ULS_10.1-MED-Artigos
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- Tumor lysis syndrome rare presentation as uremic pericarditis: a case reportPublication . Emidio, Fábio Caleça; Pereira, Rafaela; Santos, Pedro Martins dos; Abegão, TeresaTumor lysis syndrome (TLS) is an oncological emergency characterized by the massive destruction of malignant cells and the release of their contents into the extracellular space, which might occur spontaneously or post-chemotherapy. According to the Cairo&Bishop Classification, it can be defined by both laboratory criteria: hyperuricemia, hyperkalemia, hyperphosphatemia, hypocalcemia (two or more); and clinical criteria: acute kidney injury (AKI), convulsions, arrhythmias, or death. We report the case of a 63-year-old man with a previous medical history of colorectal carcinoma and associated multiorgan metastasis. The patient was initially admitted to the Coronary Intensive Care Unit, five days after the chemotherapy session, on suspicion of Acute Myocardial Infarction. Upon admission, he presented without significant elevation of myocardial injury markers, but with laboratory abnormalities (hyperkalemia, hyperphosphatemia, hyperuricemia, and hypocalcemia) and clinical symptoms (sudden sharp chest pain with pleuritic characteristics and electrocardiographic anomalies suggesting uremic pericarditis, and acute kidney injury), all consistent with TLS. The best approach to established TLS is aggressive fluid therapy and a decrease in uric acid levels. Rasburicase proved to be notoriously more effective, both in terms of prevention and treatment of established TLS, thus consisting of the first-line drug. However, in the present case, rasburicase was not available at the hospital level, so a decision was made to initiate treatment with allopurinol. The case evolved with slow but good clinical evolution. Its uniqueness resides in its initial presentation as uremic pericarditis, scarcely described in the literature. The constellation of metabolic alterations from this syndrome translates into a spectrum of clinical manifestations that can go unnoticed and ultimately may prove to be fatal. Its recognition and prevention are crucial for improving patient outcomes.
- Serum neutrophil biomarkers to predict crohn's disease progression and infliximab treatment outcomesPublication . Magalhaes, D.; Santiago, M.; Patita, M.; Arroja, B.; Lago, P.; Rosa, I.; Sousa, Helena Tavares; Ministro, P.; Mocanu, I.; Vieira, A.; Castela, J.; Moleiro, J.; Roseira, J.; Eugenia, C.; Sousa, P.; Portela, F.; Correia, L.; Dias, S.; Afonso, J.; Danese, S.; Peyrin‐Biroulet, L.; Dias, C. C.; Magro, F.Background and aims: Predicting the treatment outcomes of biological therapies is an unmet need in Crohn's Disease. In this study, we explored the potential of serum neutrophil-related biomarkers to predict infliximab therapeutic results and disease progression in Crohn's Disease patients, over a 2-year period, in a real-world setting. Methods: The study included 100 asymptomatic Crohn's Disease patients in the IFX maintenance phase from the prospective, observational, multicenter DIRECT study. Patients were categorized according to a composite outcome reflecting progression that included surgery, hospitalizations, new fistulae, abscess or stricture, and drug treatment escalation. Serum neutrophil elastase, lipocalin-2, lactoferrin, and resistin (non-neutrophil control) were analyzed via multiplex magnetic bead assays at multiple touchpoints. Fecal calprotectin was assessed by ELISA. Results: Over up to 2 years of follow-up, serum biomarkers did not differentiate between the composite outcome groups, whereas fecal calprotectin was significantly higher in patients with worse outcomes. During the infliximab maintenance phase, there was a significant, sustained reduction of neutrophil elastase (p < 0.001), lipocalin-2 (p < 0.001), and lactoferrin (p < 0.001), but not of resistin, despite stable neutrophil levels. Correlations between NE and NGAL levels were strong (Pearson correlations 0.75-0.85); all other correlations were of small magnitude. Conclusion: Our real-world data do not support using serum neutrophil elastase, lipocalin-2, or lactoferrin concentrations as predictors of treatment outcomes or disease evolution in infliximab -treated Crohn's Disease patients. On the other hand, the sustained decrease in biomarkers over time suggests that neutrophil stabilization might be an additional infliximab mechanism of action.
