2224 research outputs found
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Obsessive-Compulsive Disorder and Attachment
Get PDFIntrodução: A teoria da vinculação pretende
explicar de que forma as disposições biológicas e as experiências precoces predispõem o
indivíduo à saúde mental ou à patologia.
Objetivos: Reportar um caso de Perturbação
Obsessivo-Compulsiva num jovem com padrão de vinculação ansiosa, realizando uma
revisão da literatura sobre a associação entre
as duas entidades.
Métodos: É apresentado um caso clínico de
um jovem com Perturbação Obsessivo-Compulsiva com Perturbação de Ingestão Alimentar/Restritiva e de Ansiedade Generalizada
comórbidas. O Questionário de Vinculação ao
Pai e à Mãe foi aplicado para avaliar o estilo de
vinculação. Uma análise bibliográfica sobre o
tema foi realizada, evidenciado a contribuição
dos processos de vinculação, a abordagem e o
tratamento.
Resultados: O Questionário de Vinculação ao
Pai e à Mãe evidenciou uma vinculação ansiosa no jovem.
Conclusões: O presente caso pode ilustrar
como um padrão ansioso de vinculação poderá ter influenciado o subsequente desenvolvimento de psicopatologia. Uma abordagem
psicofarmacológica, a par da psicoterapêutica
envolvendo doente e cuidadores, parece ser a
mais adequada tendo-se revelado eficaz neste
caso.info:eu-repo/semantics/publishedVersio
Clinical Reasoning: A 71-year-old woman with subacute progressive distal weakness and paresthesia after vaccination.
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Hepatobiliary and Pancreatic: Gastric outlet obstruction from pancreatitis-induced intramural duodenal haematoma.
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A Case Report of Nonvasculitic Autoimmune Inflammatory Meningoencephalitis with Sensory Ganglionopathy: A Rare Presentation of Sjögren Syndrome
Get PDFA 68-year-old Caucasian female was admitted to the emergency department with a progressive history of behavioural symptoms and anxiety followed by visual and auditory hallucinations, forgetfulness, and impaired gait in the previous 3 months. On examination she was psychotic and had a postural and rest tremor of the upper limbs, cogwheel rigidity of the four limbs, retropulsion on standing position, and inability to walk. During the following 2 weeks she developed xerostomia and unilateral parotiditis that improved with steroids. A simultaneous improvement of the cognitive abilities allowed for the detection of sensory ataxia of the lower limbs. Sensory ganglionopathy was then detected with electrophysiological studies. A diagnosis of Sjögren syndrome was suspected and confirmed by salivary gland scintigraphy, Schirmer's test, and submaxillary gland biopsy. We report a case of Sjögren syndrome associated with central and peripheral nervous system involvement, without sicca symptoms preceding the neurological clinical picture. The coexistence of ganglionopathy and a favourable response to immunosuppression are key features that can lead to the correct diagnosis in cases with atypical CNS symptoms, mimicking a rapidly progressive dementia.info:eu-repo/semantics/publishedVersio
The who-when-why triangle of CAM use among Portuguese IBD patients
No full textThe use of complementary and alternative medicines is increasing among chronic patients, particularly those afflicted with inflammatory bowel diseases.
AIM:
This study aimed to address the prevalence of complementary and alternative medicines use among Portuguese inflammatory bowel diseases' patients.
METHODS:
Patients were invited to fill an anonymous questionnaire concerning the use of complementary and alternative medicines.
RESULTS:
Thirty-one per cent of the patients reported having used complementary and alternative medicines in the past, whereas 12% were using them by the time the questionnaire was administered. Fifty-nine per cent of the users did not share this information with their physician, whereas 14% and 8% discontinued their medication and periodical examination, respectively. Steroids prescription (OR=2.880) and a higher instruction level (OR=3.669) were predictors of complementary and alternative medicines use in this cohort.
CONCLUSIONS:
Roughly a third of Portuguese IBD patients had used CAM. Steroid treatment and an academic degree are associated with CAM use. Given the potential side effects and interactions, patient information about the benefits and limitations of conventional and complementary treatments should be reinforced.info:eu-repo/semantics/publishedVersio
Clinical, biochemical, molecular, and histological features of 65 Portuguese patients with mitochondrial disorders.
No full textINTRODUCTION:
Mitochondrial disorders display remarkable genetic and phenotypic heterogeneity.
METHODS:
We performed a retrospective analysis of the clinical, histological, biochemical, and genetic features of 65 patients with molecular diagnoses of mitochondrial disorders.
RESULTS:
The most common genetic diagnosis was a single large-scale mitochondrial DNA (mtDNA) deletion (41.5%), and the most frequent clinical phenotype was chronic progressive external ophthalmoplegia (CPEO). It occurred in 41.5% of all patients, primarily in those with mtDNA deletions. Histological signs of mitochondrial dysfunction were found in 73.8% of patients, and respiratory chain enzyme assay (RCEA) abnormalities were detected in 51.9%.
