MED 1A - Artigos publicados em revistas indexadas na Pubmed/Medline
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- An Immunological Non-responder Human Immunodeficiency Virus/Hepatitis C Virus Coinfected Patient: Considerations About a Clinical CasePublication . Correia, Rui; França, MargaridaHuman immunodeficiency virus (HIV) and hepatitis C virus (HCV) infections are two chronic viral infections that share the same mode of transmission, making HIV/HCV coinfection frequent. Highly active antiretroviral therapy (HAART) was a turning point in HIV treatment and has been shown to successfully restore immune function and reduce the frequency of opportunistic infections. Despite a virological response to HAART, a proportion of patients fail to achieve substantial immune recovery, as measured by peripheral CD4 cell counts. Herein, we present the case of a patient with HIV/HCV coinfection who did not achieve successful immune function restoration despite HIV suppression and HCV treatment. Our goal is to promote discussion. Despite considerable advances in the understanding of the impact of HCV on HIV disease progression, there are many individual variables that influence a patient's immune function. In addition, we consider hypogammaglobulinemia as a possible contributor. Further understanding and improvement of immune reconstitution in patients infected with HIV remain an important field of scientific research.
- A Rare Case of Mediastinal Mass: Thymoma and Thymic TumorPublication . Moura De Azevedo, Sofia; Baptista, Patrícia; Pichel, Rita C; Dias, Rita R; Bertão, ManuelaThymomas and thymic carcinomas are rare mediastinal neoplasms arising from thymic epithelial cells, and the presence of synchronous or metachronous primary thymic neoplasms in a single patient is an extremely rare event. Thymoma patients appear to have an inherent predisposition toward developing additional neoplasms. This additionally presents a diagnostic challenge, revealing the importance of multidisciplinary expertise to the management of these patients. This is a case report of a patient with a thymoma and thymic carcinoma, submitted to surgical resection and postoperative radiotherapy
- 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
- Cervical Whiplash Syndrome: A Case Report of a Work AccidentPublication . Costa De Almeida, Maria José; Almeida, Luís; Freire Duarte, Moreira; Alvez de Matos, SaraCervical whiplash syndrome (CWS) or whiplash syndrome is a highly debated concept because there is still no consensus on its definition -- symptoms are usually very severe but the pain's root cause is typically uncertain. Clinical investigation and detailed radiology seldom identify a specific pathology. Thus, soft tissue injury is generally considered the most likely explanation for the symptoms, although it is difficult to confirm, even by MRI. We describe the clinical case of a physical education teacher who suffers an accident in one of her classes. The following day she is assessed at the emergency department and, after undergoing a radiological study of the cervical spine, she is diagnosed with straight cervical spine (kyphosis). She is observed again seven days later due to persistent pain but sent home with unchanged indications for rest and medication. After that her cervicobrachialgia progressively worsens, limiting her left shoulder active mobility and leading to associated muscle atrophy (in addition to a burnout syndrome). Several years after she is considered to have a total permanent disability. Finally, the authors propose that CWS should be approached according to the post-traumatic bodily injury evaluation methodology, suggesting some interventions
- Spontaneous Pneumomediastinum: A Rare Cause of Chest PainPublication . Barroso, Daniela; Rocha, Diana I.; Abelha Pereira, Filipa; Ribeiro, Rui; Pimenta Fernandes, João; Pais Monteiro, Ana; Silva, Isabel Fonseca; Gonçalves, FabienneSpontaneous pneumomediastinum is a rare medical condition characterized by the presence of free air in the mediastinum, not preceded by trauma, surgery, or another medical procedure. It predominantly affects young adult males and usually has a benign course, and in most cases, it is not possible to identify the precipitating factor. There are some conditions that predispose to its occurrence, namely those that lead to an increase in intrapleural pressure, such as coughing, vomiting, or vigorous exercise. We report a case of a 21-year-old male who presented with acute-onset shortness of breath after an episode of coughing and was found to have mediastinal and subcutaneous emphysema. Clinical, laboratory, and radiological studies did not demonstrate any predisposing factor, and the case was classified as spontaneous pneumomediastinum
- Aortic Dissection With Cardiac Tamponade in Pregnancy: A Challenging Clinical ScenarioPublication . Barroso, Daniela; Santos, Sérgio; Tomás, Ana Sofia; Castro, Heloísa; Pinheiro Vieira, AntónioAortic dissection is the acute aortic syndrome with the highest mortality, and pregnancy and arterial hypertension are known risk factors. Its association with the perinatal period is a particularly unique and potentially devastating clinical catastrophe which is why the approach to a pregnant woman in cardiorespiratory arrest (CRA) should be multidisciplinary and early, with extraction of the fetus ideally within five minutes after the arrest. We present the case of a 39-year-old pregnant woman, who presented with a cardiorespiratory arrest in the context of an aortic dissection with cardiac tamponade and the need for an urgent perimortem cesarean section. Increasing knowledge and understanding among healthcare professionals has the potential to aid in the early detection and effective treatment of this challenging medical issue.
