https://repositorio.ufba.br/handle/ri/10072 2026-05-05T04:42:43Z https://repositorio.ufba.br/handle/ri/43151 Título: Variabilidade na percepção de cuidados paliativos e cuidados de fim de vida entre profissionais de hematologia de um mesmo centro de referência na Bahia, Brasil: um estudo de corte transversal Autor(es): Miranda, Diego Lopes Paim Primeiro Orientador: Araújo, Marco Aurélio Salvino de Abstract: Introduction: Several illness-specific cultural and system-based barriers to palliative care (PC) integration and optimal end-of-life (EOL) care exist in the oncohematology scenario. Limited research exists exploring determinants of the discrepancies in daily implementation of PC among healthcare professionals in this field. Objective: We aimed to investigate the variability in PC and EOL care among hematologists and hematology residents at the hematology service of Clinics Hospital of the Federal University of Bahia (UFBA). Methods: Cross-sectional study performed between October and December 2022. Variables were collected through a sociodemographic questionnaire and an adaptation of clinical questionnaires used in previous studies. Results: During the research period, all twenty physicians from the hematology division of the Clinics Hospital of the UFBA participated. Median age was 44 years-old, with 80% of participants identifying as female and 75% were graduated hematologists. Participants were presented with a hypothetical scenario involving the treatment of a 65-year-old female patient with poor prognosis acute myeloid leukemia refractory to first-line treatment. Sixty percent of participants chose to follow other chemotherapy regimens, while 40% implemented PC. Participants next considered a case salvage for the patient who developed septic shock following chemotherapy and were prompted to choose their most probable conduct and the conduct they thought would be better for the patient. Even though being part of the same center, we found a divergence from the most probable conduct among 40% of participants. Reasons involved personal convictions, legal aspects and other physicians’ reactions. Discussion: We found considerable differences within PC decisions between professionals despite being under the same service and protocols. Such investigations hold immense importance for existing literature, as they may identify modifiable factors that can effectively enhance quality of PC and EOL care within the oncohematology setting. Editora / Evento / Instituição: Universidade Federal da Bahia Tipo: Dissertação 2024-01-18T00:00:00Z https://repositorio.ufba.br/handle/ri/42272 Título: Preditores da resposta ao tratamento em pacientes com urticária crônica Autor(es): Fonseca, Joice Trigo da Primeiro Orientador: Campos, Régis de Albuquerque Abstract: PREDICTORS OF TREATMENT RESPONSE IN PATIENTS WITH CHRONIC URTICARIA. Introduction: Chronic urticaria (CU) is characterized by the recurrent appearance of wheals and/or angioedema for more than six weeks and is classified as either spontaneous or inducible, significantly impacting patients’ quality of life. Treatment begins with H1-antihistamines, in doses that may be increased up to four times the standard dosage. In refractory cases, the monoclonal anti-immunoglobulin E (IgE) antibody—IgE being the main antibody involved in allergic reactions (omalizumab)—is used, and in the absence of response, cyclosporine is indicated. This study aimed to identify clinical and laboratory predictors of treatment response in patients with CU.Methods: This was a cross-sectional study involving 175 patients with CU treated at the Urticaria Center of Reference and Excellence (UCARE) of the University Hospital Professor Edgard Santos (HUPES/UFBA). Sociodemographic, clinical, and laboratory data were collected, including age, sex, BMI, CU subtype, and presence of angioedema. Treatment response was assessed using the Urticaria Control Test (UCT) or Angioedema Control Test (AECT), with scores ≥12 and ≥10, respectively, considered satisfactory. Treatment steps were compared, and clinical-laboratory predictors of refractoriness were analyzed.Results: Most patients were female (80.6%), with a mean age of 45.3 years and an average disease duration of 11.9 years. Chronic spontaneous urticaria (CSU) was the predominant subtype (86.3%), and 30.9% had coexisting inducible forms. Higher BMI, earlier disease onset, longer disease duration, and psychiatric disorders were associated with lower response to H1-antihistamines. Responders at this stage had a shorter disease duration and a lower proportion of females compared to those requiring omalizumab. Among omalizumab users, mental disorders remained a significant predictor of refractoriness. All patients with a partial response to omalizumab had total IgE <40 IU/mL, although this was not observed in non-responders. None of the laboratory parameters evaluated (ESR, CRP, IgE, D-dimer, anti-TPO, and eosinophils) showed a significant association with treatment response. There was no statistical difference in therapeutic response between patients with CSU and those with inducible urticaria.Conclusion: Higher BMI, female sex, earlier symptom onset, prolonged