PALLIATIVE CARE: ONE WAY TO REFLECT THE APPROACH OF THE ONCOLOGY NURSE TO THE CLIENT

Objetivo: conhecer o significado oriundo das ações de cuidar realizado pelo enfermeiro ao cliente oncológico no processo de morrer. Metodologia: O método escolhido foi o qualitativo. O local de investigação foi um hospital público no Rio de Janeiro, destinado a realização de práticas de cuidado a clientes em condições oncológicas avançadas. Os envolvidos nesse estudo foram doze enfermeiros. A produção de dados ocorreu a partir de uma entrevista semi-estruturada. Resultados: Os conteúdos significativos de análise perpassam pelas principais práticas de cuidado ao cliente oncológico em finitude; interação família-cliente no espaço de cuidar domiciliar; interfaces do modelo biomédico e do cuidado sensível na abordagem pelo enfermeiro ao cliente oncológico. Conclusão: o cuidado nesse tipo de cliente é avaliado e incluído, dentro das perspectivas do cuidar, pelos enfermeiros, como aquele que converge para promoção do bem-estar aos clientes envolvidos no processo de finitude

Casuística dos diagnósticos histopatológicos de cães e gatos atendidos no município de Natal, Rio Grande do Norte

Descrevem-se os diagnósticos histopatológicos de cães e gatos atendidos em Natal, Rio Grande do Norte, Brasil. Foram revisados os registros de biópsia de um laboratório de serviço patológico, dos quais se obtiveram informações sobre espécie, idade, sexo e perfil racial dos animais, além do padrão histopatológico das lesões. Para cálculo da faixa etária, considerou-se filhotes (até um ano de idade), adultos (de um a oito anos de idade) e idosos (acima de oito anos de idade). Os diagnósticos foram agrupados em lesões neoplásicas, inflamatórias e outros diagnósticos. Ao todo foram avaliadas 161 amostras referentes a 157 animais. Destes, 87,9% (138/157) corresponderam a cães e 12,1% (19/157) a gatos. 63,06% (99/157) corresponderam a fêmeas e 36,94% (58/157) a machos, enquanto 40,76% (64/157) eram adultos, 41,4% (65/157) eram idosos e 5,73% (9/157) eram jovens. 38,41% (53/138) dos caninos não tinha raça definida. 154 diagnósticos foram conclusivos, dos quais 63% (97/154) corresponderam a neoplasias, 22,08% (34/154) a inflamações e 14,94% (23/154) a outros diagnósticos. Quanto às neoplasias, o sistema tegumentar 48,45% (47/97) foi o mais afetado, seguido do sistema reprodutor e glândula mamária 32,99% (32/97) e oftalmológico 7,22% (07/97), destacando-se mastocitoma, lipoma, hemangioma e melanoma. Dentre as lesões inflamatórias, merecem destaque as alterações do sistema digestório e tegumentar, com ênfase para a gastroenterite linfoplasmocitária. No grupo outros diagnósticos, destacaram-se os infartos esplênicos, mucocele da vesícula biliar e as hiperplasias glandulares. Estudos que caracterizem o perfil histopatológico das lesões devem ser incentivados, pois fornecem um rol dos diagnósticos diferenciais para os veterinários da região

Casuística dos diagnósticos histopatológicos de cães e gatos atendidos no município de Natal, Rio Grande do Norte

The aim of this study was to describe the casuistic of histopathological diagnoses of dogs and cats seen in the city of Natal, Rio Grande do Norte, Brazil. For this purpose, the biopsy records of a pathological service laboratory were reviewed, and information related to the origin, records, age, sex and breed of the animals, as well as the histopathological pattern of the lesions, were obtained. A total of 161 samples from 158 animals were evaluated. Of these, 87.35% corresponded to dogs and 12.02% to cats, with females (62.7%) being more affected than males (36.7%). Adult and elderly animals (40.5% to 41.1%) prevailed at the expense of young animals. In relation to the dog breeds, Poodle, Labrador, Yorkshire and Pitbull stood out. Overall, the integument was the most affected system, followed by the mammary gland and gastrointestinal tract. Regarding the type of lesion, neoplasms stood outMast cell tumors, lipomas, hemangiomas and melanomas were the main skin neoplasms observed in dogs, while squamous cell carcinoma, fibrosarcoma and sebaceous carcinoma were observed in cats. Dermatitis and nodular panniculitis, foreign body reactions and inflammatory lesions in the gastrointestinal tract were expressive, highlighting chronic gingivostomatitis in cats and lymphoplasmacytic gastroenteritis in dogs. The histopathological patterns visualized corroborated what was exposed in the literature. Studies that aim to characterize the histopathological profile of the lesions should be encouraged, as they can provide a list of the most common differential diagnoses, and to serve as a tool for understanding the main diseases in the region.Descrevem-se os diagnósticos histopatológicos de cães e gatos atendidos em Natal, Rio Grande do Norte, Brasil. Foram revisados os registros de biópsia de um laboratório de serviço patológico, dos quais se obtiveram informações sobre espécie, idade, sexo e perfil racial dos animais, além do padrão histopatológico das lesões. Para cálculo da faixa etária, considerou-se filhotes (até um ano de idade), adultos (de um a oito anos de idade) e idosos (acima de oito anos de idade). Os diagnósticos foram agrupados em lesões neoplásicas, inflamatórias e outros diagnósticos. Ao todo foram avaliadas 161 amostras referentes a 157 animais. Destes, 87,9% (138/157) corresponderam a cães e 12,1% (19/157) a gatos. 63,06% (99/157) corresponderam a fêmeas e 36,94% (58/157) a machos, enquanto 40,76% (64/157) eram adultos, 41,4% (65/157) eram idosos e 5,73% (9/157) eram jovens. 38,41% (53/138) dos caninos não tinha raça definida. 154 diagnósticos foram conclusivos, dos quais 63% (97/154) corresponderam a neoplasias, 22,08% (34/154) a inflamações e 14,94% (23/154) a outros diagnósticos. Quanto às neoplasias, o sistema tegumentar 48,45% (47/97) foi o mais afetado, seguido do sistema reprodutor e glândula mamária 32,99% (32/97) e oftalmológico 7,22% (07/97), destacando-se mastocitoma, lipoma, hemangioma e melanoma. Dentre as lesões inflamatórias, merecem destaque as alterações do sistema digestório e tegumentar, com ênfase para a gastroenterite linfoplasmocitária. No grupo outros diagnósticos, destacaram-se os infartos esplênicos, mucocele da vesícula biliar e as hiperplasias glandulares. Estudos que caracterizem o perfil histopatológico das lesões devem ser incentivados, pois fornecem um rol dos diagnósticos diferenciais para os veterinários da região

