Repositório do Hospital Prof. Doutor Fernando Fonseca
(1.489 recursos)
The Hospital Prof. Dr. Fernando Fonseca E.P.E. (HFF) institutional repository collects, preserves and disseminates the intellectual output of its professionals in digital format. Its aims are to increase the HFF’s investigation visibility and citation impact, to foster scientific communication and to preserve the HFF’s intellectual memory.
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Is Manchester (MTS) more than a triage system? A study of its association with mortality and admission to a large Portuguese hospital. - Martins, H; Cunha, L; Freitas, P
BACKGROUND: The Manchester Triage System (MTS) is a 5-point triage scale used to triage patients presenting to the emergency department. It was introduced in the UK in 1996 and is now widespread, especially in Europe, and has been in use in our hospital since 2000 via a computerised protocol. A study was undertaken to determine whether the subgroups created by the application of MTS have different propensities for indirect triage outcomes such as death in the A&E department or being admitted to hospital.
METHODS: A database of 321 539 patients triaged during a 30-month period (from January 2005 to June 2007)...
4.
Clinical findings in 67 patients with tuberous sclerosis - Fernández-Guarino, M; Boixeda, P; Anaya, MJ; Beldar, P; Jaén, P
BACKGROUND: Tuberous sclerosis is an uncommon neurocutaneous syndrome characterized by the appearance of hamartomas in multiple organs. Diagnosis is based on clinical criteria. OBJECTIVE. To report the clinical findings in a series of 67 patients with tuberous sclerosis.
MATERIAL AND METHODS: This was a descriptive and observational retrospective study of patients with tuberous sclerosis referred to our dermatology clinics between January 1994 and March 2007.
RESULTS: All patients presented neurological or dermatological disorders. Other disorders, in descending frequency, were psychiatric (55.5%), renal (32.8%), cardiac (22.4%), skeletal and pulmonary (13.4%), and ophthalmological (11.9%).
CONCLUSIONS: We report the clinical findings in a series of patients...
5.
Tetrahedron of medical academics: reasons for training in management, leadership and informatics. - Martins, H
Medical school professors and lecturers are often called to be practicing clinicians, researchers in their own field, in addition to executing their education and curricular responsibilities. Some further accumulate healthcare management responsibilities. These areas pose conflicting demands on time and intellectual activity, but despite their apparent differences, knowledge and skills from management, leadership and informatics may prove useful in helping to smooth these conflicts and hence increase personal effectiveness in these areas. This article tries to clarify some concepts and advance why training in management, leadership and health informatics would seem particularly useful for the medical academic. As opposed to...
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Reversible myocardial calcification following severe leptospirosis complicated with rhabdomyolysis-induced acute kidney injury and magnesium-wasting nephropathy - Zakout, R; Perloiro, MC; Freitas, P
We present a patient with leptospirosis infection who presented septic
shock with multiple-organ dysfunction syndrome, severe rhabdomyolysis
and acute myocarditis. He developed biphasic blood
calcium pattern with hypocalcemia in the oliguric phase followed
by hypercalcemia during the recovery diuretic phase in the context
of rhabdomyolysis and oliguric acute kidney injury. Meanwhile,
he developed an extensive calcification of the myocardium. Severe
renal magnesium wasting was observed during the convalescence
phase. Follow-up showed progressive resorption and later almost
total disappearance of the calcific deposits in the heart by the 18th
month after discharge. Renal magnesium wasting decreased gradually,
but yet persisted beyond the 18th and was normalized only by
the 36th month after discharge....
8.
Paralisia por hipocaliémia: manifestação inaugural da síndrome de Sjögren primário - Martinho, A; Capela, A; Duarte, F
O Síndrome de Sjögren é uma doença auto-imune sistémica caracterizada por inflamação crónica das glândulas exócrinas. As manifestações extraglandulares têm uma incidência até 25%. O envolvimento renal ocorre em 18,4-67% dos casos, e nestes a nefrite tubulointersticial é a lesão mais frequente. Apresenta-se o caso clínico de uma mulher de 37 anos, internada por fraqueza muscular generalizada de grau 2 com uma semana de evolução. Objectivou-se hipocaliémia, rabdomiólise, pH urinário 6,5, proteinúria, e acidémia metabólica. O estudo da acidose renal tubular distal com hipocaliémia conduziu ao diagnóstico de nefrite tubulo-intersticial linfoplasmocitária, confirmada na biópsia renal, e à suspeita de Síndrome...
9.
