2224 research outputs found
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Um Afrodisíaco Potencialmente Fatal: Intoxicação por Cantaridina
Full text linkCantharidin is a toxin extracted from coleoptera beetles, commonly known as 'Spanish fly'. Traditionally it was used as an aphrodisiac, a vesicant or as an abortifacient. Intoxication by this substance has been widely reported, generally associated with gastrointestinal complications, such as digestive hemorrhage, and genitourinary disorders, such as hematuria and acute kidney injury. The authors describe the case of a 51-year old male patient who developed severe cantharidin poisoning after ingesting a preparation ('tea formulation') containing the substance. The patient reported a burning sensation in his oral cavity, diarrhea and hematuria, having sustained acute kidney injury and atypical neurological symptoms. Due to the lack of an antidote, the available treatment options are reduced to supportive measures. This case strengthens the need for a thorough medical history to ascertain the use of 'natural' products and medicinal herbs (i.e. of unregulated origin), and the importance of educating the community to their potential toxicity.A cantaridina é uma toxina extraída de coleópteros, comummente conhecidos como ‘Spanish fly’. Historicamente utilizada como afrodisíaco, vesicante e abortivo. A intoxicação por este agente encontra-se amplamente descrita, tipicamente com envolvimento das mucosas gastrointestinal, com hemorragia digestiva, e genitourinária, com hematúria e lesão renal aguda. Os autores apresentam o caso de
um doente do sexo masculino, com 51 anos que desenvolveu um quadro de intoxicação aguda por cantaridina, após ingestão de uma
preparação (‘chá’) desta substância, com ardor na cavidade oral, diarreia, disúria, hematúria, lesão renal aguda e com um quadro neurológico atípico. A toxicidade pela cantaridina é sistémica, contudo, o envolvimento neurológico é raro. Dada ausência de um antídoto,
preconiza-se a terapêutica de suporte. Este caso reforça a importância de uma anamnese detalhada, incluindo a utilização de produtos
‘naturais’ ou de ervanária (i.e. de origem não controlada), e da necessidade de alertar os doentes para a sua potencial toxicidade.info:eu-repo/semantics/publishedVersio
HIV, HBV and syphilis screening in antenatal care in Lubango, Angola.
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Instantaneous wave-free ratio cutoff values for nonculprit stenosis classification in patients with ST-segment elevation myocardial infarction (an iSTEMI substudy).
No full textAn iSTEMI substudyOBJECTIVES:
The instantaneous wave-free ratio cutoff value of <0.90 for hemodynamic significance of coronary stenoses has been validated in stable patients. We examined different cutoff values in the evaluation of nonculprit stenoses in patients with ST-segment elevation myocardial infarction.
METHODS:
We measured instantaneous wave-free ratio across nonculprit stenoses in the acute setting and at follow-up in 120 patients with ST-segment elevation myocardial infarction and 157 nonculprit stenoses, of which, 113 patients with 147 nonculprit stenoses completed follow-up.
METHODS:
The prevalence of nonculprit stenosis hemodynamic significance was 52% in the acute setting and 41% at follow-up. With follow-up, instantaneous wave-free ratio as reference, acute instantaneous wave-free ratio >0.90 had a negative predictive value of 89%. Acute instantaneous wave-free ratio 0.93 had a negative predictive value of 100%. Acute instantaneous wave-free ratio <0.86 and <0.83 had positive predictive values of 71 and 77%. Using acute instantaneous wave-free ratio <0.90 as cutoff for hemodynamic significance yielded the highest degree of classification agreement between acute and follow-up instantaneous wave-free ratio.
CONCLUSIONS:
In patients with ST-segment elevation myocardial infarction, acute instantaneous wave-free ratio with the cutoff values <0.90 for hemodynamic significance appears optimal in the evaluation of nonculprit stenoses and has a high negative predictive value and a moderate positive predictive value.info:eu-repo/semantics/publishedVersio
Pulmonary artery sling: a rare cause of stridor and respiratory distress
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Letter to the editor: Acute Kidney Injury in patients referred for ECMO therapy
No full textinfo:eu-repo/semantics/publishedVersio
FACE GROSSEIRA, HIPOTONIA E REGRESSÃO DO NEURODESENVOLVIMENTO
Full text linkInborn errors of metabolism are a heterogeneous class of multisystemic diseases which, although individually rare, are collectively quite
common. Central nervous system is usually affected.
The authors report the case of a five-month-old girl, daughter of non-consanguineous parents, born after an unremarkable full-term
pregnancy and delivery. Hypotonia and neurodevelopmental regression were noted from the age of five months, along with progressive onset
of facial dysmorphism, hepatomegaly, seizures, and dilated cardiomyopathy. Gangliosidosis type 1 diagnosis was confirmed by biochemical,
enzymatic, and genetic findings.
