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Journal Cover   Acta Médica Portuguesa
  [SJR: 0.155]   [H-I: 11]   Follow
  This is an Open Access Journal Open Access journal
   ISSN (Print) 0870-399X - ISSN (Online) 1646-0758
   Published by Ordem dos Médicos Homepage  [1 journal]
  • Cure of Hepatitis C

    • Authors: Françoise Roudot-Thoraval
      Abstract: Keywords: Hepacivirus; Hepatitis C, Chronic/drug therapy.
      PubDate: 2015-02-27
      Issue No: Vol. 28 (2015)
  • Analysis of the Cochrane Review: Thrombolysis for Acute Deep Vein
           Thrombosis. Cochrane Database Syst Rev. 2014,1: CD002783.

    • Authors: Liliana Sousa Nanji, André Torres Cardoso, João Costa, António Vaz-Carneiro
      Abstract: The standard treatment for acute deep vein thrombosis (DVT) targets to reduce immediate complications, however thrombolysis could reduce the long-term complications of post-thrombotic syndrome in the affected limb. This systematic review aimed to assess the effects of thrombolytic therapy and anticoagulation versus anticoagulation in people with deep vein thrombosis of the lower limb through the effects on pulmonary embolism, recurrent deep vein thrombosis, major bleeding, post-thrombotic complications, venous patency and venous function. The Cochrane Peripheral Vascular Diseases Group Trials Search Co-ordinator searched the Specialised Register (last search in April 2013) and CENTRAL (2013, Issue 4). A total of 17 randomised controlled trials (RCTs) and 1103 participants were included. In the experimental group receiving thrombolysis, complete clot lysis occurred more frequently and there was greater improvement in venous patency. The incidence of post-thrombotic syndrome decreased by a 1/3 and venous ulcers were less frequent. There were more bleeding complications and 3 strokes occurred in less recent studies, yet there seemed to be no significant effect on mortality. Data on the occurrence of pulmonary embolism and recurrent deep vein thrombosis were inconclusive. There are advantages to thrombolysis, yet the application of rigorous criteria is warranted to reduce bleeding complications. Catheter-directed thrombolysis is the current preferred method, as opposed to systemic thrombolysis in the past, and other studies comparing these procedures show that results are similar.Keywords: Randomized Controlled Trials as Topic; Thrombolytic Therapy; Venous Thrombosis.
      PubDate: 2015-02-27
      Issue No: Vol. 28 (2015)
  • The National Health Service: Dream and Reality

    • Authors: António Arnaut
      Abstract: Keywords: Interview; National Health Programs; Portugal.
      PubDate: 2015-02-27
      Issue No: Vol. 28 (2015)
  • Clinical Semiology at the Technology Age: the New Cardiology

    • Authors: Nuno Cardim
      Abstract: Keywords: Cardiology/education; Cardiovascular Diseases/ultrasonography; Cardiovascular Diseases/radiography; Diagnosis, Differential; Echocardiography; Education, Medical, Continuing.
      PubDate: 2015-02-27
      Issue No: Vol. 28 (2015)
  • Thank You, Reviewers of Acta Médica Portuguesa

    • Authors: Rui Tato Marinho, José Manuel Silva
      Abstract: Acta Médica Portuguesa is the only indexed Portuguese medical journal with a general scope, an audience of approximately 45,000 Portuguese doctors, other health professionals, reaching out to the general population. As such, the contribution of experts in several areas is crucial, supporting and identifying the most relevant issues, commenting on the relevance of the proposed studies and emphasizing innovative lines of the presented methodologies, amongst others.
      To all and every one of you – that continuously maintain full recognition of ‘Peer-Review’ as a duty of the scientific community – a sincere acknowledgement of the Portuguese General Medical Council and Acta Médica Portuguesa.
      PubDate: 2015-02-27
      Issue No: Vol. 28 (2015)
  • Etiological Agents and Antimicrobial Susceptibility in Hospitalized
           Children with Acute Pyelonephritis

