Browsing by Author "Mendes-Bastos, P"
Now showing 1 - 10 of 15
Results Per Page
Sort Options
- Allergic Contact Dermatitis Caused by Laurel Leaf OilPublication . Brás, S; Mendes-Bastos, P; Amaro, C; Cardoso, J
- Atopic Dermatitis: Improving Patient Access to Health Care in DermatologyPublication . Torres, T; Gonçalo, M; Paiva-Lopes, MJ; Claro, C; Varela, P; Silva, JM; Cordeiro, A; Mendes-Bastos, PIntroduction and Objective: The present study on atopic dermatitis (AD) in Portugal aims to characterize patient needs and discuss measures to improve health care in dermatology, particularly in cases of moderate to severe disease. Methods: The study was conducted in three phases–(1) data collection on the patient access to healthcare and subsequent analysis; (2) critical evaluation of the data in individual interviews with dermatologists and one pediatrician; and lastly, (3) data discussion in consensus meetings to validate the existing care capacity in dermatology, to identify gaps in care for patients with AD and to define mitigation strategies. Results: In Portugal, it is estimated that AD affects ~ 360,000 patients, 70,000 of whom have moderate to severe disease. Healthcare capacity analysis confirmed that the private system plays an important role in the management of AD. It is estimated that 30% of patients rely solely on the Portuguese public health service. Nevertheless, patients with moderate to severe disease can only access advanced targeted therapies from public healthcare providers. Analysis of public care capacity in dermatology shows relevant gaps in the referral system, the geographical coverage of specialized centers, the number of specialists and high waiting times for first appointments. Considering the negative impact of the disease on patients’ quality of life, 86% of patients with AD use private settings to better manage their disease. Conclusion: In conclusion, private setting bridges the gaps in public health care capacity in dermatology, and therefore, it is crucial for patients with AD. However, a major limitation is the lack of reimbursement for advanced targeted therapies recommended for moderate to severe AD when they are prescribed in a private setting, thus compromising patient access to these therapies. A possible strategy could be to extend the prescription of these therapies to a private setting based on a reimbursement model similar to that outlined in Act 48/2016 of 22 March.
- Calcinose Cutis, Insuficiência Renal e Heparinas de Baixo Peso Molecular Contendo CálcioPublication . Mendes-Bastos, P; Coelho Macias, V; Carvalho, R; Milheiro, A; Cardoso, JFoi solicitada observação por Dermatologia de uma doente de 35 anos de idade, de raça negra, por 2 nódulos subcutâneos localizados na região paraumbilical direita e flanco direito com 2 semanas de evolução. Da história prévia, destaque para doença renal crónica em programa de hemodiálise e infeção pelo vírus da imunodeficiência humana (VIH-1). Ao exame objetivo observaram-se 2 nódulos bem delimitados, subcutâneos, sem alteração da coloração; à palpação, estes eram dolorosos, de consistência pétrea e não aderentes aos planos profundos. Foi realizada biópsia incisional para exame histopatológico, que confirmou a hipótese diagnóstica de calcinose cutis. Uma revisão cuidadosa de toda a medicação realizada permitiu estabelecer a relação entre este achado e a administração subcutânea de nadroparina cálcica nessa localização, umas semanas antes. A dermatose regrediu espontaneamente em 2 meses após a suspensão das injeções subcutâneas de nadroparina cálcica. A calcinose cutis devida à administração de heparinas de baixo peso molecular contendo cálcio é rara, admitindo-se que elevação do produto fósforo-cálcio possa ser determinante na sua fisiopatologia. É geralmente autolimitada, resolvendo espontaneamente.
