O desempenho físico funcional reduzido antes da hospitalização prediz limitações de suporte de vida e mortalidade em pacientes não cirúrgicos de unidade de terapia intensiva / Reduced physical functional performance before hospitalization predicts life support limitations and mortality in nonsurgical intensive care unit patients

RESUMO Objetivo: Avaliar se as escalas de desempenho físico funcional e a pergunta surpresa ("Eu ficaria surpreso se esse paciente morresse em 6 meses?") predizem limitações de suporte de vida e mortalidade em pacientes críticos não cirúrgicos. Metódos: Participaram desta coorte prospectiva 114 pacientes admitidos do serviço de emergência em uma unidade de terapia intensiva. O desempenho físico funcional foi avaliado pelo Palliative Prognostic Score, pela Escala de Desempenho de Karnofsky e pela escala de Atividades de Vida Diária de Katz. Dois intensivistas responderam à pergunta surpresa. Resultados: Os escores de desempenho físico funcional propostos foram significativamente menores em pacientes com limitações de suporte de vida e naqueles que vieram a óbito durante a hospitalização. A resposta negativa à pergunta surpresa foi mais frequente no mesmo subgrupo de pacientes. A análise univariada ajustada mostrou aumento da razão de chances para limitações de suporte de vida e morte em relação à escala de Atividades de Vida Diária (1,35 [1,01 - 1,78] e 1,34 [1,0 - 1,79], respectivamente) e uma resposta negativa para a pergunta surpresa (42,35 [11,62 - 154,43] e 47,79 [11,41 - 200,25], respectivamente), com p < 0,05 para todos os resultados. Conclusão: Todas as escalas de desempenho físico funcional apresentaram escores mais baixos em não sobreviventes e em pacientes com limitações de suporte de vida. A redução da capacidade funcional prévia à internação e a resposta negativa à pergunta surpresa aumentaram as chances de limitações de suporte de vida e mortalidade em nossa coorte de pacientes não cirúrgicos da unidade de terapia intensiva com entrada no serviço de emergência.

ABSTRACT Objective: To assess whether scales of physical functional performance and the surprise question ("Would I be surprised if this patient died in 6 months?") predict life support limitations and mortality in critically ill nonsurgical patients. Methods: We included 114 patients admitted from the Emergency Department to an intensive care unit in this prospective cohort. Physical functional performance was assessed by the Palliative Prognostic Score, Karnofsky Performance Status, and the Katz Activities of Daily Living scale. Two intensivists responded to the surprise question. Results: The proposed physical functional performance scores were significantly lower in patients with life support limitations and those who died during the hospital stay. A negative response to the surprise question was more frequent in the same subset of patients. Adjusted univariable analysis showed an increased odds ratio for life support limitations and death regarding the activities of daily living scale (1.35 [1.01 - 1.78] and 1.34 [1.0 - 1.79], respectively) and a negative response for the surprise question (42.35 [11.62 - 154.43] and 47.79 [11.41 - 200.25], respectively); with a p < 0.05 for all results. Conclusion: All physical functional performance scales showed lower scores in nonsurvivors and patients with life support limitations. The activities of daily living score and the surprise question increased the odds of life support limitations and mortality in our cohort of nonsurgical intensive care unit patients admitted from the Emergency Department.

Effect of Karnofsky performance status scale and lactate dehydrogenase as well as their interaction on the therapeutic efficacy of diffuse large B-cell lymphoma / 白血病·淋巴瘤

Objective:To explore the factors influencing complete remission in patients with diffuse large B-cell lymphoma (DLBCL), and to explore the effect of the interaction of Karnofsky performance status scale (KPS) scores and the level of lactate dehydrogenases (LDH) on whether patients with DLBCL are completely relieved.Methods:The clinical data of 373 DLBCL patients admitted to Shanxi Province Cancer Hospital from January 2014 to December 2020 were retrospectively analyzed. SPSS 25.0 logistic regression model and Cox proportional risk regression models were used to explore the factors affecting complete remission in patients with DLBCL and to explore whether there was a multiplicative interaction between the factors. For factors with multiplicative interactions, the Matrix package, epiR package, and survival package in R 4.2.0 software were used to analyze whether there was an additive interaction. The relative excess risk of interaction (RERI), attributable proportion due to interaction (AP), and the synergy index (S) were used to evaluate the presence of additive interactions.Results:Elevated β 2 macroglobulin (β 2-MG), KPS scores below 80, and elevated LDH were risk factors for incomplete remission in patients with DLBCL (all P < 0.05). The risk of incomplete remission in patients with elevated β 2-MG, KPS scores below 80 and LDH was 1.971 times ( OR = 1.971, 95% CI 1.161-3.346), 2.056 times ( OR = 2.056, 95% CI 1.057-4.000) and 3.351 times ( OR = 3.351, 95% CI 1.783-6.300) higher than those in patients with normal β 2-MG, KPS scores above 80 and non-elevated LDH, respectively. There was a negative multiplicative interaction between the two risk factors of KPS scores below 80 and elevated LDH ( OR = 0.317, 95% CI 0.126-0.785). The estimated value of RERI, AP and S was -2.07 (95% CI -4.79-0.64),0.50 (95% CI -1.68-0.32),0.50 (95% CI 0.22-1.13), respectively; and there was no additive interaction among them. Conclusions:Elevated β 2-MG, KPS scores below 80, and elevated LDH are risk factors influencing incomplete remission for patients with DLBCL. The combined effect in patients with the combination of elevated LDH and KPS scores below 80 is lower than the single effect of the multiple of the both. There is a negative multiplicative interaction and no additive interaction in DLBCL patients with KPS scores below 80 and elevated LDH level.

Sobrevida e funcionalidade em idosos na atenção domiciliar / Survival and functionality in elderly in home care

Com o envelhecimento ocorrem complicações que afetam a funcionalidade e a independência dos indivíduos, muitas vezes sendo necessário o acompanhamento contínuo por profissionais da saúde, entre eles o fisioterapeuta. Diante disso, objetivou-se verificar a sobrevida, a funcionalidade e a ocorrência de comorbidades em indivíduos idosos acompanhados pelo serviço de Fisioterapia domiciliar. Um estudo com delineamento transversal foi realizado com 121participantes de um Serviço de Atenção Domiciliar, utilizando a Karnofsky Performance Scale para verificar a funcionalidade, e o Índice de Comorbidades de Charlson para avaliar as multimorbidades. Constatou-se que aproximadamente metade dos participantes apresentou cronicidade funcional, com condição potencialmente incapacitante, com piora dos índices de funcionalidade em indivíduos que sofreram alguma intercorrência. Os resultados demonstraram também que o acesso à Fisioterapia aumentou a taxa de sobrevida dos idosos e que o acompanhamento fisioterapêutico mais frequente possibilitou que a funcionalidade se mantivesse.

With aging, there are complications affecting the functionality and independence of individuals, often requiring continuous monitoring by health professionals, including the physical therapist. The objective was to analyze survival, functionality and the occurrence of comorbidities in elderly individuals monitored by the home physical therapy service. A cross-sectional study was carried out with 121 participants from a home care service, using the Karnofsky Performance Scale to check functionality, and the Charlson Comorbidity Index to assess multimorbidity. It was found that approximately half of the participants evaluated had functional chronicity, with potentially disabling condition, with worsening of functionality indices in individuals who have suffered some complication. The results also demonstrated that access to physical therapy increased the survival rate of the elderly and that the more frequent physical therapy follow-up enabled the functionality to be maintained.

