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- Recurrent optic neuropathy: a case of Harding’s disease?Publication . Miranda, M; Andrade, MM; Silva, MI; Sousa, SC; Carmona, C
- Subacute Meningitis: A Rare Presentation of BrucellosisPublication . Duarte, M; Tiago, V; Sousa, R; Aldomiro, FA young male adult presented with a two-week-long history of myoarthralgia, vomiting, febrile sensation, holocranial headache with photophobia, neck stiffness, anorexia, and weight loss. He worked as a butcher in a local slaughterhouse, and two of his coworkers had recently been diagnosed with brucellosis. On his fourth visit to the Emergency Department (ED), fever was observed for the first time. He was admitted for subacute meningitis. A lumbar puncture revealed high protein concentration, low glucose concentration, and pleocytosis without predominance. He was started on empirical treatment for acute meningitis and neurobrucellosis with ceftriaxone, doxycycline, and rifampin. There was a complete symptom remission over one week. The etiological investigation yielded a positive cerebrospinal fluid (CSF) and serum Rose Bengal Tests (RBTs), as well as a positive anti-Brucella IgG titer, leading to a final diagnosis of neurobrucellosis. After nine months of antimicrobial therapy and two years of follow-up, the patient remained asymptomatic.
- Epidemiological and Clinical Aspects of Cutaneous and Mucosal Leishmaniases in Portugal: Retrospective Analysis of Cases Diagnosed in Public Hospitals and Reported in the Literature between 2010 and 2020Publication . Rocha, R; Conceição, C; Gonçalves, L; Carvalho, AC; Maia, A; Martins, A; Carujo, A; Maio, A; Forra, C; Melita, C; Couto, D; Fernandes, D; Pereira, D; Leal, E; Sarmento, H; Sousa, I; Gonçalves, JP; Marinho, J; Vasconcelos, J; Cunha, J; Rodrigues, J; Silva, JM; Caley, L; Malheiro, L; Santos, L; Garcia, M; Cunha, M; Lima, M; Andrade, MM; Marques, M; Alpalhão, M; Silva, M; Ferraz, R; Soares, R; Fernandes, S; Llobet, S; Cruz, S; Guimarães, T; Branco, T; Robalo-Nunes, T; Almeida, V; Maia, CLeishmania infantum, a zoonotic vector-born parasite, is endemic in the Mediterranean region, presenting mostly as visceral (VL), but also as cutaneous (CL) and mucosal leishmaniasis (ML). This study aimed to describe the epidemiological and clinical aspects of the CL and ML cases diagnosed in mainland Portugal between 2010 and 2020. Collaboration was requested from every hospital of the Portuguese National Health System. Cases were screened through a search of diagnostic discharge codes or positive laboratory results for Leishmania infection. Simultaneously, a comprehensive literature search was performed. Descriptive statistics and hypothesis testing were performed using IBM® SPSS® Statistics. A total of 43 CL and 7 ML cases were identified, with a predominance of autochthonous cases (86%). In CL, immunosuppressed individuals constituted a significant proportion of patients (48%), and in this group, disseminated CL (22%) and simultaneous VL (54%) were common. In autochthonous cases, lesions, mostly papules/nodules (62%), were frequently observed on the head (48%). The approach to treatment was very heterogeneous. ML cases were all autochthonous, were diagnosed primarily in older immunosuppressed individuals, and were generally treated with liposomal amphotericin B. The findings suggest a need for enhanced surveillance and reporting, clinical awareness, and diagnostic capacity of these forms of leishmaniasis to mitigate underdiagnosis and improve patient outcomes. A holistic One Health approach is advocated to address the multifaceted challenges posed by leishmaniases in Portugal and beyond.
- Treatment patterns and preferences of people living with HIV starting or switching antiretroviral therapy: Real-world evidence from PortugalPublication . Pedro, L; Zagalo, A; Tavares, R; Pacheco, P; Oliveira, J; Vaz Pinto, I; Serrão, R; Tavares, S; Brito, P; Maltez, F; Neves, I; Carvalho, A; Teófilo, E; Almeida, J; Lains, IBackground: There is a lack of up-to-date real-life evidence on antiretroviral therapy (ART) strategies among people living with HIV (PLWH) in Portugal. This study aimed to describe the treatment strategy used in PLWH either initiating or switching ART. Methods: Non-interventional, cross-sectional, multicenter study carried out between December 2019 and October 2021 in Portugal. Results: A total of 237 PLWH were included in this study, 171 of whom were ART-experienced and 66 were ART-naïve. The study showed that triple regimens were the most common ART strategy and integrase strand transfer inhibitors-based therapy was the most frequently used therapeutic class in both ART-naïve and ART-experienced PLWH. Nevertheless, about a third of PLWH who started a triple regimen transitioned to a dual regimen. Patient-reported outcomes revealed high HIV literacy and similar ART preferences in both groups. Conclusions: This real-world study showed that triple regimens were the most widely used ART strategy, even after the European AIDS Clinical Society guidelines introduced the recommendation of a dual regimen for naïve patients. The cohorts of this study presented a high level of HIV literacy at the time of inclusion. Our findings highlighted that taking pills only once a day is considered a very important feature for most patients.