disease duration, and psychiatric disorders were associated with poorer treatment response. The laboratory markers evaluated were not effective predictors of treatment response. Editora / Evento / Instituição: Universidade Federal da Bahia Tipo: Dissertação 2025-05-09T00:00:00Z https://repositorio.ufba.br/handle/ri/40591 Título: Lesão renal aguda em nonagenários: incidência, preditores e prognóstico Autor(es): Souza, André Luis Bastos Primeiro Orientador: Rocha, Paulo Novis Abstract: Introduction: The aging of the population has increased the frequency with which nephrologists encounter nonagenarians with acute kidney injury (AKI). The management of these patients has peculiarities that even involve bioethical aspects, such as the introduction of renal support therapy (RTR) at this end of life. Objective: to investigate the incidence, predictors and prognosis of AKI in nonagenarians. Methods: We conducted a retrospective cohort study in a tertiary care hospital. Between 2006 and 2016, 832 nonagenarians were admitted to this hospital for two or more days and a random sample of 461 patients was obtained, respecting the sample size calculation. AKI was defined using serum creatinine using the KDIGO (Kidney Disease Improving Global Outcomes) criteria. Results: Of the 461 patients selected, 25 were excluded because they did not have 2 or more creatinines; thus, 436 patients participated in the final analysis. The mean age was 93.5 ± 3.3 years and the incidence of AKI was 45%. Length of hospital stay, intensive care unit (ICU) admission, use of vasoactive drugs (VAD) and mechanical ventilation (MV) were independent risk factors for AKI. Mortality was significantly higher in patients with AKI: 66.8% versus 23.8% in the group without AKI (p<0.001). After multivariate analysis, age, Charlson comorbidity score, use of DVA, MV and KDIGO classification stage remained independent predictors of mortality. Only 13 patients underwent RRT; all of them were in the ICU, using VAD and almost 77% on MV, highlighting the extreme severity of this subgroup. Mortality among dialysis patients was 100% compared to 64% among non-dialysis patients (p=0.008). However, when dialysis patients were compared to a random sample of nonagenarians with AKI matched for severity, there was no difference in mortality (100% x 96%, p=1.0). Conclusion: the incidence of AKI in nonagenarians is very high and accompanied by a poor prognosis. The 100% mortality rate in patients undergoing RRT, composed of critically ill nonagenarians in an intensive care environment, highlights the need for discussion about the usefulness versus futility of this therapy in this population. Editora / Evento / Instituição: Universidade Federal da Bahia Tipo: Dissertação 2019-02-07T00:00:00Z https://repositorio.ufba.br/handle/ri/38266 Título: Conhecimento de pacientes idosos sobre a indicação de medicamentos prescritos Autor(es): Gama, Romana Santos Primeiro Orientador: Passos, Luiz Carlos Santana Abstract: Patient adherence is associated to successful pharmacotherapy; however, many patients do not take their medications as prescribed because of poor understanding of their purpose. To understand how to use the medication correctly, patients need to obtain clear guidelines and instructions, as their behavior and characteristics play a fundamental role in the effectiveness of a medication. Objective: The aim of this study was to evaluate older people’s knowledge of the purpose of drugs prescribed at medical appointments in primary care units and the aspects related to their level of knowledge of their medications. Methods: This was a cross-sectional study conducted in 22 basic health units in Brazil. Older adults who were waiting for medical consultations in the study facilities were interviewed after a consultation with a family practice physician. Data were collected from September 2016 to March 2019. Patients who were ≥ 60 years old who visited the primary care units were included in the study (n = 674). Knowledge of prescribed medications was assessed by comparing the responses to the questionnaire and the medication and prescription information. Multivariate analyses were conducted using a Poisson regression with robust variance. Results: The mean age of the sample was 70.1 (standard deviation ± 7.1) years. Among 674 patients, 272 (40.4%) did not know the indication of at least 1 of their prescribed drugs; among them 78 (11.6%) did not know the indication of any of their prescribed drugs. In the final multivariate analysis, polypharmacy, illiteracy, and cognitive impairment were found to be associated with misunderstanding the purpose of at least 1 prescribed drug. Moreover, illiteracy and cognitive impairment were associated with a greater misunderstanding of the purpose of all prescribed drugs. Conclusion: This study demonstrated that there is a considerable lack of knowledge about prescribed medications among older Brazilian adults after a medical appointment. For this reason, health services and professionals need to implement strategies to improve patient’s knowledge Editora / Evento / Instituição: Universidade Federal da Bahia Tipo: Dissertação 2022-06-09T00:00:00Z