Palliative Prognostic Index accuracy of survival prediction in an inpatient palliative care service at a Brazilian tertiary hospital.

PURPOSE: The Palliative Prognostic Index (PPI) was developed to improve survival prediction for advanced cancer patients. However, there is limited data about the PPI application in a real-world scenario. This study aimed to assess the accuracy of PPI > 6 in predicting survival of cancer inpatients. METHODS: A prospective observational cohort in an inpatient palliative care service at a tertiary hospital in São Paulo-SP, Brazil, between May 2011 and December 2018. RESULTS: We included 1,376 critically ill cancer inpatients. Patients were divided into three PPI subgroups: PPI ≤ 4, PPI 4-6, and PPI ≥ 6. Their respective medium overall survival values were 44 days (95% confidence interval [CI] 35.52-52.47), 20 days (95% CI 15.40-24.59), and 8 days (95% CI 7.02-8.98), (p < 0.001). PPI ≥ 6 predicted survival of <3 weeks with a positive predictive value (PPV) of 72% and an negative predictive value (NPV) of 68% (sensitivity 67%, specificity 72%). PPI > 4 predicted survival of <6 weeks with a PPV of 88% and an NPV of 36% (sensitivity 74%, specificity 59%). When PPI was <4, the mortality rate over 3 weeks was 39% with a relative risk (RR) of 0.15 (95% CI 0.11-0.20; p < 0.001), and the 6-week mortality rate was 63% with a RR of 0.18 (95% CI 0.13-0.25; p < 0.001) compared to PPI ≥ 4. CONCLUSIONS: PPI was a good discriminator of survival among critically ill cancer inpatients and could assist in hospital discharge decision. PPI may help healthcare policymakers and professionals in offering high-quality palliative care to patients.

BRAZILIAN SOCIETY OF HEPATOLOGY UPDATED RECOMMENDATIONS FOR DIAGNOSIS AND TREATMENT OF HEPATOCELLULAR CARCINOMA.

Hepatocellular carcinoma (HCC) is one of the leading causes of cancer-related mortality worldwide. The Brazilian Society of Hepatology (SBH) published in 2015 its first recommendations about the management of HCC. Since then, new data have emerged in the literature, prompting the governing board of SBH to sponsor a single-topic meeting in August 2018 in São Paulo. All the invited experts were asked to make a systematic review of the literature reviewing the management of HCC in subjects with cirrhosis. After the meeting, all panelists gathered together for the discussion of the topics and the elaboration of updated recommendations. The text was subsequently submitted for suggestions and approval of all members of the Brazilian Society of Hepatology through its homepage. The present manuscript is the final version of the reviewed manuscript containing the recommendations of SBH.

Atualização das recomendações da Sociedade Brasileira de Hepatologia para o diagnóstico e tratamento do carcinoma hepatocellular / Brazilian society of hepatology updated recommendations for diagnosis and treatment of hepatocellular carcinoma

ABSTRACT Hepatocellular carcinoma (HCC) is one of the leading causes of cancer-related mortality worldwide. The Brazilian Society of Hepatology (SBH) published in 2015 its first recommendations about the management of HCC. Since then, new data have emerged in the literature, prompting the governing board of SBH to sponsor a single-topic meeting in August 2018 in São Paulo. All the invited experts were asked to make a systematic review of the literature reviewing the management of HCC in subjects with cirrhosis. After the meeting, all panelists gathered together for the discussion of the topics and the elaboration of updated recommendations. The text was subsequently submitted for suggestions and approval of all members of the Brazilian Society of Hepatology through its homepage. The present manuscript is the final version of the reviewed manuscript containing the recommendations of SBH.

RESUMO O carcinoma hepatocelular (CHC) é uma das principais causas de mortalidade relacionada a câncer no Brasil e no mundo. A Sociedade Brasileira de Hepatologia (SBH) publicou em 2015 suas primeiras recomendações sobre a abordagem do CHC. Desde então, novas evidências sobre o diagnóstico e tratamento do CHC foram relatadas na literatura médica, levando a diretoria da SBH a promover uma reunião monotemática sobre câncer primário de fígado em agosto de 2018 com o intuito de atualizar as recomendações sobre o manejo da neoplasia. Um grupo de experts foi convidado para realizar uma revisão sistemática da literatura e apresentar uma atualização baseada em evidências científicas visando que pudesse nortear a prática clínica multidisciplinar do CHC. O texto resultante foi submetido a avaliação e aprovação de todos membros da SBH através de sua homepage. O documento atual é a versão final que contêm as recomendações atualizadas e revisadas da SBH.

Validation of questionnaire on the Spiritual Needs Assessment for Patients (SNAP) questionnaire in Brazilian Portuguese.

