Estado nutricional, força muscular e capacidade funcional em portadores de mieloma múltiplo / Nutritional status, muscle strength and functional capacity in patients with multiple myeloma

O mieloma múltiplo é uma neoplasia maligna caracterizada pela proliferação clonal de plasmócitos na medula óssea. O objetivo deste trabalho foi avaliar as possíveis associações entre o estado nutricional, força muscular e capacidade funcional de pacientes ambulatoriais portadores de mieloma múltiplo. Trata-se de estudo transversal realizado em amostra não probabilística de pacientes com mieloma múltiplo atendidos no Hospital das Clínicas, em Goiânia. Os dados foram coletados entre agosto e dezembro de 2015, utilizando-se de entrevistas e informações dos prontuários. O estado nutricional foi avaliado aplicando-se a Avaliação Subjetiva Global Produzida pelo Próprio Paciente; a força muscular medida por meio da Força do Aperto de Mão e a capacidade funcional, pela Escala de Performance de Karnofsky. O estudo foi aprovado pelo Comitê de Ética e Pesquisa do referido hospital. Foram avaliados 52 pacientes, em que 48,1% estavam desnutridos, 30,8% apresentavam baixa força muscular e 73,1%, comprometimento da capacidade funcional. A força muscular e a capacidade funcional foram menores nos desnutridos. Observou-se que aqueles que utilizavam corticoides apresentaram 18% menos chance de se tornarem desnutridos (OR=0,18; IC=0,05-0,62; p=0,011) porém, é importante considerar as possíveis causas de viés; por outro lado, os pacientes com baixa força muscular ou faziam quimioterapia apresentaram, aproximadamente, quatro vezes mais chances de desnutrição, respectivamente (OR=3,46; IC=0,99-12,08; p=0,047) (OR=3,64; IC=1,13-11,69; p=0,027). Concluiu-se que a desnutrição é comum nos pacientes portadores de mieloma múltiplo, indicando a necessidade premente de intervenção nutricional apropriada e precoce.

Multiple myeloma is a malignant neoplasm characterized by the clonal proliferation of plasma cells in the bone marrow. The objective of this study was to evaluate possible associations between nutritional status, muscle strength and functional capacity of outpatients with multiple myeloma. This is a cross-sectional study carried out on a non-probabilistic sample of patients with multiple myeloma treated at Hospital das Clínicas, in Goiânia. Data were collected between August and December 2015, using interviews and information from medical records. Nutritional status was assessed using the Patient Generated Subjective Global Assessment; muscular strength measured using Hand Grip Strength and functional capacity, using the Karnofsky Performance Scale. The study was approved by the Ethics and Research Committee of that hospital. 52 patients were evaluated, of which 48.1% were malnourished, 30.8% had low muscle strength and 73.1% had impaired functional capacity. Muscle strength and functional capacity were lower in malnourished individuals. It was observed that those who used corticosteroids were 18% less likely to become malnourished (OR=0.18; CI=0.05-0.62; p=0.011), however, it is important to consider the possible causes of bias; on the other hand, patients with low muscle strength or undergoing chemotherapy were approximately four times more likely to be malnourished, respectively (OR=3.46; CI=0.99-12.08; p=0.047) (OR=3.64; CI=1.13-11.69; p=0.027). It was concluded that malnutrition is common in patients with multiple myeloma, indicating the pressing need for appropriate and early nutritional intervention.

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.

