Lage, A; Pinho, J; Alves, R; Capela, C; Lourenço, E; Lencastre, L
Strychnine acts as an inhibitor of post-synaptic neuronal inhibition and intoxication leads to distinct clinical manifestations which may culminate in death. Since its commercialization is prohibited in most countries, cases of strychnine intoxication are now rare. We present a case of an elderly patient who voluntarily ingested a white powder thought to be strychnine. He developed myoclonus, startle response, and episodes of generalized muscle contractions accompanied by respiratory arrest in one occasion. Diazepam, valproic acid and supportive treatments were able to control manifestations, however the patient died after 2 days. Our aim is to alert clinicians that, despite its rarity,...
Lafeuillade, A; Clumeck, N; Mallolas, J; Jaeger, H; Livrozet, JM; Ferreira, MS; Jonhson, S; Cheret, A; Antoun, Z; European Trizal team.
To analyze the evolution of clinical lipodystrophy (LD) and metabolic abnormalities in patients continuing to receive HAART versus patients switched to Trizivir (zidovudine, lamivudine, abacavir) after 48 weeks.
Patients treated with HAART >6 months with plasma HIV-1 RNA viral load (VL) <400 copies/mL and <50 copies/mL at screening were randomly assigned to continue HAART (103 patients) or to receive Trizivir (106 patients). Clinical LD was evaluated using a standardized patient questionnaire only at baseline, weeks 4 and 8, and then every 8 weeks until Week 48. Laboratory evaluation was performed every 4 weeks.
The proportion of patients exhibiting >or=1 LD symptom at...
Caridade, S; Machado, A; Ferreira, C
Stroke in patients with sickle cell anemia is multifactorial but occurs mainly by 2 mechanisms: occlusive arteriopathy and obliteration of small vessels with plugs of sickle cells. The high individual risk can be assessed by simple and well-defined strategies such as ultrasounds with transcranial and cervical Doppler Ultrasonography.
The authors report the clinical case of a 25 year-old black female patient with sickle cell anemia, who was admitted with right hemiparesis. Cerebral MRI showed small recent fronto-temporo-parietal cortical-subcortical infarcts and several, older, posterior periventricular lacunae of left preponderance.
A brief discussion is made, with particular emphasis on the proper treatment and prevention...
Fernandes, V; Ramalho, J; Santos, MJ; Oliveira, N; Pereira, M
Martins Alves, EP; Moura Neto, AJ
Neste estudo de caso inserido no 'Ciclo de Reflexões de Enfermagem 2006', realizado no Serviço de Medicina Norte, aborda-se o processo clínico de uma doente com neoplasia terminal do cólon, que manifestou com insistência a vontade de falecer em sua casa. (Introdução) O Serviço de Medicina Norte, no seu plano de formação em serviço, incluíu para o ano de 2006 um ciclo de reflexões de enfermagem sobre casos clínicos verificados no Serviço e respectivos cuidados de enfermagem prestados. O caso clínico a que se refere este trabalho foi um dos inseridos nesse ciclo, e foi seleccionado pela sensibilidade que despertou...
Antunes, R; Diogo, M; Carvalho, A; Pimentel, T; Oliveira, J
Recently there has been an exponential increase in invasive infections caused by Streptococcus ß hemolyticcus group A. In about one third of cases they are complicated by toxic shock syndrome, characterized by septic shock and multiorgan failure. The authors, by their rarity, report a case of bacteraemia caused by Streptococcus pyogenes complicated by toxic shock syndrome.
Pimentel-Santos, FM; Ligeiro, D; Matos, M; Mourão, AF; Sousa, E; Pinto, P; Ribeiro, A; Sousa, M; Barcelos, A; Godinho, F; Cruz, M; Fonseca, JE; Guedes-Pinto, H; Trindade, H; Evans, DM; Brown, MA; Branco, JC
Association between ankylosing spondylitis (AS) and two genes, ERAP1 and IL23R, has recently been reported in North American and British populations. The population attributable risk fraction for ERAP1 in this study was 25%, and for IL23R, 9%. Confirmation of these findings to ERAP1 in other ethnic groups has not yet been demonstrated. We sought to test the association between single nucleotide polymorphisms (SNPs) in these genes and susceptibility to AS among a Portuguese population. We also investigated the role of these genes in clinical manifestations of AS, including age of symptom onset, the Bath Ankylosing Spondylitis Disease Activity, Metrology and...
