RESUMO
Objective: To determine the nutritional status and its association with functional capacity in patients with digestive tract cancer. Methods: We retrospectively studied all adult patients hospitalized who were diagnosed as having a cancer of the digestive tract. Nutritional status and functional capacity were assessed. Descriptive statistic and odds ratio were used to determine the association in SPSS 14.0. Results: 57 patients were included, 96% had weight loss. Using subjective global assessment (SGA) as a method of screening, 82.5% of the patients were found malnutrition and by biochemical and immunological test 82% and 65% respectively. Functional capacity was assessed by Karnofsky index, finding that 75.5% of the patients have some activity limitation. Results show an association between malnutrition by SGA and limitation in functional capacity (c2 = 1.56; p = 0.212; OR: 2.46; 95% confidence interval [95% CI]: 0.581-10.465). In addition, we observe an association between the total lymphocyte count and limitation in functional capacity (χ2 = 6.94; p = 0.008; OR: 5.23; 95% CI: 1.441-19.025). Conclusions: Malnutrition in patients with digestive tract cancer was associated with limitation in functional capacity.
Assuntos
Neoplasias Gastrointestinais/patologia , Desnutrição/epidemiologia , Avaliação Nutricional , Estado Nutricional , Adulto , Idoso , Feminino , Hospitalização , Humanos , Avaliação de Estado de Karnofsky , Contagem de Linfócitos , Masculino , Desnutrição/diagnóstico , Pessoa de Meia-Idade , Estudos Retrospectivos , Redução de PesoRESUMO
PROBLEM: Up to 35% of hospitalized patients may experience functional decline during or after hospitalization. Subjective Global Assessment (SGA) and handgrip strength at admission, have been proposed as simple and accessible tools to predict functional decline, but there are few studies in hospitalized patients to confirm these findings. OBJECTIVE: To assess the predictive value of handgrip strength at hospital admission, on functional decline after 30 days. METHODS: 125 non-critical patients hospitalized for medical and surgical conditions, were studied in El Pino hospital in Santiago, Chile. Upon admission, nutritional status was assessed by SGA, functional status through the Karnofsky index (KI), and handgrip strength by dynamometry. Change in functionality was assessed by the difference between KI at admission and 30 days later. Multivariate logistic regression models were used to establish associations between the variables at hospital admission, and subsequent functional decline. RESULTS: Thirty days post-hospital admission, 28.8% of the sample showed functional decline. In a multivariate analysis, only handgrip strength was associated with this decline (ß = -0.025, OR = 0.974 (CI 0.956-0.992), p = 0.007). CONCLUSIONS: Handgrip strength upon hospital admission can be a useful independent and early method to predict deterioration of functional status during hospitalization.
Assuntos
Força da Mão , Dinamômetro de Força Muscular , Admissão do Paciente , Adulto , Idoso , Chile , Comorbidade , Feminino , Humanos , Avaliação de Estado de Karnofsky , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Avaliação Nutricional , Estado Nutricional , Razão de Chances , Valor Preditivo dos Testes , Prognóstico , Fatores de Risco , Fatores de Tempo , Adulto JovemRESUMO
BACKGROUND: The main function of the HLA-G molecule in its membrane-bound and soluble forms is to inhibit the immune response by acting on CD4+ T cells, cytotoxic T cells, NK cells and dendritic cells. Lung cancer is a leading cause of death worldwide, and annual incidence is high in both women and men. Some studies have reported an increase of HLA-G serum levels in lung cancer, probably generated by tumor cells escaping the antitumor immune response. In this study the concentration of soluble HLA-G in bronchoalveolar lavage (BAL) in patients with primary and metastatic lung cancer was measured to determine its relation with tumor histological type and overall patient status according to the Karnofsky scale. METHODS: Thirty-one lung cancer patients were included. A tumor biopsy was obtained by bronchoscopy and the tumor type was determined by hematoxylin and eosin staining. BAL samples were obtained to measure soluble HLA-G concentrations in an ELISA sandwich assay. RESULTS: The average value of soluble HLA-G was 49.04ng/mL. No correlation between soluble HLA-G levels and age, gender or smoking was observed. A highly significant difference was observed in the levels of soluble HLA-G in BAL from patients with different histological types of lung cancer, especially in metastatic tumors. The Karnofsky index showed a significant and inverse correlation with soluble HLA-G levels in BAL. CONCLUSIONS: Soluble HLA-G protein is significantly associated with metastatic tumors and patients with lower Karnofsky index and may be useful as a prognostic marker in lung cancer.
