Acta Medica Port
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In Portugal, constitutional and legal norms stipulate that the healthcare system should be organized to ensure equity in access to healthcare. To guarantee this objective, it is usually assumed that individuals from different socio-economic groups presenting equal levels of need should have access to the same level of care. The present narrative review describes current knowledge on this topic. ⋯ In Portugal, equity in access has not been achieved for most types of health care. Particularly in the case of specialized health care, better-off groups of the population used more care for a given level of need. The situations where inequity exists should be examined and corrected; potential access barriers within the National Health Service should be considered, as the public healthcare system bears the responsibility for ensuring equity.
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Warthin's tumor is the second most common benign neoplasm of the parotid gland and frequently presents with multifocal and bilateral involvement, either synchronously or metachronously, up to 20% - 30% of cases. More rarely, extraparotid locations may also occur. ⋯ This low incidence is likely underestimated and could be explained by several reasons. Increased awareness of this potentially higher incidence may aid physicians in better evaluating and treating their patients.
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Immune checkpoint inhibitor and tyrosine kinase inhibitor combinations have become the new standard of care in the first-line treatment of metastatic clear cell renal cell carcinoma. However, there is a growing concern regarding severe immune-related adverse events. A 78-year-old man with metastatic clear cell renal cell carcinoma, treated with pembrolizumab and axitinib, was admitted to the emergency department 30 days after initiating treatment due to rapidly progressive myositis. ⋯ On the eleventh day, a sudden malignant arrhythmia occurred, followed by cardiac arrest. This represents one of the first case reports describing myocarditis and myositis during treatment with pembrolizumab-axitinib. While immune checkpoint inhibitor may play a major role, it is also possible that the tyrosine kinase inhibitor, while attempting to promote immune modulation, also increases severe toxicities.