- Ciprofloxacin: an Uncommon Drug Reaction to a Commonly Used DrugPublication . Mendes-Bastos, P; Carvalho, R; Cunha, D; Cardoso, J
- De Novo HIV Infection Diagnoses in a Department of Dermatology and Venereology in Lisbon, PortugalPublication . Mendes-Bastos, P; Brasileiro, A; Pires, E; Rodrigues, I; Marques, C; Coelho Macias, V; Fernandes, CBACKGROUND: Portugal has the highest prevalence rate of HIV infection in Western Europe. The proportion of patients with a late diagnosis, carried out in full-blown AIDS stage, remains high. Skin and mucous membrane manifestations are not rare in these patients. OBJECTIVE: A demographic, clinical, and laboratorial characterization of patients with de novo HIV infection diagnosis made in the Department of Dermatology and Venereology of a central hospital in Lisbon, Portugal. METHODS: Retrospective review of medical records of adult patients newly diagnosed with HIV infection (reactive immunoassay for antibodies to HIV-1/HIV-2 or HIV p24 antigen) in the Dermatology and Venereology Department of a Portuguese central hospital in the period between January 2005 and December 2013. RESULTS: During the study period, 97 new cases were diagnosed, 70 men and 27 women. The median age at diagnosis was 36 years. Of the total, 50 cases were diagnosed with a concomitant sexually transmitted infection (STI), more frequently syphilis and ano-genital HPV infection. The remaining 47 patients were diagnosed with other dermatological conditions such as prurigo nodularis, psoriasis, and Kaposi's sarcoma. The duration of complaints that lead to medical attention ranged from <1 week to 8 years, being significantly lower in patients diagnosed with a concomitant STI (p < 0.01). Basal viral load was also lower in this group of patients (p < 0.05). Of all the new diagnosed cases, 80% of patients are currently retained in care. CONCLUSION: This study grants a descriptive overview of de novo HIV infection diagnoses performed by dermatovenereologists in a central hospital in Lisbon, Portugal. As in the past, the importance of Dermato-Venereology for HIV infection diagnosis remains present in daily clinical practice.
- Dermatose Febril. Um Diagnóstico a Não EsquecerPublication . Mendes-Bastos, P; Coelho Macias, V; Fernandes, C; Cardoso, JApresenta-se o caso de um doente de 46 anos, com coinfecção VIH-1/VHC e cirrose hepática, internado por febre, prostração e astenia. Ao exame objetivo, observavam-se escassas pústulas necróticas em base eritematosa acantonadas aos dedos das mãos e pés com edema, dor e limitação funcional dos mesmos e da articulação tíbio-társica esquerda. Analiticamente, apenas elevação ligeira da enzimologia hepática e da PCR. Admitiram-se as hipóteses diagnósticas de endocardite, meningococcémia ou gonococcémia. Após isolamento de Neisseria gonorrhoeae em hemocultura, iniciou-se ceftriaxone 1g/dia EV com melhoria clínica. A positividade da PCR para N.gonorrhoeae no exsudado orofaríngeo confirmou o diagnóstico de gonococcémia disseminada de ponto de partida orofaríngeo. A gonorreia é uma infeção sexualmente transmitida causada pelo diplococo Gram negativo Neisseria gonorrhoeae. A gonococcémia disseminada na forma da síndrome clássica “dermatite-artrite” acompanha apenas 1-2% das infeções mucosas. A gonorreia orofaríngea é geralmente assintomática em homens e mulheres, constituindo provavelmente um reservatório importante do agente. O aumento da incidência de gonorreia torna este caso pertinente na prática clínica actual do dermatologista.
- A Dermatosis of PregnancyPublication . Brás, S; Oliveira, A; Mendes-Bastos, P; Amaro, C
- Dermoscopic and Reflectance Confocal Microscopic Presentation of Relapsing Eccrine PorocarcinomaPublication . Pinheiro, R; Oliveira, A; Mendes-Bastos, P
- Erythema Annulare Centrifugum During Rituximab Treatment for Autoimmune Haemolytic AnaemiaPublication . Mendes-Bastos, P; Coelho-Macias, V; Moraes-Fontes, MF; Milheiro, A; Rodrigues, AM; Cardoso, J
- A Fast-Growing Cold Skin Abscess Revealing Disseminated Mycobacterium Intracellulare Infection in an HIV-Infected PatientPublication . Mendes-Bastos, P; Brás, S; Carvalho, RA 66-year-old woman with HIV-1 infection recently commenced on antiretroviral therapy (CD4+ 25 cells/mm3 was referred to the Dermatology Clinic the following month due to a well-demarcated nodule in the extensor surface of the left arm with evident fluctuation but only slight pain on palpation, with no increase in temperature. Surgical drainage was performed with aspiration of yellowish-green exudate, with no characteristic smell. In culture of cutaneous exudate, Mycobacterium intracellulare was isolated. Upon careful review of the laboratory tests that were in progress at discharge, the same agent was isolated in one of the bronchoalveolar lavage cultures. The diagnosis of cutaneous abscess caused by M. intracellulare from hematogenous dissemination of lung infection was made. The patient was treated with clarithromycin, ethambutol and rifabutin for 24 months. M. intracellulare species and Mycobacterium avium constitute the Mycobacterium avium-intracellulare complex (MAC), responsible for the majority of human infections by atypical mycobacteria. They are ubiquitous bacteria and MAC infection mainly affect immunocompromised patients, with M. intracellulare being isolated in <5% of HIV patients with MAC infection. Cutaneous infection is rare and may present clinically with erythematous plaques, chronic ulcers or abscesses. When present, skin involvement is usually secondary to pulmonary infection.