- A Gelatinous Pleural Effusion as a Diagnostic CluePublication . Barroso, Daniela; Rego, RitaPleural effusion is a common presentation of several pathologies, and the determination of its cause is facilitated by macroscopic, biochemical, microbiological, and cellular analysis. A systematic approach to analyzing the fluid allows for a reduction in clinical diagnoses. Only a select number of diagnoses can be established definitively by thoracentesis, including effusions because of malignancy. We report the case of an 84-year-old male with a right large-volume pleural effusion with an initial diagnostic thoracocentesis demonstrating an exudate with a gelatinous appearance and exudate characteristics. The physical characteristics of the pleural effusion quickly raised the suspicion of mesothelioma, a rare tumor associated with a poor prognosis. In most diseases related to pleural effusion, fluid analysis yields important diagnostic information, and in certain cases, fluid analysis alone is enough for diagnosis. Malignant pleural mesothelioma may present as a viscous pleural effusion with gelatinous characteristics, which may immediately raise suspicion and contribute as a diagnostic clue in the initial study of a pleural effusion. This article was previously presented as a meeting abstract at the 28º Congresso Nacional de Medicina Interna in October 2022.
- Case Report and Literature Review of Cardiac Amyloidosis: A Not-So-Rare Cause of Heart FailurePublication . Baptista, Patrícia; Moura De Azevedo, Sofia; Alexandre, André; Dias-Frias, AndréRestrictive cardiomyopathy secondary to cardiac amyloidosis is an underdiagnosed cause of heart failure and it is associated with significant morbidity and mortality. The most common types of amyloidosis are light chain amyloidosis, transthyretin amyloidosis and secondary amyloidosis. We report the case of a 84-year-old man that presented with new onset signs and symptoms of heart failure. Multimodality imaging with echocardiogram and bone tracer cardiac scintigraphy along with biomarkers, monoclonal proteins analysis and genetic test allowed to diagnosed a wild-type transthyretin amyloidosis. We discuss the clinical and diagnostic features and review the current literature about cardiac amyloidosis. This paper aims to increase clinicians' awareness of cardiac amyloidosis to promptly recognize, diagnose and treat it.
- Spanish and Portuguese Societies of Internal Medicine consensus guideline about best practice in end-of-life carePublication . Díez-Manglano, J.; Sánchez Muñoz, L.Á.; García Fenoll, R.; Freire, Elga; Isasi de Isasmendi Pérez, S.; Carneiro, A.H.; Torres Bonafonte, O.Aim: To develop consensus recommendations about good clinical practice rules for caring end-of-life patients. Methods: A steering committee of 12 Spanish and Portuguese experts proposed 37 recommendations. A two rounds Delphi method was performed, with participation of 105 panelists including internists, other clinicians, nurses, patients, lawyers, bioethicians, health managers, politicians and journalists. We sent a questionnaire with 5 Likert-type answers for each recommendation. Strong consensus was defined when >95% answers were completely agree or >90% were agree or completely agree; and weak consensus when >90% answers were completely agree or >80% were agree or completely agree. Results: The panel addressed 7 specific areas for 37 recommendations spanning: identification of patients; knowledge of the disease, values and preferences of the patient; information; patient's needs; support and care; palliative sedation, and after death care. Conclusions: The panel formulated and provided the rationale for recommendations on good clinical practice rules for caring end-of-life patients.
- Burnout, engagement & leadershipPublication . Chan, Sónia