This report enhances the relevance of multidisciplinary approach and follow-up.Os erros hereditários do metabolismo são um grupo de doenças heterogéneas e multissistémicas. Apesar de cada doença individualmente
ser rara, no seu conjunto são relativamente comuns. O sistema nervoso central é habitualmente afetado.
Os autores apresentam o caso de uma lactente de cinco meses de idade, filha de pais não consanguíneos, nascida de uma gravidez de termo
e parto sem intercorrências. Aos cinco meses, iniciou um quadro de hipotonia e regressão do desenvolvimento, apresentando ao longo do
tempo dismorfismo facial, hepatomegália, convulsões e cardiomiopatia dilatada. O diagnóstico de Gangliosidose tipo 1 foi confirmado por
achados bioquímicos, enzimáticos e genéticos.
Este caso clínico reforça a relevância de uma abordagem e seguimento multidisciplinares.info:eu-repo/semantics/publishedVersio
SomosHFF (33): Newsletter do Hospital Prof. Dr. Fernando Fonseca, E.P.E.
No full textinfo:eu-repo/semantics/publishedVersio
Atopic Dermatitis Host and Environment Model: Revisiting Therapeutic Options
Full text linkAtopic Dermatitis affects both children and adults and is a serious health concern in many countries. AD is a complex disease with host and environmental factors underlying its pathology. Its treatment is multidimensional reflecting the diverse nature of its triggers and includes emollients, topical steroids and calcineurin inhibitors among others. Immunological dysfunction can be addressed broadly with systemic immunosupressors and specifically with monoclonal antibodies. Dupilumab, which targets IL-4 and IL-13 was granted approval for treatment of moderate-to-severe AD. Biologics targeting IgE/Th2 pathways may have its role in patients with overlapping AD and asthma. Psychological distress can exacerbate symptoms and is associated with increased severity of AD. Environmental triggers, such as, allergens can be addressed in selected cases with allergic immunotherapy. In this paper, we discuss AD treatment and propose a new step-by-step approach aiming at maintaining disease control and improving quality of life.info:eu-repo/semantics/publishedVersio
In Vitro Activity of Ceftolozane-Tazobactam Against Enterobacterales and Pseudomonas Aeruginosa Causing Urinary, Intra-Abdominal and Lower Respiratory Tract Infections in Intensive Care Units in Portugal: The STEP Multicenter Study
No full textThe STEP surveillance study was designed to increase knowledge about distribution of multidrug-resistant (MDR) Enterobacterales and Pseudomonas aeruginosa in Portugal, focusing on the intensive care unit (ICU). Antimicrobial susceptibility of common agents was also evaluated and compared with that of one of the latest therapeutic introductions, ceftolozane-tazobactam (C/T). Clinical isolates of Enterobacterales (n=426) and P. aeruginosa (n=396) from patients admitted in Portuguese ICUs were included. Activity of C/T and comparators was investigated using standard broth microdilution. Isolates were recovered from urinary tract (UTI, 36.9%), intra-abdominal (IAI, 24.2%) and lower respiratory tract (LRTI, 38.9%) infections. In P. aeruginosa, overall distribution of MDR/extremely-drug resistant (XDR)/pan-drug resistant (PDR) isolates accounted for 21.2%, 23.2% and 0.8%, respectively. C/T was the most potent agent tested against P. aeruginosa and MDR/XDR/PDR phenotypes. In Escherichia coli, extended-spectrum beta-lactamases (ESBL) and carbapenemase (CP) phenotypes accounted for 16.6% and 1.7%, respectively, whereas in Klebsiella spp., ESBL and CP-phenotypes represented 28.5% and 17.9%, respectively. Overall, susceptibility of C/T against Enterobacterales was 86.9%. C/T was the least affected agent in E. coli (99.4% susceptibility), whereas its activity was moderate in Klebsiella spp. (71.5%) and Enterobacter spp. (70.4%), due in part to a high rate of ESBL and CP-phenotypes. In Enterobacterales, blaKPC was the most prevalent CP gene (63.0%), followed by blaOXA-48 (33.3%) and blaVIM (3.7%). These microbiological results reinforce C/T as a therapeutic option in ICU patients with UTI, IAI or LRTI due to P. aeruginosa or Enterobacterales isolates, but not for CP producers.info:eu-repo/semantics/publishedVersio
Wernicke-Korsakoff Syndrome: A Case Series in Liaison Psychiatry.
Full text linkWernicke-Korsakoff syndrome (WKS) is a life-threatening and underdiagnosed neuropsychiatric condition caused by thiamine deficiency that comprises Wernicke encephalopathy and Korsakoff syndrome. Although mainly associated with chronic alcoholism, WKS can arise from other circumstances. This report describes a series of cases of WKS that were clinically evaluated by liaison psychiatrists on a nonpsychiatric inpatient unit. The cases illustrate a deficit in the recognition and adequate treatment of WKS, demonstrating its clinical complexity and the need to improve physicians' knowledgeinfo:eu-repo/semantics/publishedVersio