- Tumor lysis syndrome rare presentation as uremic pericarditis: a case reportPublication . Emidio, Fábio Caleça; Pereira, Rafaela; Santos, Pedro Martins dos; Abegão, TeresaTumor lysis syndrome (TLS) is an oncological emergency characterized by the massive destruction of malignant cells and the release of their contents into the extracellular space, which might occur spontaneously or post-chemotherapy. According to the Cairo&Bishop Classification, it can be defined by both laboratory criteria: hyperuricemia, hyperkalemia, hyperphosphatemia, hypocalcemia (two or more); and clinical criteria: acute kidney injury (AKI), convulsions, arrhythmias, or death. We report the case of a 63-year-old man with a previous medical history of colorectal carcinoma and associated multiorgan metastasis. The patient was initially admitted to the Coronary Intensive Care Unit, five days after the chemotherapy session, on suspicion of Acute Myocardial Infarction. Upon admission, he presented without significant elevation of myocardial injury markers, but with laboratory abnormalities (hyperkalemia, hyperphosphatemia, hyperuricemia, and hypocalcemia) and clinical symptoms (sudden sharp chest pain with pleuritic characteristics and electrocardiographic anomalies suggesting uremic pericarditis, and acute kidney injury), all consistent with TLS. The best approach to established TLS is aggressive fluid therapy and a decrease in uric acid levels. Rasburicase proved to be notoriously more effective, both in terms of prevention and treatment of established TLS, thus consisting of the first-line drug. However, in the present case, rasburicase was not available at the hospital level, so a decision was made to initiate treatment with allopurinol. The case evolved with slow but good clinical evolution. Its uniqueness resides in its initial presentation as uremic pericarditis, scarcely described in the literature. The constellation of metabolic alterations from this syndrome translates into a spectrum of clinical manifestations that can go unnoticed and ultimately may prove to be fatal. Its recognition and prevention are crucial for improving patient outcomes.
- Reabilitação psicossocial nos cuidados continuados integrados em saúde mental: ponto de situação em PortugalPublication . Martins, João Borba; Viseu, Maria T. D.; Pinto, Mónica BarbosaAs doenças mentais constituem a principal causa de anos perdidos por incapacidade, sendo o seu impacto económico muito relevante. Se a esse aspeto associarmos desigualdades socioeconómicas agravadas pelo aumento global da inflação, uma guerra na Europa, o rescaldo de uma pandemia e uma crise climática – ameaças estruturais globais à saúde mental –, a reabilitação psicossocial assume uma importância mais destacada.
- Dance of the sugar: two case reports of chorea associated with nonketotic hyperglycemiaPublication . Pereira, Rafaela C.; Emidio, Fábio Caleça; Dias, Ângelo; Saez, Rosário Blanco; Shamasna, Motasem; Pestana, JoanaHyperglycemia-induced chorea/ballism is a rare clinical entity that often occurs in the setting of nonketotic hyperglycemia due to poor glycemic control in elderly patients with a diagnosis of type 2 diabetes mellitus (DM). This condition is typically characterized by hemichorea/hemiballism and unique brain imaging findings in the contralateral basal ganglia. Treatment involves the correction of blood glucose, and most cases resolve without additional therapy. Here we report two cases of this condition in which patients with type 2 DM presented with nonketotic hyperglycemia and typical neuroimaging findings. Although rare, clinicians should be aware of this condition in patients with diabetes who present with sudden abnormal movements since its prompt diagnosis and treatment often lead to a favorable outcome.
- Rectal bezoar: a rare cause of intestinal obstructionPublication . Emidio, Fábio Caleça; Pereira, Rafaela C.; Saez, Rosário Blanco; Abegão, Teresa; Ribeiro, Ana S.Bezoars are conglomerates of undigested contents that accumulate in the gastrointestinal tract. They can have different compositions, such as fibers, seeds, vegetables (phytobezoars), hair (trichobezoars), and medication (pharmacobezoars). Bezoars are typically caused by an impaired grinding mechanism of the stomach or interdigestive migrating motor complex, but the composition of ingested material can also play a role in their formation. Gastric dysmotility, previous gastric surgery, and gastroparesis are some of the risk factors that can increase the likelihood of developing bezoars. While bezoars are usually asymptomatic and found in the stomach, they can sometimes migrate to the small intestine or colon and cause complications such as intestinal obstruction or perforation. Endoscopy is essential for diagnosis and etiology, and treatment depends on the composition, which can include chemical dissolution or surgical intervention. We present a case of an 86-year-old woman, who had a bezoar located in an unusual location (rectum), most likely due to migration. This condition led to symptoms of intermittent intestinal obstruction and rectal bleeding. However, due to anal stenosis, the patient was unable to expel the bezoar. Its removal was not possible through various endoscopic techniques. Therefore, it was removed via fragmentation, using an anoscope and forceps, due to its hard/stone-like consistency. This case highlights the importance of considering bezoars in the differential diagnosis of gastrointestinal bleeding and illustrates the importance of prompt diagnosis and appropriate techniques for the removal of bezoars.
