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1.
Mediterr J Hematol Infect Dis ; 12(1): e2020044, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32670522

RESUMO

The emergence and spread of 2019 novel coronavirus have led to an unprecedented public health crisis around the globe, threatening the lives of millions of people. We report a severe case of COVID-19 in a patient with chronic lymphocytic leukemia and describe primarily the clinical presentation and the challenges encountered in the COVID-19 diagnosis, treatment, and specimens sampling pitfalls. This case highlights the importance of a comprehensive diagnostic approach of pneumonia in immunocompromised hosts, including timely and safe bronchoscopy, because of the broad differential diagnosis, more challenging with the current outbreak of COVID-19.

3.
J Intensive Care Med ; 34(1): 55-61, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28030995

RESUMO

OBJECTIVE:: To determine resource utilization and outcomes of out-of-hospital transfer patients admitted to the intensive care unit (ICU) of a cancer referral center. DESIGN:: Single-center cohort. SETTING:: A tertiary oncological center. PATIENTS:: Patients older than 18 years transferred to our ICU from an outside hospital between January 2013 and December 2015. MEASUREMENTS AND MAIN RESULTS:: A total of 2127 (90.3%) were emergency department (ED) ICU admissions and 228 (9.7%) out-of-hospital transfers. The ICU length of stay (LOS) was longer in the out-of-hospital transfers when compared to all other ED ICU admissions ( P = .001); however, ICU and hospital mortality were similar between both groups. The majority of patients were transferred for a higher level of care (77.2%); there was no difference in the amount of interventions performed, ICU LOS, and ICU mortality between nonhigher level-of-care and higher level-of-care patients. Factors associated with an ICU LOS ≥10days were a higher Sequential Organ Failure Assessment (SOFA) score, weekend admissions, presence of shock, need for mechanical ventilation, and acute kidney injury on admission or during ICU stay ( P < .008). The ICU mortality of transferred patients was 17.5% and associated risk factors were older age, higher SOFA score on admission, use of mechanical ventilation and vasopressors during ICU stay, and renal failure on admission ( P < .0001). Data related to the transfer such as LOS at the outside facility, time of transfer, delay in transfer, and longer distance traveled were not associated with increased LOS or mortality in our study. CONCLUSION:: Organ failure severity on admission, and not transfer-related factors, continues to be the best predictor of outcomes of critically ill patients with cancer when transferred from other facilities to the ICU. Our data suggest that transferring critically ill patients with cancer to a specialized center does not lead to worse outcomes or increased resource utilization when compared to patients admitted from the ED.


Assuntos
Institutos de Câncer/estatística & dados numéricos , Estado Terminal/terapia , Unidades de Terapia Intensiva , Neoplasias/terapia , Encaminhamento e Consulta , Adulto , Estado Terminal/mortalidade , Feminino , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Neoplasias/mortalidade , Escores de Disfunção Orgânica , Avaliação de Resultados em Cuidados de Saúde , Transferência de Pacientes , Estudos Retrospectivos
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