cystic kidneys, and cardiomegaly was born with generalized subcutaneous edema, several dysmorphic features, and progressive renal failure requiring dialysis. The infant continued to deteriorate and died at 52 days of age. Autopsy confirmed bilateral renal dysplasia with cysts. Array-comparative genomic hybridization (CGH) identified a large deletion on 4q25-q28.3, which is not yet described in association with renal disease. The clinical progression could be expected due to the severity of the perinatal clinical presentation.
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