Quality of life and performance status after cardiopulmonary resuscitation: A study in Cova da Beira University Hospital Center's intensive care unit.

INTRODUCTION AND OBJECTIVES: Cardiac arrest (CA) is associated with high morbidity and mortality. Many studies focus on survival, but few explore the outcomes. The aim of this study is to analyze the survival curve, independence, quality of life, and performance status after CA. METHODS: This retrospective study included adults admitted to the intensive care unit of Cova da Beira University Hospital Center after CA between 2015 and 2019. We analyzed patient records and applied a questionnaire including EuroQoL's EQ-5D-3L and ECOG performance status. RESULTS: Ninety-seven patients were included (mean age 75.74 years). Thirty-one patients (32.0%) survived to hospital discharge. There was a significant loss of independence for activities of daily living, with 50.0% of those previously independent becoming dependent and 47.5% of those previously at home being institutionalized. Diabetes, female gender, and length of hospital stay were especially impactful on these findings. One year after CA, only 20.6% were alive and only 13.4% (65% of the one-year survivors) were independent. Nine patients answered our questionnaire. Mean EQ-5D quality of life index (0.528±0.297) and the most affected domains ('Pain/discomfort' and 'Anxiety/depression') were similar to the Portuguese population aged >30 years. However, 66.6% reported a decline in their quality of life. Lastly, seven respondents had a good performance status (ECOG 0-1). CONCLUSIONS: There was a significant loss of independence after CA. Moreover, despite the acceptable performance status and the quality of life results being similar to the general population, there was a perceived deterioration post-CA. Ultimately, we emphasize the need to improve care for these patients.

Fulminant Emphysematous Hepatitis - A Rare Cause of Septic Shock.

Emphysematous hepatitis is a rare entity characterized by the replacement of hepatic parenchyma by gas, leading to acute liver failure. Often it occurs in patients with diabetes mellitus, liver disease or a recent history of abdominal surgery. We present a case of emphysematous hepatitis in a 74-year-old man with no recognizable risk factors. Despite the early broad-spectrum antimicrobial therapy and supportive care, the condition progressed to a fatal outcome, as seen in other case reports. Early recognition of this condition and rapid and aggressive management may improve patient outcomes. LEARNING POINTS: Emphysematous hepatitis is a rare condition characterized by replacement of hepatic parenchyma by gas.The diagnosis of emphysematous hepatitis requires imaging, preferably a computed tomography scan.Emphysematous hepatitis warrants awareness among clinicians for early diagnosis and rapid and aggressive management.

[Adult nesidioblastosis]. / Nesidioblastose do adulto.

In adults, endogenous hyperinsulinemic hypoglycaemia is almost invariably due to insulinoma. The authors describe a 29 year old patient with repeated postprandial symptomatic hypoglycaemias and negative prolonged fast test. Distal pancreatectomy was performed, directed by positive arteriographic testing. Histological examination revealed pancreatic nesidioblastosis and no tumoral lesion. Distinct pathogenetic, clinical, diagnostic and therapeutic aspects of this rare disease in the adult are reviewed.