Factores pronóstico de supervivencia en adultos por gliomas de alto grado en un hospital de Lima, Perú / Prognostic Factors And Survival Study In High-Grade Glioma In A Hospital In Lima, Peru

Introducción: Los Gliomas son tumores primarios del sistema nervioso central. Son clasificados del I-IV grado, siendo los de alto grado el III y IV los más frecuentes y de pobre pronostico. Objetivo: Determinar los factores pronósticos de supervivencia en pacientes por gliomas de alto grado en un hospital de Lima, Perú. Métodos: Se revisaron retrospectivamente las historias clínicas con glioma de alto grado del 2010-2014, se analizaron diez variables; con graficas de supervivencia de Kaplan-Meiery Long-rank y el modelo de regresión de Cox. Resultados: De un total de 278 pacientes con gliomas de alto grado 136 fueron varones y 142 mujeres. El análisis de la Supervivencia Libre de Progresión(SLP) tuvo un rango de 5,6-80,3 (mediana 22,7) y el análisis de supervivencia global (PS) tuvo un rango de 4-83,2 (mediana 26,2) meses. La supervivencia global para el tumor de IV grado fue 15,7 meses (IC95% 14,2-17,1); el III grado fue de 38,4 meses (IC 95% 35,8-40,9). El grado (PS: HR 15; SLP: HR 25,1); el tratamiento quirúrgico (PS: HR 0,6; SLP: HR 0,49), edad (PS: HR 1,47; SLP: HR 1,7), tratamiento adyuvante(PS: HR 0,6; SLP: HR 0,58) y karnofsky (PS: HR 0,7) tuvieron correlación; mientras el Karnofsky para SLP no (P=0,146). Conclusión: La edad, el estado funcional, el tratamiento quirúrgico, el tratamiento adyuvante y el grado del tumor son factores pronósticos de PS; en contraste, para SLP los factores pronósticos fueron la edad, tratamiento quirúrgico, tratamiento adyuvante y el grado del tumor.

Introduction: Gliomas are primary tumors of the central nervous system. They are classifiedfrom grade I-IV, with high grade III and IV being the most frequent and with poor prognosis. Objective: To determine the prognostic factors of survival in patients with high-gradegliomas in a hospital in Lima, Peru. Methods: The medical records with high-grade gliomafrom 2010-2014 were retrospectively reviewed, ten variables were analyzed with Kaplan-Meier and Log Rank survival graphs and the Cox regression model. Results: Out of a total of278 patients with high-grade gliomas, 136 were men and 142 women. The analysis of Progression-Free Survival (SLP) had a range of 5.6-80.3 (median 22.7) and the analysis ofoverall survival (PS) had a range of 4-83.2 (median 26, 2 months. The overall survival for theIV grade tumor was 15.7 months (95% CI 14.2-17.1); the III degree was 38.4 months (95%CI 35.8-40.9). The grade (PS: HR 15; SLP: HR 25.1); surgical treatment (PS: HR 0.6; SLP:HR 0.49), age (PS: HR 1.47; SLP: HR 1.7), adjuvant treatment (PS: HR 0.6; SLP: HR 0 , 58)and karnofsky (PS: HR 0.7) were correlated; while the Karnofsky for SLP does not (P =0.146). Conclusion: age, functional status, surgical treatment, adjuvant treatment, and tumorgrade are prognostic factors for PS. In contrast, for SLP the prognostic factors were age,surgical treatment, adjuvant treatment, and tumor grade.

Investigation on nutrition status and clinical outcome of patients with common cancers in Chinese patients: a multicenter prospective study protocol

Background:Malnutrition is common in patients with cancer, whichadversely affectsthesurvival and quality of life ofcancer patients.However, there is no national data on the prevalence of malnutrition inChinese cancer patients. Thisstudy aims to evaluate the prevalenceof malnutrition and quality of life(QOL)ofChinese patients with localregional, recurrentor metastatic cancer,to address the prognostic value of nutritional status and QOLon the survival of cancer patients in China and to validate the patient-generated subjective global assessment (PG-SGA) questionnaire in Chinese cancer patients.Methods:Thisisanobservational,multi-centered,and hospital-based prospective cohort study.We aimed to recruit 50,000 cancer patients (age 18and above)overan 8-year period.Data collection will occur within 48hrafter patientsare admitted to hospital, 30-days after hospital admission, and the follow-up will be conducted1-8years after enrolment. The primary outcomeisoverall survival, and secondaryoutcomes arelength of hospital stay and hospital costs. Factors measured are demographic characteristics, tumor characteristics, anthropometry measurements,hematological measurement, body composition, PG-SGAscores,Karnofsky performance status scores,and QLQ C30 scores. This protocol wasapproved by local ethical committees of all the participant hospitals.Conclusions: This multi-centered, large-scale, long-time follow-up prospective study will help diagnose malnutrition in cancer patients in China, and identify the related risk factors associated with the negative outcomes. The anticipated results will highlight the need for a truly scientific appraisal of nutrition therapy, and help to improve outcomes among cancer patients in China.Trial Registration: The trial has been registered with the Chinese Clinical Trial Registry, ChiCTR1800020329. Registered on 19 December 2018

Avaliação da Qualidade de Vida de Pacientes Oncológicos em Cuidados Paliativos / Evaluation of the Quality of Life of Oncological Patients in Palliative Care / Evaluación de la Calidad de Vida de los Pacientes Oncológicos en Atención Paliativa

Introdução: Os cuidados paliativos para pacientes oncológicos têm por finalidade promover a qualidade de vida por meio do controle de sinais e sintomas, melhoria do bem-estar físico, emocional, social e espiritual. Objetivo: Avaliar a qualidade de vida de pacientes oncológicos em cuidados paliativos. Método: Trata-se de uma pesquisa descritiva, transversal, de abordagem quantitativa, realizada com 21 pacientes internados em uma unidade de cuidados paliativos. Foram coletados dados sobre aspectos sociodemográficos e clínicos, e utilizada a escala do European Organization for Research and Treatment of Cancer Quality-of-Life Questionnaire Core15 PAL (EORTC QLQ C-15 PAL) para avaliação da qualidade de vida. Resultados: A média de saúde global foi de 60,32, sendo a qualidade de vida considerada satisfatória. Na escala de sintomas, os domínios mais afetados foram dor (52,38), constipação (46,03) e fadiga (42,86). A função emocional (37,30) mostrou-se pior do que a avaliação da função física (59,79). Houve relação significativa do tempo de diagnóstico com a qualidade de vida geral e a dispneia do performance status de Karnofsky(KPS) com o funcionamento físico, bem como da presença de metástase com dispneia. Conclusão: A qualidade de vida deve ser avaliada diariamente, visto que os cuidados paliativos consideram, além dos sintomas, o conforto do próprio paciente durante o estado de doença que ameaça à vida e as intervenções efetivas de cuidados, permitindo assim o direcionamento da atuação da equipe multiprofissional.