- Thrombocytopenia induced by clopidogrel: a rare adverse effectPublication . Cruz, D; Rodrigues dos Santos, J; Távora, CIntroduction: Immune thrombocytopenic purpura (ITP) can be induced by several drugs but there are few case reports of ITP induced by clopidogrel. Second-line treatment with thrombopoietin receptor agonists (TPO-RA) presents solid evidence and should be considered in patients in need of elective surgery who are poor responders to steroids. Case description: We report the case of a 79-year-old male who developed severe immune thrombocytopenic purpura after initiating treatment with clopidogrel. Because he needed elective orthopaedic surgery and he did not respond to corticotherapy and immunoglobulin, second-line treatment with romiplostim was initiated with a significant increase in platelet count. Discussion and conclusion: Clopidogrel can induce ITP and this diagnosis should be considered in patients who present with isolated thrombocytopenia. First-line therapy of ITP is not always successful; second-line treatment with TPO-RA has a high response rate and should be considered in patients in need of elective surgery who have failed to respond to first-line therapy. Learning points: Clopidogrel can cause immune thrombocytopenic purpura (ITP); although there are some published cases in literature, it is a rare adverse effect.ITP induced by clopidogrel should be considered in the differential diagnosis of patients experiencing isolated thrombocytopenia.Second-line treatment of ITP with thrombopoietin receptor agonists (TPO-RA) presents solid evidence and should be considered in patients in need of elective surgery who are poor responders to steroids.
- Epidemiological and Clinical Aspects of Cutaneous and Mucosal Leishmaniases in Portugal: Retrospective Analysis of Cases Diagnosed in Public Hospitals and Reported in the Literature between 2010 and 2020Publication . Rocha, R; Conceição, C; Gonçalves, L; Carvalho, AC; Maia, A; Martins, A; Carujo, A; Maio, A; Forra, C; Melita, C; Couto, D; Fernandes, D; Pereira, D; Leal, E; Sarmento, H; Sousa, I; Gonçalves, JP; Marinho, J; Vasconcelos, J; Cunha, J; Rodrigues, J; Silva, JM; Caley, L; Malheiro, L; Santos, L; Garcia, M; Cunha, M; Lima, M; Andrade, MM; Marques, M; Alpalhão, M; Silva, M; Ferraz, R; Soares, R; Fernandes, S; Llobet, S; Cruz, S; Guimarães, T; Branco, T; Robalo-Nunes, T; Almeida, V; Maia, CLeishmania infantum, a zoonotic vector-born parasite, is endemic in the Mediterranean region, presenting mostly as visceral (VL), but also as cutaneous (CL) and mucosal leishmaniasis (ML). This study aimed to describe the epidemiological and clinical aspects of the CL and ML cases diagnosed in mainland Portugal between 2010 and 2020. Collaboration was requested from every hospital of the Portuguese National Health System. Cases were screened through a search of diagnostic discharge codes or positive laboratory results for Leishmania infection. Simultaneously, a comprehensive literature search was performed. Descriptive statistics and hypothesis testing were performed using IBM® SPSS® Statistics. A total of 43 CL and 7 ML cases were identified, with a predominance of autochthonous cases (86%). In CL, immunosuppressed individuals constituted a significant proportion of patients (48%), and in this group, disseminated CL (22%) and simultaneous VL (54%) were common. In autochthonous cases, lesions, mostly papules/nodules (62%), were frequently observed on the head (48%). The approach to treatment was very heterogeneous. ML cases were all autochthonous, were diagnosed primarily in older immunosuppressed individuals, and were generally treated with liposomal amphotericin B. The findings suggest a need for enhanced surveillance and reporting, clinical awareness, and diagnostic capacity of these forms of leishmaniasis to mitigate underdiagnosis and improve patient outcomes. A holistic One Health approach is advocated to address the multifaceted challenges posed by leishmaniases in Portugal and beyond.
- Thinking Outside the Box: A Case of Persistent Symptomatic HypomagnesemiaPublication . Relvas, R; Ferreira Monteiro, N; Vale Rodrigues, R; Cruz, DAlthough present in a significant number of people, hypomagnesemia is still an undervalued diagnosis. Therefore, its awareness and comprehensive etiological investigation become imperative. Among its multiple possible causes, drug iatrogenesis plays an important and often overlooked role. Here, we present a case of a 78-year-old female with recurrent bouts of severe hypomagnesemia of unknown origin, which, after an extensive study, was determined to be induced by proton pump inhibitors (PPIs). As such, our goal is to raise awareness of the potential risk of this side effect even in monotherapy, as well as to elucidate its underlying mechanisms, which are still not fully understood. Furthermore, it is intended to foster a systematic therapeutic review in these patients and raise discussion about the potential benefits of systematic magnesium monitoring in patients on long-term PPIs.
