Browsing by Author "Tosatto, V"
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- Hepatic Hydrothorax: Indwelling Catheter-Related Acinetobacter Radioresistens InfectionPublication . Cruz, C; Tosatto, V; Nascimento, P; Barata Moura, RHepatic hydrothorax, a rare and debilitating complication of cirrhosis, carries high morbidity and mortality. First-line treatment consists of dietary sodium restriction and diuretic therapy. Some patients, mainly those who are refractory to medical management, will require invasive pleural drainage. The authors report the case of a 76-year-old man in a late cirrhotic stage of alcoholic chronic liver disease, presenting with recurrent right-sided hepatic hydrothorax, portal hypertension, hepatosplenomegaly and thrombocytopaenia. After recurrent admissions and complications, the potential for adjusting diuretic therapy was limited. After unsuccessful talc pleurodesis, an indwelling tunnelled pleural catheter was placed with effective symptomatic control. One month later, the patient was readmitted with empyema due to Acinetobacter radioresistens Despite optimised medical and surgical treatment, the patient died 4 weeks later.
- Oxigenoterapia na Doença Avançada: Conhece a Evidência?Publication . Frade, L; Carreira, N; Tosatto, V; Marote, S; Galriça Neto, IA dispneia é um dos sintomas que tem mais impacto tanto para o doente com doença avançada, como para o profissional de saúde com a responsabilidade de o acompanhar. Sem prejuízo de se dever aprofundar a evidência disponível sobre as indicações e eficácia da oxigenoterapia, é já vasta a informação que suporta a evidência de que o uso de oxigénio com intenção paliativa deve ser prescrito de forma criteriosa pois, à semelhança de qualquer outro tratamento, tem efeitos secundários associados e pode causar malefícios. O artigo que se apresenta é uma revisão bibliográfica das mais recentes matérias publicadas neste âmbito, com o objetivo de contribuir para melhorar a prática clínica no contexto do tratamento dos doentes em fim de vida.
- Recurrent Klebsiella Pneumoniae Infection Causing Transcatheter Aortic Valve Implantation (TAVI)-Related EndocarditisPublication . Tosatto, V; Cruz, C; Ferreira, T; Moreira Marques, T; Boattini, M; Almeida, A; Barata Moura, RThe authors report the case of an 86-year-old woman presenting with recurrent Klebsiella pneumoniae bacteraemia. She had severe aortic stenosis submitted to a recent transcatheter aortic valve implantation (TAVI). Initially, Klebsiella pneumoniae bacteraemia from a urinary source was diagnosed. Following another 4 episodes of bacteraemia with the same agent, the source was ultimately found to be a periprosthetic abscess. Considering the patient's unsuitability for surgery, a decision was made for life-long antimicrobial therapy. This approach has been successful in preventing recurrences or complications. Endocarditis is one of the most severe complications seen following TAVI, often carrying a poor prognosis. Even though Klebsiella spp. are common pathogens for healthcare-associated infections among the elderly, they are seldom the causative agent for endocarditis. Being the first reported case of TAVI-related Klebsiella endocarditis, it was successfully managed using a medical approach.
- Weil's Disease in a Young Homeless Man Living in LisbonPublication . Moreira Marques, T; Nascimento, P; Almeida, A; Tosatto, VLeptospirosis is a zoonotic disease of worldwide distribution caused by infection with Leptospira genus bacteria, a pathogenic spirochaete. We present the case of a 29-year-old man admitted to our hospital with fever and multiorgan failure. He provided poor information about his symptoms. No recent travel or occupational history was reported and his clinical presentation did not suggest any infectious foci. His relatives later disclosed that he had been homeless for 3 weeks in the context of behavioural changes, obtaining foodstuff from waste containers and water from rain puddles. In the setting of this epidemiology, his presentation of fever, jaundice, acute renal injury and thrombocytopaenia suggested leptospirosis. Prompt empirical antimicrobial coverage was started, alongside organ support therapy. The diagnosis was later confirmed through microscopical and molecular methods. The patient made a full recovery. Leptospirosis should be considered early in the diagnostic work-up of any patient with acute febrile illness with multiorgan system involvement, with the identification of risk factors being essential to treat early in development of the disease.