Assuntos
Adenocarcinoma/imunologia , Biomarcadores Tumorais/análise , Líquido da Lavagem Broncoalveolar/química , Antígenos HLA-G/análise , Neoplasias Pulmonares/imunologia , Adenocarcinoma/química , Adenocarcinoma/patologia , Idoso , Carcinoma de Células Pequenas/química , Carcinoma de Células Pequenas/imunologia , Carcinoma de Células Pequenas/patologia , Carcinoma de Células Escamosas/química , Carcinoma de Células Escamosas/imunologia , Carcinoma de Células Escamosas/patologia , Feminino , Humanos , Avaliação de Estado de Karnofsky , Pulmão/química , Neoplasias Pulmonares/química , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Metástase Neoplásica , Fumar/metabolismo , SolubilidadeRESUMO
Se realizó un estudio descriptivo, observacional, prospectivo y transversal de 50 pacientes con cáncer de pulmón -- diagnosticada clínica, radiológica, tomográfica e histológicamente --, quienes fueron ingresados en el Servicio de Neumología del Hospital General Docente "Dr. Juan Bruno Zayas Alfonso" de Santiago de Cuba, durante el año 2011, bajo tratamiento oncoespecífico, a fin de identificar los aspectos bioéticos relacionados con la información ofrecida sobre el diagnóstico a los afectados en estadios IIIA, IIIB y IV de la enfermedad. Como resultados de la serie figuraron: una mayor frecuencia del grupo etario de 61-70 años y del sexo masculino, así como una superioridad del índice de Karnofsky en los que recibían tratamiento ambulatorio más de 50 % del tiempo. Los pacientes fueron informados con mayor frecuencia sobre el proceso inflamatorio pulmonar, los quistes pulmonares y la afección micótica; también, la gran mayoría tenía conocimientos acerca del tratamiento oncoespecífico, la cantidad de ciclos que les correspondían y las reacciones adversas a los fármacos. Los principios de bioética más conocidos en orden decreciente fueron: justicia, beneficencia, autonomía y no maleficencia.
A descriptive, observational, prospective and cross sectional study of 50 patients with lung cancer -- who were diagnosed clinically, radiologically, tomographically and histologically -- admitted in the Pneumology Service of "Dr. Juan Bruno Zayas Alfonso" Teaching General Hospital in Santiago de Cuba was carried out during the year 2011, under specific oncological treatment, in order to identify the bioethical aspects related to the information offered on the diagnosis of those affected in stadiums IIIA, IIIB and IV of the disease. As results of the series there were: higher frequency of the age group 61-70 years and of the male sex, as well as superiority in Karnofsky index in those who received ambulatory treatment more than 50% of the time. Patients were informed with more frequency on the lung inflammatory process, the lung cysts and the fungal disorders; also, the great majority had knowledge about the specific oncological treatment, the quantity of cycles to receive and the adverse reactions to drugs. The most known bioethical principles in decreasing order were: justice, charity, autonomy and non malice.
Assuntos
Avaliação de Estado de Karnofsky , Neoplasias Pulmonares , Atenção Secundária à SaúdeRESUMO
BACKGROUND AND OBJECTIVES: A large proportion of the patients on peritoneal dialysis (PD) in Brazil have low levels of education and family income. The present study assessed whether education level and family income are associated with baseline and longitudinal changes in health-related quality of life (HRQOL) scores during the first year of PD therapy. METHODS: We evaluated 1624 incident patients from the Brazilian Peritoneal Dialysis Multicenter Study (BRAZPD) at baseline, and 486 of them after 12 months. The SF-36 was used to determine HRQOL and the Karnofsky index (KI), physical performance. RESULTS: At baseline, patients received high KI scores compared with scores on the SF-36. The means of the mental and physical components at baseline and after 12 months were 39.9 ± 10.5 compared with 38.7 ± 11.7 and 41.8 ± 9.6 compared with 40.7 ± 9.8 respectively, which were not statistically different. A multivariate regression analysis showed that age, sex, diabetes, and cardiovascular disease were predictors of the mental component (respectively, ß = 0.12, p < 0.001; ß = 0.11, p < 0.001; ß = -0.08, ß = 0.007; and ß = -0.07, p = 0.007) and that age, sex, diabetes, cardiovascular disease, hemoglobin, glucose, and creatinine were predictors of the physical component (respectively, ß = -0.28, p < 0.001; ß = 0.06, p = 0.009; ß = -0.09, p = 0.002; ß = -0.09, p = 0.001; ß = 0.07, p = 0.004; ß = -0.05, p = 0.040; and ß = 0.05, p = 0.040). Education level and family income were not significantly associated with HRQOL (mental and physical components) in the multivariate regression. CONCLUSIONS: The results indicate that, as predictors, family income and education level have no impact on HRQOL, supporting the idea that socio-economic status should not be a barrier to the selection of PD as a treatment modality in Brazil.