Browsing by Issue Date, starting with "2023-02"
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- Anterior Penetrating Neck Injury: A Path to the Cervical SpinePublication . Alves, Duarte Gil; Sousa, Jessica; Ferreira, Vítor; Almeida Pinto, João; Teixeira, NunoWhile rare in incidence, penetrating neck injuries are often life-threatening. When a patient's physiological status is appropriate, the first step in treatment should be a detailed preoperative imaging assessment. Formulating a treatment plan that includes computed tomography (CT) imaging and discussing the surgical approach with a multidisciplinary team before operating allows for a successful selective surgical approach. The authors report the case of a Zone II penetrating injury with a right laterocervical entry wound in which an impaled blade with an inferomedial oblique path pierced deeply into the cervical spine. The blade missed multiple vital structures in the neck, such as the common carotid artery, jugular vein, trachea, and esophagus. The patient underwent a formal neck exploration, and controlled extraction of the blade under direct vision was achieved. Therefore, the author's recommendation for implementing any management algorithm for penetrating neck injuries should rely primarily on a multidisciplinary selective approach.
- Nasal Polyposis and Serum Albumin: Systemic Effects of Local InflammationPublication . Sousa-Machado, André; Rosa, Francisco; Silva, Ana; Meireles, LuisIntroduction The genesis of chronic rhinosinusitis is always a topic of debate. A polyp is a pale, edematous tissue emerging mostly from the middle meatus. An epithelial injury caused by continuous inflammation of the nasal mucosa is considered to be a possible cause of the genesis of nasosinusal polyps. Objective To understand the link between serum albumin levels and nasal polyposis. Methods A retrospective study of 180 consecutive patients between January 2016 and January 2020 at our center. We then divided the patients into three age- and gender-matched groups: 60 patients with chronic rhinosinusitis with nasal polyposis, 60 patients with chronic rhinosinusitis without nasal polyposis, and a control group with 60 patients. No patient had a history of any pathology that could alter serum albumin. We then compared the level of serum albumin between the three groups. Results The group of patients with rhinosinusitis and nasal polyposis consisted of 60 patients with a serum albumin value of 4.49 ± 0.29 g/dL, whereas in the control group, the serum albumin value was 4.67 ± 0.2 g/dL. We found a significant difference between the group with nasal polyposis and the other two groups evaluated: chronic rhinosinusitis without nasal polyposis (p<0.001) and the control group (p<0.001). Conclusions Lower levels of serum albumin can be seen in patients with chronic rhinosinusitis with nasal polyposis. Further studies should aim to apply its value since it is a non-expensive marker, to the follow-up of those patients or even to stratify them according to their endotype.
- A Patient With Mental Disorder Wrongly Detained in a European Migrant Detention CentrePublication . França, Gustavo; Corvacho, Mafalda; Cunha, Catarina; Almeida, BarbaraThe admission of undocumented migrants and refugees to detention centres (DC) has been systematically associated with several poor mental health outcomes. Much less is known about people with mental health disorders, non-migrants, who might be wrongfully committed to these facilities. This article draws on Dave's case, where a German citizen was detained in a migrant DC in Porto. The patient was later treated and diagnosed with schizophrenia. In light of another case report, we conceptualize the "Cornelia's phenomenon" by which a person with full citizenship rights but with a severe mental disorder is wrongly committed to a DC. We hypothesize that this worrisome phenomenon is underestimated, and we will discuss how pre-existent psychopathology might predispose vulnerable people to this situation. We will discuss the negative impact that detention might have on these patients, proposing solutions that might amend this worrisome phenomenon.