- Key factors for effective implementation of healthcare workers support interventions after patient safety incidents in health organisations: a scoping reviewPublication . Guerra-Paiva, S; Lobão, MJ; Simões, DG; Fernandes, Joana; Donato, H; Carrillo, I; Mira, JJ; Sousa, PObjectives: This study aims to map and frame the main factors present in support interventions successfully implemented in health organisations in order to provide timely and adequate response to healthcare workers (HCWs) after patient safety incidents (PSIs). Design: Scoping review guided by the six-stage approach proposed by Arksey and O'Malley and by PRISMA-ScR. Data sources: CINAHL, Cochrane Library, Embase, Epistemonikos, PsycINFO, PubMed, SciELO Citation Index, Scopus, Web of Science Core Collection, reference lists of the eligible articles, websites and a consultation group. Eligibility criteria for selecting studies: Empirical studies (original articles) were prioritised. We used the Mixed Methods Appraisal Tool Version 2018 to conduct a quality assessment of the eligible studies. Data extraction and synthesis: A total of 9766 records were retrieved (last update in November 2022). We assessed 156 articles for eligibility in the full-text screening. Of these, 29 earticles met the eligibility criteria. The articles were independently screened by two authors. In the case of disagreement, a third author was involved. The collected data were organised according to the Organisational factors, People, Environment, Recommendations from other Audies, Attributes of the support interventions. We used EndNote to import articles from the databases and Rayyan to support the screening of titles and abstracts. Results: The existence of an organisational culture based on principles of trust and non-judgement, multidisciplinary action, leadership engagement and strong dissemination of the support programmes' were crucial factors for their effective implementation. Training should be provided for peer supporters and leaders to facilitate the response to HCWs' needs. Regular communication among the implementation team, allocation of protected time, funding and continuous monitoring are useful elements to the sustainability of the programmes. Conclusion: HCWs' well-being depends on an adequate implementation of a complex group of interrelated factors to support them after PSIs.
- Perceção dos Profissionais de Saúde do Processo de Reconciliação Terapêutica em Contexto Hospitalar: Estudo de CasoPublication . Mylkivska, A; Campos-Fernandes, A; Lobão, MJ; Falcão, MFIntrodução: O processo de reconciliação terapêutica visa, em momentos de transição entre níveis de prestação de cuidados de saúde, diminuir os incidentes com medicamentos e contribuir para o uso seguro da medicação. Com este estudo pretendeu-se explorar barreiras e fatores que influenciam o processo de reconciliação terapêutica num serviço de Medicina Interna de um hospital de nível distrital e identificar oportunidades de melhoria. Métodos: Estudo de natureza qualitativa, do tipo de estudo de caso único e exploratório, com a realização de entrevistas semiestruturadas a médicos, enfermeiros e farmacêuticos. Resultados: Destacam-se as dificuldades na comunicação com o doente, família, entre os profissionais de saúde, serviços e outras instituições. A nível informático, dificuldades na prescrição em contexto de emergência, alertas de medicação repetidos e o não acesso à plataforma de dados de saúde pelos farmacêuticos. Como oportunidades de melhoria na reconciliação terapêutica, os profissionais de saúde apontaram para a formação, seguimento do doente após alta hospitalar, melhoria da comunicação entre as instituições de saúde e integração entre os sistemas de informação em saúde. Conclusão: Os resultados obtidos demonstram que as barreiras ao processo de reconciliação terapêutica persistem, com consequências expetáveis a nível da qualidade dos cuidados prestados. Este estudo alerta para a necessidade de implementação de medidas que as permitam mitigar.
- Thrombocytopenia induced by clopidogrel: a rare adverse effectPublication . Cruz, D; Rodrigues dos Santos, J; Távora, CIntroduction: Immune thrombocytopenic purpura (ITP) can be induced by several drugs but there are few case reports of ITP induced by clopidogrel. Second-line treatment with thrombopoietin receptor agonists (TPO-RA) presents solid evidence and should be considered in patients in need of elective surgery who are poor responders to steroids. Case description: We report the case of a 79-year-old male who developed severe immune thrombocytopenic purpura after initiating treatment with clopidogrel. Because he needed elective orthopaedic surgery and he did not respond to corticotherapy and immunoglobulin, second-line treatment with romiplostim was initiated with a significant increase in platelet count. Discussion and conclusion: Clopidogrel can induce ITP and this diagnosis should be considered in patients who present with isolated thrombocytopenia. First-line therapy of ITP is not always successful; second-line treatment with TPO-RA has a high response rate and should be considered in patients in need of elective surgery who have failed to respond to first-line therapy. Learning points: Clopidogrel can cause immune thrombocytopenic purpura (ITP); although there are some published cases in literature, it is a rare adverse effect.ITP induced by clopidogrel should be considered in the differential diagnosis of patients experiencing isolated thrombocytopenia.Second-line treatment of ITP with thrombopoietin receptor agonists (TPO-RA) presents solid evidence and should be considered in patients in need of elective surgery who are poor responders to steroids.
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