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A Rare Case of Bilateral Proptosis
Get PDFA 65-year-old man presented with a 2-year history of severe bilateral proptosis, palpable lymphadenopathy and moderate hepatosplenomegaly. A blood test was positive for hepatitis C infection. CT showed palpebral infiltrative lesions with regional progression through the temporal and masticatory spaces to the pharynx and hypopharynx causing almost complete airway obstruction. A palpebral biopsy was consistent with low-grade Bcl-2+ extra-nodal MALT non-Hodgkin B-cell lymphoma. The patient received six cycles of rituximab-based chemotherapy with clinical remission at 9-month follow-up. Bilateral proptosis is a rare presentation of several diseases. When brain CT excludes cavernous sinus pathology, thyroid ophthalmopathy or haematological malignancy should be considered.
LEARNING POINTS:
Bilateral proptosis is a rare presentation with a broad differential diagnosis, and is most frequently is caused by cavernous sinus disease, thyroid ophthalmopathy or haematological malignancy.Hepatitis C may be associated with MALT lymphoma and presents mainly at non-gastric locations even with few hepatic manifestations of the infection.Long-term low-grade lymphoma may present with severe disseminated disease at diagnosis, but treatment response is generally good.info:eu-repo/semantics/publishedVersio
Bilateral Pneumothorax, Pneumoperitoneum and Pneumomediastinum: Anesthetic Approach of Rare ERCP Complications
Get PDFA colangiopancreatografia retrógrada endoscópica (CPRE) é um procedimento de diagnóstico e tratamento cada vez mais utilizado. Apesar de raras, algumas complicações decorrentes desta técnica podem ter consequências graves para o doente, exigindo deteção precoce e a abordagem sistematizada pelo anestesista.
O caso clínico apresentado refere-se a uma doente de 47 anos submetida a CPRE eletiva por coledocolitíase, sob sedação com propofol. O exame é complicado por falso trajeto duodenal que conduz a um quadro de pneumotórax bilateral, enfisema subcutâneo, pneumoperitoneu e pneumomediastino com necessidade de intubação orotraqueal emergente e abordagem das referidas
complicações. A doente foi transferida para a unidade de cuidados intensivos para vigilância sob medidas conservadoras. Houve necessidade posterior de intervenção cirúrgica por sépsis com ponto de partida abdominal.
Neste artigo pretende-se enfatizar a importância da presença do anestesista durante a CPRE, revendo a abordagem do doente perante um quadro clínico raro e com implicações importantes na morbimortalidade.info:eu-repo/semantics/publishedVersio
Social determinants of health at a pediatric age in a hospital setting: a systematic review
Get PDFIntrodução: As desigualdades em saúde são reconhecidamente um problema de saúde pública. A relação entre determinantes sociais e as desigualdades em saúde são um achado robusto. Enquanto nos adultos é claro que estas desigualdades socioeconómicas se manifestam no seu estado de saúde, a situação é menos clara nas crianças e adolescentes. Foi então efetuada uma revisão da literatura sobre a influência dos determinantes sociais na saúde na idade pediátrica. De forma a contribuir para um melhor conhecimento sobre a matéria.
Metodologia: A pesquisa foi efetuada segundo as normas PRISMA, com base nos termos MeSH: Social Class, Pediatric, Hospital, Emergency Treatment, Socioeconomic factor e Healthcare Disparities, na PubMed, Scielo e nas bases de dados da Cochrane. Foram excluídos artigos de revisão, opinião bem como artigos que tratavam de questões de acesso aos cuidados. Foi efetuada uma descrição quantitativa e qualitativa dos resultados.
Resultados: Foram selecionadas 17 publicações, exceto uma do tipo descritiva, todas referentes a estudos observacionais analíticos, a maioria usando dados retrospetivos. Encontrou-se forte evidência na relação entre desigualdades em saúde e os fatores socio económicos na idade pediátrica.
Conclusão: Apesar de nenhuma das publicações selecionadas apresentar dados colhidos em Portugal, é seguro afirmar que é possível encontrar a mesma relação na idade pediátrica. É importante estudar mais esta área, identificar os determinantes sociais mais importantes bem como as populações mais vulneráveis, para melhor poder planear os cuidados de saúde e combater as desigualdadesinfo:eu-repo/semantics/publishedVersio
Transporte de amostras e de componentes sanguíneo. Particularidades do Serviço de Sangue e Medicina Transfusional . Porque é a conduta dos assistentes operacionais tão importante?
No full textN/
Polymicrobial interactions influence the agr copy number in Staphylococcus aureus isolates from diabetic foot ulcers
No full textDiabetic foot ulcers are a major complication of diabetes and are often colonised by complex bacterial communities, where Staphylococcus aureus is frequently co-present with Pseudomonas aeruginosa. These bacteria interact through quorum sensing, encoded in S. aureus by the accessory gene regulator (agr). Typing and copy number of S. aureus agr were assessed here to give insights on strain variability and possible interspecies influence. As agr is classified in four genetic groups, agr-I, agr-II, agr-III and agr-IV, the agr type of 23 S. aureus diabetic foot ulcers isolates was evaluated by PCR and gene copy number determined by qPCR, including in S. aureus present in polymicrobial infections. agr-I and agr-II were found to be present in 52 and 39% of the isolates, respectively. In two isolates, no agr type was identified, and types III and IV were not detected. Interestingly, agr-II copy number was higher in dual suspensions than in S. aureus single suspension. We conclude that agr type I was the most frequent in clinical centers in Lisbon, and variations in agr-I and agr-II copy numbers were strain specific. Variations in agr copy number in dual suspensions suggests that P. aeruginosa may influence S. aureus agr-II gene regulation, confirming an interaction between these two bacteria. This is a first approach to characterise agr variation in S. aureus from diabetic foot ulcers in vitro.info:eu-repo/semantics/publishedVersio
Ultrasound requested by general practitioners or for symptoms unrelated to the thyroid gland may explain higher prevalence of thyroid nodules in females.