Infected pancreatic necrosis: outcomes and clinical predictors of mortality. A post hoc analysis of the MANCTRA-1 international study

: The identification of high-risk patients in the early stages of infected pancreatic necrosis (IPN) is critical, because it could help the clinicians to adopt more effective management strategies. We conducted a post hoc analysis of the MANCTRA-1 international study to assess the association between clinical risk factors and mortality among adult patients with IPN. Univariable and multivariable logistic regression models were used to identify prognostic factors of mortality. We identified 247 consecutive patients with IPN hospitalised between January 2019 and December 2020. History of uncontrolled arterial hypertension (p = 0.032; 95% CI 1.135-15.882; aOR 4.245), qSOFA (p = 0.005; 95% CI 1.359-5.879; aOR 2.828), renal failure (p = 0.022; 95% CI 1.138-5.442; aOR 2.489), and haemodynamic failure (p = 0.018; 95% CI 1.184-5.978; aOR 2.661), were identified as independent predictors of mortality in IPN patients. Cholangitis (p = 0.003; 95% CI 1.598-9.930; aOR 3.983), abdominal compartment syndrome (p = 0.032; 95% CI 1.090-6.967; aOR 2.735), and gastrointestinal/intra-abdominal bleeding (p = 0.009; 95% CI 1.286-5.712; aOR 2.710) were independently associated with the risk of mortality. Upfront open surgical necrosectomy was strongly associated with the risk of mortality (p < 0.001; 95% CI 1.912-7.442; aOR 3.772), whereas endoscopic drainage of pancreatic necrosis (p = 0.018; 95% CI 0.138-0.834; aOR 0.339) and enteral nutrition (p = 0.003; 95% CI 0.143-0.716; aOR 0.320) were found as protective factors. Organ failure, acute cholangitis, and upfront open surgical necrosectomy were the most significant predictors of mortality. Our study confirmed that, even in a subgroup of particularly ill patients such as those with IPN, upfront open surgery should be avoided as much as possible. Study protocol registered in ClinicalTrials.Gov (I.D. Number NCT04747990)

Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): Study protocol for a randomized controlled trial

Background: Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). Methods/Design: ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH(2)O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure <= 30 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. Discussion: If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration method.Hospital do Coracao (HCor) as part of the Program 'Hospitais de Excelencia a Servico do SUS (PROADI-SUS)'Brazilian Ministry of Healt

Nearly one-half of Brazilian patients with multiple sclerosis using natalizumab are DNA-JC virus positive

Objective Natalizumab is a new and efficient treatment for multiple sclerosis (MS). The risk of developing progressive multifocal leukoencephalopathy (PML) during the use of this drug has created the need for better comprehension of JC virus (JCV) infection. The objective of the present study was to assess the prevalence of JCV-DNA in Brazilian patients using natalizumab. Method Qualitative detection of the JCV in the serum was performed with real-time polymerase chain reaction (PCR). Results In a group of 168 patients with MS who were undergoing treatment with natalizumab, JCV-DNA was detectable in 86 (51.2%) patients. Discussion Data on JCV-DNA in Brazil add to the worldwide assessment of the prevalence of the JCV in MS patients requiring treatment with natalizumab

Multiple sclerosis starting before the age of 18 years: the Brazilian experience

Multiple sclerosis (MS) starting in childhood and adolescence poses a challenge for diagnosis and management of the disease. The aim of the present study was to assess the characteristics of early onset MS in Brazilian patients. Methods Retrospective data collection from specialized MS units. Results From 20 MS units in 11 Brazilian states, 117 cases of MS starting before the age of 18 years were collected. These patients had an average of 10 years of disease duration, still typically with low disability and one relapse every 2.5 years. The mean age for disease onset was 13.7 years. Conclusion The present study introduces a large series of Brazilian cases of pediatric MS. Although some patients presented a very severe form of MS, on the whole the group of patients with MS starting in childhood or adolescence presented a relatively mild form of this disease in Brazil