[Neutropenic Fever in Lung Cancer: Clinical Aspects Related to Mortality and Antibiotic Failure].

BACKGROUND: Lung cancer (LC) is the leading cause of cancer death. Patients treated with chemotherapy are at risk of developing chemotherapy-induced febrile neutropenia (FN), a potentially life-threatening complication. The aims of this study were (1) to characterize FN admissions of patients with LC in a pulmonology department, and (2) to determine associations between patient profiles, first-line antibiotic failure (FLAF) and mortality. METHODS: Retrospective observational case-series, based on the analysis of medical records of LC patients that required hospitalization due to chemotherapy-induced FN. RESULTS: A total of 42 cases of FN were revised, corresponding to 36 patients, of which 86.1% were male, with a mean age of 66.71±9.83 years. Most patients had a performance status (PS) equal or less than 1, and metastatic disease was present in 40.5% (n=17). Respiratory tract infections accounted for 42.9% (n=18) of FN cases, and multidrug-resistant Staphylococcus aureus was the most isolated agent. The mortality rate was 16.7% (n=7), and the FLAF was 26.2% (n=11). Mortality was associated with a PS≥2 (P=0.011), infection by a Gram-negative agent (P=0.001) and severe anemia (P=0.048). FLAF was associated with longer hospitalizations (P=0.020), PS≥2 (P=0.049), respiratory infections (P=0.024), and infection by a Gram-negative (P=0.003) or multidrug-resistant agent (P=0.014). CONCLUSIONS: Lower PS, severe anemia, and infections by Gram-negative or multi-resistant agents seem to be associated with worse outcomes in FN patients.

Insights on chronic hypersensitivity pneumonitis' treatment: Factors associated with a favourable response to azathioprine.

BACKGROUND: The use of immunosuppressive and antifibrotic agents for the treatment of chronic hypersensitivity pneumonitis (CHP) appears promising, but there is still no evidence supporting the clinical decision regarding the implementation of each specific pharmacological strategy. METHODS: Patients diagnosed with CHP and treated with azathioprine (AZA) were retrospectively selected from a single centre for Interstitial Lung Diseases. Baseline clinical data, as well as functional, imaging, bronchoalveolar lavage (BAL) and histology features were assessed. Longitudinal data on functional parameters were collected and comparatively analysed with patients' characteristics. RESULTS: In this cohort of 80 patients, of those who reached 12 months of treatment, 78.3% presented a preserved forced vital capacity, with 59 being eligible to be classified as AZA responders (n = 36) or non-responders (n = 23). BAL lymphocytosis was associated with a favourable response to AZA treatment (OR 1.051; 95% CI 1.015-1.089), although it didn't identify all responders. CONCLUSIONS: AZA revealed to be effective in disease stabilisation in most patients, while ineffective for a subset. BAL lymphocytosis appears as a potentially valuable strategy to identify AZA responders, although with limited accuracy. Further studies are needed to clarify other response markers to immunosuppressive agents, in order to optimize the therapeutic options for this condition.

Functional and Endoscopic Indicators for Percutaneous Endoscopic Gastrostomy (PEG) in Amyotrophic Lateral Sclerosis Patients.

(1) Background: Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative condition, whose bulbar involvement compromises language, swallowing, and airway protection. When oral nutrition is no longer adequate, percutaneous endoscopic gastroscopy (PEG) may be indicated. However, as exact timing is still debatable, we tried to find it. (2) Methods: A prospective cohort study was performed using fiber-optic endoscopic evaluation of swallowing (FEES), functional evaluation scales (ALS Functional Rating Scale-Revised (ALSFRS-R) and bulbar sub-score (ALSFRS-R-B)), lung function tests (like Forced Vital Capacity (FVC), Cough Peak Flow (CPF)) and anthropometric data. (3) Results: Twenty-three patients were enrolled (mean 65.4 ± 9.1 years, 60.9% males), 12 with spinal-onset. During the study period, 58 FEES were performed (1⁻4/patients). Even before formal the PEG indication, suggestions were given to correct the alterations found. PEG was placed in 12 patients, on average 21.8 months after diagnosis (FVC = 69.9% ± 26.7%, ALSFRS-R-B = 7.7 ± 3.7, ALSFRS-R = 28.9 ± 12.3), and being 91.7% under ventilatory support. ALSFRS-R-B, CPF, FVC, and ALSFRS-R showed significant discriminant ability for PEG placement. Sensitivity and specificity were, respectively, ALSFRS-R-B ≤ 8 (100/90.9), CPF ≤ 205 (83.3), FVC ≤ 74 (83.3/74.2), and ALSFRS-R < 29 (83.3/65.1). (4) Conclusions: FEES provide additional information beyond formal PEG indication. ALSFRS-R-B score ≤ 8 was found as a best functional and noninvasive indicator for PEG performance in ALS patients.

Histórias patográficas de mutilados dentais de um serviço de prótese do Sistema Único de Saúde / Patographics histories of dental maimed of a Unified Health System prosthesis service

Objetivo Analisar as dimensões objetivas e subjetivas de pacientes mutilados dentais que utilizaram, estão utilizando ou ainda aguardam um Serviço de Prótese Dental do Sistema Único de Saúde, Campinas, São Paulo. Métodos Foram consideradas a Política Municipal de Saúde, a estruturação do serviço, as práticas e a assistência em face das necessidades de saúde bucal do sujeito-paciente. O percurso teórico-metodológico fundamenta-se na Análise Institucional. Os instrumentos de investigação foram entrevistas com 18 mutilados dentais do referido serviço, a fim de elaborar suas histórias patográficas, e um diário de pesquisa realizado ao longo do trabalho. Resultados Os resultados encontrados apontam para a insuficiência e inadequação do Serviço existente, embora seja solução para aqueles usuários que conseguem a finalização de suas próteses. Conclusão Espera-se apontar possibilidades de reestruturação do Serviço mencionado, a fim de contribuir para qualificação da Política Nacional de Saúde Bucal em seus micro espaços de trabalho, levando em conta a percepção dos pacientes edêntulos. Isso porque estes possuem sentimentos de inferioridade, insegurança, vergonha, entre outros, o que os leva à sensação de exclusão perante a sociedade.

Objective To analyze the objective and subjective dimensions of dental maimed patients who have used, are still using or are waiting to use the Unified Health System in Campinas, São Paulo, Brazil. Methods Were considered the Municipal Health Politics, structuring of the service, assistance, and practice in the point of view of the patients. The theoretical-methodological course is based on the Institutional Analysis. The research instruments were interviews with 18 dental maimed of the service in order to elaborate their Patographic Histories, and a research diary carried out during the work. Results The results found show the insufficiency and inadequacy of the existing Service, although it is still a solution for those users who achieve the finalization of their prostheses. Conclusion We hope to point out possibilities of restructuring the aforementioned Office in order to contribute to the qualification of the National Oral Health Policy in its micro spaces, taking the perception of edentulous patients into account, since these have feelings of inferiority, insecurity, shame among others leading them to feel excluded from society.