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Immune Thrombocytopenia and Type 1 von Willebrand Disease in a Patient With a Femoral Fracture: A Case Report.
No full textThis article describes the case of a complex medical patient with immune thrombocytopenia (ITP) and von Willebrand disease (vWD), among other comorbidities, who underwent urgent orthopedic surgery and discusses the specificities of the perioperative anesthetic management of these bleeding disorders. Immune thrombocytopenia is an acquired autoimmune condition characterized by a diminished platelet count due to immune destruction. vWD is the most common inherited bleeding disorder, in which there is a defect of von Willebrand factor, a fundamental component of the hemostatic process. By compromising primary hemostasis, both conditions carry an important hemorrhagic risk in surgical patients, which is compounded by their coexistence
Successful Management of Rhino-Orbital Mucormycosis in a Diabetic Patient: a Case Report.
No full textMucormycosis is a rare but aggressive fungal infection, primarily affecting immunocompromised patients, with diabetes being a significant risk factor. This report describes the case of a 20-year-old male with poorly controlled type 1 diabetes who presented with facial swelling, proptosis, and necrotic nasal lesions. Imaging and biopsy confirmed rhino-orbital mucormycosis with . The patient underwent multiple surgical debridements and received dual antifungal therapy with liposomal amphotericin B and isavuconazole, alongside adjunctive hyperbaric oxygen therapy. Despite multiple complications, such as septic and cardiogenic shock, "in and out" diabetic ketoacidosis, and long-term oral compromise, clinical stabilization was achieved after prolonged hospitalization and a multidisciplinary approach. Currently, the patient is clinically and radiologically stable over two years of suppressive therapy with isavuconazole. This case highlights the importance of early diagnosis, aggressive multidisciplinary management, and tailored antifungal therapy in the treatment of rhino-orbital mucormycosis
Official Development Assistance and Private Voluntary Support for Reproductive, Maternal, Neonatal, and Child Health in Guinea-Bissau: Assessing Trends and Effectiveness.
No full textBackground: Reproductive, maternal, neonatal, and child health (RMNCH) remains a key priority for official development assistance and private voluntary assistance (ODA+) in low-income countries. In Guinea-Bissau, maternal and child mortality rates remain high, with the healthcare system heavily dependent on foreign aid. This study analyzes ODA+ trends for RMNCH in Guinea-Bissau from 2002 to 2018 and assesses its impact on maternal, neonatal, infsupplent, and under-five mortality rates.
Methods: We used data from the OECD Creditor Reporting System and applied the Muskoka2 methodology to estimate RMNCH-related disbursements. Funding trends were categorized by donor type and RMNCH subsectors. A longitudinal analysis used regression models to assess the relationship between aid categories and mortality outcomes.
Results: RMNCH funding accounted for 8.9% of total ODA+ to Guinea-Bissau, with most aid directed toward child health. Models revealed a negative association between child health funding and under-five and infant mortality, while reproductive health funding showed no significant correlation with maternal or neonatal mortality.
Conclusions: Although variable, ODA+ for RMNCH in Guinea-Bissau has helped reduce child mortality. However, maternal and neonatal mortality require targeted interventions and improved coordination. Fluctuating aid disbursements emphasize the need for sustainable health financing and stronger donor alignment with national priorities
Burden of Disease and Cost of Illness of Triple-Negative Breast Cancer in Portugal.
No full textBackground: Triple-negative breast cancer accounts for 15% of all breast cancer cases, and it has a lower survival rate and higher incidence of early recurrence, particularly during the first 10 years after diagnosis.
Objective: This study aimed to estimate the cost and burden of triple-negative breast cancer among the female population in 2019 in Portugal from a societal perspective.
Methods: The prevalence of triple-negative breast cancer was calculated using a cumulative incidence model on the basis of national epidemiological data. The burden of disease was expressed as disability-adjusted life years, including the years lost due to disability and years of life lost. Healthcare resource utilization was quantified with input from an expert panel, and costs were estimated on the basis of diagnosis-related groups. Indirect costs were established following the human capital approach and supported by inputs from an expert panel.
Results: Considering a prevalence of 7052 cases of triple-negative breast cancer in 2019, the expert panel confirmed that approximately 24%, 29%, 28% and 19% of the patients were in stages I, II, III and IV, respectively. The burden of this disease in Portugal was estimated at 22,566 disability-adjusted life years per year, 94% of which resulted from premature deaths. The total annual cost was equal to €50,351,934, with direct and indirect costs representing 56% and 44%, respectively. The average cost per patient with triple-negative breast cancer was €7140. Direct costs accounted for €28 million and were associated mainly with triple-negative breast cancer locoregional stage treatment and follow-up (65%). Indirect costs represented €22 million and were largely linked to withdrawal from the job market (94%).
Conclusion: Triple-negative breast cancer is an impactful disease with high humanistic and economic costs at the national level. The high mortality and low survival rates of this subtype mean that most disability-adjusted life years are due to years of life lost rather than years lost due to disability. Its prevalence is greater among women aged 45-49 years, suggesting a considerable burden regarding labour absenteeism and withdrawal from the job market
Simultaneous Aortic Dissection and Saddle Pulmonary Embolism: Were They Intertwined?