Helicobacter pylori and autoimmune diseases - Faria, C; Zakout, R; Araújo, JM
It is now widely accepted that Helicobacter pylori may play a role in several extra-gastric diseases. In particular, H. pylori infection seems to be implicated in various autoimmune diseases. Many recent studies have shown a healing or an improvement in different autoimmune disorders after H. pylori eradication therapy in infected patients. The exact mechanisms behind this relationship remain under discussion, but molecular mimicry is a consistent hypothesis. This subject is particularly relevant taking into consideration the high prevalence of H. pylori infection, the existence of inexpensive and noninvasive diagnostic methods, as the urea breath test or the stool antigen test,...
10.
Cystatin C as a marker of acute kidney injury in the emergency department - Soto, K; Coelho, S; Rodrigues, B; Martins, H; Frade, F; Lopes, S; Cunha, L; Papoila, A; Devarajan, P
BACKGROUND AND OBJECTIVES: The diagnosis of acute kidney injury (AKI) is usually based on changes in serum creatinine, which is a poor marker of early renal dysfunction. The discriminative and predictive abilities of serum and urinary cystatin C were examined for the prediction of AKI.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: In this prospective cohort study, serum and urinary cystatin C were serially measured in a heterogeneous group of patients (n = 616) presenting to a tertiary care emergency department. The primary outcome was AKI, classified according to RIFLE and AKIN criteria. The secondary outcome was an adjudication based on clinical criteria...
11.
Primary hyperparathyroidism with severe bone disease: osteitis fibrosa cystica vs. fibrous dysplasia. case report and review of the literature - Leitão, MJ; Cuña, L; Pinheiro, N; Coelho, V; Oliveira, M; Araújo, JM
Primary hyperparathyroidism _HPT. is associated with generalized skeletal changes, its full-blown osseous manifestations known as osteitis fibrosa cystica. Fibrous dysplasia _FD., a benign bone disorder, is differentiated from generalized fibrocystic disease caused by hyperparathyroidism. The classic triad of McCune–Albright syndrome includes polyostotic FD, patchy skin pigmentation, and sexual precocity. Other associated endocrinopathies are hyperthyroidism, Cushing’s syndrome, acromegaly, and HPT. We describe a patient with severe generalized and focal bone lesions and sexual precocity. HPT was diagnosed and treated with persistence of cystic bone lesions.
The similarities between HPT and FD are discussed, focusing on a possible genetically determined mechanism to explain...
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Hepatic nodule: a case of primary myelofibrosis - Cardoso, F; Pires, J; Miranda, J; Araújo, JM
Primary myelofibrosis is one of the entities that may manifest with lesions of extramedullary haematopoiesis, especially in spleen and liver. The authors report a case of primary myelofibrosis presenting incidentally as an intrahepatic focal lesion of extramedullary haematopoiesis, a rare occurrence that highlights the challenge of hepatic nodule differential diagnosis, and allows reflection about the diagnostic criteria and prognostic factors of this myeloproliferative disease
13.
Why management and leadership education for internists? - Martins, H
Around the world, there is an increasing need for more efficiency in healthcare alongside cost containment. Internal medicine physicians are in a pivotal position in this regard. In many countries, they act as bridges between ambulatory/continuity of care systems and hospital-based intensive care and sophisticated therapies. Within the medical field, they often bridge gaps between many specialities increasingly required to provide modern medical care. These skills of managing complex environments, being sensitive to health economics and using large amounts of information, are not normally taught or developed in programmes of internal medicine. While some skills are natural and acquired through...
14.
Tocilizumab: is there life beyond anti-TNF blockade? - Alves, J; Marinho, A; Serra, M
Anti-TNF-α therapy has become the most effective biological treatment for rheumatoid arthritis. Despite having changed the prognosis of the disease establishing new targets for treatment strategy, there are several aspects that still remain unmatched. About 30% of the patients with rheumatoid arthritis have a less than satisfactory response to anti-TNF therapy, which has led the way for the pursuit of new targets and approaches to treatment. IL-6 is one of these alternative targets and data from the more recent clinical trials involving tocilizumab (an anti-IL-6 soluble receptor antibody) suggest advantages in relation to some clinical aspects which are not addressed...