- Myocardial deformation analysis using cardiac magnetic resonance in apical hypertrophic cardiomyopathy: is it an useful tool to predict adverse outcomes?Publication . Fernandes, Raquel; Brandão, Mariana; Lopes, Ricardo Ladeiras; Faria, Rita; Ferreira, Nuno Dias; Carvalho, Ricardo FontesApical hypertrophic cardiomyopathy (AHCM) has a broad phenotypic spectrum and still poses many diagnostic and prognostic challenges. Our team performed a retrospective study to examine the prognostic value of myocardial deformation obtained with cardiac magnetic resonance tissue tracking (CMR-TT) analysis in predicting adverse events in AHCM patients. We included patients with AHCM referred to CMR in our department from August 2009 to October 2021. CMR-TT analysis was performed to characterize the myocardial deformation pattern. Clinical, other complementary diagnostic exams characteristics and follow-up data were analysed. Primary endpoint was the composite of all-cause hospitalizations and mortality. During the 12-year period, 51 AHCM patients were evaluated by CMR, with a median age of 64 years-old and male predominance. 56,9% had an echocardiogram suggestive of AHCM. The most frequent phenotype was "the relative form" (43,1%). CMR evaluation revealed a median maximum left ventricle thickness of 15 mm and the presence of late gadolinium enhancement in 78,4%. Applying CMR-TT analysis, median global longitudinal strain was - 14,4%, with a median global radial strain of 30,4% and global circumferential strain of -18,0%. During a median follow-up of 5,3 years, the primary endpoint occurred in 21,3% of patients, with a hospitalization rate of 17,8% and all-cause mortality rate of 6,4%. After multivariable analysis, longitudinal strain rate in apical segments was an independent predictor of the primary endpoint (p = 0,023), showing that CMR-TT analysis could be useful in predicting adverse events in AHCM patients.
- Ascites, pleural, and pericardial effusion in primary hypothyroidism: a rare case reportPublication . Santos, Pedro Gomes; Marques, Roberto Calças; Santos, Pedro Martins dos; Costa, Catarina Carreira da; Mogildea, MihailHypothyroidism is caused by a deficiency of thyroid hormones and is a common endocrine disorder worldwide. It can affect nearly every organ, resulting in multiple clinical manifestations. Ascites, pleural effusion, and pericardial effusion, although less frequent than peripheral edema, can also be present. These manifestations are thought to be caused by increased vascular permeability to albumin, extravasation of mucopolysaccharides, and inappropriate antidiuretic hormone secretion. Most effusions in hypothyroid patients resolve with thyroxine replacement therapy. However, due to the insidious and nonspecific nature of these symptoms, hypothyroidism is seldom considered a differential diagnosis. We report a case of a 48year-old male with pericardial effusion, pleural effusion, and ascites due to primary hypothyroidism. Although isolated effusions can be frequent in patients with hypothyroidism, the presentation of Hashimoto's thyroiditis as a combination of pericardial effusion, pleural effusion, and ascites is extremely rare. With this case report, we highlight the importance of considering hypothyroidism as a possible cause of unexplained polyserositis, even in the absence of other signs and symptoms.
- Resposta a “Consulta Não Presencial no Serviço Nacional de Saúde Português Durante a Pandemia de COVID-19”Publication . Azeredo, Melanie; Santos, Pedro Martins dos; Jesus, Nuno; Aveiro, Mafalda; Cojocar, IonelaO artigo “Consulta Não Presencial no Serviço Nacional de Saúde Português Durante a Pandemia de COVID-19: Estudo da Opinião dos Médicos e Implicações para o Futuro” permitiu fazer a caracterização da utilização da tele-consulta no início da pandemia de COVID-19 e revelou que esta pode vir a ter um papel importante em Portugal.
- Lung cancer with cold agglutinin syndrome as a Paraneoplastic syndrome: a case reportPublication . Barros, Pedro Pereira; Santos, Bruno dos; Brito, Ulisses62-Year-old male, smoker (100 Pack-year), presented with dry cough and dizziness within the past 3 week, being hospitalized after detecting a lung mass in the right upper lobe in the chest X-ray. CT scan confirmed the presence of the lung mass, also identifying bilateral lung nodules, mediastinal adenopathies, and a hepatic nodule.