    • Authors: Filipa Flor-de-Lima, Tânia Martins, Ana Teixeira, Helena Pinto, Edgar Botelho-Moniz, Alberto Caldas-Afonso
      Abstract: Introduction: Antibiotic resistance driven by antibiotic use remains a major public health and professional concern. Our aim was to know the local prevalence of uropathogens and their antimicrobial susceptibility profile in acute pyelonephritis.
      Material and Methods: A prospective study of patients admitted in a level III Pediatric Department ward with acute pyelonephritis from 1994 to 2012 was performed in Northern Portugal. Etiological agents and their antimicrobial sensitivity profile were evaluated in four timed periods (G1: 1994-97; G2: 2002; G3: 2007; G4: 2012).
      Results: We evaluated 581 patients, 66% female with median age 22 months. Escherichia coli was the leading uropathogen and its prevalence remained stable during the last 18 years. It showed an increased sensitivity to amoxicillin-clavulanate from 71% in G1 to 81.5% in G4 (p = 0.001) and a decreased resistance rate from 8.7% in G1 to 2.8% in G4 (p = 0.008). Its sensitivity to 2nd and 3rd generation cephalosporin was more than 90% (p = ns) and more than 95% to nitrofurantoin (p = ns). Resistance rate of cotrimoxazole increased from 22% to 26% (p = 0.008).
      Discussion: Escherichia coli remains the main uropathogen responsible for acute pyelonephritis, reason why its antimicrobial sensitivity profile will determine the empirical therapeutic choice.
      Conclusions: Amoxicillin-clavulanate remains a good first-line choice for empirical treatment of acute pyelonephritis in our inpatient health care.
      Keywords: Anti-Bacterial Agents; Child; Drug Resistance, Bacterial; Pyelonephritis.

      PubDate: 2015-02-27
      Issue No: Vol. 28 (2015)
  • Problems Identified in the Package Leaflets of the Portuguese Non-Generic

    • Authors: Carla Pires, Afonso Cavaco, Marina Vigário
      Abstract: Introduction: All medicines for human use are marketed with a package leaflet. Every package leaflet must contain an initial list mentioning all sections of the document in accordance to the European template Quality Review of Documents, being not to extensive, i.e. comprising approximately 1500 words. The so-called mixed leaflets contain information about medicines with more than one strength/ pharmaceutical form, and only exceptionally are authorized. In this context, the objectives of the present study comprised the identification of issues in all package leaflets of Portuguese non-generic medicines: 1. to confirm the presence of an initial list, 2. to quantify the number of mixed leaflets, and 3. to evaluate their length (in number of pages).
      Material and Methods: Consultation of the leaflets, in a public database (Infomed), according to the classification of the National Prescribing Guide (1st trimester 2012). The data collected was subject to quality control and statistical analysis.
      Results: Identification of 2729 package leaflets, representing 3080 medicines. A total of 2042 leaflets were evaluated, with 181 (8.9%) missing the initial list and 351 (17.2%) being mixed. The average number of pages was 6.9 (SD=2.6), the minimum = 2 and the maximum = 26.
      Discussion: In some cases, readability and comprehension of some Portuguese leaflets might be compromised since: 1) some leaflets did not contain an initial list, 2) were classified as mixed leaflets, and/or 3) were classified as too extensive.
      Conclusion: Regulatory authorities and marketing authorization holders might need to take into consideration these issues during the development and approval of package leaflets.
      Keywords: Pamphlets; Drug Labeling; Portugal.
      PubDate: 2015-02-27
      Issue No: Vol. 28 (2015)
  • Gestational Diabetes and the New Screening Test’s Impact