CONCLUSIONS:
This study confirms the high relative frequency of single large-scale deletions among mitochondrial disorders as well as its particular association with CPEO. Muscle histology seems to be particularly useful in older patients and those with mtDNA deletions, whereas RCEA might be more helpful in young children or individuals with mtDNA depletioninfo:eu-repo/semantics/publishedVersio
Clinical rating scale for pantothenate kinase-associated neurodegeneration: A pilot study.
No full textBACKGROUND:
Pantothenate kinase-associated neurodegeneration is a progressive neurological disorder occurring in both childhood and adulthood. The objective of this study was to design and pilot-test a disease-specific clinical rating scale for the assessment of patients with pantothenate kinase-associated neurodegeneration.
METHODS:
In this international cross-sectional study, patients were examined at the referral centers following a standardized protocol. The motor examination was filmed, allowing 3 independent specialists in movement disorders to analyze 28 patients for interrater reliability assessment. The scale included 34 items (maximal score, 135) encompassing 6 subscales for cognition, behavior, disability, parkinsonism, dystonia, and other neurological signs.
RESULTS:
Forty-seven genetically confirmed patients (30 ± 17 years; range, 6-77 years) were examined with the scale (mean score, 62 ± 21; range, 20-106). Dystonia with prominent cranial involvement and atypical parkinsonian features were present in all patients. Other common signs were cognitive impairment, psychiatric features, and slow and hypometric saccades. Dystonia, parkinsonism, and other neurological features had a moderate to strong correlation with disability. The scale showed good internal consistency for the total scale (Cronbach's α = 0.87). On interrater analysis, weighted kappa values (0.30-0.93) showed substantial or excellent agreement in 85% of the items. The scale also discriminated a subgroup of homozygous c.1583C>T patients with lower scores, supporting construct validity for the scale.
CONCLUSIONS:
The proposed scale seems to be a reliable and valid instrument for the assessment of pediatric and adult patients with pantothenate kinase-associated neurodegeneration. Additional validation studies with a larger sample size will be required to confirm the present results and to complete the scale validation testing. © 2017 International Parkinson and Movement Disorder Society.info:eu-repo/semantics/publishedVersio
Estudo da prevalência e aplicação da escala de Fagerström a adolescentes que recorrem ao SUP do HFF
Get PDFIntrodução: É consensual, e tem suporte em forte evidência científica, que fumar prejudica gravemente a saúde. Segundo a OMS (2011), é a principal causa evitável de doença e de morte, repercutindo‐se pesadamente em custos sociais, económicos e de saúde. A exposição ao fumo ambiental do tabaco, em casa, em veículos, nos locais de trabalho e em espaços públicos fechados é um grave risco para a saúde dos não fumadores expostos, não existindo um limiar seguro de exposição. Segundo o último inquérito do Serviço de Intervenção dos Comportamentos Aditivos e Dependências (SICAD), ascende a 28,3% a prevalência do tabagismo no escalão etário 15-24 anos.
Este trabalho teve como objetivo conhecer a prevalência do tabagismo nos adolescentes que recorrem ao serviço de urgência pediátrica (SUP) e aplicar o teste de Fagerström de dependência física à nicotina. Foi também proposto o objetivo de caracterizar o consumo de tabaco dos adolescentes e a perceção do risco associado ao consumo de tabaco na adolescência e conhecer a exposição ao fumo passivo nesta faixa etária.
Metodologia: Procedeu-se a estudo do tipo quantitativo, observacional e descritivo. Com base na aplicação de um questionário baseado nas recomendações da OMS e na escala de Fagerstrom adotada pela DGS. Foi selecionada uma amostra aleatória composta por 217 adolescentes dos 12 aos 17 anos.
Resultados: Com base numa amostra de 217 adolescentes foi obtida uma prevalência de vida de 19,82%. Existe forte evidência de uma correlação entre fumar com ter chumbado de ano (OR – 5,51), com ser filho de pais fumadores (OR - 7,093) e com possuir uma baixa perceção do perigo do tabaco (OR - 5,367). Não parece existir evidência de haver relação entre o concelho de origem e o fumar. A média de idade para começar a fumar é 14,42 (IC 5%- ]12,5 - 16,34[)
Conclusão: Foi encontrada uma prevalência semelhante a outros estudos nacionais. Apenas 11,9% dos jovens tem uma perceção “pouco” ou “nada” do perigo do tabaco, que demonstra que não é por falta de informação que o consumo se mantém. A influência dos determinantes sociais e do tabagismo dos pais tem que ser considerada em futuras ações de prevenção. A monitorização da prevalência do consumo de tabagismo assume-se de extrema importância, de forma a estabelecer a base a partir da qual podemos planear e avaliar as medidas de prevenção e cessação tabágica.info:eu-repo/semantics/publishedVersio