Acta Medica Port
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Traumatic brain injury is a frequent reason for admission at pediatric emergency services. In severe cases, with basilar skull fracture, bacterial meningitis is a serious and potentially fatal complication to be considered. ⋯ Bacterial meningitis is a complication to be considered in head injury with basilar skull fracture, particularly when associated with cerebrospinal fluid leakage, even though the injury occurred several years earlier, and is usually a serious condition. One of our children died. Similar to what is described, S. pneumoniae was the most common bacteria, and this fact supports that children with head trauma and cerebrospinal fluid leakage should receive pneumococcal vaccine. The follow-up of these children requires constant vigilance and should include a multidisciplinary approach.
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Mechanical ventilation is probably the medical intervention which resulted in more lifes saved in the history of Medicine. However, it is associated with several potential deleterious consequences, especially when it's maintained for unnecessarily long periods or, on the other hand, when suspended before full recovery is attained. ⋯ Nowadays, most hospitals in developed countries have placed rehabilitation as an essential therapeutic intervention in critically ill patients. Nonetheless, its precise role varies from unit to unit, taking into account the country, local traditions, experience and technical quality of the professionals The authors present an overview of different respiratory and neuromuscular rehabilitation strategies currently available through the clinical course of invasively ventilated patients and throughout the weaning process.
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Local anesthetics (LA) are frequently used in medical and surgical and dental procedures. Adverse reactions to LA are rare, and hypersensitivity reactions are very rare. Nevertheless, they are the third more frequent cause of referral to Allergy Clinics due to drug allergy, after betalactamic antibiotics and non-steroidal anti-inflammatory agents. In this paper we review hypersensitivity reactions to LA and propose a diagnostic approach to them.
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Stress urinary incontinence (SUI) is involuntary leakage from effort or exertion or from sneezing or coughing and it is usually related to increased urethral mobility and/or poor intrinsic sphincter function. Pelvic floor muscle training (PFMT) has principally been recommended in the management of SUI. The aims of PFMT are to improve pelvic organ support (bladder, bladder neck, and urethra) and increase intraurethral pressure during exertion. The PFMT programmes are prescribed to increase strength, endurance and coordination muscle. ⋯ Based on the few data available there is strong evidence for the efficacy of physical therapy for the treatment for SUI in women but further studies are needed to evaluate the optimal training protocol and length of treatment.
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Clinical guidelines have the potential to increase health gains, but also to cause harm. In this opinion article we state some misgivings about the application of the Portuguese National Health Directorate's guideline type 2 diabetes therapy: metformin in primary care. We seek to highlight guideline wording that may allow for multiple interpretations (alternatives to monotherapy with metformin, hierarchy of drugs to be associated with metformin, and metformin contraindications). Furthermore, we argue that it seems that choosing a glycemic target of 6.5% in a normative document to be applied in the general population may have unforeseen consequences.