Risk factors of pressure injury in patients with advanced cancer / 中国基层医药

Objective:To investigate the risk factors of pressure injury in patients with advanced cancer.Methods:100 patients with advanced malignant tumors who received treatment in The First People's Hospital of Huzhou from January to December 2019 were included in this study. After filling in data registration form, all patients received the first pressure injury risk assessment to assess their skin conditions within 2 hours after admission. At the same time, Karnofsky Performance Scale (KPS), Braden Scale score, serum albumin and hemoglobin levels were determined and assessed. Logistic multiple regression was used to analyze the correlation between various factors and stress injury.Results:Among the 100 patients, five patients had pressure injury. The incidence of hospital-acquired pressure injury was 5.00%. These five patients, consisting of three males (60.0%) and two females (40.00%), were aged 38-89 years. One (20%) patient had stage I pressure injury, three (60%) patients had type II pressure injury, and one (20.00%) patient had non staged injury. Pressure injury was compared between patients at different ages, with different Braden Scale scores, serum albumin and hemoglobin levels, KPS scores ( χ2 = 7.916, 34.657, 5.432, 18.034, 38.922, all P < 0.05). The incidence of pressure injury in patients aged ≥ 70 years with low serum albumin level, low hemoglobin level, KPS score ≤ 30 points, Braden Scale score ≤ 16 points was significantly higher than that in patients aged < 70 years with high serum albumin level, high hemoglobin level, KPS score > 30 points, Braden Scale score > 16 points ( χ2 = 18.034, 5.432, 7.916, 38.922, 34.657, all P < 0.05). Taking pressure injury as the dependent variable and a single factor as the independent variable, correlation analysis results revealed that low serum albumin level, low hemoglobin level, age ≥ 70 years, KPS score ≤ 30 points, Braden Scale score ≤ 16 points were independent risk factors for pressure injury in advanced cancer. Conclusion:KFS score, Braden scale score, serum albumin and hemoglobin levels are closely related to the occurrence of pressure injury in patients with advanced cancer. They are independent risk factors for pressure injury in patients with advanced cancer.

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.

Association between Psychiatric Illness and Social Support, Cognitive Functioning, Treatment Adherence and Functional ability in Chronic Kidney Disease Patients

Introduction: Chronic Kidney Disease (CKD) is emergingas an important chronic disease globally. In India, it isestimated that prevalence of CKD is around 15 -20%. Patientswith CKD are prone to develop psychiatric illness likedepression, anxiety, insomnia and even psychosis. Multiplefactors contribute to the risk of psychiatric morbidity inCKD. Psychiatric morbidity in CKD is associated withpoor adherence and outcome. Study aimed to determine theassociation of psychiatric morbidity in CKD with factors likesocial support, functional ability, cognitive functioning and itsimpact on treatment adherence in chronic kidney disease.Material and methods: Cross sectional study, conductedin department of nephrology, Kilpauk Medical College for6 months from February 2017 to August 2017. Consentingpatients in the age group of 18 – 60 years, diagnosed tohave CKD by consultant nephrologist and on varioustreatment modalities (conservative treatment, hemodialysis,renal transplantation) were included in this study. Patientsdiagnosed to have mental illness prior to the onset of CKDwere excluded.Results: A total of 110 patients consented to participate in thestudy. Of these, 36.4% (n=40) were in conservative treatment,31.8% (n= 35) were in hemodialysis, 31.8% (n=35) were postrenal transplant patients.Conclusion: Treatment adherence, social support systemand functional ability were better for patients on postrenal transplantation than either conservative treatment orhemodialysis

Evaluation Of Quality Of Life In Nasopharyngeal Carcinoma Based On Eortc Qlq-H And N35 And Karnofsky Scale In Adam Malik General Hospital Medan

Introduction: Nasopharyngeal carcinoma (NPC) is a malignant epithelial cell that lines the nasopharyngeal surface and is aneck head malignancy that has received much attention due to the relatively high mortality rate. Evaluating the quality of lifefor patients with malignancies is important as an “end-point” for treatment and an indicator of patient monitors.Method: This study is an analytical study with cross-sectional research design by analyzing the EORTC QLQ-H and N35 andKarnofsky Scale on 60 NPC patients.Results: Most NPC patients were male, most in Stages III and IV. The most histopathological type is non crystallizing SCC.Based on EORTC QLQ-H and N35, the most complaints of patients with NPC were found to be weight loss and the use ofpainkillers Karnofsky scores of NPC patients who were assessed as having a mean of 70.33.Conclusion: There is a significant correlation between EORTC QLQ - H and N35 with Karnofsky scores (r = −0.612; P = 0.000).The greater the Karnofsky value, the smaller the value of EORTC QLQ - H and N35 means that the quality of life of the patientis getting better, and vice versa

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.