Introduction: Palliative care for cancer patients aims to promote quality of life, by controlling signs and symptoms, improving physical, emotional, social and spiritual well-being. Objective: To evaluate the quality of life of cancer patients in palliative care. Method: Descriptive, cross-sectional, quantitative approach study, conducted with 21 patients admitted to a palliative care unit. Data on sociodemographic and clinical aspects were collected, using the European Organization for Research and Treatment of Cancer Quality-of-Life Questionnaire Core15 PAL (EORTC QLQ C-15) PAL scale to assess quality of life. Results: The average global health was 60.32, with quality of life considered satisfactory. In the symptom scale, the most affected domains were pain (52.38), constipation (46.03) and fatigue (42.86). Emotional function (37.30) was assessed worse than physical function (59.79). There was a significant relationship between the time of diagnosis with the general quality of life and dyspnea, of Karnofsky(KPS) performance status, with physical functioning, and presence of metastasis with dyspnea. Conclusion: Quality of life should be assessed daily, as palliative care considers, in addition to symptoms, the patient's own comfort during a life-threatening illness and effective care interventions, helping the multiprofessional team to focus their action.

Introducción: Los cuidados paliativos para pacientes con cáncer tienen como objetivo promover la calidad de vida, controlando los signos y síntomas, mejorando el bienestar físico, emocional, social y espiritual. Objetivo: evaluar la calidad de vida de los pacientes con cáncer en cuidados paliativos. Método: Este es un enfoque descriptivo, transversal y cuantitativo, realizado con 21 pacientes ingresados en una unidad de cuidados paliativos. Se recopilaron datos sobre aspectos sociodemográficos y clínicos, utilizando la escala del European Organization for Research and Treatment of Cancer Quality-of-Life Questionnaire Core15 PAL (EORTC QLQ C-15 PAL) para evaluar la calidad de vida. Resultados: La salud global promedio fue de 60.32, con calidad de vida considerada satisfactoria, en la escala de síntomas los dominios más afectados fueron dolor (52.38), estreñimiento (46.03) y fatiga (42.86). La función emocional (37.30) se evaluó peor que la función física (59.79). Hubo una relación significativa entre el momento del diagnóstico y la calidad de vida general y la disnea, del performance status de Karnofsky(KPS) con el funcionamiento físico, así como la presencia de metástasis con disnea. Conclusión: La calidad de vida debe evaluarse diariamente, como lo consideran los cuidados paliativos, además de los síntomas, así como la propia comodidad del paciente durante una enfermedad potencialmente mortal e intervenciones de atención efectivas, lo que permite la dirección del desempeño del equipo multiprofesional.

Clinical regularities in acupuncture-moxibustion treatment of cancer pain in recent 30 years / 针灸推拿医学（英文版）

Objective:To explore the clinical regularities in acupuncture-moxibustion treatment of cancer pain by reviewing the relevant studies published between 1985 and 2017.Methods:Based on the Chinese Medicine Acupuncture-moxibustion Information Database,quantitative analysis,correlation analysis and Chi-square test were applied to analyze the commonly used acupoints,meridian affiliations and body region distributions,commonly used methods and acupoint correlations,treatment method correlations,the efficacy of acupuncture-moxibustion plus the three-step analgesic ladder for cancer pain,and indicators.Results:Zusanli (ST 36),Ashi point and Sanyinjiao (SP 6) ranked the top on the list of frequency;points from Bladder Meridian of Foot Taiyang and Stomach Meridian of Foot Yangming were often used;points from the lower limbs and back had high frequencies.The most commonly used treatment method was acupuncture-moxibustion plus medication.Acupuncture-moxibustion plus the three-step analgesic ladder showed certain advantage compared with the two methods used separately,and among the integrated methods,acupoint application plus the three-step analgesic ladder produced the most significant efficacy.It took (44.77±55.54) min for the analgesic effect to act and the effect lasted for (12.81±14.59) h.Numerical rating scale (NRS),visual analog scale (VAS) and Karnofsky performance status (KPS) scores all showed significant changes after interventions (all P＜0.01);there was no significant change in the score of quality of life (QOL) after interventions (P＞0.05).Conclusion:Zusanli (ST 36),Ashi point and Sanyinjiao (SP 6) are commonly selected in acupuncture-moxibustion treatment of cancer pain;acupuncture and acupoint application are often used;acupuncture-moxibustion plus the three-step analgesic ladder can boost the treatment efficacy.

The impact of Karnofsky performance status of posttreatment on survival with concurrent chemotherapy and thoracic three-dimensional radiotherapy for stage Ⅳ non-small cell lung cancer / 中华放射医学与防护杂志

Objective To investigate the impact of the changes of posttreatment karnofsky performance status (KPSpost) on the overall survival (OS) for patients with stage Ⅳ non-small cell lung cancer (NSCLC) underwent concurrent chemoradiation.Methods A total of 279 patients (male 198 and female 81) with histological confirmed stage Ⅳ NSCLC were enrolled in this study with a median age of 58 years old (range 22 to 80 years old).There were 166 cases of squamous carcinoma,87 cases of adenocarcinoma,and 22 cases of unclassified carcinoma,respectively.All enrolled patients received more than 2 cycles of chemotherapy and more than 36 Gy of concurrent radiotherapy.Kaplan-Meier method and Log-rank test were applied to evaluate OS.Multivariate analyses were carried out by the Cox proportionalhazard model.Chi-square test and logistic regression analysis were used to explore the related factors of KPSpost.Results There were 198 patients with improved KPSpost and 81 patients with decreased KPSpost,respectively.Univariate and multivariate analyses indicated that the improvement of KPSpost was associated with longer OS.Logistic regression analysis showed that the improvement of KPSpost was positively related with treatment of more than 4-6 cycles chemotherapy concurrent with over 63 Gy radiation to primary tumor.The improvement of KPSpost also correlated positively with disease control rate (DCR),but negatively with PLT toxicity and radiation esophagitis.Conclusions KPSpost was an independent prognostic factor of OS for patients with stage Ⅳ NSCLC underwent concurrent chemoradiation.Chemotherapy of 4-6 cycles and concurrent over 63 Gy radiotherapy dose to primary tumor,as well as DCR were positive factors for KPSpost improvement.However,stage 3-4 PLT toxicities and radiation esophagitis decreased the KPSpost.

Efectividad del bloqueo neurolítico simpático abdominal en una serie de casos descriptiva en pacientes con dolor oncológico / Effectiveness of neurolytic sympathetic plexus block in a descriptive case series of patients with oncological pain / Efetividade do bloqueio neurolítico simpático abdominal em uma série descritiva de casos em pacientes com dor oncológica

Introducción. El dolor es el principal síntoma que se presenta en el 40% de los pacientes oncológicos en tratamiento y en entre el 80% y el 85% de pacientes con la enfermedad avanzada. Dentro de las herramientas farmacológicas, los opioides son una opción con los consecuentes efectos secundarios, momento en el cual los procedimientos intervencionistas adquieren su importancia. El objetivo del artículo es mostrar el impacto sobre el control del dolor y la calidad de vida en paciente con dolor oncológico abdominal sometido a bloqueo celíaco o hipogástrica en un periodo de 3 meses, con el fin de generar conocimiento del tema en el área de la salud. Metodología. Se realizó una serie descriptiva de casos en un período de 3 meses. Se incluyeron 34 pacientes adultos con dolor abdominal de origen oncológico, con propuesta de bloqueo neurolítico de plexos celíacos o hipogástrico superior como método de control del dolor y se realizó un análisis de las variables en el programa estadístico IBM SPSS Versión 19. Resultados. Se encontró alivio del dolor en el 79.4% de los pacientes intervenidos al poco tiempo del procedimiento y de 33.3% a los 3 meses. No se encontró significante mejoría en la calidad de vida evaluada con el cuestionario SF-36. Conclusiones. Se encontró en este estudio que pacientes con índice de Karnofsky <50 tuvieron alta tasa de mortalidad posterior al bloqueo. La técnica de fenolización más radiofrecuencia podrían tener mejor respuesta terapéutica. Son necesarios más estudios para evaluar posibles asociaciones. Cómo citar. Jaimes J, Leotau MA, Rangel GW, Miranda N, García-Salazar N, Rangel-Vera JA. Efectividad del bloqueo neurolítico simpático abdominal en una serie de casos descriptiva en pacientes con dolor oncológico. MedUNAB. 2019;22(3):330-340. doi: 10.29375/01237047.3337

