Factors affecting do-not-resuscitate decisions among patients with amyotrophic lateral sclerosis in Taiwan.

Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease. Usually, patients survive for approximately 2-4 years after the onset of the disease, and they often die of respiratory failure. This study examined the factors associated with signing a "do not resuscitate" (DNR) form in patients with ALS. This cross-sectional study included patients diagnosed with ALS between January 2015 and December 2019 in a Taipei City hospital. We recorded patients' age at disease onset; sex; presence of diabetes mellitus, hypertension, cancer, or depression; use of invasive positive pressure ventilator (IPPV) or non-IPPV (NIPPV); use of nasogastric tube (NG) or percutaneous endoscopic gastrostomy (PEG) tube; follow-up years; and number of hospitalizations. Data from 162 patients were recorded (99 men). Fifty-six (34.6%) signed a DNR. Multivariate logistic regression analyses revealed that the factors associated with DNR included NIPPV (OR = 6.95, 95% CI = 2.21-21.84), PEG tube feeding (OR = 2.86, 95% CI = 1.13-7.24), NG tube feeding (OR = 5.75, 95% CI = 1.77-18.65), follow-up years (OR = 1.13, 95% CI = 1.02-1.26), and number of hospital admissions (OR = 1.26, 95% CI = 1.02-1.57). The findings suggest that end-of-life decision making among patients with ALS may often be delayed. DNR decisions should be discussed with patients and their families during the early stages of disease progression. Physicians are advised to discuss DNR with patients when they can speak and to offer palliative care options.

Epidermal Growth Factor Receptor Tyrosine Kinase Inhibitor Treatment Response in Advanced Lung Adenocarcinomas with G719X/L861Q/S768I Mutations.

BACKGROUND: Epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI) is the standard therapy for advanced lung adenocarcinomas with common EGFR mutations. Preclinical studies have suggested that uncommon G719X, L861Q, and S768I mutations are also sensitive to EGFR-TKIs. However, the efficacy of EGFR-TKIs in patients with these uncommon mutations remains unclear. METHODS: A nationwide survey was performed to collect data from gefitinib and erlotinib treatment outcomes of patients with stage IIIB/IV lung adenocarcinoma bearing EGFR G719X/L861Q/S768I mutations. The results were compared with those regarding patients with exon 19 deletions or L858R mutations. RESULTS: One hundred and sixty-one patients with uncommon EGFR mutations were enrolled from 18 institutes throughout Taiwan. Mutations of G719X, L861Q, S768I, G719X + L861Q, and G719X + S768I were observed in 78, 57, 7, 9, and 10 patients, respectively. After receiving EGFR-TKI treatment, patients with uncommon mutations exhibited a significantly inferior tumor response rate (41.6% vs. 66.5%; p < 0.001) and progression-free survival (median, 7.7 vs. 11.4 months; p < 0.001) than patients with common mutations. Among the patients who used EGFR-TKIs as first-line treatment, there was a significant difference in overall survival between these two groups of patients (median, 24.0 vs. 29.7 months; p = 0.005). CONCLUSION: Gefitinib and erlotinib are active in patients with G719X/L861Q/S768I mutations; however, less effective than in those with common mutations.

Hyponatremia in patients with symptomatic pericardial effusion.

BACKGROUND: Hyponatremia is related to cardiac tamponade in isolated case reports. However, the incidence of hyponatremia in patients with cardiac tamponade is still undetermined. METHODS: In a tertiary referral medical center, patients who presented with cardiac tamponade necessitating evacuation of pericardial effusion were included. Medical records were reviewed for the diagnosis of effusion and the underlying disease in each patient. Serum sodium concentrations before and after evacuation of effusion were analyzed. RESULTS: A total of 48 patients were identified during a 3-year period and 26 patients (54.2%) were found to have hyponatremia. The condition was mild (130-134 mEq/L) in eight; moderate (120-129 mEq/L) in 16; and severe (<120 mEq/L) in two patients. The frequency of hyponatremia was significantly higher in patients with malignancy-related rather than nonmalignancy-related cardiac tamponade (62.2% vs. 27.3%, p = 0.041). Nineteen patients had hyponatremia at presentation and had paired serum sodium concentrations measured after evacuation of pericardial effusion. The postevacuation serum sodium concentrations were significantly higher than the pre-evacuation levels in all patients (p < 0.001). CONCLUSION: Hyponatremia is common in patients with cardiac tamponade. However, prompt management of pericardial effusion will result in spontaneous and rapid recovery from hyponatremia.