    • Authors: Ana Catarina Massa, Ricardo Rangel, Manuela Cardoso, Ana Campos
      Abstract: Introduction: In 2011, a new screening test for gestational diabetes was introduced which allowed an earlier and larger diagnosis with the goal of reducing maternal and perinatal complications. The aim of our study was to evaluate the prevalence of gestational diabetes, compare maternal and perinatal outcomes with the previous and present screening tests and analyze postpartum screening results.
      Material and Methods: Retrospective study of women with singletons and gestational diabetes diagnosed during 2009 (n = 223) and 2012 (n = 237), at Maternidade Dr. Alfredo da Costa, Portugal. Analysis of clinical charts and assessment of demographic data, medical and obstetric history, weight gain during pregnancy, gestational age at diagnosis, treatment regimens, neonatal outcomes and postpartum screening results, followed by comparison of these variables between the years of 2009 and 2012.
      Results: In 2012, there was an increased gestational diabetes prevalence, lower weight gain during pregnancy (p < 0.001), more frequent use of pharmacological therapy (p < 0.001) and more diagnosed cases during first and second trimester (p < 0.001). As for neonatal outcomes, in this group, the medium weight at birth was significantly lower (p = 0.001) with a decrease of newborns great for gestational age (p = 0.002). Postpartum screening rate was similar among both groups but in 2012 there was an increase of normal results and a decrease of impaired fasting glucose.
      Discussion: Tighter criteria of the current screening test resulted in reduction of the majority of gestational diabetes complications but raised new questions.
      Conclusion: The introduction of the current screening test resulted in an increased prevalence, earlier diagnosis and reduction of macrosomia.
      Keywords: Gestational Diabetes; Mass Screening.
      PubDate: 2015-02-27
      Issue No: Vol. 28 (2015)
  • FATA Study: Prevalence of Atrial Fibrillation and Antithrombotic Therapy
           in Primary Health Care in a Northern City of Portugal

    • Authors: Eva Gomes, Rui Campos, Renata Morais, Marta Fernandes
      Abstract: Introduction: Atrial fibrillation is the most prevalent sustained arrhythmia. The efficacy of oral anticoagulation has been proved in prevention stroke in these patients. However, this seems to be an underutilized treatment.
      Objectives: to determine the prevalence of known atrial fibrillation in a Primary Health Care population; to identify major comorbidities, current antithrombotic therapy and evaluate their suitability according to the European Society of Cardiology guidelines.
      Material and Methods: Observational cross-sectional analytical study. Population: all patients aged 30 or above, enrolled in eight Family Health Units of Vila Nova de Gaia and diagnosed with atrial fibrillation.
      Results: Prevalence of atrial fibrillation was 1.29% (n = 940), being higher in males (p = 0.01) and increasing with age (p < 0.001). The most common comorbidities were hypertension (76.4%), heart failure (32.0%) and diabetes mellitus (28.2%). A total of 52% was performing anticoagulant therapy, 29% antiplatelet agents and 4% both therapies. Of those with low thrombotic risk, 63.6% was wrongly performing some kind of antithrombotic therapy; among patients with high risk or valvular disease 56.8% was properly undergoing anticoagulant therapy.
      Conclusion: The prevalence of atrial fibrillation as well as the frequency of the main comorbidities associated with it are in line with the majority of studies. Although most patients are undergoing oral anticoagulation, only 56.8% of those with atrial fibrillation was performing adequate antithrombotic therapy as recommended by the European Society of Cardiology guidelines, which denote a marked underutilization of this treatment.
      Keywords: Atrial Fibrillation; Fibrinolytic Agents; Stroke; Primary Health Care; Portugal.
      PubDate: 2015-02-27
      Issue No: Vol. 28 (2015)
  • Psychiatric Comorbidities Associated with Headaches: the Experience of the
           Liaison Consultation

    • Authors: Vera Martins, José Temótio, Ilda Murta
      Abstract: Introduction: The comorbidity between headaches and psychiatric disorders is common and may be explained by different mechanisms in terms of uni or bi-directional models, or sharing of genetic and environmental risk factors relating to development of both clinical conditions. The presence of this comorbidity has important implications for patients with headaches and for patients with psychiatric disorders, worsens the clinical situation, increases the risk of chronicity, the pain intensity and the rate of treatment failure.
      Material and Methods: The authors performed a descriptive, retrospective study of prevalence, involving 250 patients seen in Psychiatry - Headaches liaison consultation, over a period of 3 years, from July 1, 2011 to July 1, 2013. The authors undertook the analysis of the clinical records, in respect to sociodemographic and clinical data, neurological and psychiatric diagnosis and prescribed therapy.
      Results and Discussion: During this period were made 689 liaison consultations, with a prevalence of female patients (84%) and a mean age of 47 years. The tension type headache (60.8%), migraine (24.8%) and headache attributed to psychiatric disorders (7.2%) were the most prevalent types of headaches. Mood disorders (62%) and neurotic stress related disorders (39.2%) were the most frequent psychiatric diagnoses. The therapeutic intervention in these cases emphasizes the multidisciplinary approach with the collaboration of Neurologist and Psychiatrist, based in psychoeducation, cognitive-behavioral intervention and psychopharmacological treatment.
      Conclusion: Given the complexity of the clinical picture in cases of comorbidity, the experience of psychiatry liaison consultation and multidisciplinary intervention has proved particularly valuable in treating these patients, configuring itself as the proper treatment of this comorbidity.
      Keywords: Comorbidity; Headache; Mental Disorders; Psychiatry.
      PubDate: 2015-02-27
      Issue No: Vol. 28 (2015)
  • Prevalence of Autonomic Dysfunction in Patients with Multiple Sclerosis

