This was a case-control study to identify prognostic indicators of bacterial meningitis in a reference hospital in Pernambuco/Brazil. The data were collected from charts of 294 patients with bacterial meningitis between January 2000 and December 2004. Variables were grouped in biological, clinical, laboratory and etiologic agent/treatment. Variables selected in each step were grouped and adjusted for age. Two models were created: one containing clinical variables (clinical model) and other containing laboratory variables (laboratory model). In the clinical model the variables associated with death due to bacterial meningitis were dyspnea (p=0.006), evidence of shock (p=0.051), evidence of altered mental state (p=0.000), absence of headache (p=0.008), absence of vomiting (p=0.052), and age ≥40 years old (p=0.013). In the laboratory model, the variables associated with death due to bacterial meningitis were positive blood cultures (p=0.073) and thrombocytopenia (p=0.019). Identification of prognostic indicators soon after admission may allow early specific measures, like admission of patients with higher risk of death to Intensive Care Units.
A despeito dos enormes avanços tecnológicos quanto ao diagnóstico, compreensão da sua patogênese e seu tratamento, a meningite bacteriana (MB) ainda permanece como importante doença de distribuição mundial, sendo também endêmica no Brasil ABSTRACTThere is controversy regarding indications for cerebrospinal fluid control tests on patients who have clinically recovered from bacterial meningitis, as a cure criterion. Some authors advocate discharge after confirmation of clinical and cerebrospinal fluid normalization, while others maintain that cerebrospinal fluid analysis is not justified in all cases. This case series with group comparisons investigated changes seen in cerebrospinal fluid control tests and evaluated the importance of this for the discharge decision. Out of 297 patients studied, the cerebrospinal fluid control test did not change the discharge intention in 89.9% of the cases (healed cerebrospinal fluid), while in 10.1%, the discharge was suspended (non-healed cerebrospinal fluid). Of these, the antibiotic scheme was changed in 30%. Among the variables that might predict the presence of non-healed cerebrospinal fluid on admission, cerebrospinal fluid protein levels higher than 100mg/dl (p = 0.04) and glycorrhachia lower than or equal to 20 mg/dl (p = 0.03) were associated with a 2.5-times greater chance. These may be useful as criteria for indicating cerebrospinal fluid control tests before discharge.Key-words: Bacterial meningitis. Cerebrospinal fluid. Cerebrospinal fluid protein levels. Glycorrhachia.por pneumococos resistentes à penicilina e cefalosporina, que receberam terapia com dexametasona e vancomicina 13. Contudo, há dúvidas sobre a indicação do exame do liquor de controle em todos os pacientes, após o tempo estimado de antibioticoterapia e estando já recuperados clinicamente da MB, como critério de alta hospitalar. Alguns autores defendem que a alta hospitalar só deve ser dada após a normalização do quadro clínico e liquórico 1 6 11 . Outros consideram que o critério para alta é fundamentalmente clínico e o exame de controle, como rotina, não é justificável em todos os pacientes 7 8 9 13 . Atualmente, no Hospital Correia
Resumo: Os cânceres de cabeça e pescoço tem crescido no mundo inteiro. São cerca de 200 mil pessoas por ano. Em termos de localização, os cânceres de cavidade oral, possuem uma incidência média de 13.470 novos casos novos por cada 100 mil habitantes, somente no Brasil. O objetivo do presente estudo foi analisar o perfil dos pacientes que tiveram câncer de cabeça e pescoço e que foram atendidos no hospital de câncer de Pernambuco no ano de 2014. Este estudo analisou 560 pacientes no ano de 2014, em um hospital especializado de Recife, Pernambuco, Brasil. As variáveis analisadas incluíram sexo, idade, histórico de consumo de álcool e cigarro, diagnóstico, localização do tumor, o tipo do tumor, primeiro tratamento recebido e desfecho deste tratamento. Os resultados demonstraram que a amostra foi predominantemente de homens (76,1%), de cor da pele parda (68,6%), tabagistas (59,5%), etilistas (51,4%) com idades entre 50 e 59 anos (32,5%), sendo que 61,2% possui nível de instrução fundamental. O local do tumor mais prevalente foi C02.9 (17,3%), o tipo histológico 807013 (80,5%) e o local da metástase mais prevalente foi C77 em 85,5% dos casos. Conclusões: Este estudo reafirma achados da literatura sobre a temática, bem como contribui para um maior conhecimento sobre as características dos pacientes atendidos num hospital especializado em Recife. Certamente uma grande contribuição para que se possa traçar políticas públicas mais adequadas para este tipo de doença.Palavras-chave: Câncer, neoplasias de cabeça e pescoço, álcool e tabaco. Patients Profile with Cancer Diagnosis of Head and Neck at a Specialized Hospital of Recife -Pernambuco, in the Year of 2014Abstract: Head and neck cancers have been growing all over the world. There are about 200 thousand people a year. In terms of location, oral cavity cancers have an average incidence of 13,470 new cases per 100,000 inhabitants, in Brazil alone. The objective of the present study was to analyze the profile of patients who had head and neck cancer who were treated at the Pernambuco Cancer Hospital in the year 2014. This study analyzed 560 patients in the year 2014 at a specialized hospital in Recife, Pernambuco Brazil. The analyzed variables included sex, age, history of alcohol and cigarette consumption, diagnosis, tumor location, tumor type, first treatment received and outcome of this treatment. The results showed that the sample was predominantly male (76.1%), brown skin color (68.6%), smokers (59.5%), and alcoholics (51.4%) aged 50-59 (32.5%), with 61.2% having a fundamental education level. The most prevalent tumor site was C02.9 (17.3%), histological type 807013 (80.5%) and the most prevalent site of metastasis was C77 in 85.5% of the cases. Conclusions: This study reaffirms findings from the literature on the subject, as well as contributes to a better knowledge about the characteristics of patients attended at a specialized hospital in Recife. Certainly a great contribution to the development of public policies more suitable for this type of disease.
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