Introduction. Pain is the main symptom that occurs in 40% of cancer patients undergoing treatment and between 80% and 85% of patients with advanced cancer. Out of the pharmacological tools, opioids are an option with secondary effects, which makes interventional procedures important. The objective of the article is to demonstrate the impact of celiac or hypogastric plexus block in a three-month period on the pain control and quality of life of patients with abdominal oncological pain in order to generate knowledge of this topic in the healthcare sector. Methodology. A descriptive case series was conducted in a three-month period. Thirtyfour adult patients with oncological abdominal pain with proposed celiac or superior hypogastric plexus block as a method of pain control were included and an analysis was conducted of the variables in the statistical program IBM SPSS Version 19. Results. Pain relief was found in 79.4% of the treated patients shortly after the procedure and in 33.3% of the treated patients after 3 months. No significant improvement was evidenced in the quality of life evaluated with the SF-36 questionnaire. Conclussions. The study found that patients with a Karnofsky performance score of < 50 had a high mortality rate after the block. The technique of phenolization and radiofrequency could have a better therapeutic response. More studies are needed to assess possible associations. Cómo citar. Jaimes J, Leotau MA, Rangel GW, Miranda N, García-Salazar N, Rangel-Vera JA. Efectividad del bloqueo neurolítico simpático abdominal en una serie de casos descriptiva en pacientes con dolor oncológico. MedUNAB. 2019;22(3):330-340. doi: 10.29375/01237047.3337

Introdução. A dor é o principal sintoma que ocorre em 40% dos pacientes oncológicos em tratamento e entre 80% e 85% dos pacientes com a doença avançada. Dentro das ferramentas farmacológicas, os opióides são uma opção com consequentes efeitos colaterais, momento em que os procedimentos intervencionistas se tornam importantes. Objetivo. O objetivo do artigo é mostrar o impacto no controle da dor e na qualidade de vida em pacientes com dor oncológica abdominal submetido a bloqueio celíaco ou do plexo hipogástrico em um período de 3 meses, a fim de gerar conhecimento sobre o assunto na área da saúde. Métodos. Foi feita uma série descritiva de casos durante um período de 3 meses. Foram incluídos 34 pacientes adultos com dor abdominal de origem oncológica, com proposta de bloqueio neurolítico do plexo celíaco ou hipogástrico superior como método de controle da dor e a análise das variáveis foi realizada no programa SPSS statistic 19 IBM. Resultados. Observou-se alívio da dor em 79.4% dos pacientes operados logo após o procedimento e em 33.3% 3 meses depois. Não houve melhora significativa na qualidade de vida avaliada com o questionário SF-36. Discussão. Encontrou-se neste estudo que pacientes com índice de Karnofsky > 50 apresentaram alta taxa de mortalidade após o bloqueio. A técnica de fenolização e a radiofrequência poderiam ter melhor resposta terapêutica. Mais estudos são necessários para avaliar possíveis associações. Cómo citar. Jaimes J, Leotau MA, Rangel GW, Miranda N, García-Salazar N, Rangel-Vera JA. Efectividad del bloqueo neurolítico simpático abdominal en una serie de casos descriptiva en pacientes con dolor oncológico. MedUNAB. 2019;22(3):330-340. doi: 10.29375/01237047.3337

Extraspinal Percutaneous Osteoplasty for the Treatment of Painful Bony Metastasis

BACKGROUND: Extraspinal percutaneous osteoplasties (POPs) are novel techniques for the treatment of painful bony metastasis, which is often the cause of both persistent and incidental breakthrough pain. This retrospective study explored the efficacy and complications of extraspinal POPs. METHODS: The origin of the cancer metastasis, performed POP sites, necessity of adjacent joint injections, pain and Karnofsky Performance Scale (KPS) scores, complications related to the POPs, and life expectancy were evaluated from the medical records from 2009 to 2016. RESULTS: A total of 47 (M/F = 28/19) patients had received 54 POPs, including costoplasty, scapuloplasty, ilioplasty, humeroplasty, ischioplasty, femoroplasty, sternoplasty, and puboplasty, in order of frequency. The most common sites for the origin of the cancer, in order of frequency, were the lung, liver, breast, colon, and kidney. All patients receiving POPs including scapuloplasty, ilioplasty, humeroplasty, and femoroplasty needed adjacent joint injections before or after the POPs. Pain due to metastatic lesions was reduced significantly immediately after the POPs and the reduction was sustained until the end of their lives. The median KPS was increased from 35.4% to 67.7% immediately after the POPs. There were no complications related to the procedures. The mean life expectancy after performing the POPs, for 35 patients which died afterwards, was 99.3 days, ranging from 1 to 767 days. CONCLUSION: Even though pain in the isolated POP sites may be difficult to measure due to overlapping systemic pain, the POPs provided immediate local pain relief, and the patients showed better physical performance without procedure-related complications.

Comparação entre Escala de Performance de Karnofsky e Escala de Avaliação de Sintomas de Edmonton como determinantes na assistência paliativa / Comparison of Karnofsky Performance Status Scale and Edmonton Symptom Assessment Scale as determinants in Palliative Assistance

Objetivo: Confrontar a baixa capacidade física do paciente com o número de sintomas apresentados, identificando o melhor momento para iniciar a intervenção paliativa. Métodos: Estudo de coorte em uma enfermaria geral de clínica médica com busca ativa por pacientes que necessitariam de assistência paliativa, aplicando a Escala de Performance de Karnofsky e a Escala de Avaliação de Sintomas de Edmonton. Foram avaliados 98 pacientes, com, no mínimo, 48 horas de internação, no período de 22 a 31 de julho de 2015. Resultados: Dentre os pacientes que necessitavam de cuidados paliativos, 21% apresentavam Escala de Perfomance de Karnofsky de 100% (sem sinais ou queixas e sem evidência de doença) e possuíam uma quantidade superior a cinco sintomas de graduações altas que necessitariam de abordagem. Porém, quando a dependência era acentuada, com Escala de Perfomance de Karnofsky de 30% (extremamente incapacitado, necessitando de hospitalização, mas sem iminência de morte), os pacientes apresentavam quantidade inferior a cinco sintomas na Escala de Avaliação de Sintomas de Edmonton. Conclusão: Quanto maior o grau de independência, maior a quantidade de sintomas e mais expressivas foram as queixas. Seria vantajoso, para o paciente e seus familiares, uma assistência paliativa precoce; pois, se estes sintomas forem corretamente controlados, seria possível viver de uma forma mais digna. Já quando a dependência física é alta, os sintomas tenderam a ser menos expressivos, diminuindo as opções para atingir uma melhor qualidade de vida, justificando também a realização de uma abordagem paliativa logo após o diagnóstico.