    • Authors: Bitia Vieira, Andreia Costa, Gonçalo Videira, Maria José Sá, Pedro Abreu
      Abstract: Background: Autonomic nervous system dysfunction is commonly seen in multiple sclerosis patients and should be explored in the routine evaluation. Composite Autonomic Symptom Score questionnaire was validated as a self-assessment instrument of autonomic symptoms.
      Objectives: Determine the frequency of autonomic symptoms in multiple sclerosis patients through a Portuguese version of Composite Autonomic Symptom Score; compare questionnaire results between patients and a control group; assess the feasibility of this questionnaire application in multiple sclerosis Portuguese patients.
      Material and Methods: This case-control study used a Portuguese translated version of Composite Autonomic Symptom Score to determine the frequency of autonomic symptoms in multiple sclerosis patients.
      Results: One-hundred and three relapsing-remitting multiple sclerosis patients – median age 41 years, median disease duration 6 years, median EDSS score 1 - and 80 healthy subjects were included. Alterations in autonomic function were reported in 97.1% of the cases, with statistical significance in orthostatic intolerance and gastrointestinal domain scores. Nevertheless, the difference between multiple sclerosis patients (41.7%) without confounding factors that could interfere with autonomic dysfunction (i.e. comorbidities or medications) and controls showed no statistical significance.
      Discussion: Our results may be related to the short disease duration, young age and lowdisability status of our patients unaffected by confounding factors. The questionnaire was not designed specifically for multiple sclerosis and it may not be as sensible to early autonomic symptoms as to more severe manifestations.
      Conclusions: Further studies are needed to achieve more robust results, validate this questionnaire and assess its application in multiple sclerosis patients in Portugal.
      Keywords: Autonomic Nervous System; Multiple Sclerosis; Portugal; Questionnaires.

      PubDate: 2015-02-27
      Issue No: Vol. 28 (2015)
  • Congenital Adrenal Hyperplasia Due to 21-Hydroxylase Deficiency:
           Genotype-Phenotype Correlation

    • Authors: Catarina Mendes, Inês Vaz Matos, Luís Ribeiro, Maria João Oliveira, Helena Cardoso, Teresa Borges
      Abstract: Introduction: Congenital adrenal hyperplasia due to 21-hydroxylase deficiency is one of the most frequent inborn conditions. It is caused by distinct mutations in the CYP21A2 gene and in the majority of cases the disease’s severity correlates with CYP21A2 allelic variation Our aim was to describe the mutational spectrum of CYP21A2 and evaluate genotype-phenotype correlation in a cohort of portuguese patients with 21-hydroxylase deficiency.
      Material and Methods: Retrospective study of 22 patients with clinical diagnosis of 21-hydroxylase deficiency. Molecular analysis of CYP21A2 was performed and genotype-phenotype correlation was then established.
      Results: Genotyping was performed in 22 unrelated patients: 5 with classic salt-wasting (average age of diagnosis 10,2 days; minimum 1, maximum 20 days), 7 with classic simple virilizing (average age of diagnosis 3,5 years; minimum 0 days, maximum 7 years) and 10 with nonclassical form (average age of diagnosis 5,7 years; minimum 4 years, maximum 8 years). The most frequent genetic defects in the classic forms were I2 splice (24%) and I172N (24%), followed by Q318X (16%) and gene deletions (16%) and in the nonclassical form, the V281L (80%). The overall concordance between genotype and phenotype was 81,8%. Genotype accurately predicted phenotype in 83,3%, 100% and 90% of patients with classic salt-wasting, classic simple virilizing and nonclassical mutations, respectively.
      Discussion: The frequency of genetic defects in our patients was comparable to similar studies. In most cases there was a good correlation between genotype and phenotype.
      Conclusions: Molecular analysis of CYP21A2 provides useful information in terms of prediction of disease severity, genetic and prenatal counseling.
      Keywords: Adrenal Hyperplasia, Congenital; Genotype; Phenotype; Steroid 21-Hydroxylase.
      PubDate: 2015-02-27
      Issue No: Vol. 28 (2015)
  • Efficacy and Safety of Percutaneous Radiofrequency Thermal Ablation in the
           Treatment of Lung Cancer Lesions

