“AVALIAÇÃO E TRATAMENTO DA DESCOMPENSAÇÃO DE DOENÇAS CRÔNICAS”

    Decompensation of chronic diseases poses a significant challenge in healthcare management, requiring a careful and integrated approach. Precise assessment plays a pivotal role in early identification of signs of decompensation, enabling timely interventions to prevent severe complications. Healthcare professionals should conduct a comprehensive assessment, considering not only the patient’s current symptoms but also their medical history, risk factors, and adherence to treatment. Once decompensation is identified, appropriate treatment is essential to stabilize the patient and improve their health condition. This may include medication adjustments, additional therapies, lifestyle changes, and supportive interventions as needed. Furthermore, ensuring effective communication among healthcare team members and providing patient education on managing their chronic condition and preventing future decompensations are crucial. Addressing decompensation of chronic diseases requires a multidisciplinary approach involving physicians, nurses, pharmacists, therapists, and other healthcare professionals. Collaborative teamwork allows for comprehensive assessment and a variety of perspectives in crafting the most suitable treatment plan for each patient. In conclusion, assessment and treatment of decompensation in chronic diseases demand a holistic and coordinated approach, aiming not only for immediate patient stabilization but also for long-term health promotion and recurrence prevention. This patient-centered approach is essential to ensure positive outcomes and improved quality of life for individuals affected by chronic diseases.  A descompensação de doenças crônicas representa um desafio significativo na gestão da saúde, exigindo uma abordagem cuidadosa e integrada. A avaliação precisa desempenha um papel fundamental na identificação precoce de sinais de descompensação, permitindo intervenções oportunas para prevenir complicações graves. Os profissionais de saúde devem realizar uma avaliação abrangente, considerando não apenas os sintomas atuais do paciente, mas também sua história médica, fatores de risco e adesão ao tratamento. Uma vez identificada a descompensação, o tratamento adequado é essencial para estabilizar o paciente e melhorar sua condição de saúde. Isso pode incluir ajustes na medicação, terapias adicionais, mudanças no estilo de vida e intervenções de suporte, conforme necessário. Além disso, é crucial garantir uma comunicação eficaz entre os membros da equipe de saúde e fornecer educação ao paciente sobre a gestão de sua condição crônica e a prevenção de futuras descompensações. Ao abordar a descompensação de doenças crônicas, é importante adotar uma abordagem multidisciplinar, envolvendo médicos, enfermeiros, farmacêuticos, terapeutas e outros profissionais de saúde. O trabalho em equipe colaborativo permite uma avaliação abrangente e uma variedade de perspectivas na elaboração do plano de tratamento mais adequado para cada paciente. Em conclusão, a avaliação e o tratamento da descompensação de doenças crônicas exigem uma abordagem holística e coordenada, visando não apenas a estabilização imediata do paciente, mas também a promoção da saúde a longo prazo e a prevenção de recorrências. Essa abordagem centrada no paciente é essencial para garantir resultados positivos e uma melhor qualidade de vida para os indivíduos afetados por doenças crônicas

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

Where does her mood come from? An organic approach to a once functional patient

Objective: To report the rare development of manic symptoms in a patient with schizophrenia and discuss its differential diagnosis.Case description: Diagnostic criteria were based on the International Classification of Diseases, 10th edition (ICD-10). A 63-year-old female (diagnosed with schizophrenia since she was 28) was brought to the emergency room with symptoms consistent with manic episode and physical examination suggestive of thyrotoxicosis. Graves' disease was confirmed by subsequent laboratory tests. She was treated successfully with radioiodine ablation, leading to full remission of manic symptoms.Comments: Schizophrenia is a chronic disease that affects about 1% of the population worldwide. The main symptoms of the disorder are altered affection, delusions, and hallucinations. Graves' disease is an autoimmune condition in which antibodies increase the production and release of thyroid hormones. There are reports about the development of mood symptoms in patients with Graves' disease that remit with adequate treatment

Case report of adenoid cystic carcinoma of the breast – a rare lesion with favorable prognosis

Introduction: Adenoid cystic carcinoma (ACC) is a rare type of breast tumor – less than 0.1% of breast malignancies. Usually, ACC is triple-negative, with lymph node involvement not exceeding 2%, and metastases are uncommon. When localized, the disease is indolent with an excellent prognosis. Objective: To report a case of ACC of the breast and provide data for the medical literature. Method/Case report: J.S.M.S., 44 years old, had a 1 cm nodule in the right breast (RB) and free axillae. Mammography (MMG) showed focal asymmetry in the upper outer quadrant (UOQ) and BI-RADS 0. Ultrasound (US) revealed a solid, circumscribed, periareolar lesion with areas of cystic degeneration, 1.2 cm, BI-RADS 3. Fine-needle aspiration biopsy (FNAB) suggested fibroadenoma. Lesion resection led to the diagnosis of ACC, histological grade 1 (HG1), nuclear grade 1 (NG1), with associated ductal carcinoma in situ (DCIS), and sentinel lymph node with no neoplasia. Immunohistochemistry (IHC) revealed estrogen receptor-negative (ER-), progesterone receptor-negative (PR-), HER2 negative (HER2-), and Ki67 10%. Staging had no evidence of distant disease. The patient did not receive chemotherapy (CT) but underwent 18 sessions of radiotherapy (RT) in the breast with a boost to the tumor bed. She remains disease-free at 8 months of follow-up. Results/Discussion: ACC has low malignant potential with histology similar to that of primary ACC of the salivary gland (which is aggressive); in the breast, it represents 0.058% of all ACC cases. It is more common in Caucasian women aged 60 to 70 years and usually subareolar (approximately 50% of cases). Imaging tests are nonspecific. ACC has lymph node involvement in about 2% of cases. Histology shows epithelial and myoepithelial cells distributed in the classic tubular or cribriform architecture. IHC reveals epithelial cells positive for CD117 and myoepithelial cells positive for smooth muscle actin, calponin, and p63. ACC of the breast expresses proto-oncogene c-KIT and a chromosomal translocation similar to its salivary counterpart: t (6; 9) (q22-23; p23-24). Treatment consists of surgery with free margins. Axillary dissection, CT, and RT have a questionable role due to the indolent course of the disease. Until now, small studies have not suggested a benefit in overall survival when adding adjuvant CT. Although triple-negative, its prognosis is favorable. Local recurrence is approximately 3–18%, and 10-year survival is above 90%. Conclusion: The rarity of these tumors and their favorable course raise questions about the best treatment for ACC. The benefit of axillary dissection, CT, or RT remains unknown because the prognosis seems very favorable with only surgery, despite its triple-negative status. Further studies are necessary to adopt the optimal strategy for these tumors.</jats:p

Where does her mood come from? An organic approach to a once functional patient

Objective: To report the rare development of manic symptoms in a patient with schizophrenia and discuss its differential diagnosis.Case description: Diagnostic criteria were based on the International Classification of Diseases, 10th edition (ICD-10). A 63-year-old female (diagnosed with schizophrenia since she was 28) was brought to the emergency room with symptoms consistent with manic episode and physical examination suggestive of thyrotoxicosis. Graves' disease was confirmed by subsequent laboratory tests. She was treated successfully with radioiodine ablation, leading to full remission of manic symptoms.Comments: Schizophrenia is a chronic disease that affects about 1% of the population worldwide. The main symptoms of the disorder are altered affection, delusions, and hallucinations. Graves' disease is an autoimmune condition in which antibodies increase the production and release of thyroid hormones. There are reports about the development of mood symptoms in patients with Graves' disease that remit with adequate treatment.</div