RESUMO
INTRODUCTION: The majority of patients with advanced neoplasms have religious/spiritual needs, and for most of them religion and/or spirituality is important. The psychology of religion and spirituality is one the forms of support offered to patients with advanced cancer. R/S are factors which impact health-related quality of life (HRQoL). The aim of this paper was to assess the influence of R/S on the HRQoL of patients diagnosed with MM. MATERIALS AND METHODS: The patients filled out anonymous questionnaires about R/S and the HRQoL scale. The clinical data were collected from medical records. RESULTS: The study sample consisted of 83 patients with MM (51.8% women), with a mean age of 64.9 years. The leading denomination among the respondents was Catholic (N = 83, 100%): 36% described themselves as deep believers (N = 30), 53% as believers (N = 44), and 11% as nonpracticing believers (N = 9). Most patients were receiving ongoing treatment (59.8%), while 40.2% were in remission from the disease. Patients in remission declared a significantly higher interest in R/S issues than patients in active treatment and had a higher rate of intrapsychic R/S struggles dominated by anxiety and guilt. A moderate negative correlation between interest in R/S issues and unfavorable assessment of physical functioning and role functioning was observed. Anger towards God positively correlated with a negative assessment of emotional functioning. CONCLUSIONS: The findings highlight the importance of R/S for the HRQoL of MM patients and show that their QoL depends on the types of R/S coping used.
Assuntos
Mieloma Múltiplo , Espiritualidade , Humanos , Feminino , Pessoa de Meia-Idade , Idoso , Masculino , Qualidade de Vida/psicologia , Mieloma Múltiplo/terapia , Religião , Adaptação PsicológicaRESUMO
We present a case of a 30-year-old man suffering from chronic refractory immune thrombocytopenia (ITP) from early childhood. The patient was treated with all the therapeutic methods available in Poland, without platelet response: corticosteroids, intravenous immunoglobulins, splenectomy, cyclophosphamide, vinblastine, azathioprine, mycophenolate mofetil, rituximab, ciclosporin A, romiplostim, and eltrombopag. He continued to function persistently with deep thrombocytopenia, symptoms of hemorrhagic diathesis, and one episode of spontaneous subarachnoid bleeding. In April 2022, at the age of 29, the patient received avatrombopag. Within 4âweeks of starting avatrombopag 20âmg daily for 2âweeks and then 40âmg daily, he reached a platelet (PLT) count of 67âxâ10 9 /l. In the next month, platelets fell below 30âxâ10 9 /l, but subsequently the count increased to 47âxâ10 9 /l, then to 52âxâ10 9 /l, and remained stable. The symptoms of cutaneous hemorrhage diathesis have resolved completely since avatrombopag was introduced and did not reappear despite the decrease in PLT count.
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Púrpura Trombocitopênica Idiopática , Trombocitopenia , Pré-Escolar , Masculino , Humanos , Adulto , Contagem de Plaquetas , Púrpura Trombocitopênica Idiopática/complicações , Púrpura Trombocitopênica Idiopática/tratamento farmacológico , Trombocitopenia/complicações , Trombocitopenia/tratamento farmacológico , Tiazóis/farmacologia , Tiazóis/uso terapêuticoRESUMO
BACKGROUND: Immune thrombocytopenia (ITP) is a disease with variable clinical presentation, requiring different treatment lines. AIM: The study aimed to characterize a group of ITP patients in terms of clinical picture and disease treatment, as well as to present the current standard of care of ITP in Poland, in the context of local and international guidelines. MATERIALS AND METHODS: The study included adult patients diagnosed with ITP, treated at the Department of Haematology of the Jagiellonian University Hospital in Krakow from January 2006 to January 2021. Patient characteristics, clinical manifestation of ITP, and treatment methods were analyzed. RESULTS: A total of 245 ITP patients were included. 57.1% of them were asymptomatic at diagnosis. Most common symptoms were thrombocytopenic purpura (68.2%), followed by epistaxis (34.7%) and gum bleeds (19.2%). Life-threatening bleedings were noted in three cases (1.2%). 23.2% of patients did not require treatment. Prednisone was the most commonly used first-line therapy (75.5% of patients). Treatment with eltrombopag and romiplostim was used in 40.4 and 8.5% of patients requiring second-line therapy, respectively. 14.3% of all patients ultimately underwent splenectomy, including 51.5% of those who needed second-line treatment. The initial response rate was 74.3%; however, post-splenectomy relapses occurred in 22.9% of patients. CONCLUSIONS: ITP is a disease of mild clinical course, often asymptomatic. Chronic disease often requires multiple treatment lines and balancing between bleeding risk and treatment toxicity, based on individual risk-benefit assessment. Local access restrictions to thrombopoietin receptor agonists determined the treatment strategy.
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Púrpura Trombocitopênica Idiopática , Trombocitopenia , Adulto , Humanos , Púrpura Trombocitopênica Idiopática/diagnóstico , Púrpura Trombocitopênica Idiopática/epidemiologia , Púrpura Trombocitopênica Idiopática/terapia , Hemorragia/epidemiologia , Hemorragia/terapia , Prednisona/uso terapêutico , EsplenectomiaRESUMO
<b>Introduction: </b>Gastrointestinal bleeding is a common disease that surgeons encounter in everyday clinical practice. It is most often easy to diagnose and treat. However, rare causes of bleeding can lead to delayed diagnosis and ineffective treatment. Dysfibrinogenemia is a qualitative fibrinogen disorder in which functional fibrinogen level is reduced with normal antigenic level. <br><b> Case report:</b> Herein we present the case of a 59-year-old female with recurrent gastrointestinal bleeds, that turned out to be an unusual manifestation of congenital dysfibrinogenemia. Detailed imaging and endoscopic diagnostics revealed portal hypertension with a non-bleeding 1-cm gastrointestinal stromal tumor and multiple angiodysplastic lesions in close proximity.