    • Authors: Ana Tavares eCastro, Sara Freitas, Antónia Portilha, Fernando Alves, Filipe Caseiro-Alves
      Abstract: Introduction: In this study, we reviewed a clinical series composed by all malignant lung lesions submitted to computed tomographyguided percutaneous thermal radiofrequency ablation, in our hospital, a rather recent technique that has been gaining scientific recognition.
      Material and Methods: For data purposes, all radiofrequency ablation and corresponding clinical records were retrospectively
      analysed. A computed tomography scan was performed before and after each procedure to evaluate the tumour’s features, and at a second step to assess results and complications. The frequency of local recurrence and disease progression were determined based on imaging follow-up. Kaplan–Meier analysis was used to estimate survival. Univariate analysis recognized clinical and pathological factors affecting survival. These were also tested by multivariate analysis.
      Results: A total of 28 malignant lung lesions, 20 primary and 8 metastatic, from 28 patients (78.6% male; mean age 62 ± 17 years old), were submitted to computed tomography-guided radiofrequency ablation between January 2004 and July 2010. Total necrosis was achieved in 74.1% of the lesions. Immediate radiofrequency ablation-related complications were observed in half of the procedures. Among major complications, death occurred in one patient only. Median overall survival was 43.0 months for a mean 2-years follow-up.
      Median progression-free survival was 31.6 months. Lesion’s size smaller than 35 mm, stage III disease by the TNM classification and previous treatment attempts were significantly associated with better outcomes. Disease-related mortality was 46.4%.
      Discussion: This procedure proved to be efficient to treat lung cancerous lesions, with a low-rate of major complications.
      Conclusions: Computed tomography-guided percutaneous radiofrequency ablation is a minimally invasive procedure that appears to be valuable in the treatment of lung cancer lesions.
      Keywords: Catheter Ablation; Lung Neoplasms; Tomography, X-Ray Computed.
      PubDate: 2015-02-27
      Issue No: Vol. 28 (2015)
  • Effects of Local Anesthetic on the Time Between Analgesic Boluses and the
           Duration of Labor in Patient-Controlled Epidural Analgesia: Prospective
           Study of Two Ultra-Low Dose Regimens of Ropivacaine and Sufentanil

    • Authors: José Manuel Costa-Martins, Cláudia Camila Dias, Marco Pereira, Jorge Tavares
      Abstract: Background: Patient-controlled epidural analgesia with low concentrations of anesthetics is effective in reducing labor pain. The aim of this study was to assess and compare two ultra-low dose regimens of ropivacaine and sufentanil (0.1% ropivacaine plus 0.5 μ sufentanil vs. 0.06% ropivacaine plus 0.5 μ sufentanil) on the intervals between boluses and the duration of labor.
      Material and Methods: In this non-randomized prospective study, conducted between January and July 2010, two groups of parturients received patient-controlled epidural analgesia: Group I (n = 58; 1 ropivacaine + 0.5 μ sufentanil) and Group II (n = 57; 0.6 ropivacaine + 0.5 μ sufentanil). Rescue doses of ropivacaine at the concentration of the assigned group without sufentanil were administered as necessary. Pain, local anesthetic requirements, neuraxial blockade characteristics, labor and neonatal outcomes, and maternal satisfaction were recorded.
      Results: The ropivacaine dose was greater in Group I (9.5 [7.7-12.7] mg.h-1 vs. 6.1 [5.1-9.8 mg.h-1], p < 0.001). A time increase between each bolus was observed in Group I (beta = 32.61 min, 95% CI [25.39; 39.82], p < 0.001), whereas a time decrease was observed in Group II (beta = -1.40 min, 95% CI [-2.44; -0.36], p = 0.009). The duration of the second stage of labor in Group I was significantly longer
      than that in Group II (78 min vs. 65 min, p < 0.001).
      Conclusions: Parturients receiving 0.06% ropivacaine exhibited less evidence of cumulative effects and exhibited faster second stage progression than those who received 0.1% ropivacaine.
      Keywords: Analgesia, Obstetrical; Analgesia, Patient-Controlled; Labor Pain; Ropivacaine; Sufentanil.
      PubDate: 2015-02-27
      Issue No: Vol. 28 (2015)
  • Weight Control Attempts among Portuguese Adults: Prevalence, Motives and
           Behavioral Strategies

