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Bowman's layer dystrophy with irido-fundal coloboma in the same patient: a case report
Get PDFIntroduction: The corneal dystrophies are rare corneal diseases, defined as bilateral, symmetric and inherited conditions. Ocular coloboma is a congenital defect caused by embryogenesis imperfection, during the sixth week of development. Purpose: The authors report the first clinical case in literature of the association of cornea dystrophy and irido-fundal coloboma.
Case report: The authors describe the case of a 34-year-old woman, with decrease visual acuity (VA) in the right and left eyes (RLE). She has had an ocular illness since young, with corneal erosions. Her family members also have alterations in the cornea, her father has held a bilateral corneal transplant. Ophthalmic examination showed a best-corrected visual acuity (BCVA) of 20/40 in the RE and 20/100 in the LE. Biomicroscopy showed an inferior iris coloboma in the LE. A deposition of reticular/granular substance in the Bowman’s layer was observed in both eyes, sparing the limbal portion, compatible with a corneal dystrophy. Fundus examination showed a coloboma in the LE that involves the inferior retina and the optic nerve, no changes in the RE fundus was observed. She started treatment with ocular lubrificant preservative-free eyedrops. The patient has remained stable within 1-year follow-up.
Conclusions: This is the first case report of the association of cornea dystrophy and irido-fundal coloboma. The greater decrease in VA in the LE appears to be due to the combination of these two entities in this eye. Despite the Bowman’s layer dystrophy has an autosomal dominant pattern, coloboma seems to have been an acquired change.info:eu-repo/semantics/publishedVersio
Cardiopatia chagásica: predição mais eficaz de morte nestes doentes? Importância da prova de esforco cardiopulmonar.
No full textinfo:eu-repo/semantics/publishedVersio
cFFR as an alternative to FFR: please do not contrast simplicity!
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Anomalias da Experiência do Eu Fora do Espectro da Esquizofrenia
Get PDFBaseado num trabalho apresentado oralmente no 7º Simpósio do Serviço de Psiquiatria do Hospital Professor Doutor Fernando Fonseca EPE, que teve lugar a 10 e 11 de Março de 2017.Anomalous Self-Experiences (ASE) are probably the most important contemporary conceptual and empirical research topic in the field
Psychopathology of Schizophrenia. The set of
these subjective phenomena constitute particular traits of schizophrenic subjects which
were shown to be present in the first episode
of psychosis, in prodromal and in Ultra-HighRisk states. Outstandingly, such enquiries have
raised the standard of the psychopathological
examination and endorsed reconsidering that
subjective phenomena might increase validity
of a psychiatric category without sacrificing
reliability. They include changes in thought,
self and bodily experience, reality contact
and existential orientation. The keynote explored new ways of ASE’s symbolization as is
the case of Truman Symptoms and abnormal
bodily experiences subsets in Ultra-High-Risk
subjects. Also, it further isolated ASE in new
settings such as anxiety disorders. The keynote
presented the results of three studies including
two studies in Ultra-High-Risk subjects and in
Panic Disorder subjects characterizing their
profile and considering possible differences
from schizophrenia. All of them aim to be a
necessary first step to sanction a new set of
enquiries contemplating other subjective phenomena that might occur in schizophrenia
and recognizing the possible role of addressing
subjectivity in determining psychopathology
of other disorders.info:eu-repo/semantics/publishedVersio
Quality of Referrals Information from Primary Health Care to a Psychiatric Consultation
Get PDFIntrodução: Em Portugal, os médicos de fa-
mília são a principal fonte de referenciação de
casos para os serviços de saúde mental. A qua-
lidade da referenciação pode ter consequên-
cias, tanto para o médico de medicina geral e
familiar que referencia o utente, como para o
psiquiatra que o irá receber, e sobretudo para
o utente referenciado.
Objetivos: Avaliar a qualidade da informação
contida nas cartas de referenciação das uni-
dades de saúde do Agrupamento de Centros
de Saúde (ACES) do Alentejo Central para a
consulta de psiquiatria do Hospital do Espíri-
to Santo de Évora (HESE); determinar a fre-
quência dos grandes grupos de perturbações
psiquiátricas apontados como hipóteses diag-
nósticas na referenciação.
Métodos: Estudo observacional descritivo
transversal. Foram incluídas todas as refe-
renciações correspondentes ao período entre
dezembro de 2013 e maio de 2014. Os docu-
mentos de referenciação foram analisados
em termos de estrutura e conteúdo, tendo em
conta os critérios de referenciação descritos
pela Organização Mundial de Saúde (OMS).