Analysis of prognostic factors for survival in elderly patients with glioma / 中南大学学报(医学版)

Objective:To analyze the prognostic factors for survival in elderly patients with glioma.Methods:We performed a retrospective analysis of prognostic factors for elderly patients with glioma,who were treated by the same attending doctor during June 2014 and June 2016,to investigate the correlations of the age,dimension of pathology,histological grade,extent of resection,adjuvant therapy,preoperative Karnofsky Performance Scale (KPS) score,postoperative KPS score,molecular markers [isocitrate dehydrogenase-1 (IDHH-1),O6-methylguanine DNA-transferase (MGMT),epidermal growth factor receptor (EGFR),Ki-67] with the prognosis.Results:A total of 45 patients were included in the study.The median overall survival (OS) was 11 months.The median progression-free survival (PFS) was 6 months.Univariate analysis revealed that the age,gender,dimension ofpathology,histological grade and preoperative KPS score had no significant correlation with survival (P＞0.05).The gross total resection,higher postoperative KPS score,adjuvant therapy,lower Ki-67 index were significantly correlated with survival.The expressions of MGMT and EGFR were significant factors for survival.High postoperative KPS score (P=0.019),adjuvant therapy (P=0.024),and the expression of MGMT (P=0.026) were independent predictors for increased median OS in a multivariate regression model.Conclusion:The extent of resection,adjuvant therapy,postoperative KPS score and molecular markers are the influential factors for survival.Larger prospective studies are needed to confirm these findings.

Influência do Tempo de Internamento sobre a Força Muscular Respiratória e Nível Funcional de Adultos com Leucemia e Linfoma / Influence of Hospitalization Time about Respiratory Muscle Strength and Functional Level of Adults with Leukemia and Lymphoma / Influencia del Tiempo de Internamiento sobre la Fuerza Muscular Respiratoria y Nivel Funcional de Adultos con Leucemia y Linfoma

Introdução: As neoplasias hematológicas, leucemias e linfomas são patologias que afetam o sangue ou tecidos formadores dele. Durante o período de hospitalização, os pacientes podem desenvolver redução da capacidade funcional que pode interferir na sua função respiratória. Objetivo: Avaliar a influência do tempo de internamento sobre a força muscular respiratória e o nível funcional de adultos com leucemia e linfoma. Método: Estudo observacional, com delineamento longitudinal e abordagem quantitativa, realizado na enfermaria onco-hematológica do Complexo Hospitalar Universitário Professor Edgard Santos (Hupes). A avaliação da força muscular respiratória foi mensurada pelo manovacuômetro e a capacidade funcional pela escala de desempenho de Karnofsky (KPS). Resultados: No decorrer do tempo de internamento dos pacientes, houve uma diminuição da pressão expiratória máxima (PEM) (p=0,000), porém não foi observada diferença significativa na pressão inspiratória máxima (PIM) (p>0,05). Em relação à KPS, os pacientes apresentaram nível de funcionalidade de 70%. Conclusão: Este estudo demonstrou que a PEM foi alterada durante o internamento, porém não houve modificação da PIM e da funcionalidade dos pacientes.

Introduction: Hematologic neoplasms, leukemias and lymphomas are pathologies that affect the blood or tissues that form it. During the hospitalization period patients may develop functional capacity reduction, which may interfere with their respiratory function. Objective: Evaluate the influence of hospitalization time about respiratory muscle strength and functional level of adults with leukemia and lymphoma. Method: Observational study, with longitudinal design and quantitative approach, performed at the onco-hematological ward of the University Hospital Complex Professor Edgard Santos (Hupes). The assessment of respiratory muscle strength was measured using the manovacuometer and functional capacity using the Karnofsky Performance Scale (KPS). Results: During the hospitalization time, there was a decrease in the maximum expiratory pressure (PEM) (p=0.000), but no significant difference was observed in the maximum inspiratory pressure (PIM) (p>0.05). In relation to KPS, the patients presented functional level of 70%. Conclusion: This study demonstrated that PEM was altered during hospitalization, but there was no modification of the PIM and the functionality of the patients.

Introducción: Las neoplasias hematológicas, leucemias y linfomas son patologías que afectan a la sangre o tejidos formadores de él. Durante el período de hospitalización los pacientes pueden desarrollar una reducción de la capacidad functional, que puede interferer en su función respiratoria. Objetivo: Evaluar la influencia del tiempo de internamiento sobre la fuerza muscular respiratoria y nivel funcional de adultos con leucemia y linfoma. Método: Estudio observacional, con delineamiento longitudinal y el enfoque cuantitativo, realizado en la enfermería onco-hematológica del Complejo Hospitalario Universitario Profesor Edgard Santos (Hupes). La evaluación de la fuerza muscular respiratoria se midió utilizando el manovacuómetro y la capacidad funcional utilizando la escala de rendimiento de Karnofsky (KPS). Resultados: En el transcurso del tiempo de internamiento de los pacientes, hubo una disminución de la presión espiratoria máxima (PEM) (p=0,000), pero no se observó diferencia significativa en la presión inspiratoria máxima (PIM) (p>0,05). En relación a KPS, los pacientes presentaron un nivel de funcionalidad del 70%. Conclusión: Este estudio demostró que la PEM fue alterada durante el internamiento, pero no hubo modificación de la PIM y de la funcionalidad de los pacientes.