OBJECTIVES: Spirituality is related to the care and the quality of life of cancer patients. Thus, it is very important to assess their needs. The objective of this study was the translation and cultural adjustment of the Spiritual Needs Assessment for Patients (SNAP) questionnaire to the Brazilian Portuguese language. METHODOLOGY: The translation and cultural adjustment of the SNAP questionnaire involved six stages: backtranslation, revision of backtranslation, translation to the original language and adjustments, pre-test on ten patients, and test and retest with 30 patients after three weeks. Adult patients, with a solid tumour and literate with a minimum of four years schooling were included. For analysis and consistency we used the calculation of the Cronbach alpha coefficient and the Pearson linear correlation. RESULTS: The final questionnaire had some language and content adjustments compared to the original version in English. The correlation analysis of each item with the total score of the questionnaire showed coefficients above 0.99. The calculation of the Cronbach alpha coefficient was 0.9. The calculation of the Pearson linear correlation with the test and retest of the questionnaire was equal to 0.95. CONCLUSION: The SNAP questionnaire translated into Brazilian Portuguese is adequately reliable and consistent. This instrument allows adequate access to spiritual needs and can help patient care.

Hipertensão arterial pulmonar idiopática manifestada durante a gestação: correlação anátomo-clínica com necropsia. Relato de caso / Idiopathic pulmonary arterial hypertension manifested during pregnancy: anatomical-clinical correlation with necropsy. Case report

JUSTIFICATIVA E OBJETIVOS: A hipertensão arterial pulmonar idiopática (HAPI) é uma entidade rara, com prevalência estimada em 1-2 casos por milhão de pessoas. Sua relação com a gestação é relatada na literatura com freqüência de 4,5% em pacientes com HAPI. O objetivo deste estudo foi demonstrar um caso de HAPI relacionado com a gravidez, de evolução prolongada, a discordância entre o grau de lesão das artérias de pequeno calibre na anatomia patológica e a medida da pressão da artéria pulmonar no ecocardiograma. RELATO DO CASO: Paciente com 33 anos, branca, em sua segunda gestação, iniciou com quadro de dispnéia e edema nos membros inferiores, intensificados ao final do segundo trimestre, sendo realizada cesariana eletiva. Manteve os sintomas por dois meses. Referiu também dor precordial no hipocôndrio direito em sua segunda internação. Ao exame físico, observou-se estase jugular e hepatomegalia dolorosa, à ausculta cardíaca observou-se ritmo de galope protodiastólico, hiperfonese de segunda bulha em focos da base e sopro holossistólico em foco tricúspide. A investigação complementar confirmou a origem idiopática da doença. O óbito ocorreu por choque cardiogênico. CONCLUSÕES: A observação clínica indicou o diagnóstico de HAPI, afastando outras causas de hipertensão pulmonar. À necropsia, o diagnóstico pôde ser reforçado e foram afastadas outras causas específicas de hipertensão pulmonar na gestação. Apesar de não ter sido realizado estudo hemodinâmico, a pressão média da artéria pulmonar estimada pelo exame ultra-sonográfico foi discordante com a magnitude das lesões nas artérias de pequeno calibre detectadas no exame histopatológico. A HAPI durante a gestação possui elevada mortalidade e trata-se de uma doença ainda sem cura e com muitos aspectos fisiopatológicos a serem esclarecidos. As medidas de maior impacto continuam sendo a prevenção na gestação; e, se esta ocorrer, recomenda-se a sua interrupção precoce.(AU)

BACKGROUND AND OBJECTIVES: Idiopathic pulmonary arterial hypertension (IPAH) is a rare entity, with prevalence estimated in 1-2 cases/1.000.000. Its relationship with pregnancy, in the literature, is reported a 4.5% rate of patients with IPAH. The objective of this study was to demonstrate a case of IPAH related to pregnancy with extended evolution and the discord between the injury degree of the small bore arteries in the pathological anatomy and the measure of pulmonary artery pressure in echocardiography. CASE REPORT: Patient, 33 years-old, white, in her second pregnancy, initiated with symptoms of dyspnea and peripheral edema, intensified in the end of the second trimester, been realized cesarean section. She kept the symptoms for two months and related precordial and right hypochondriac pain in her second hospitalization. On physical examination, there were elevated jugular venous pressure and painful enlarged liver. On auscultation, there were gallop rhythm, prominent aortic and pulmonary second heart sounds and tricuspid pansystolic murmur. The complementary investigation confirmed the idiopathic origin of the disease. The death occurred due cardiogenic shock. CONCLUSION: The clinical observation indicates the diagnosis of IPAH, excluding other causes of pulmonary hypertension. In the necropsy, the diagnosis could have been confirmed and other specific causes of pulmonary hypertension in pregnancy could have been excluded. Although right heart catheterization haven’t been realized, the pulmonary artery pressure determined by echocardiography is discordant of the magnitude of the injuries in the small bore arteries detected in the microscopic examination. IPAH during pregnancy has great mortality and is an illness still without cure and with many physiopathological aspects to be revealed. The pregnancy prevention is recommended, if the pregnancy occurs, precocious interruption of the same one must be realized.(AU)