OBJECTIVE: To confront the patient's low physical capacity with their symptoms, identifying the best moment to iniciate palliative intervention. METHODS: Cohort study in a general clinic infirmary with active search of patients that require palliative assistance, through the application of Karnofsky Performance Status Scale and Edmonton Symptoms Assessment Scale. Ninetyeight patients with at least 48 hours of hospitalization were analyzed from July 22 to 31, 2015. RESULTS : Of the patients in need for palliative assistance, 21% had a 100% score in the Karnofsky Performance Status Scale (no signs or complaints; no evidence of disease) and had more than five high-ranking symptoms that would require palliative approach. Nevertheless, when the symptoms were severe, presenting a 30% score in the Karnofsky Performance Status Scale (extremely incapacitated in need for hospitalization, but no imminence of death), patients showed less than five symptoms in Edmonton Symptoms Assessment Scale. CONCLUSI ON: The greater the independency, the more symptoms and more expressive the complaints. An early palliative assistance would be beneficial for the patients and their family, because if those symptoms were correctly controlled, that would allow the patients to live a more decent life. However, when physical dependency is high, the symptoms tend to be less expressive, reducing the options to achieve a better quality of life, what warrants a palliative approach right after the diagnosis.

Perspectivas para os cuidados paliativos na atenção primária à saúde: estudo descritivo / Prospects for palliative care in primary healthcare: a descriptive study / Perspectivas para los cuidados paliativos en la atención primaria a la salud: estudio descriptivo

OBJETIVO: identificar pacientes elegíveis para cuidados paliativos e caracterizar os serviços envolvidos na atenção primária à saúde. MÉTODO: estudo descritivo, documental, realizado em 19 unidades de saúde de um município do interior de Minas Gerais, Brasil. Aplicou-se a Escala de Performance de Karnofsky nos prontuários dos pacientes do setor sanitário com maior número de elegíveis. RESULTADOS: identificou-se 2715 elegíveis, o que representa 3,59% da população cadastrada e 25,3% dos pacientes no setor sete, que apresentou maior número de elegíveis. A patologia de destaque foi a diabetes, seguida de câncer e de doenças cardiovasculares. Ainda, 17,2% requereram CP precocemente; 9,7%, exclusivos, e os idosos, acima de 60 anos, foram o maior número entre aqueles elegíveis. DISCUSSÃO: os dados confirmam a necessidade de estruturação da APS para o atendimento precoce em CP, com destaque para a população idosa. CONCLUSÃO: faz-se necessária a estruturação de uma rede de atenção integrada e ordenada pela APS e a capacitação profissional.

AIM: To identify eligible patients for palliative care and characterize the services involved in primary healthcare. METHOD: This was a descriptive and documental study conducted in 19 health units in a municipality in the countryside of Minas Gerais in Brazil. The Karnofsky performance scale was applied to the medical records of patients in the health sector with the largest number of eligible individuals. RESULTS: We identified 2,715 eligible individuals, representing 3.59% of the registered population and 25.3% of patients in sector seven, which had the highest number of eligible individuals. Diabetes was the most common pathology, followed by cancer and cardiovascular diseases. Furthermore, 17.2% of these individuals have required palliative care precociously; 9.7%, required exclusive care, and the elderly above 60 years constituted the highest number among those eligible. DISCUSSION: The data confirmed the need for structuring the primary healthcare for early care in palliative care, especially for the elderly. CONCLUSION: It is necessary to structure a care network that is integrated and ordained by PHC and professional training.

OBJETIVO: identificar a pacientes elegibles para cuidados paliativos y caracterizar los servicios envueltos en la atención primaria a la salud. MÉTODO: estudio descriptivo, documental, realizado en 19 unidades de salud de un municipio del interior de Minas Gerais, Brasil. Se aplicó la Escala de Performance de Karnofsky en los prontuarios de los pacientes del sector sanitario con mayor número de elegibles. RESULTADOS: Fueron identificados 2715 elegibles, lo que representa 3,59% de la población registrada y 25,3% de los pacientes en el sector siete, que presentó mayor número de elegibles. La patología de destaque fue la diabetes, seguida de cáncer y de enfermedades cardiovasculares. También, 17,2% requirieron CP precozmente; 9,7%, exclusivos, y entre los elegibles, los ancianos con más de 60 años, fueron el mayor número. DISCISSIÓN: Los datos confirman la necesidad de estructuración de la APS para un atendimiento precoz en los CP, con destaque para la población anciana. CONCLUSIÓN: Se hace necesaria la estructuración de una red de atención integrada y ordenada por la APS y la capacitación profesional.

New demands for primary health care in Brazil: palliative care / Nuevas demandas para la atención primaria em salud en Brasil: los cuidados paliativos / Novas demandas para a atenção primária à saúde no Brasil: os cuidados paliativos

Objective.Assess the need for incorporation of palliative care in primary health care (PHC) through the characterization of users eligible for this type of care, enrolled in a program for devices dispensing. Methods. Descriptive study of case series conducted in 14 health units in São Paulo (Brazil) in 2012. It was included medical records of those enrolled in a program for users with urinary and fecal incontinence, and it was applied Karnofsky Performance Scale Index (KPS) to identify the indication of palliative care. Results. 141 of the 160 selected medical records had KPS information. Most cases (98.3%, 138/141) had performance below 70% and, therefore, patients were eligible for palliative care. The most frequent pathologies was related to chronic degenerative diseases (46.3%), followed by disorders related to quality of care during pregnancy and childbirth (24.38%). Conclusion. It is necessary to include palliative care in PHC in order to provide comprehensive, shared and humanized care to patients who need this.

Objetivo.Evaluar la necesidad de la incorporación de los cuidados paliativos en la Atención Primária en Salud (APS), a partir de la caracterización de los usuarios elegibles para esta modalidad de cuidados, registrados em um programa de dispensación de insumos. Métodos. Investigación descriptiva del tipo series de casos realizada en 14 unidades de salud del municipio de São Paulo (Brasil) en 2012. Fueron incluídas las historias clínicas de los usuarios registrados en um programa de dispensación de insumos para las incontinencias urinaria y fecal, siendo aplicado el índice de Karnofsky (KPS) para identificar la indicación de cuidados paliativos. Resultados. 141 de las 160 historias clínicas seleccionadas tenían información de KPS. La mayoría de los casos (98.3%, 138/141) tenían desempeño por debajo del 70%, por lo cual eran pacientes elegibles para cuidados paliativos. Las patologías con mayor frecuencia se relacionaban con cuadros crónicos y degenerativos (46.3%), seguidos por las patologías relacionadas com la calidad de la atención de la gestación y el parto (24.38%). Conclusión. Existe necesidad de incluir los cuidados paliativos en la APS, con el fin de brindar un cuidado integral, compartido y humanizado a los pacientes que lo requieren.

