Religion as a determining factor for invasive care among physicians in end-of-life patients.

OBJECTIVE: Describe the knowledge of physicians in an Oncology Clinic and a school hospital, of both the private health network, located in Manaus-AM about palliative care (PC), and define the role of religion in medical care of patients with advanced severe illness, with no disease modifying therapy. METHOD: This is a cross-sectional, descriptive, and observational study. After signing the Free and Informed Consent Term, the physicians included completed a professional membership record and answered questions about a hypothetical clinical case through multiple choice answers. The clinical case described a patient with advanced chronic disease not a candidate for disease-modifying therapy in the final phase of life. The questions involved aspects related to nutrition, venous access, and hospitalization in the intensive care unit (ICU). RESULTS: A total of 31 physicians from different specialties were included. About 67.7% consider their knowledge about PC insufficient, and none of the participants is unaware of this modality of care. The prevalence of invasive behaviors related to patient nutrition, venous access, and indication of ICU and cardiopulmonary resuscitation (CPR) was higher among physicians without religion (HR = 1.84; HR = 2.89; HR = 1.04, respectively) than among those who follow a religion. CONCLUSION: Absence of religion is associated with higher invasive behaviors on the part of physicians. Further studies are needed to better define this relationship.

Cystic angiomatosis, pleural effusion and multiple bone lesions mimicking a metastatic malignant neoplasia: a case report.

BACKGROUND: We report a case of a patient with a rare clinical condition: cystic angiomatosis presenting as pleural effusion and multiple bone lesions mimicking a metastatic malignant neoplasia. With only about 50 such cases published in the literature, it is important to report the clinical presentation and proposed treatment and to share information about the clinical evolution in these patients. CASE PRESENTATION: We report a case of a 45-year-old white man who presented to our hospital with ventilator-dependent pain. Chest tomography detected pleural effusion and multiple osteolytic bone lesions. Oncologic investigation for metastatic malignant neoplasia was started after exclusion of an infectious process. Imaging examinations revealed diffuse osteolytic lesions as well as cystic lesions of the spleen, with discrete glycolytic hypermetabolism visualized by positron emission tomography. After negative results were obtained by investigation of the primary tumor site and a bone biopsy, a final diagnosis of cystic angiomatosis was made. CONCLUSIONS: In view of the fact that cystic angiomatosis is a heterogeneous disorder of unpredictable prognosis and uncertain treatment, it is necessary to disseminate new cases so that further studies may be undertaken to obtain further physiopathological findings and an effective treatment.