Pires, A; Rocha, S; Rodrigues, M; Machado, A; Lourenço, E; Ferreira, C
Diogo, M; Faustino, C; Pimentel, T; Amorim, J; Tavares, I
Gouveia, P; Pires, A; Coimbra, F; Trindade, I; Capela, C; Gomes, G; Rua, A
The authors present the case of a 45 -year -old female patient with Down syndrome, and known past medical history of COPD with multiple hospital admissions in the context of exacerbation of his lung disease. The facts refer to his latest hospitalization, whose motive, prior interpreted as a further exacerbation episode, after careful clinical reassessment and use of appropriate additional means of diagnosis, appeared to be due to an unusual cause. By presenting this case, the authors call the attention to the difficulty presented by particular situations, as well as to the risks of uncritical acceptance of common diagnoses.
Caridade, S; Leite, A; Agonia, I; Rocha, M; Oliveira, N; Brandão, I
Antunes, R; Azevedo, M; Paz, J; Ferreira, MS
Diogo, M; Pimentel, T; Rocha, M; Tavares, I
Ângela, C; Leal, D; Carvalho, A; Oliveira, N; Pimentel, T; Ferreira, MS
Rocha, S; Pires, A; Gomes, J; Sousa, F; Pinho, J; Rodrigues, M; Ferreira, C; Machado, A; Maré, R; Fontes, JR
It was suggested that intravenous thrombolysis (IT) leads to larger
extent recanalization in cardioembolic stroke. In this work we assess
if this has beneficial clinical traduction.
METHOD: We evaluated 177 patients undergoing IT, which were
categorized into cardioembolic (CE) and non-cardioembolic (NCE).
National Institutes of Health Stroke Scale (NIHSS) and modified Rankin
scale were compared.
RESULTS: The mean age was 67.4±12.01 and 53.8% were male. The mean
NIHSS was: 14 (admission), 9 (24 h) and 6 (discharge), similar in
subgroups. The difference between NIHSS at admission and 24 hours was
4.17±4.92 (CE: 4.08±4.71; NCE: 4.27±5.17, p=0.900) and at admission
and discharge there was an average difference of 6.74±5.58 (CE:
6.97±5.68; NCE: 6.49±5.49,...
Trindade, I; Almeida, M; Coimbra, F; Portela, C; Esperança, S; Marques, H
Na maioria dos linfomas não-Hodgkin (LNH), o envolvimento extra-ganglionar surge durante o curso da doença. Contudo alguns LNH têm origem em locais que não os gânglios linfáticos ou o baço, sendo designados por LNH extra-ganglionares. Este estudo tem como objectivo ilustrar as características clínico-patológicas dos doentes com LNH extra-ganglionares primários (LNH-EP). Foram avaliados 125 casos de LNH, dos quais 37 (30%) foram considerados LNH-EP. A proporção entre os sexos foi de 1:1, com uma média de idades de 61 anos. Surgiram 8 casos (20%) de LNH de fenótipo T e 29 casos (80%) de LNH de fenótipo B. Os locais...
Diogo, M; Soares, J; Pimentel, T; Ferreira, A
Fever of unknown origin remains a diagnostic challenge with up to 50% of unexplained cases. Adult-onset Still disease typically present high fever, arthralgia, rash, pharyngitis and serositis, lymphadenopathy and hepatosplenomegaly, inflammatory markers and hepatic enzymes elevation and negative immunological study. The authors present a 46-year old man with previous admissions for fever of unknown origin with a 3-week history of fever and systemic symptoms. The study disclosed anaemia, inflammatory markers and hepatic enzymes elevation, splenomegaly and negative serological and immunological studies. The patient posteriorly presented polyarthralgias and cutaneous rash. The introduction of corticotherapy resolved symptoms and laboratories alterations. Adult-onset Still...
Capela, C; Gouveia, P; Sousa, M; Regadas, MJ
Swyer-James-MacLeod syndrome or unilateral hyperlucent lung syndrome is a rare entity associated with postinfectious bronchiolitis obliterans occurring in childhood. It is characterized by hypoplasia and/or agenesis of the pulmonary arteries resulting in pulmonary parenchyma hypoperfusion.
Here we report the case of a 53-year-old Caucasian woman with Swyer-James-MacLeod syndrome found in the differential diagnosis workup for a new onset of heart failure, secondary to pulmonary arterial hypertension complicated by a patent ductus arteriosus.
Typically, this disorder is diagnosed in childhood after evaluation for recurrent respiratory infections, but sometimes an indolent course means diagnosis is not made until adulthood.
Pires, A; Capela, C; Gouveia, P; Mariz, J; Gomes, G; Oliveira, J