Objetivo.Avaliar a necessidade de incorporação dos cuidados paliativos na atenção primária à saúde (APS) a partir da caracterização dos usuários elegíveis para este tipo de cuidados, registrados em um programa de dispensação de insumos. Métodos. Estudo descritivo do tipo série de casos, realizado em 14 unidades de saúde do município de São Paulo (Brasil), em 2012. Foram incluídos prontuários de inscritos em um programa de distribuição de insumos para usuários com incontinência urinária e fecal, sendo aplicada Escala de Performance de Karnofsky (KPS) para identificar a indicação de cuidados paliativos. Resultados. 141 dos 160 prontuários selecionados tinham informações de KPS. A maioria dos casos (98,3%, 138/141) teve desempenho abaixo de 70% e, portanto, eram pacientes elegíveis para cuidados paliativos. As patologias mais frequentes relacionavam-se a quadros crônico-degenerativos (46,3%), seguidas pelas patologias relacionadas com a qualidade da atenção à gestação e ao parto (24,38%). Conclusão. Há necessidade de se incluir cuidados paliativos na APS, a fim de prestar um cuidado integral, compartilhado e humanizado aos pacientes que necessitam deste.

Profile of patients with brain tumors and the role of nursing care / Perfil dos pacientes com tumores cerebrais e o papel do enfermeiro / Perfil de pacientes con tumores cerebrales y el papel de la enfermería

ABSTRACT Objective: to describe the profile of 200 patients with central nervous system tumors (CNST), and the role of the nursing care. Method: prospective, quantitative and descriptive analysis of medical records of 200 patients with TSNC. Results: a total of 61% of our patients had benign CNST and 39% had malignant tumors. The extent of patient dependence, according to the Karnofsky Performance Status scale, was significantly greater for patients with malignant CNST (p < .05), indicating that these patients needed more support with their activities of daily living. Conclusion: patients with CNST need specialized care, with specific guidance regarding their disease and aspects of daily living after treatment. Thus, the nurse can function as a key element for the effectiveness of care provided to patients and family members with the aim of enhancing the quality of life of all those affected, directly or indirectly, by the disease.

RESUMO Objetivo: descrever o perfil de 200 pacientes com tumores no sistema nervoso central (TSNC) e o papel do cuidado em enfermagem. Método: análise prospectiva, quantitativa e descritiva de prontuários de 200 pacientes com TSNC. Resultados: 61% dos pacientes possuíam TSNC benignos e 39% tumores malignos. O grau de dependência do paciente de acordo com a Escala de Karnofsky foi significativamente maior para pacientes com tumores malignos (P <0,05), indicando que estes precisam de maior esforço e, consequentemente, apoio em suas atividades diárias. Conclusão: Pacientes com TSNC necessitam de cuidados especializados, com orientações específicas a respeito de sua doença e aos aspectos da sua vida diária após o tratamento. Assim, o enfermeiro pode ser um elemento-chave para a eficácia dos cuidados prestados aos pacientes e familiares com o objetivo de melhorar a qualidade de vida de todas as pessoas afetadas, direta ou indiretamente, pela doença.

RESUMEN Objetivo: describir el perfil de los 200 pacientes con tumores del sistema nervioso central (TSNC) y el papel de la enfermería. Método: análisis prospectivo, cuantitativo y descriptivo de los registros médicos de 200 pacientes con TSNC. Resultados: 61% de los pacientes tenían TSNC benignos y 39% tumores malignos. El grado de la dependencia de los pacientes según la Escala de Karnofsky fue significativamente mayor en los pacientes con tumores malignos (P <0,05), lo que indica que estos pacientes necesitan más apoyo en las actividades diarias. Conclusión: los pacientes con tumores cerebrales requieren atención especializada, con directrices específicas sobre su enfermedad y aspectos de la vida diaria después del tratamiento. Por lo tanto, los enfermeros pueden ser un elemento clave para la eficacia de la atención prestada a los pacientes y sus familias con el objetivo de mejorar la calidad de vida de las personas afectadas por la enfermedad.

Influência de variáveis clínicas na capacidade funcional de mulheres em tratamento quimioterápico / Influence of clinical variables on the functional capacity of women undergoing chemotherapy / Influencia de variables clínicas en la capacidad funcional de mujeres en tratamiento quimioterápico

Objetivo: Avaliar a influência do protocolo quimioterápico e tipo tumoral sobre a capacidade funcional de mulheres diagnosticadas com câncer ginecológico, câncer de mama e doença trofoblástica gestacional durante o tratamento quimioterápico. Métodos: Trata-se de um estudo observacional e retrospectivo com abordagem quantitativa e delineamento longitudinal. Participaram do estudo 438 mulheres em tratamento quimioterápico, em um hospital de clínicas no período de janeiro de 2000 a dezembro de 2012. Resultados: A capacidade funcional da população estudada apresentou um escore médio de 70,00 no índice de Karnofsky. Notou-se maior impacto pontual no declínio da capacidade funcional das pacientes com câncer ginecológico e nas mulheres que utilizaram protocolos baseados em quimioterápicos taxanos. Conclusão: É oportuno o estabelecimento de medidas capazes de garantir a prevenção dos efeitos colaterais causados pelo tratamento quimioterápico, proporcionando uma assistência integral e de qualidade às pacientes oncológicas.

Objective: To evaluate how the chemotherapy protocol and tumor type influence the functional capacity of women diagnosedwith gynecological cancer, breast cancer and gestational trophoblastic disease during chemotherapy. Methods: This was anobservational and retrospective study with a quantitative approach and longitudinal design. The study included 438 womenundergoing chemotherapy in a general hospital from January 2000 to December 2012. Results: The functional capacity of thestudy population had a mean score of 70 on the Karnofsky Performance Scale. A higher decline was noted in the functionalcapabilities of patients with gynecological cancer, and in women who used taxane chemotherapy protocols. Conclusion: It isgermane to establish measures aimed at ensuring the prevention of side effects caused by chemotherapy, providing comprehensiveand effective care for oncology patients.

Objetivo: Evaluar la influencia del protocolo quimioterápico y tipo tumoral en la capacidad funcional de mujeres diagnosticadascon cáncer ginecológico, cáncer de mama y enfermedad trofoblástica gestacional durante el tratamiento quimioterápico.Métodos: Se trata de estudio observacional y retrospectivo con abordaje cuantitativa y delineamiento longitudinal. Participarondel estudio 438 mujeres en tratamiento quimioterápico, en un hospital de clínicas en el período de enero de 2000 a diciembrede 2012. Resultados: La capacidad funcional de la población estudiada presentó un escore promedio de 70,00 en el índicede Karnofsky. Se notó mayor impacto puntual en el declino de la capacidad funcional de las pacientes con cáncer ginecológicoy en mujeres que utilizaron protocolos embazados en quimioterápicos taxanos. Conclusión: Es oportuno el establecimientode medidas capaces de garantizar la prevención de los efectos colaterales causados por el tratamiento quimioterápico,proporcionando una asistencia integral y de calidad a las pacientes oncológicas.

