This study was carried out to evaluate the early results and the prognostic factors affecting the outcome during the in-hospital stay of 110 patients with civilian gunshot wounds to the head admitted at the Hospital of Restauração, Recife, Brazil. Penetrating injury (66%) was the most prevalent type of wound encountered in the present series. Twelve of the 110 (10.9%) patients presented a unilateral dilated pupil at the admission. Motor impairment was present in 24/110 (21.8%) patients. Intracerebral hematoma was present in 36/110 (32.7%) and there were 15/110 (13%) patients with cerebrospinal fluid fistula. Eleven of 110 patients developed meningitis and in 9/110 intracranial abscesses occurred. Nine of 110 patients developed deep venous thrombosis, 11/110 had urinary infection, and coagulopathy was detected in 8/110. Following the surgical procedure, 27/110 (24.5%) patients died during their hospital stay. When the two groups, survivors and non-survivors, were compared, there were significant statistical differences and the univariate analysis identified five preoperative predictors of a poor outcome following surgery: age over 40 years (odds ratios (OR) 5.4, 95% CI 1.73-16.82); presence of unilateral pupil dilatation (OR 5.5, 95% CI 1.641-18.13); low (≤8) Glasgow coma score on admission (OR 6.50, 95% CI 2.27-18.60), presence of intracranial hematoma (OR 3.0, 95% CI 1.21-7.34), and respiratory infection (OR 4.8, 95% CI 1.75-13.47). Thus, (a) age of the patient (juvenile/young age), (b) high preoperative Glasgow coma score, (c) lack of pupil abnormalities, and (d) absence of intracerebral hematoma are predictors of a good prognosis.
The discussion about the palliative care approach in spinocerebellar ataxia (SCA) has become extremely relevant. Mainly after considering that most progressive ataxias are incurable, there are few published studies on their palliative and end-of-life care. Although many patients with degenerative neurological diseases have a normal life expectancy, some forms of SCA (e.g., type 1, 2, 3, and 17) can progress rapidly, with a shorter life span. This chapter will discuss current guidelines and recommendations that have been drawn from the broader field of progressive neurological conditions. In addition, we also review aspects of strategic end-of-life care management, the involvement of the multidisciplinary team and the contribution of allied health professionals are essential for excellent patient support care in a palliative approach. More studies on your supportive care and end-of-life care to manage this serious illness to improve quality of life and reduce suffering, addressing complex medical symptoms, psychosocial issues, general well-being, and planning strategies for better living and coping are needed.
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