Medicina Interna

DRESS Syndrome: A Review Based on a Clinical Report

2023-11-10T02:10:04-08:00

DRESS syndrome is a rare but potentially life-threatening disease that may present with multiorgan involvement and cutaneous eruptions.

We report the case of a 28-year-old puerperal woman who developed a cutaneous exanthema 2 months after cesarean delivery, along with muscle pain, odynophagia, cough, and fever. The cutaneous eruption started on the lower limbs and
progressed throughout the entire body. The patient had received ceftriaxone intravenously during delivery and had a history of oral intake of diclofenac and methyldopa. Scored 6 on RegiSCAR,
confirming the diagnosis of DRESS syndrome. The
patient also developed toxic hepatitis, which was managed with intravenous corticotherapy. After 2 weeks of treatment and the removal of probable drugs, the patient was discharged with clinical and laboratory improvement.

This case highlights the importance of prompt diagnosis
and treatment of late pharmacological reactions, particularly
DRESS Syndrome, which can be challenging to diagnose due
to its delayed presentation.

PoCUS Enhanced Physical Examination in the Diagnosis of a Silent Appendicitis

2023-10-24T07:54:26-07:00

Acute abdomen is an abdominal pain of abrupt onset, comprising a vast group of diagnoses. Appendicitis, included within this group of diseases, is the most common surgical abdominal emergency worldwide and can lead to high mortality and morbidity. Although this diagnosis is clinical, there are some cases where it is difficult to distinguish from the different abdominal conditions.

The use of ultrasound (US) in the emergency department (ED) has become widespread. However, given the time constraint and patients' critical conditions, there is a need for a focused and specific approach according to patients' symptoms. Therefore, point-of-care augmented clinical exam (PACE) has assumed an increasingly important role, namely in the acute abdomen, because it allows early recognition and diagnosis and consequently prompt initiation of interventions.

We describe the case of a patient with an acute abdomen in which PACE, performed by an experienced professional, helped to diagnose appendicitis despite all other complementary exams being normal.

Rare Cause of Left Ventricular Dysfunction in Adulthood

2024-01-11T01:27:59-08:00

Pneumocephalus: Bubble Brain

2024-08-29T01:00:34-07:00

Clinical Significance of Extreme Elevation of the Erythrocyte Sedimentation Rate: Diagnoses and Survival in 681 Patients in a Portuguese Hospital.

2024-09-11T01:57:07-07:00

Introduction: We aimed to study the association between extreme erythrocyte sedimentation rate (ESR) elevations (>100 mm/h), and the distribution of disease categories, diseases, age, sex, C-reactive protein levels and five-year survival.

Methods: a retrospective study of all patients with extreme ESR values examined at a Portuguese hospital, from January 1, 2008, through December 31, 2012. Independent variables included disease categories, subcategories, age, sex, and CRP level. Living status and date of death were determined
using the Portuguese Electronic Prescription System.

Results: An ESR above 100 mm/h was found in 681 patients (1.5% of all determinations). The leading diagnosis category was infection (461, 65.1%), followed by malignancy (107, 15.1%), and inflammatory/autoimmune (85, 12.0%). The most
prevalent disease was pneumonia (227, 33.3% of all patients). Infection was less likely in outpatients (20.7%), as was malignancy in females (11.4%). Five-year mortality was 70.3%, higher in patients with malignancy (83%) and lower in patients with inflammatory/autoimmune disease (45.9%).

Conclusion: We found that almost all patients with an extreme ESR elevation have an identifiable etiology, with infection observed in nearly two-thirds and pneumonia being the most common disease in one-third of all patients. Infection was less likely in outpatients, as was malignancy in females. The ESR and CRP levels correlated poorly in patients with extremely elevated ESRs. The five-year mortality rate was 70.3%, with survival being significantly lower in patients with malignancy, and higher in those with inflammatory/autoimmune disease. These findings may enhance the diagnostic and prognostic evaluation of patients with extreme elevations in ESR.

User Behaviour at the Horta-Azores Hospital Emergency Department

2024-07-05T06:57:46-07:00

Introduction: The inappropriate use of emergency services, with all the negative consequences for health systems, is a widespread, multifactorial phenomenon with an increasing trend.

Methods: To understand our reality, we carried out a study
of the user behavior of the emergency service at Hospital da Horta through a survey, having analyzed 463 cases, representing 6.5% of all episodes during the study period, of which 44% were male and 56% female and two-thirds of whom were aged between 24 and 66 years old.

Results: Based on the Manchester triage, 60% of respondents were classified as non-urgent (Green, Blue and White). Only 5% had contact with the Saúde24 line and only 12% tried to consult any family doctor.

Conclusion: The main reasons for choosing a hospital were the self-perception of clinical urgency, the search for speed in the Emergency Department to solve the problem, the shorter waiting time for care, the greater probability of access to a hospital specialist and/or diagnostic tests and an expectation of higher quality in the service provided.

Diabetes, a Possible Treatable Trait in Chronic Obstructive Pulmonary Disease: Analysis of a Cohort

2024-07-23T03:19:47-07:00

Introduction: Diabetes mellitus is a common comorbidity and is associated with a worse prognosis in chronic obstructive pulmonary disease. Recently, an approach based on treatable traits has been proposed to manage chronic
obstructive pulmonary disease. Despite the evidence on the physiopathological relationship between diabetes and chronic obstructive pulmonary disease, data on diabetes as a treatable
trait for chronic obstructive pulmonary disease is still scarce.

Methods: A retrospective cohort study was conducted on chronic obstructive pulmonary disease patients evaluated in the Internal Medicine outpatient clinic of a university hospital. Occurrence of diabetes mellitus, glycemic control and chronic obstructive pulmonary disease outcomes were assessed.

Results: Two hundred seventy-nine chronic obstructive pulmonary disease patients were enrolled. Most patients were male (76.3%). The mean age was 71.1 ± 9.5 years. Diabetes prevalence was 30.8%. Most diabetic patients (54.7%) presented glycemic control under target (HbA1c < 7%). Median HbA1c was 6.7% [1.0]. There was no statistically significant difference in chronic obstructive pulmonary disease stage, acute exacerbation risk, length of hospital stays, and mortality between diabetic and non-diabetic patients.

Conclusion: Diabetes prevalence and incidence in
chronic obstructive pulmonary disease patients were higher in comparison to the general population. Good glycemic control was achieved in most diabetic patients. In this population,
diabetes was not associated with worse outcomes in chronic obstructive pulmonary disease. Diabetes should be considered as a treatable trait of chronic obstructive pulmonary disease and glycemic control should be a therapeutical target among these patients. Internal Medicine consultation has an important role in the integrative approach chronic obstructive pulmonary disease patients benefit from.

Improving Acute Cardiac Syndrome Outcomes by Adopting the Occlusion Myocardial Infarction (OMI/NOMI) Classification

2024-12-18T08:27:55-08:00

Peer Review and Scientific Citizenship

2025-03-27T07:26:32-07:00