Characterization and functional capacity in women with breast cancer, gynaecological cancer and gestational trophoblastic disease / Caracterización y capacidad funcional de mujeres con cáncer mamario, cáncer ginecológico y enfermedad trofoblástica gestacional / Caracterização e capacidade funcional de mulheres com câncer ginecológico, câncer mamário e doença trofoblástica gestacional

Objective: to describe the social, demographic and clinical profile, and functional capacity of women diagnosed with gynecological cancer, breast cancer and gestational trophoblastic disease during chemotherapy. Method: longitudinal retrospective study that evaluated the records of women treated in hospital clinics from January 2000 to December 2012. Results: they evaluated the records of 438 women. The analysis showed that were not able to perform their daily activities, limited to the activities of self-care. Older patients had greater functional impairment during therapy. Conclusions: the sample was women 41 to 50 years, diagnosed with breast cancer (50.9%) and made use of anthracycline based protocols (47%); the scores of the functional capacity of the sample fell from 78.22 to 73.57. It is evident that nursing care should focus on the control of signs and symptoms that impact the functional capacity of women under chemotherapy.

Objetivo: describir el perfil socio demográfico, clínico y capacidad funcional de mujeres diagnosticadas con cáncer ginecológico, mamario y enfermedad trofoblástica gestacional en tratamiento quimioterápico. Método: estudio longitudinal retrospectivo, que evaluó los registros de mujeres en tratamiento en un hospital de clínicas en el período de enero/2000-diciembre/2012. Resultados: fueron evaluados los registros de 438 mujeres. El análisis mostró que las pacientes no eran capaces de realizar sus actividades cotidianas, limitándose a las actividades del autocuidado. Las pacientes mayores sufrieron más comprometimiento funcional durante la terapéutica. Conclusiones: la muestra estudiada era de mujeres con 41-50 años, diagnosticadas con cáncer de mama (50,9%) y hacían uso de protocolos basados en antracíclicos (47%); los escores de la capacidad funcional de la muestra decayeron de 78,22 para 73,57. Se evidencia que los cuidados de enfermería deben centrarse en el control de señales y síntomas que causan impacto en la capacidad funcional de las mujeres en quimioterapia.

Objetivo: descrever o perfil sociodemográfico e clínico e a capacidade funcional de mulheres diagnosticadas com câncer ginecológico, câncer mamário e doença trofoblástica gestacional em tratamento quimioterápico. Método: estudo longitudinal retrospectivo, que avaliou os registros de mulheres em tratamento em um hospital de clínicas no período de janeiro de 2000 a dezembro de 2012. Resultados: foram avaliados os registros de 438 mulheres. A análise mostrou que as pacientes não eram capazes de realizar suas atividades cotidianas, limitando-se àquelas do autocuidado. As pacientes idosas sofreram maior comprometimento funcional durante a terapêutica. Conclusões: a amostra estudada era de mulheres com 41 a 50 anos, diagnosticadas com câncer de mama (50,9%), que faziam uso de protocolos baseados em antracíclicos (47%); os escores da capacidade funcional da amostra decaíram de 78,22 para 73,57. Evidencia-se que os cuidados de enfermagem devem centrar-se no controle de sinais e sintomas que causam impacto na capacidade funcional das mulheres sob quimioterapia.

A model for the functional assessment of elderly with myeloid neoplasms

Objective: Myeloid neoplasms are heterogeneous diseases that are more incident in the elderly. The goals of this study were to aggregate a geriatric approach to the patient assessment, to show the impact of gender, age, hemoglobin concentration and comorbidities on the functionality of elderly with myeloid neoplasms and to better understand how the instruments of functional assessment work according to the aggressiveness of the disease. Methods: Elderly patients (≥60 years old) with myeloid neoplasms were assessed using the Karnofsky scale, Eastern Cooperative Oncologic Group scale, and basic and instru- mental activities of daily living scales. The hematopoietic cell transplantation-comorbidity index assessed the comorbidities. A mixed logistical regression model was fitted to estimate the impact of gender, age, hemoglobin concentration and the hematopoietic cell transplantation-comorbidity index on patients' functionality. Results: Eighty-two patients with a mean age of 72.8 years (range: 60-92 years) were evaluated. Eighty percent had good Karnofsky and Eastern Cooperative Oncologic Group scales and 39% were independent according to the daily living activity scales. All of the patients with poor Karnofsky and Eastern Cooperative Oncologic Group scales were classified as dependent by the daily living activity scales. The mixed logistic regression models showed that age, gender, hemoglobin concentration and the comorbidity index impacted on the daily living activity scales. Karnofsky and Eastern Cooperative Oncologic Group scales were affected by hemoglobin and the comorbidity index. The model hypothesized the hemoglobin concentration at which there was a higher risk of poor Karnofsky and Eastern Cooperative Oncologic Group scales. This hemoglobin concentration depended on comorbidities and on the aggressiveness of the myeloid neoplasm. Conclusion: The geriatric approach improved the sensitivity and specificity ...

Caracterización de los tumores cerebrales en un Hospital Universitario de Pereira, Colombia: un estudio retrospectivo / Characterization of brain tumors in a university hospital of Pereira, Colombia: a retrospective study

Objetivo: determinar las características demográficas, frecuencia, métodos diagnósticos, mortalidad, supervivencia, y tratamiento de pacientes con tumores cerebrales en el Hospital Universitario San Jorge de Pereira, Risaralda, Colombia. Materiales y métodos: Se realizó un estudio descriptivo retrospectivo, en el cual se tuvo en cuenta 78 historias clínicas de pacientes que ingresaron al Hospital Universitario San Jorge entre los años 2008-2011, con diagnóstico de tumor cerebral, de ellas se analizaron y compararon con estudios nacionales e internacionales datos demográficos, clasificación del tumor según la Organización Mundial de la Salud (OMS), método diagnóstico, hallazgos positivos en la Tomografía Axial Computar izada simple y contrastada, Imagen por Resonancia Magnética Cerebral y biopsia, localización del tumor, tratamiento recibido (cirugía, quimioterapia y radioterapia), sobrevida y funcionalidad del paciente mediante la escala de Karnofsky. Resultados: De los 78 pacientes el 62,8% eran hombres, la edad promedio fue 45,9 años, con una moda de 35, los tumores más frecuentes fueron el glioblastoma multiforme y el tumor metastásico (17,9% cada uno), el tratamiento de elección fue la cirugía (80,8%), seguido de la radioterapia (29,5%) y la quimioterapia (17,9%). La mortalidad fue del 45% con una sobrevida de 3,4 años (DE 1,2). El 51% de los pacientes que ingresaron con Karnofsky menor de 70 murieron. Discusión: La supervivencia de los tumores cerebrales en el Hospital Universitario San Jorge es mayor a la esperada por la OMS, la cirugía fue el tratamiento de elección junto a tratamiento complementario con radioterapia y quimioterapia, incrementando la sobrevida; la Tomografía Axial Computarizada se usó en todos los pacientes por su disponibilidad, precisión y costo-efectividad para este medio, la biopsia es una herramienta necesaria para el diagnóstico definitivo del tipo de tumor y la escala funcional de Karnofsky se podría utilizar como factor pronóstico de mortalidad en tumores cerebrales.