- Visual Analog Scale and Olfactory Objective Tests in Hyposmia Patients: Is There a Link?Publication . Sousa-Machado, André; Sousa, Francisco Alves de; Silva, Ana; Meireles, LuísIntroduction Olfactory dysfunction (OD) is often a devaluated sensorial affection. The objective evaluation of this dysfunction does not evaluate its compromise in patients' daily life. It is unclear to what extent there is a correlation between the objective evaluation of OD and patient-reported impairment. Objective We aim to search if Sniffin Sticks® correlates with the Visual Analog Scale (VAS) of Hyposmia Symptoms, and therefore if it is a useful method for clinical use. Methods A prospective study was carried out to evaluate and compare consecutive patients who had olfactory impairment due to COVID-19 that were referred to an otolaryngology office. The variables evaluated were gender, age, co-morbidities, and olfactory thresholds (measured according to Sniffin Sticks®). Patients were also enquired about their sense of impairment according to VAS from 1 (worst possible) to 10 (best possible). Statistical analysis was performed using SPSS (IBM SPSS Statistics 26). Normal distribution was checked using both skewness and kurtosis and Kolmogorov-Smirnov tests. Pearson correlation test was used to seek a correlation between VAS and olfactory thresholds. All reported p-values are two-tailed, with a p-value ≤ 0.05 indicating statistical significance. Results Our sample of 47 patients was composed of 30 females (63.8%) and 17 females (36.2%). We found a mean variation between olfactory thresholds before and after the intervention of 3.91±2.466, and an average improvement of 2.29±2.93 in the visual analog scale for subjective evaluation of olfactory impairment. According to the Pearson correlation test, with 95% confidence, there is evidence to claim a moderate association (0.512) between an improvement in olfactory thresholds and VAS (p=0.05). Conclusions There was a moderate correlation between ratings and measures of olfactory function. On an individual basis, there were remarkable differences between measures and ratings of olfactory function. VAS should be considered in the evaluation of the hyposmic patient, due to its simplicity and quick applicability.
- Type IX Superior Labrum Anterior and Posterior Lesion in a Professional Football Player: A Rare Pattern of Shoulder Instability in a Non-throwing AthletePublication . Amorim, Edgar; Maganinho, Pedro; Rodrigues-Gomes, Diogo; Rodrigues-Gomes, Sérgio; Sevivas, NunoAnterior shoulder instability is the most frequent type of glenohumeral instability, especially among young athletes. Superior labral anterior-posterior (SLAP) injuries involve the superior glenoid labrum where the long head of the biceps tendon (LHBT) inserts. There is still some debate regarding the pathogenesis, clinical presentation, and treatment of these lesions. We report a clinical case of an 18-year-old male professional football player with a rare type IX SLAP lesion. Given the recurrence of instability after prior nonoperative management, surgical treatment was seen as the best option, and a pan-labral arthroscopic repair suture anchor fixation was performed. Three months after undergoing a personalized postoperative rehabilitation program, he was able to return to full sport with the same competitive level, and no recurrent instability or other symptoms were reported throughout the 18-month follow-up period
- Pulmonary Actinomycosis: A Diagnostic ChallengePublication . Ferreira, Marli; Ferreira, Luís; Amorim Pereira, Inês; Santos Silva, André; Henriques Ferreira, InêsPulmonary actinomycosis is an uncommon and challenging infectious disease with non-specific symptoms and imaging findings. The authors report a case of a 68-year-old man with diabetes and a history of past smoking who presented with anorexia and weight loss with no significant findings on physical examination. A parenchymal consolidation in the anterior segment of the right upper lobe was detected after a chest computed tomography (CT). Bacterial colonies of Actinomyces species were identified in the histology of transbronchial biopsy. Imaging reassessment after six weeks of treatment with oral amoxicillin showed progression with a high metabolism 10.5 standardized uptake value (SUV) documented on the f-fluorodeoxyglucose positron emission tomography/CT. Concern about the possibility of lung cancer was raised and ruled out by a negative transthoracic needle biopsy. The diagnosis of pulmonary actinomycosis with pyogenic superinfection was presumed. The patient was successfully treated with intravenous amoxicillin and clavulanate for two weeks, followed by six months of oral treatment
- The Caloric Necessities of Critical Care Patients During the First Week of AdmissionPublication . Pinto Medeiros, Rita; Ramos de Sousa, Ricardo Filipe; Santos Silva, Mariana; Rego, Rita; Torrao, Cristina; Amaral, Inês; Pereira, Rita; Pinho, João P; Marinho, Ricardo Cleto; Marinho, AnibalIntroduction: The nutritional needs of critically ill patients have been the subject of intense controversy. In accordance with international guidelines, it is advocated to optimize a nutritional intake based on the following recommendation: 25-30 kcal/kg body weight per day. However, there still are authors who recommend permissive underfeeding in the first week of hospitalization. Nevertheless, energy expenditure (EE) and necessity are influenced by the catabolic phase of critical illness, which may vary over time on a patient and from patient to patient. Objective: The objective of this study is to assess if the energy needs of critically ill patients admitted in our intensive care unit (ICU) in the first week of hospitalization are in line with those recommended by the European Society for Clinical Nutrition and Metabolism (ESPEN) international guidelines. Methods: A prospective cross-sectional study was carried out from September to December 2019. The energy needs were evaluated by indirect calorimetry and by the Harris-Benedict equation. Stress variables were evaluated, namely, the type of pathology, hemodynamic support, sedation, temperature, sequential organ failure assessment (SOFA) score, and state at discharge. Results: Forty-six patients were included in this study, with an average energy expenditure by indirect calorimetry of 19.22 ± 4.67 kcal/kg/day. The energy expenditure was less than 20 kcal/kg/day in 63% of the measurements. The concordance rate did not show the relationship between the Harris-Benedict equation and the values of indirect calorimetry. Stress variables were analyzed, with the SOFA score as the only variable with values close to statistical significance. Conclusion: In our ICU, the energy needs of critically ill patients in the first week of hospitalization are lower than the intake recommended by the guidelines.