No full textWe report the case of a 92-year-old woman who developed sudden paraplegia. A magnetic resonance imaging (MRI) of the dorsal spine revealed extensive spinal cord infarction. Subsequent imaging demonstrated a Stanford type B aortic dissection complicated by false-lumen thrombosis, along with a coexistent saddle pulmonary embolism. Although the coexistence of pulmonary embolism and aortic dissection has been reported, it remains poorly understood and represents a major therapeutic challenge. In this case, the close anatomical relationship between the descending aortic dissection and the site of pulmonary artery thrombosis strongly suggests that the aortic dissection may have contributed to pulmonary thrombus formation through direct mechanical compression and disturbed local hemodynamics arising from their anatomical contiguity. This case illustrates a rare yet clinically significant overlap between two life-threatening vascular entities, suggesting a poorly characterized pathophysiological interplay and underscoring the need for early diagnosis and patient-specific therapeutic approaches
Bridging Primary and Specialist Care in Atopic Dermatitis: Outcomes of an Interregional Referral Protocol in Portugal.
No full textAtopic dermatitis (AD) is a chronic inflammatory skin disease with a significant impact on quality of life and healthcare systems. In Portugal, access to specialist care remains limited, particularly for patients requiring advanced therapies available only in hospital settings. This study aimed to implement and evaluate a structured referral protocol between primary and hospital dermatology services to improve AD management. Between April 2024 and February 2025, adult patients (≥18 years) coded with AD were identified at the USF Planície primary care center and assessed using a structured telephone questionnaire evaluating disease severity (Patient-Oriented Eczema Measure (POEM)), pruritus (Itch Numeric Rating Scale (INRS)), and sleep disturbance (Sleep Numeric Rating Scale (SNRS)). Of 213 identified patients, 119 (55.8%) were excluded - 94 (44.1%) could not be contacted; 19 (8.9%) denied the diagnosis; and 6 (2.8%) refused to participate - and 94 (44.1%) completed the assessment. Among these patients, 74 (78.7%) had mild or well-controlled disease, whereas 21 (22.3%) presented with moderate-to-severe AD. Patients with moderate-to-severe POEM showed a higher disease burden, with INRS ≥ 5 in 17 patients (85.0%), SNRS ≥ 5 in 5 patients (25.0%), and involvement of high-impact areas in 15 patients (75.0%), whereas in mild POEM, most patients had INRS < 5 (71, 95.9%), SNRS < 5 (74, 100%), and limited involvement of high-impact areas (16, 21.6%). This protocol demonstrated feasibility and clinical relevance, improving patient stratification and facilitating timely referral for specialist evaluation
RSV-Bacterial Co-Infection Is Associated With Increased Illness Severity in Hospitalized Children - Results From a Prospective Sentinel Surveillance Study.
No full textDuring the autumn/winter respiratory syncytial virus (RSV) epidemics, bacterial co-infection is common and affects the disease severity. We aimed to understand the relationship between RSV-bacterial co-infections and clinical severity since the RSV seasonality change after COVID-19 pandemic. We conducted a prospective, sentinel surveillance study at 20 sites in Portugal in children under 2 years hospitalized with RSV, between April 21 and January 23. Effect of co-infection with potentially pathogenic bacteria (PPB) on the length of hospitalization and disease severity was investigated using multivariate linear and log-binomial regression models. Among 678 RSV hospitalizations, 67.4% occurred in children under 6 months and 15.3% in preterm; 20.4% tested positive for PPB; median length of hospitalization was 5 days (IQR: 3-7days). Children coinfected with PPB had a higher rate of ICU admission (29.7% vs. 3.5%, p < 0.001), resulting in more prolonged hospitalizations (7 vs. 5 days, p < 0.001) and a 13-fold risk of having severe disease (RR: 13.2, 95% CI:7.3-23.9). RSV-bacterial co-infection was associated with increased length of hospitalization and severe illness during off-season epidemics. This risk is probably overestimated, as laboratory testing for bacterial infections is usually higher in severely ill-appearing children. Measures to prevent outgrowth of pathogenic bacteria within the respiratory tract should be discussed
Impact of Parathyroidectomy on Kidney Function in Adults With Primary Hyperparathyroidism.
No full textIntroduction Primary hyperparathyroidism (PHPT) is characterized by persistent hypercalcemia and is associated with renal complications, including nephrolithiasis and progressive decline in the estimated glomerular filtration rate (eGFR). Although parathyroidectomy (PTX) is the definitive treatment, its impact on renal function remains uncertain, particularly in patients with pre-existing renal impairment. This study aims to evaluate 12-month changes in renal function after PTX in patients with PHPT, according to baseline kidney function. Methods This retrospective study included 48 patients with PHPT who underwent PTX between 2017 and 2020. Patients were stratified by baseline eGFR into two groups: ≥60 mL/min/1.73 m² (Group 1) and <60 mL/min/1.73 m² (Group 2). Clinical and laboratory parameters, including serum creatinine and eGFR, were analyzed at baseline and at 12 months postoperatively. Results Patients were predominantly women (ratio 3.8:1), and the surgical cure rate was 95.8%. Group 2 presented higher baseline calcium and PTH levels. At 12 months, both groups showed significant reductions in calcium and PTH. Group 1 experienced a statistically significant decline in eGFR, whereas Group 2 showed a slight, non-significant improvement, suggesting stabilization of renal function. Conclusion PTX does not appear to improve renal function in most patients with PHPT but may prevent further deterioration in those with pre-existing renal impairment. These findings support current guideline recommendations favoring surgical intervention in PHPT patients with compromised baseline kidney function