Objectives: determine the demographic characteristics, frequency, diagnosis, mortality, survival and treatment of patients with brain tumors at the Hospital Universitario San Jorge of Pereira, Risaralda, Colombia. Materials and methods: We performed a retrospective study, which took into account medical records of 78 patients admitted to the Hospital Universitario San Jorge between the years 2008-2011 with a diagnosis of brain tumor; they were analyzed and compared with national and international studies; data demographic, tumor classification according to the World Health Organization (WHO), diagnostic method, positive findings on computed tomography simple and contrast, cerebral magnetic resonance imaging and biopsy, tumor location, treatment received (surgery, chemotherapy and radiotherapy), survival and functionality of the patient by the Karnofsky scale. Results: From a total of 78 patients, 62.8% were male, age 45.9 years average, with statistical mode of 35, the glioblastoma multiforme and the metastatic tumor were the commonest tumors (17.9% each one), the treatment of choice was the surgery (80.8%), followed by radiation therapy (29.5%) and chemotherapy (17.9%.) The mortality was 45% with a survival of 3.4 years (DE 1.2), 51% of patients who were admitted with Karnofsky score under 70 they died. Discussion: The survival of brain tumors in Hospital Universitario San Jorge is higher than expected according to WHO, surgery was the preferred treatment with adjunctive radiotherapy and chemotherapy, increasing survival; Computed Axial Tomography was used in all patients for its availability, accuracy and cost-effectiveness for this setting, a biopsy is a necessary tool for a definitive diagnosis of the tumor type and the Karnofsky Performance Status could be used as a predictor of mortality in brain tumors.

Avaliação da mortalidade e qualidade de vida dois anos após a alta do CTI: dados preliminares de uma coorte prospectiva / Mortality assessment and quality of life two years after discharge from the ICU: preliminary data from a prospective cohort

OBJETIVOS: Avaliar a mortalidade e qualidade de vida dos pacientes que receberam alta do centro de tratamento intensivo a longo prazo. MÉTODOS: Coorte prospectiva em que foram avaliados todos os pacientes que internaram em um centro de tratamento intensivo durante 6 meses e entrevistados, via telefone, após dois anos da alta do centro de tratamento intensivo, visando o preenchimento de duas escalas de qualidade de vida: escala de Karnofsky e escala de atividades de vida diária (ADL). RESULTADOS: De um total de 380 pacientes, 100 (26,5 por cento) indivíduos estavam vivos na época da entrevista, 94 por cento vivendo em suas casas e 90 por cento sem necessidade de cuidado familiar ou especializado. Houve uma redução significativa na qualidade de vida dos sobreviventes (Karnofsky pré-CTI = 90 ±10 vs. Karnofsky após dois anos = 79±11; p<0,05), porém com manutenção da sua capacidade funcional (ADL pré-CTI = 28±4 vs. ADL após dois anos = 25±8; p=0,09). Esta queda na qualidade de vida deveu-se principalmente aos pacientes que sofreram acidente vascular encefálico (Karnofsky pré-CTI = 88±7 vs. Karnofsky após dois anos = 60±15; p<0,01). CONCLUSÃO: Estes dados preliminares sugerem que o desempenho dos pacientes após dois anos da alta do centro de tratamento intensivo é preservado, pois os mesmos mantêm a capacidade de realizar auto cuidado, exceto naqueles com danos cerebrais, os quais pioram muito a sua qualidade de vida.

OBJECTIVES: To evaluate mortality and long term quality of life of patients who were discharged from the intensive care unit. METHODS: A prospective cohort, in which all the admitted patients in a intensive care unit (ICU) during 6 months were evaluated and interviewed by telephone after two years of discharge, aiming the completion of two quality of live scales: Karnofsky scale and activities of daily living (ADL) scale. RESULTS: From a total of 380 patients, 100 (26.5 percent) individuals were alive at the time of interview, 94 percent living in their homes and 90 percent without the need for family or specialized care. There was a significant reduction in quality of life of the survivors (Karnofsky pre-ICU = 90±10 vs. Karnofsky after two years = 79±11; p<0.05), although maintaining their functional capacity (ADL pre-ICU = 28±4 vs. ADL after two years = 25±8; p=0.09). This drop in the quality of life occurred mainly to patients who suffered stroke (Karnofsky pre-ICU = 88±7 vs. Karnofsky after two years = 60±15; p<0. 01). CONCLUSION: These preliminary data suggest that the performance of patients after two years of the intensive care discharge is preserved, since they retain the ability to perform self care, except in those with brain damage which shows an inferior quality of life.

Low-cost outpatient chemotherapy regimen of cisplatin, 5-fluorouracil and leucovorin for advanced head and neck and esophageal carcinomas

CONTEXT AND OBJECTIVE: Patients with advanced head and neck (H/N) and esophageal squamous cell carcinoma (SCC) often have a poor performance status and a dire prognosis. Our aim was to evaluate the feasibility, activity and quality of life (QOL) of an outpatient chemotherapy regimen consisting of cisplatin, 5-fluorouracil and leucovorin (CFL). DESIGN AND SETTING: Prospective phase II study conducted at a Brazilian public institution. METHODS: Fifteen patients with residual, recurrent or metastatic SCC of the H/N or esophagus received bolus infusions of leucovorin 20 mg/m²/day and 5-fluorouracil 370 mg/m²/day on days 1-4, and 90 minutes of infusion of cisplatin 25 mg/m²/day on days 1-3, every 21 to 28 days, depending on hematological recovery. We also evaluated QOL by applying the European Organization for Research and Treatment of Cancer Quality of Life-C30 questionnaire (EORTC QLQ-C30) before each cycle. RESULTS: The overall response rate was 36 percent, and the mean overall survival and progression-free survival were six and three months, respectively. We observed grade 3 or higher hematological toxicity in seven patients and one patient had grade 3 nausea and vomiting. One patient died because of neutropenic fever. Seven out of the 12 patients who could be evaluated regarding QOL presented an improvement in their overall health status and functional QOL scores over the course of the treatment. CONCLUSIONS: CFL is an active outpatient protocol with tolerable toxicity and a favorable QOL impact. Larger studies are warranted, in order to confirm these results.

CONTEXTO E OBJETIVO: Pacientes com carcinoma espinocelular (CEC) de cabeça e pescoço e esôfago frequentemente tem um baixo Karnofsky Performance Status (KPS) e um prognóstico ruim. Nosso objetivo foi avaliar eficácia, taxa de resposta e qualidade de vida nesse contexto, em pacientes tratados com o regime ambulatorial cisplatina, 5-fluoruracil e leucovorin (CFL). TIPO DE ESTUDO: Estudo prospectivo fase II conduzido em uma instituição pública brasileira. MÉTODOS: 15 pacientes com CEC de cabeça e pescoço e esôfago persistente, recorrente ou metastático receberam leucovorin 20 mg/m²/dia, in bolus seguido de 5-fluoruracil 370 mg/m²/dia, in bolus nos dias 1 a 4 e cisplatina 25 mg/m²/dia em infusão de 90 minutos nos dias 1 a 3 a cada 21 ou 28 dias, dependendo da recuperação hematológica. Qualidade de vida foi analisada utilizando o questionário EORTC QLQ-C30, aplicado antes de cada ciclo. RESULTADOS: A taxa de resposta objetiva foi de 36 por cento e a sobrevida global e a sobrevida livre de progressão médias foram de 6,7 e 3,7 meses, respectivamente. Toxicidade hematológica maior ou igual a grau 3 foi observada em sete pacientes e um paciente apresentou náusea e vômito grau 3. Um paciente foi a óbito por neutropenia febril. Sete de 12 pacientes avaliáveis apresentaram melhora no estado geral de saúde e oito nas escalas funcional e sintomática com o tratamento. CONCLUSÃO: CFL é um protocolo ambulatorial factível, com toxicidade aceitável e com impacto favorável na qualidade de vida. Estudos maiores devem ser realizados para confirmar estes resultados.