Acta Medica Port
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Case Reports
Catatonia in Anti-N-Methyl-D-Aspartate (NMDA) Receptor Encephalitis Misdiagnosed as Schizophrenia.
Anti-N-Mmethyl-D-aspartate receptor encephalitis is an autoimmune disease of the central nervous system with prominent neurologic and psychiatric features. Symptoms appear progressively and sometimes with an exclusively psychiatric initial presentation. ⋯ The aim of this case report is to highlight the importance of close surveillance for neuropsychiatric symptoms, especially catatonia, and to recognize autoimmune encephalitis in the differential diagnosis of psychotic disorders with neurological symptoms and resistance or intolerance to antipsychotics. A prompt diagnosis will contribute to a faster onset of therapy and an overall improvement in prognosis.
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The emergence of strains of methicillin-resistant Staphylococcus aureus is a serious therapeutic challenge in healthcare provision. With this study, we aimed to investigate the risk factors and clinical outcomes (mortality and length of hospital stay) associated with methicillin-resistant Staphylococcus aureus infections in patients admitted to a district hospital in Portugal. ⋯ Our study underlines the additional burden imposed by methicillin resistance in Staphylococcus aureus infections. This highlights an urgent need to reinforce and optimize prevention, control, timely detection and effective treatment strategies for multidrug--resistant Staphylococcus aureus strains.
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Pneumothorax is an infrequent complication of laparoscopic surgery. Most cases occur during upper abdominal surgery, since a head-down position (Trendelenburg) pushes the liver and peritoneum against the diaphragm, reducing gas release. ⋯ We report a case of right-sided hypertensive capnothorax due to a diaphragmatic defect, during lower abdominal surgery, which was successfully managed without the need for chest drainage. This case highlights the importance of maintaining active vigilance and a high index of suspicion for pneumothorax during laparoscopic surgery.
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Early diagnosis is a crucial tool for containing the human immunodeficiency virus and other sexually transmitted infections, particularly in key populations such as sex workers. Despite its relevance, there is a gap considering epidemiological studies and interventions aimed at the monitoring and diagnosis of sexually transmitted infections in Portugal. The objectives of this study are: (i) to contribute to a better understanding of the epidemiology of sexually transmitted infections; and (ii) to evaluate the transfer of screening methods from clinical settings to the outreach context in hidden populations such as sex workers. ⋯ The adaptation of the screening methodology performed in a clinical setting to the proximity context has shown to be an innovative response in Portugal, especially in sentinel populations.
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In about 28% of patients, dyslipidemia has a secondary cause. Many times, the treatment of these causes can lead to the total correction of dyslipidemia. We describe the case of a 50-year-old female patient with class II obesity and primary biliary cirrhosis, evaluated for mixed dyslipidemia with poor control (statins and fibrates were being administered) as well as abnormal liver tests. ⋯ After normalisation of thyroid function by treatment with levothyroxine, as well as suspending the administration of statins and fibrates, there was an improvement in the lipid profile, although hypercholesterolemia continued. During this time, the patient was diagnosed with diabetes and she re-commenced statin therapy (atorvastatin 10 mg), which resulted in a normal lipid profile being achieved. In this case, the authors set out to highlight the importance of excluding secondary causes of dyslipidemia - including hypothyroidism, and then go on to discuss particular aspects of statin therapy for liver disease.