Medicina
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The use of antidementia drugs near the end of life remains controversial. We evaluated the prevalence of and factors associated with antidementia drug use in the last 6 months of life in older adults with dementia. ⋯ One out of three patients with dementia receive antidementia drugs in the 6 months prior to death despite limited evidence in such a scenario.
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Rare encephalopathies are here described in order to summarize practical tools that should be considered in the anamnesis, as well as in the physical examination. The way in which the clinical picture was established was the primary point for structuring the review; subsequently, the encephalopathies were subclassified etiologically. Focal symptoms, headaches, abdominal pain, fever or extrapyramidalism, added to the findings in the magnetic resonance imaging, especially if damage to the gray or white matter is observed, and if the lesions are bilateral or not, can be helpful when hypothesizing the etiology of the encephalopathy.
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Breastfeeding in newborn infants born to people living with HIV continues to be a controversial issue. However, there is numerous evidence that reveals that in the context of sustained virological suppression, the risk of postnatal HIV transmission through breast milk is less than 1%. From the activism of people with HIV, civil society and the medical and scientific community, there is a demand for reopening the issue, with the purpose of defining new guidelines for the feeding of children born to people with HIV. This review analyzes the available scientific evidence and the current knowledge gaps regarding breastfeeding in HIV situations and proposes an institutional approach and shared decision-making modality for HIV-positive pregnant people who wish to breastfeed.
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Klebsiella pneumoniae liver abscess syndrome due to hypermucoviscous strains is defined by the presence of monomicrobial liver abscess, without biliary tree or colorectal disease. These strains may be easily identified in the laboratory by performing a string test. It has the potential to spread to other organs, leading to a high morbimortality. We report two cases of liver abscess due to naturally susceptible Klebsiella pneumoniae, one of them with endogenous endophthalmitis as metastatic involvement that required evisceration.
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Phlegmonous gastritis in an uncommon bacterial infection of the gastric wall, predominantly affects immunocompromised patients, with high mortality rates despite appropriate treatment. Various risk factors compromising gastric mucosal integrity have been described. ⋯ Available literature on patients with oncohematological diseases or undergoing chemotherapy who develop phlegmonous gastritis, is limited. We present the case of a female patient with relapsed acute lymphoblastic leukemia who developed phlegmonous gastritis during the neutropenic period following chemotherapy.