Gliomas cerebrales en el adulto: Descripción de los hallazgos clínicos, patológicos y sobrevida a dos años en el Hospital Carlos Andrade Marín / Cerebral gliomas in the adult: Description of the clinical, pathological findings and two-year survival at Carlos Andrade Marín Hospital

Introducción: Los gliomas son los tumores malignos primarios más frecuentes en el cerebro. Los gliomas representan el 5% de los tumores en nuestro servicio de oncología y se asocian con una alta mortalidad. El objetivo fue describir los hallazgos clínicos, patológicos y la mortalidad a dos años en pacientes diagnosticados con gliomas. Materiales y métodos: Presentamos la experiencia de nuestra institución con este tipo de tumores, durante el período de enero de 2012 a diciembre del 2013. Describimos las características clínicas y los reportes histopatológicos. Empleamos análisis de supervivencia, Resultados: Estudiamos 42 pacientes con un promedio (DE) de edad de 50 (±16.6) años. Las manifestaciones clínicas más comunes fueron: cefalea, crisis convulsivas y hemiparesia (39 pacientes, 89%). De acuerdo a la clasificación OMS tuvimos un paciente grado I (2%); veinte y cinco, grado II (60); doce, grado III (29%); y cuatro, grado IV (10%). La mortalidad global a los 2 años fue del 57%. Pacientes con edades superiores a 40 años tuvieron peor pronóstico (p= 0,0002). Discusión: Las características demográficas, clínicas y de mortalidad coinciden con los reportes de la literatura. El glioblastoma fue menos frecuente que lo esperado y el pronóstico sigue siendo ominoso.

Introduction: Gliomas are among the most common primary brain malignant tumors. They are relatively infrequent lesions compared with others neoplasms, though, they are associated with both, high mortality and morbidity. The main objective was to define the rate of mortality and describe clinical manifestation in patients with glioma newly diagnosed. Methods: We conducted a retrospective review that assessed clinical manifestations, treatment and mortality at Carlos Andrade Marín hospital, Quito Ecuador, over a period going from January 2012 to December 2013. The study design was a case series. Results: We reported 42 patients with glioma newly diagnosed. Mean (SD) age was 50(±16.6) year-old. The most common symptoms reported on admission were headache, seizures and headache and hemiparesia. According to the WHO classification, we ha done (2%) patient grade I, 25 (60%) patients grade II, 12 (29% mortality rate at two yearse was 57%. Patients older than 40 y.o had worse prognosis (p=0.0002). Discusion: Clinical features do not differ from other published studies and the mortality was higher in patients with low-grade glioma with poor Karnofsky Performance Status Scale.

Fluorescence-Guided versus Conventional Surgical Resection of High Grade Glioma: A Single-Centre, 7-Year, Comparative Effectiveness Study

Background: High grade gliomas (HGGs) are locally invasive brain tumours that carry a dismal prognosis. Although complete resection increases median survival, the difficulty in reliably demonstrating the tumour border intraoperatively is a norm. The Department of Neurosurgery, Hospital Sungai Buloh is the first public hospital in Malaysia to overcome this problem by adopting fluorescence-guided (FG) surgery using 5-aminolevulinic acid (5-ALA). Methods: A total of 74 patients with histologically proven HGGs treated between January 2008 and December 2014, who fulfilled the inclusion criteria, were enrolled. Kaplan-Meier survival estimates and Cox proportional hazard regression were used. Results: Significant longer survival time (months) was observed in the FG group compared with the conventional group (12 months versus 8 months, P 80 (P = 0.010), histology (P < 0.001), surgical method (P < 0.001) and adjuvant therapy (P < 0.001). Conclusion: This study showed a significant clinical benefit for HGG patients in terms of overall survival using FG surgery as it did not result in worsening of post-operative function outcome when compared with the conventional surgical method. We advocate a further multicentered, randomised controlled trial to support these findings before FG surgery can be implemented as a standard surgical adjunct in local practice for the benefit of HGG patients.

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.