Acta Medica Port
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Case Reports
Diagnosis and Treatment of Neuroleptic Malignant Syndrome in the Intensive Care Unit: A Case Report.
Neuroleptic malignant syndrome is a neurological emergency caused by dysregulation of dopaminergic neurotransmission. While it is typically characterized by muscle rigidity, fever and altered mental status, it may have a heterogeneous and non-specific presentation, leading to delays in diagnosis and treatment. ⋯ The patient recovered after electroconvulsive therapy and administration of bromocriptine. This unusually severe case illustrates the need for a high level of suspicion for neuroleptic malignant syndrome in critically ill patients with malignant catatonic syndromes, allowing for an early diagnosis and potentially lifesavingtreatment.
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Multicenter Study
Use of Therapeutic Hypothermia in Sudden Unexpected Postnatal Collapse: A Retrospective Study.
Sudden and unexpected postnatal collapse is a rare event with potentially dramatic consequences. Intervention approaches are limited, but hypothermia has been considered after postnatal collapse. The aim of this study was to analyse sudden and unexpected postnatal collapse cases that underwent therapeutic hypothermia in the five Portuguese hypothermia centres. ⋯ In our national sample of 22 infants who suffered sudden and unexpected postnatal collapse and underwent therapeutic hypothermia, a significant proportion had poor outcomes. Absolute conclusions from our experience with hypothermia in postnatal collapse cannot be drawn, but systematic reporting of cases and long-term clinical evaluation would facilitate understanding of the real benefits of hypothermia. As this procedure has not been validated with clinical trials for this indication, its use should be considered on a case-by-case approach. The potentially avoidable nature of unexpected postnatal collapse is evident from its association with certain behaviours and risk factors. Surveillance practices during the first hours should be implemented, whilst the benefits of breastfeeding and skin-to-skin care should continue to be widely promoted.
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Review
[Vestibular Disorders in the Pediatric Age: Retrospective Analysis and Review of the Literature].
Vestibular disorders in pediatric patients is still a controversial subject but has gained relevance over the years. In recent studies, its prevalence varied between 0.7% and 15%. Nevertheless, the true prevalence can be underestimated given that its clinical presentation is expressed compared to adults; it can present as rotatory vertigo, but It can also cause vision complaints, headaches, motor delay, and learning disability. Although middle ear effusion is considered the main cause of vestibular dysfunction in this age group, other diagnoses should be considered. The aim of this study was to describe clinical features of the pediatric population referred to a subspecialist Otorhinolaryngology vertigo clinic in a tertiary hospital between 2013 and 2017. We also aimed to compare the results and carry out a literature about the most common causes, diagnostic features and treatment approach. ⋯ Vestibular dysfunction in the pediatric age can have several causes; pediatricians, neurologists, physiatrists, family doctors and otorhinolaryngologists must be aware of the different forms of presentation. Referral and evaluation protocols addressing pediatric patients should be created.
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Multicenter Study
Prevalence of Nutritional Risk at Admission in Internal Medicine Wards in Portugal: The Multicentre Cross-Sectional ANUMEDI Study.
Disease-related undernutrition is highly prevalent and requires timely intervention. However, identifying undernutrition often relies on physician judgment. As Internal Medicine wards are the backbone of the hospital setting, insight into the prevalence of nutritional risk in this population is essential. We aimed to determine the prevalence of nutritional risk in Internal Medicine wards, to identify its correlates, and to assess the agreement between the physicians' impression of nutritional risk and evaluation by Nutritional Risk Screening 2002. ⋯ The high prevalence of at-risk patients and poor subjective physician evaluation suggest the need to implement mandatory nutritional screening.
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Observational Study
HIPTCN: Prospective Observational Study of Hypocoagulated Head Trauma Patients with Normal Admission Computed Tomography Scan.
Our national protocol for traumatic brain injury dictates that hypocoagulated patients with mild trauma and initial tomography scan with no intracranial traumatic changes must be hospitalized for 24 hours and do a post-surveillance tomography scan. The main goal of this study was to evaluate the clinical relevance of these measures. ⋯ Delayed hemorrhage is a rare event and the need for surgery even rarer. The need for in-hospital surveillance should be reassessed.