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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

Thu, 18 Jan 2024 00:00:00 GMT

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

Preditores da resposta ao tratamento em pacientes com urticária crônica

Fri, 09 May 2025 00:00:00 GMT

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

Lambda light chain-induced monoclonal gammopathy of renal significance, manifesting with Fanconi Syndrome and osteomalacia

Sat, 01 Jan 2022 00:00:00 GMT

Título: Lambda light chain-induced monoclonal gammopathy of renal significance, manifesting with Fanconi Syndrome and osteomalacia Autor(es): Gutiérrez-Peredo, Gabriel Brayan; Oliveira Filho, José César Batista; Montaño-Castellón, Iris; Gutiérrez-Peredo, Andrea Jimena; Crusoé, Edvan de Queiroz; Gusmao-Flores, Dimitri Abstract: Background: Monoclonal gammopathy of renal significance (MGRS) encompasses a heterogeneous group of kidney diseases in which a monoclonal immunoglobulin secreted by a clone of B cells or plasma cells causes kidney damage without meeting the hematological criteria for malignancy. Among the various forms of involvement, MGRS can manifest as a proximal tubule disorder, such as Fanconi syndrome (FS), characterized by urinary loss of phosphate, glucose, amino acids, uric acid and bicarbonate. Few cases of MGRS have been described in the literature, manifesting as FS and monoclonal production of lambda light chains, almost all of which are secondary to the production of kappa light chains. Case presentation: Here we report a clinical case of a 45-year-old Brazilian male, African descent, with proximal weakness of the lower limbs, whose initial assessment showed a urine summary with the presence of proteinuria and glycosuria without hyperglycemia, associated with mild worsening of renal function, hypouricemia, hypocalcemia and phosphaturia. Evolution was characterized by a MGRS manifesting as FS and osteomalacia. Conclusion: The diagnosis of MGRS is not always easy, it requires knowledge of the clinical characteristics, diagnostic criteria and prognosis of each case. Therefore, all possible efforts should be made for multidisciplinary diagnosis. Editora / Evento / Instituição: Programa de Pós-Graduação em Medicina e Saúde (PPgMS), Universidade Federal da Bahia (UFBA) Tipo: Artigo de Periódico

The urine protein/creatinine ratio as a reliable indicator of 24-h urine protein excretion across different levels of renal function and proteinuria: the TUNARI prospective study

Mon, 01 Jan 2024 00:00:00 GMT

Título: The urine protein/creatinine ratio as a reliable indicator of 24-h urine protein excretion across different levels of renal function and proteinuria: the TUNARI prospective study Autor(es): Gutiérrez-Peredo, Gabriel Brayan; Montaño-Castellón, Iris; Gutiérrez-Peredo, Andrea Jimena; Lopes, Marcelo Barreto; Tapioca, Fernanda Pinheiro Martin; Guimaraes, Maria Gabriela Motta; Montaño-Castellón, Sony; Guedes, Sammara Azevedo; Costa, Fernanda Pita Mendes da; Mattoso, Ricardo José Costa; Oliveira Filho, José César Batista; Norris, Keith C.; Almeida, Antonio Raimundo Pinto de; Lopes, Antonio Alberto Abstract: Introdução A excreção urinária de proteína em 24 horas (24-hUP) é o padrão-ouro para a avaliação da proteinúria. Este estudo teve como objetivo avaliar a eficácia diagnóstica da razão proteína/creatinina (PCR) para estimar a 24-hUP em diferentes níveis de função renal e de proteinúria. Métodos Estudo transversal realizado entre dezembro de 2021 e dezembro de 2023, em Salvador, Bahia – Brasil, como uma extensão de dados previamente publicados do estudo TUNARI. Foram incluídas 217 amostras de 152 pacientes com diferentes níveis de função renal e proteinúria. A PCR em amostras isoladas e a 24-hUP foram determinadas por métodos convencionais dentro de um intervalo de 24 horas. Os pacientes foram classificados em três grupos de acordo com o nível de função renal (Grupo 1 = 10 a <30 mL/min; Grupo 2 = 30–60 mL/min; e Grupo 3 = >60 mL/min) e de acordo com o nível de proteinúria (<0,3 g/dia; 0,3–3,5 g/dia; e >3,5 g/dia). Os dados foram analisados utilizando a correlação de Spearman (rs), o coeficiente de determinação (r²), gráficos de Bland–Altman e curva ROC (receiver operating characteristic). Razões de verossimilhança positiva (LR+) e negativa (LR-) foram derivadas da sensibilidade e especificidade da PCR. Resultados A média de idade foi de 41,5 ± 15,7 anos; 61,8% eram mulheres, 36,8% negros e 52% pardos. Glomerulopatias representaram 80,3%, sendo 46,1% com nefrite lúpica. Das amostras totais de urina, observou-se alta correlação entre a PCR e a 24-hUP (rs = 0,86; p < 0,001) em todos os níveis de função renal. No entanto, a concordância entre PCR e 24-hUP foi reduzida nos níveis mais elevados de proteinúria. A análise ROC mostrou uma AUC de 0,95 (IC 95% = 0,92–0,98), com sensibilidade de 91% e especificidade de 86,5% (LR+ 6,7; LR– 0,1), com ponto de corte ótimo de 0,77. Esses resultados foram semelhantes entre os diferentes níveis de função renal. Para proteinúria ≤0,3 g/dia, a sensibilidade foi de 83,3% e a especificidade de 90%, com AUC de 0,85 (IC 95% = 0,71–0,94). Na faixa de 24-hUP >0,3–3,5 g/dia, a sensibilidade foi de 64,1%, especificidade de 84,6% e AUC de 0,76 (IC 95% = 0,67–0,84). A PCR identificou todos os casos com proteinúria >3,5 g/dia. Conclusões A PCR é uma medida adequada para ser usada como indicador da 24-hUP em diferentes níveis de função renal, embora possa apresentar limitações em níveis elevados de proteinúria. A análise da PCR por faixa de proteinúria mostrou que a concordância e a sensibilidade diminuem nos níveis mais altos, mas a especificidade se mantém boa, sendo capaz de identificar proteinúria na faixa nefrótica. Editora / Evento / Instituição: Programa de Pós-Graduação em Medicina e Saúde (PPgMS), Universidade Federal da Bahia (UFBA) Tipo: Artigo de Periódico