- Food Allergy in Preschoolers: Parents’ Perception and Self-Reported PrevalencePublication . Da Silva Cardoso, Juliana; Ashworth, Joanna; Pinto, Diana; Teixeira, Fernanda; Araújo, Ana RitaBackground: Food allergy is a potentially fatal condition (in the case of anaphylaxis, for example) and is characterized by an increasing prevalence. The main purpose of this study is to identify preschool children with parent-reported food allergies and characterize this population and type of allergy. Methods: This is a cross-sectional study, based on questionnaires to parents/legal guardians. All children who attend daycare or preschool in an area of the city of Porto, Portugal, were included. Results: A total of 740 questionnaires were distributed to nine schools, and responses were obtained from 363 (49.1%). Self-reported food reaction and/or allergy was related in 11.2% of children. The median age of the first reaction was 12 months and the most registered foods were milk, dry seed, and peanut. Cutaneous (48.7%) and gastrointestinal (35.9%) symptoms were the main manifestations. History of parents' and siblings' food allergies had statistically significant associations with food reactions and/or allergies of the child, with OR 3.05 (p=0.04, 95% CI 1.01-8.81) and OR 8.69 (p<0.01, 95% CI 2.11-35.79), respectively. Besides that, children's atopic dermatitis also had a statistically significant association with self-reported food reactions and/or allergies, with OR 2.30 (p<0.05, 95% CI 1.01-5.21). Conclusion: Food reactions and/or allergies were reported in 11.2% of children. The history of parents' and siblings' food allergies and children's atopic dermatitis had statistically significant associations with food reactions and/or allergies, which shows that it may be an important factor to consider.
- Clinical Role of Codon 87 of the CYFIP2 Gene in Early Infantile Epileptic Encephalopathy: A Clinical Case DescriptionPublication . Da Silva Cardoso, Juliana; Gomes, Rita; Abreu, Maria; Parente Freixo, João; Falcão Reis, Cáudia; Garrido, CristinaThe diagnosis of early infantile epileptic encephalopathy (EIEE) remains challenging, and next-generation sequencing (NGS) techniques have played a key role in identifying genetic causes. Recent studies have shown an association between mutations in the CYFIP2 gene and EIEE, with 20 deleterious variants reported so far and a de novo mutational hotspot at codon 87. A male infant presented with seizures since the age of four months as well as significant developmental delay and microcephaly. The seizures were of different types, frequent and refractory to treatment, including different anticonvulsant drugs. Metabolic studies showed no significant changes. The initial electroencephalogram revealed bilateral paroxysmal activity with hemispherical diffusion. Brain MRI showed no pathological changes. Analysis of a whole exome sequencing (WES) based multigene panel for epilepsy disclosed a heterozygous CYFIP2 gene variant [c.258_266del; p.(Trp86_Ser88del)] established as de novo. We describe the case of an infant with EIEE due to a de novo heterozygous in-frame deletion of three amino acids in CYFIP2: c.258_266del; p.(Trp86_Ser88del). This in-frame deletion eliminates codon 87, a mutational hotspot associated with a particularly severe EIEE phenotype. All previous reports had missense variants with a presumably gain-of-function mechanism. The clinical picture of our patient is very similar to the ones with deleterious variants affecting codon 87 reported in the literature. Our case report is the first to describe a disease-causing in-frame deletion in CYFIP2 and reiterates a consistent genotype-phenotype correlation.