    • Authors: Inês Santos, Ana M. Andrade, Pedro J. Teixeira
      Abstract: Introduction: In Portugal, there are no representative data on how many people are actively trying to control their weight and which strategies and motives underlie those attempts. The aim of this study was to estimate the prevalence of weight loss/maintenance attempts and to identify the associated behavioral strategies and motives, in a representative sample of Portuguese adults.
      Material and Methods: Cross-sectional study with a sample of 1098 Portuguese adults. Sociodemographic information, anthropometric data and weight loss/maintenance strategies and motives were assessed by telephone interview.
      Results: About 44% of Portuguese adults (53% women and 35% men) are actively trying to control their weight. About 22% of women with normal weight are trying to lose weight while 53% of men and 34% of women with excess weight are not trying to manage their weight. About 49% of men with higher educational level are trying to control their weight, which compares to 32% among the least educated men. The most frequently used strategy to manage weight is regular vegetable consumption and the motives most frequently
      reported were improving health/preventing diseases and improving wellbeing.
      Discussion and Conclusion: More than half of Portuguese women and about one-third of men are actively trying to control their weight, using behavioral strategies which are generally consistent with public health recommendations. The predominant motives are related to improving health and wellbeing. This study contributes to understanding weight management in Portugal, and could be useful in the development of obesity prevention strategies that match the population profile.
      Keywords: Obesity; Overweight; Portugal; Treatment Outcome; Weight Loss.
      PubDate: 2015-02-27
      Issue No: Vol. 28 (2015)
  • Diabetic Eye Disease

    • Authors: José Henriques, Sara Vaz-Pereira, João Nascimento, Paulo Caldeira Rosa
      Abstract: Diabetes mellitus is a chronic metabolic disease characterized by sustained hyperglycemia leading to macro and microvascular complications. The eye is one of the main organs affected by this disease, being diabetic retinopathy the most well-known microvascular complication and the leading cause of blindness in the working age population. However, diabetic ocular disease is not only characterized by diabetic retinopathy. Other important ocular manifestations of diabetes mellitus include cataract, glaucoma, ischemic optic neuropathy, cranial nerve palsies and recurrent corneal erosion syndrome. Here, we emphasize diabetic retinopathy as the most important and characteristic complication of diabetes mellitus, but also review less well-known complications with the aim to alert and sensitize non-ophthalmologist clinicians that treat diabetic individuals, in order to promote an early diagnosis and treatment of the sight-threatening complications of diabetes.
      Keywords: Diabetes Complications; Diabetes Mellitus; Diabetic Retinopathy.
      PubDate: 2015-02-27
      Issue No: Vol. 28 (2015)
  • A Rare Abdomino-Pelvic Tumor: Paraganglioma

    • Authors: Célia Pedroso, Raquel Robalo, Pedro Sereno, Carlos Barros, Carlos Marques
      Abstract: Paragangliomas are rare tumors, with a reported incidence of 2–8 per million. They are chromaffin cell tumors that develop from the neural crest cells and may be divided in tumors derived from the parasympathetic or sympathetic ganglia. We report a case a of a 32-year-old nulliparous woman, referred to our Infertility Clinic. Abdomino-pelvic ultrasound identified a large abdominopelvic tumor, without ovarian origin (both ovaries were identified and had normal morphology). Magnetic Resonance Imaging suggested a right adnexal multicystic, vascularized mass close to iliac vessels and questioning an ovarian origin. At exploratory laparotomy, a 10 cm encapsulated and vascularized mass was found beginning just below right renal artery and extending to the level of the broad ligament. This mass was totally excised and histopathology was consistent with Paraganglioma.
      Keywords: Abdominal Neoplasms; Paraganglioma; Pelvic Neoplasms.
      PubDate: 2015-02-27
      Issue No: Vol. 28 (2015)
  • Primary Meningococcal Septic Arthritis in a Two Month Old Infant