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Síndrome de Churg-Strauss - Rodrigues, B; Araújo, JM
A síndrome de Churg-Strauss é uma vasculite ANCA-associada de
pequenos e médios vasos. As manifestações clínicas mais comuns
são eosinofilia marcada, asma, sinusite crónica, infiltrados pulmonares,
cardiomiopatia, queixas gastrointestinais e mononeurite
multiplex. Os anticorpos Anti-MPO (anti-mieloperoxidade), pANCA
(com padrão de imunoflurescência perinuclear) encontram-se
presentes em 38-59% dos casos. O envolvimento cardíaco é
uma importante causa de morbilidade e a principal causa de
mortalidade no síndrome de Churg-Strauss. Histologicamente
caracteriza-se por uma vasculite necrotizante eosinofílica.
O tratamento é baseado na corticoterapia e em fármacos imunosupressores
(ciclofosfamida e azatioprina) sendo determinado
de acordo com critérios de prognóstico.
A remissão completa ocorre em cerca de 90% dos casos,
sendo as recaídas frequentes (25% dos casos).
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Granulomatose de Wegener - João, C; Santos, E; Leite, A; Miranda, C; Serra, I; Revés, L; Brandão, T; Martins, F; Freitas, P; Dutschmann, L
A granulomatose de Wegener corresponde a uma
vasculite sistémica com atingimento das artérias de pequeno e médio calibre, em particular das vias aéreas superiores e inferiores e do rim, incluindo-se
no diagnóstico diferencial das síndromas pulmão-rim.
Os AA apresentam o caso clínico de uma senhora de 59 anos, internada na Unidade de Cuidados Intensivos Polivalente (UCIP) do Hospital Fernando da Fonseca com um quadro de insuficiência respiratória, hemoptises e insuficiência renal. Descreve-se o estudo etiológico desta situação, concluindo tratar-se de um caso de granulomatose de Wegener.
A propósito deste caso são discutidos aspectos relevantes do diagnóstico, terapêutica e seguimento destes doentes.
18.
Síndrome de Churg-Strauss - Rodrigues, B; Araújo, JM
A síndrome de Churg-Strauss é uma vasculite ANCA-associada de pequenos e médios vasos. As manifestações clínicas mais comuns
são eosinofilia marcada, asma, sinusite crónica, infiltrados pulmonares,
cardiomiopatia, queixas gastrointestinais e mononeurite multiplex. Os anticorpos Anti-MPO (anti-mieloperoxidade), pANCA
(com padrão de imunoflurescência perinuclear) encontram-se presentes em 38-59% dos casos. O envolvimento cardíaco é
uma importante causa de morbilidade e a principal causa de mortalidade no síndrome de Churg-Strauss. Histologicamente
caracteriza-se por uma vasculite necrotizante eosinofílica.
O tratamento é baseado na corticoterapia e em fármacos imunosupressores
(ciclofosfamida e azatioprina) sendo determinado de acordo com critérios de prognóstico. A remissão completa ocorre em cerca de 90% dos casos, sendo as...
19.
Colite por Clostridium difficile numa enfermaria de medicina interna - Cardoso, F; Miranda, J; Araújo, JM
A colite por Clostridium difficile condiciona cada vez mais morbilidade
e mortalidade em doentes hospitalizados. Estudaram-se retrospectivamente características epidemiológicas e clínicas dos casos de colite por Clostridium difficile ocorridos numa enfermaria
de Medicina Interna, num certo período de tempo, como contributo à melhoria da abordagem desta infecção em Portugal.
A incidência da doença esteve ao nível dos registos mais baixos conhecidos do início deste século. A utilização em grande
escala de antibióticos de espectro alargado aparentou ser um factor de risco determinante, entre outros. Apesar dos surtos da doença causados por estirpes resistentes a certos antibióticos,
os resultados da terapêutica com metronidazol e/ou vancomicina foram...
20.
Síndrome de Sweet: a propósito de um caso clínico - Figueiredo, P; Garcia, A; Rodrigues, A; Perloiro, MC; Dutschmann, L
A associação da síndrome de Sweet e doença de Crohn é conhecida, embora rara, sendo considerada uma manifestação
extra-intestinal da doença.
É descrito um caso desta dermatose neutrofílica num homem de 65 anos com antecedentes de espondilite anquilosante e
doença de Crohn, sob terapêutica imunossupressora, que inicia
subitamente febre, artralgias e exantema papular eritemato-violáceo disseminado. Analiticamente apresentava elevação
marcada dos parâmetros inflamatórios. A investigação não revelou causa infecciosa. A biopsia de pele a duas lesões mostrou edema
sub-epidérmico e infiltrado neutrofílico perivascular sem sinais de vasculite. Com a manutenção da terapêutica imunossupressora
e a associação de ibuprofeno ocorreu regressão gradual das queixas e do exantema ao fim...
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