Browsing by Author "Amaral, M"
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- Fenómeno da Migração nas Doenças InfeciosasPublication . Amaral, M; Ferrão, J; Piteira, MT; Pinheiro, S
- High-Flow Nasal Cannula Oxygen Therapy in Pulmonary Fat Embolism - Case ReportPublication . Ferrão, J; Amaral, M; Ilharco, M; Casimiro, J; Germano, N
- Limbic Encephalitis When the Immune Response Is the Hidden ProblemPublication . Amaral, M; Ferrão, J; Duarte, B; Pinheiro, SLimbic Encephalitis (LE) defined as a rare and frequently underrecognized immunomediated syndrome, presents with a constellation of unspecific behavioral and neuropsychiatric symptoms, developing over weeks to months. Personality disturbance, complex partial mesotemporal seizures and a subacute severe impairment of short-term memory are the cardinal symptoms, reflecting the involvement of the grand lobe limbique. The etiology is still poorly understood. Until recently, paraneoplastic etiology was thought to be the most common cause of LE, often preceding the malignancy identification (60%–75%). In the last decade other associations have been considered, namely infectious or autoimmune diseases. It appears that non-paraneoplastic LE (unassociated with onconeural antibodies) is at least 5 times more frequent than the one where paraneoplastic antibodies are detected, even excluding the cases of paraneoplastic LE that are antibody-negative (40%). To date, co-occurrence of two possible etiologies of this rare syndrome, in the same patient, has never been reported.
- Pneumonia por Pneumocystis e Citomegalovírus no Doente VIH. A Propósito de Dois Casos ClínicosPublication . Lourenço, S; Amaral, M; Almeida, R; Marcelino, P; Marum, S; Milheiro, MA; Oliveira, J; Mourão, LNos doentes com infecção pelo vírus da imunodeficiência humana (VIH) o citomegalovírus torna-se um agente de doença importante quando existe imunossupressão avançada. O seu papel como agente de doença pulmonar neste contexto tem sido amplamente debatido. Nos doentes com pneumocistose, a presença do citomegalovírus no pulmão não parece conferir pior prognóstico, excepto nos que recebem terapêutica adjuvante com corticóides. Os autores apresentam dois casos de doentes com infecção VIH e imunossupressão avançada, admitidos na unidade de cuidados intensivos por insuficiência respiratória. Em ambos houve isolamento de Pneumocystis jirovecii no lavado broncoalveolar. Apesar da terapêutica instituída ambos vieram a falecer. A biópsia pulmonar post mortem mostrou, nos dois casos, a presença de Pneumocystis e inclusões por citomegalovírus. Perante este achado tecem-se algumas considerações sobre o papel do citomegalovírus como agente de pneumonia na SIDA e sobre o seu significado como co-infectante na pneumocistose, sobretudo nos casos de falência terapêutica.
- Stress-Related Mucosal Disease: Incidence of Bleeding and the Role of Omeprazole in its ProphylaxisPublication . Amaral, M; Favas, C; Delgado Alves, J; Riso, N; Vaz Riscado, MBACKGROUND: Upper gastrointestinal bleeding is the severe complication of stress-related mucosal disease in hospitalized patients. In intensive care units (ICU), risk factors are well defined and only mechanical ventilation and coagulopathy proved to be relevant for significant bleeding. On the contrary, in non-ICU settings there is no consensus about this issue. Nevertheless, omeprazole is still widely used in prophylaxis of bleeding. The objective of our study was to evaluate the relevance of stress-related mucosal disease bleeding in patients admitted to an internal medicine ward, and the role of omeprazole in its prophylaxis. METHODS: We conducted a retrospective study in which we analysed consecutive patients who were admitted to our ward over a year. We recorded demographic characteristics of the patients, potential risk factors for stress-related mucosal disease (clinical data, laboratory, and medication), administration of prophylactic omeprazole, and total cost of this prophylaxis. Patients with active gastrointestinal bleeding on the admission were excluded. We recorded every upper gastrointestinal bleeding event with clinical relevance. RESULTS: Five hundred and thirty-five patients, mean age 70 years, mean length of stay 9.6+/-7.7 days; 140 (26.2%) patients were treated with 40 mg of omeprazole intravenously, 193 (36.1%) with 20mg of omeprazole orally, and 202 (37.8%) patients had no prophylaxis. There was only one episode (0.2%) of clinically relevant bleeding. CONCLUSION: In patients admitted to an internal medicine ward, incidence of upper gastrointestinal bleeding as a complication of stress-related mucosal disease is low. We found that there is no advantage in prophylaxis with omeprazole.