    • Authors: Teresa Jacinto, Helena Rego, Juan Gonçalves, Virgílio Paz Ferreira
      Abstract: Meningococcal septic arthritis, ocurring without signs of sepsis, is rare, including at pediatric age. The confinement of infection to a single articulation (monoarticular form) is even rarer in infections by Neisseria spp. We discuss the case of a two month-old caucasian girl, presenting with fever and persistent crying during nappy change. Absence of clinical sepsis was notable. She had had no previous anti-meningococcal immunizations. The ultrasound of the left hip revealed the presence of intra-articular fluid. Culture of the purulent
      sample after drainage by arthrotomy produced Neisseria meningitidis. She had a good clinical response to the antibiotics. Follow-up showed no sequels. Albeit a rare entity, primary meningococcal arthritis is a mandatory differential diagnosis concerning a feverish child with articular complaints.
      Keywords: Arthritis, Infectious; Infant; Meningococcal Infections; Neisseria meningitidis.
      PubDate: 2015-02-27
      Issue No: Vol. 28 (2015)
  • Secondary Rhinoplasty Using the Technique of Turkish Delight: a Case
           Report and a Brief Review of the Literature

    • Authors: Inês Correia-Sá, José Amarante, Ricardo Horta, Tiago Neto, Álvaro Silva, Marisa Marques
      Abstract: Rhinoplasty is a demanding task, especially when augmentation of the nasal contour is required. Autologous cartilage grafts are challenging. Contour and alignment of the graft are difficult goals. It is presented a case of a successfully nasal dorsum augmentation in a secondary rhinoplasty with the Turkish Delight technique and a brief review of literature. A 33-years-old female, with history of complete unilateral cleft nasal deformity on the right, and severe nasal deformity, previously submitted to other procedures, was referred to our Center. As she presented a visible cartilage graft, it was decided to perform the Turkish Delight technique. The autograft was effective for increasing of the nasal dorsum, at four years post-operative. There was no evidence of extrusion. The patient is satisfied with the result. The technique is effective in the reconstruction of complex dimorphism of the nasal dorsum, particularly in secondary rhinoplasty.
      Keywords: Cartilage/transplantation; Nose Deformities, Acquired; Rhinoplasty.
      PubDate: 2015-02-27
      Issue No: Vol. 28 (2015)
  • Oral Lipoma

    • Authors: Ermelindo Tavares
      Abstract: Keywords: Lipoma; Mouth Neoplasms
      PubDate: 2015-02-27
      Issue No: Vol. 28 (2015)
  • Pneumoperitoneum, Pneumomediastinum and Subcutaneous Emphysema Following
           Diagnostic Colonoscopy

    • Authors: Antonio Palomeque Jiménez, Cristina González Puga, Beatriz Pérez Cabrera
      Abstract: Keywords: Colonoscopy/adverse effects; Mediastinal Emphysema; Pneumoperitoneum; Subcutaneous Emphysema.
      PubDate: 2015-02-27
      Issue No: Vol. 28 (2015)
  • Bacteriuria and Leukocyturia in Pediatric Urinary Tract Infections: a
           Comment on the National Guideline

    • Authors: Joana Morgado, Susana Gomes, Filipe Alfaiate, José Luís Graneda
      Abstract: Keywords: Bacteriuria; Child; Leukocytes; Urinary Tract Infections.
      PubDate: 2015-02-27
      Issue No: Vol. 28 (2015)
  • Loneliness and Mental Health

    • Authors: Sílvia Ouakinin, David Pires Barreira
      Abstract: Keywords: Depression; Mental Health; Painting; Portugal; Social Isolation.
      PubDate: 2015-02-27
      Issue No: Vol. 28 (2015)
  • Evaluation of Hearing in Patients with Multiresistant Tuberculosis