No full textBACKGROUND:
A higher prevalence of thyroid nodules/carcinoma in females is well-known from the literature. The reasons for this difference are not fully explained. We intended to assess gender variation in the referral for ultrasound-guided fine needle aspiration (FNA) of thyroid nodules, to study reasons for gender referral differences, and to assess differences in nodules characteristics between genders.
METHODS:
Included were 272 consecutive patients, with 290 nodules submitted to FNA. Patients were questioned on the reason why ultrasound (US) examination was required. Electronic medical records were reviewed. Nodules' ultrasound/cytological characteristics were assessed. Variables studied: referral cause; referral pattern (hospital-specialist versus general-practitioner); number of nodules; age, thyroid function; nodule size, TIRADS classification, resistive index, Doppler pattern, Bethesda categorisation. Variables were compared between males and females referred for FNA. Significant variables were assessed with logistic regression.
RESULTS:
Of the 272 patients, 215(79%) were women with a female:male referral ratio for FNA of 3.8:1. Non-parametric statistically significant differences (p < 0.05) were found between genders in: thyroid function, nodule size, referral pattern and referral cause. Nodule size and thyroid function tests became non-significant in logistic regression. Cause and referral pattern remained significantly associated with gender. Referral by a general-practitioner was associated with a 2.6-fold increase in odds of referring a female. Causes unrelated to the thyroid were associated with a 3.2-fold increase in odds of female reference.
CONCLUSIONS:
A referral bias might be responsible for the higher rate of thyroid nodules in female patients, both due to referral by general practitioners and due to causes indirectly related to the thyroid gland.info:eu-repo/semantics/publishedVersio
Renal regeneration after acute kidney injury.
No full textAcute kidney injury is common and associated with negative renal and patient outcomes. The human kidney has a real but limited regeneration capacity. Understanding renal regeneration may allow us to manipulate this process and thus develop therapeutic weapons to improve patients' outcome. In the first part of this paper we discuss the clinical factors associated with renal recovery: baseline patient particularities, acute kidney injury characteristics and the medical approach taken in the short and long-term. In the second part, the cellular and molecular mechanisms underlying renal regeneration are explored. The immune system seems to have an important role, first promoting inflammation and then tissue healing. Other players, such as cellular senescence, mitochondrial dysfunction, renal haemodynamics and metabolic reprogramming also have a role in renal regeneration. We aim to develop a short review of renal regeneration, offering a holistic view of this process.info:eu-repo/semantics/publishedVersio
Caffeine consumption and mortality in chronic kidney disease: a nationally representative analysis
No full textBACKGROUND:
An inverse relationship between coffee consumption and mortality has been reported in the general population. However, the association between caffeine consumption and mortality in patients with chronic kidney disease (CKD) remains uncertain.
METHODS:
We analysed 4863 non-institutionalized USA adults with CKD [defined by an estimated glomerular filtration rate (eGFR) of 15-60 mL/min/1.73 m2 and/or a urinary albumin:creatinine ratio >30 mg/g] in a nationwide study using the National Health and Nutrition Examination Survey (NHANES) 1999-2010. Caffeine consumption was evaluated by 24-h dietary recalls at baseline and all-cause, cardiovascular and cancer mortality were evaluated until 31 December 2011. We also performed an analysis of caffeine consumption according to its source (coffee, tea and soft drinks). Quartiles of caffeine consumption were 213.5 (Q4).
RESULTS:
During a median follow-up of 60 months, 1283 participants died. Comparing with Q1 of caffeine consumption, the adjusted hazard ratio for all-cause mortality was 0.74 [95% confidence interval (CI) 0.60-0.91] for Q2, 0.74 (95% CI 0.62-0.89) for Q3 and 0.78 (95% CI 0.62-0.98) for Q4 (P = 0.02 for trend across quartiles). There were no significant interactions between caffeine consumption quartiles and CKD stages or urinary albumin:creatinine ratio categories regarding all-cause mortality.info:eu-repo/semantics/publishedVersio
Malária – uma causa rara de colecistite aguda
No full textA malária é uma das infecções parasitárias com maior impacto a nível mundial.
Estão descritas várias complicações associadas, nomeadamente gastrointestinais.
A colecistite acalculosa é uma complicação rara, cujo diagnóstico requer um elevado
grau de suspeição.
A colecistite acalculosa é caracterizada pela inflamação da vesícula biliar na ausência
de cálculos, estando frequentemente associada a agressões fisiológicas graves.
Apresentamos o caso de uma mulher de 37 anos, residente em Portugal. Admitida no
serviço de urgência por malária grave, uma semana após ter regressado de Angola.
Apesar da resposta favorável ao tratamento, persistiu febril, com dor à palpação do
hipocôndrio direito e parâmetros inflamatórios aumentados. A ecografia abdominal
revelou vesícula distendida de parede espessada, sem cálculos, pelo que se assumiu
o diagnóstico de colecistite aguda acalculosa.info:eu-repo/semantics/publishedVersio