Foi determinada a frequência dos grandes
grupos de perturbações psiquiátricas, defini-
dos no manual de codificação Diagnostic and
Statistical Manual of Mental Disorders, Fifth
Edition (DSM5), apontadas como hipóteses
diagnósticas na referenciação.
Resultados: Das 245 cartas de referenciação
analisadas, 220 foram incluídas no estudo.
Apenas 2,27% das referenciações tinham os
onze campos definidos na plataforma Alert
P1 ® (Alert Life Sciences Computing) devida-
mente preenchidos. Em 35% das referencia-
ções não foi identificado qualquer critério que
justificasse o encaminhamento. A falência
terapêutica constituiu o critério mais apontado, estando presente em 30,91% das cartas
de referenciação. Os quadros depressivos e an-
siosos são os mais referenciados à consulta de
psiquiatria.
Conclusões: Os resultados evidenciaram a
importância de sensibilizar os Médicos de Fa-
mília para um correto e completo preenchi-
mento do guia de referenciação da plataforma
Alert P1 ® . É imperiosa a necessidade de definir
e implementar critérios de referenciação em
Portugal que possibilitem uma melhoria da
comunicação entre cuidados de saúde primá-
rios e secundários no âmbito da Saúde Mental.info:eu-repo/semantics/publishedVersio
Estado Confusional Agudo após Corticoterapia Inalada
Get PDFBackground: The connection between corticotherapy and neuropsychiatric symptoms is
widely known, being one of the first questions
we need to assess when presenting with first
episode psychiatric symptoms or confusional
state.
Aims: To date, data on cases related to inhaled
corticotherapy and neuropsychiatric effects is
scarce. In this paper we describe a rare case in
a young woman.
Methods: The clinical case presented led us
to try to understand the data published on the
subject in order to discuss it in greater length.
Results and Conclusions: We present and
discuss a 27-year-old patient’s case, with no
previous psychiatric disease, who was admitted to our Psychiatric ward after the onset of
severe acute behavioural disturbance characterized by aggressiveness, visual and auditory
hallucinatory activity, misidentification and
altered conscience status. It was later found
that seven days earlier she had been prescribed
inhaled corticotherapy for a minor respiratory
infection. A few days after corticotherapy withdrawal, the clinical symptoms improved significantly.info:eu-repo/semantics/publishedVersio
IgA nephropathy in a young adult with nephrotic syndrome: Case report
Get PDFIgA nephropathy has many clinical presentations, of which nephrotic syndrome is possibly the rarest. Recently,
the association of IgA nephropathy with minimal change disease was better described with patients having
complete response to steroid therapy and no progression to CKD. We report a similar case in a young male presenting with nephrotic syndrome.info:eu-repo/semantics/publishedVersio
Predictors of repeat visits to hospital psychiatric emergency departments in Malaga (Spain) and in Lisbon (Portugal)
No full textThis study describes the profile of people with mental disorders attending emergency departments (EDs) in two countries and to identify specific mental disorders associated with repeat emergency visits.
METHODS:
Retrospective analyses of 1 year of EDs data from two hospitals with psychiatric departments, one in Amadora/Sintra (Lisbon, Portugal, 2008) and the other in Malaga (Spain, 2009), were carried out. To determine which mental disorders were associated with repeat visits in each setting, negative binomial models were calculated.
RESULTS:
There were 5141 visits for a mental disorder made by 3667 patients. Patients with affective disorder were the most frequent (32.2%). Among all mental health patients, 19.9% had at least one repeat visit during the year. For the two EDs setting combined, patients with personality disorders (incidence rate ratio (IRR)=3.79, 95% CI: 2.39 to 6.02) and psychotic disorders (IRR=1.46, 95% CI: 1.13 to 1.89) were more likely to have repeat visits compared with patients with affective disorders, whereas mental disorders due to psychoactive substance use (IRR=0.52, 95% CI: 0.37 to 0.73) was associated with lower likelihood of repeat visits. Nearly all significant differences were attributable to the Malaga sample, where patients with personality disorders were four times more likely to have repeat EDs visits compared with patients with affective disorders. However, at both sites, patients with mental disorders due to psychoactive substance use were less likely to have repeat visits.
CONCLUSIONS:
Certain mental disorders may be predictive of more frequent ED visits. The different results for each country suggest that further studies might focus not only on the characteristics of patients, but also on local healthcare organisation.info:eu-repo/semantics/publishedVersio