RESUMO
Introduction: Bioethics and nutrition are essential issues in end of life, advanced dementia, life-sustaining therapies, permanent vegetative status, and unacceptably minimal quality of life. Even though artificially administered nutrition (AAN), for this type of health condition, does not improve quality of life and extension of life, and there is evidence of complications (pulmonary and gastrointestinal), it has been used frequently. It had been easier considering cardiopulmonary resuscitation as an ineffective treatment than AAN for a healthy team and/or family. For this reason, many times, this issue has been forgotten. Objectives: This study aimed to discuss bioethical principles and AAN in the involved patients. Discussion: The AAN has been an essential source of ethical concern and controversy. There is a conceptual doubt about AAN be or not be a medical treatment. It would be a form of nourishment, which constitutes primary care. These principles should be used to guide the decision-making of healthcare professionals in collaboration with patients and their surrogates. Conclusions: This difficult decision about whether or not to prescribe AAN in patients with a poor prognosis and without benefits should be based on discussions with the bioethics committee, encouraging the use of advanced directives, education, and support for the patient, family, and health team, in addition to the establishment of effective protocols on the subject. All of this would benefit the most important person in this process, the patient.
Assuntos
Betacoronavirus , Infecções por Coronavirus/terapia , Tomada de Decisões/ética , Pandemias , Pneumonia Viral/terapia , Alocação de Recursos/métodos , Triagem/métodos , COVID-19 , Infecções por Coronavirus/economia , Humanos , Pandemias/economia , Pandemias/ética , Pneumonia Viral/economia , Alocação de Recursos/ética , SARS-CoV-2 , Triagem/éticaRESUMO
Hematopoietic stem cell transplantation (HSCT) is an important treatment option for children with severe and refractory sickle cell disease (SCD) with debilitating clinical complications. HSCT with cells from the bone marrow of a HLA-identical sibling used in SCD has a low mortality risk, high cure rate, and high event-free survival rate after a median follow-up of 5-6 years. However, matched donors are found in only about 20% of the patients. A boy aged 8 years with SCD had a sister, <2 years old, a fully compatible donor. The boy met all eligibility criteria to undergo HSCT, and he was suffering from cognitive and neurologic impairment due to ischemic events. A Bioethical Committee jointly discussed the ethical issues on this case after a pediatric evaluation released the very young sister for donation. The justification was that the sister would benefit from the donation too because of the greater likelihood of survival and cure and less suffering of her brother. The parents were informed about the risks and benefits for both children, and the family was psychologically evaluated. After their consent, HSCT was performed and the patient is cured from SCD. The complication for the donor was the need for blood transfusion.
RESUMO
A infecção da articulação esternoclavicular é uma condição rara quehabitualmente ocorre em pacientes com algum fator predisponente.Há poucos casos descritos na literatura de artrite séptica espontâneada articulação esternoclavicular em adultos saudáveis. O diagnósticopode ser difícil pois depende de estudos radiológicos dirigidos e ador da irritação da articulação esternoclavicular irradia-se paralocais distantes. Apresenta-se um caso de um paciente de 45anos previamente saudável com uma artrite séptica da articulaçãoesternoclavicular causada por Staphylococcus aureus cujodiagnóstico foi baseado em tomografia computadorizada da regiãoesternoclavicular e hemoculturas.
Assuntos
Artrite Infecciosa , Bacteriemia , Staphylococcus aureus , Articulação EsternoclavicularRESUMO
A medicina baseada em evidencias vem sendo descrita como uma nova abordagem do ensino e da pratica da medicina clinica. Fundamentada no metodo clinico-epidemiologico, valoriza principalmente observacoes sistematicas, a busca de evidencias objetivas e a interpretacao critica da literatura medica original. A medicina baseada em evidencias busca a solucao de problemas clinicos atraves da analise critica dos dados disponiveis na literatura, usando uma abordagem sistematizada...