    • Authors: Leandro Ribeiro, Claudia Sousa, Aida Sousa, Catarina Ferreira, Raquel Duarte, António Faria e Almeida, Artur Condé
      Abstract: Introduction: Multidrug-resistant tuberculosis and extensively drug-resistant tuberculosis constitute a major threat to worldwide tuberculosis control. The treatment demands the use of a therapeutic regimen in second-line drugs for a minimum period of 20 months, which includes aminoglycosides over a period of about eight months. These are associated with permanent cochleovestibular changes.
      Material and Methods: This cross-sectional study aims to evaluate the auditory function in individuals who completed treatment for multidrug-resistant tuberculosis (with scheme that included aminoglycosides) at the Center of Regional Reference for multidrugresistant tuberculosis located in the North of Portugal, between the years 2009 and 2012. Patients who met the inclusion criteria were submitted to tonal and vocal audiograms, otoacoustic emissions at 2000-5000 Hz frequencies, and a tympanogram.
      Results: Between 2009 and 2012, 27 patients were referred to the Centre of Regional Reference for multidrug-resistant tuberculosis, in the North Region of Portugal, resulting in five deaths. Of the 22 individuals invited, 11 attended. These were aged between 31 and 59 years (41 ± 10). Amikacin was used in 80% of patients. Six patients (60%) had sensorineural hearing loss.
      Discussion/Conclusion: The results of this study suggest the need for a more frequent audiological monitoring in patients with multidrug-resistant tuberculosis treated with aminoglycosides allowing early detect hearing loss.
      Keywords: Aminoglycosides; Hearing Loss/ chemically induced; Tuberculosis, Multidrug-Resistant.
      PubDate: 2015-01-26
      Issue No: Vol. 28 (2015)
  • Nephrocalcinosis and Subcutaneous Fat Necrosis

    • Authors: Cláudia Gomes, Luísa Lobo, António Siborro Azevedo, Carla Simão
      Abstract: Subcutaneous fat necrosis of the newborn is an uncommon, transient and self-healing panniculits. This entity generally follows an uncomplicated course, however there are rare and important complications. The authors present a case of a newborn with subcutaneous fat necrosis complicated by hypercalcemia and nephrocalcinosis. The pathogenesis of hypercalcemia is not fully understood and the nephrocalcinosis can evolve to chronic kidney disease. Clinicians should be aware of subcutaneous fat necrosis as a possible risk
      factor for hypercalcemia and patients should have serial serum and urinary calcium determinations for up to 6 months after the appearance of the skin lesions. The early diagnosis and prompt treatment of hypercalcemia are essential to prevent severe complications.
      Keywords: Hypercalcemia; Fat Necrosis; Infant, Newborn; Nephrocalcinosis; Subcutaneous Fat. 
      PubDate: 2014-12-03
      Issue No: Vol. 28 (2014)
  • Osteoarthritis

    • Authors: Duarte Pereira, Elisabete Ramos, Jaime Branco
      Abstract: Osteoarthritis is nowadays one of the most frequent chronic diseases and, with the increase in life expectancy, both its prevalence and incidence is expected to rise. This condition is progressive and leads to functional decline and loss in quality of life, with important health care and society costs. A review of relevant and recent literature on osteoarthritis was performed in PubMed. The purpose of this study is to understand important aspects about osteoarthritis estimates, burden of disease, pathophysiology, risk factors, diagnosis
      and treatment.
      Keywords: Osteoarthritis/diagnosis; Osteoarthritis/epidemiology; Osteoarthritis/physiopathology; Osteoarthritis/therapy; Portugal; Risk Factors.
      PubDate: 2014-10-09
      Issue No: Vol. 28 (2014)
  • The Tip of the Iceberg: Cutaneous Manifestations of Paediatric Diseases
           with Neurological Involvement

    • Authors: Ana Brasileiro, Paula Afonso, Filipa Diamantino, Maria João Paiva Lopes
      Abstract: Introduction: Some cutaneous lesions might be the first clinical manifestation of diseases with systemic involvement. This article aims to review the relevant dermatological semiology for the concerning diseases with neurological involvement in childhood.
      Material and Methods: Review of the related literature indexed to MedLine published in the last twelve years.
      Results: The main relevant nosologic groups include the genodermatosis (namely neurocutaneous syndromes), pigmentary, vascular and endocrine disorders, congenital enzymatic deficiencies and occult spinal dysraphisms.
      Discussion: The recognition of specific cutaneous signs is important once may enable a much earlier diagnosis.
      Keywords: Child; Nervous System Diseases; Neurocutaneous Syndromes; Skin Diseases.
      PubDate: 2014-09-25
      Issue No: Vol. 28 (2014)
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