PT - Artigos
Permanent URI for this collection
Browse
Browsing PT - Artigos by Title
Now showing 1 - 10 of 40
Results Per Page
Sort Options
- Acute fibrinous and organizing pneumoniaPublication . Santos, C; Fradinho, F; Catarin0, AThe histologic pattern of Acute Fibrinous and Organizing Pneumonia (AFOP), described by Beasley in 2002, is characterized by the existence of intra alveolar fibrin in the form of fibrin "balls" and diffuse organizing pneumonia. Presenting symptoms of this interstitial pulmonary disease can be acute or subacute. However, it differs from the well -recognized histologic patterns of acute pulmonary lesion - Diffuse Alveolar Damage (DAD), Organizing Pneumonia (OP) and Eosinophilic Pneumonia (EP). The authors carry out a review of the literature concerning this topic and describe the clinical case of a 44 -year -old patient with unusual imaging features and outcome
- Acute onset pulmonary toxicity associated to amiodaronePublication . Ferreira, PG; Saraiva, F; Carreira, CAmiodarone is a potent anti-arrhythmic drug with a well-known potential chronic pulmonary toxicity. We describe a case of acute pulmonary toxicity (APT) induced by amiodarone in a 57 year old patient submitted to a perfusion of 900 mg in just 6 hours, to control an auricular flutter with rapid ventricular response. During the administration, the patient developed hemodynamic instability and oxygen dessaturation that led to an electrical cardioversion with return of sinus rhythm. Still, the patient continued in progressive respiratory deterioration with acute bilateral infiltrates on chest x-ray and apparent normal cardiac filling pressures confirmed by echocardiography. Anon-cardiogenic pulmonar edema progressing to clinico-physiological ARDS criteria was diagnosed. Expeditive therapeutic measures were undertaken, namely by initiation of non-invasive positive airway pressure support, that attained a good result.Albeit rare, amiodarone-induced APT might have severe consequences, namely progression to ALI/ARDS with a high mortality index.As it is a frequently prescribed drug, there should be a high clinical suspicion towards this phenomenon, allowing precocious therapeutic measures to be taken in a timely fashion to prevent the associated unfavorable outcome.
- Aeroallergens sensitization in an allergic paediatric population of Cova da Beira, Portugal.Publication . Loureiro, G; Rabaça, MA; Blanco, B; Andrade, S; Chieira, C; Pereira, CCova da Beira is an interior central region of Portugal, with a population of 93,000 inhabitants. The first pollen counts performed in Portugal revealed the highest values of the country in this area. The aim of this study was to assess the aeroallergens sensitization in an allergic population, according to the age groups. In a 5 year period (1995-2000) 1790 consecutive outpatients were observed for suspected allergic symptoms. We included in this study all the 557 paediatric (< or = 15 years old) observed patients (317 male (57%) and 240 female (43%) with an average age of 7.6 < or = 4.2 years old). They were divided in three age groups (Group I: < or = 5 yr; Group II: 6-10 yr; Group III: 11-15 yr). 371 patients were submitted to skin prick tests to aeroallergens. 86.5% of these patients were sensitised to at least one allergen extract. The most representative aeroallergens sensitization were grasses mixture (44.9%), D. pteronyssinus (32.5%), D. farinae (29.1%), Olea europea (27.5%), Parietaria judaica (23.4%), cat dander (16.1%), Artemisia vulgaris (17.6%), Robinia pseudoacacia (12.2%), Platanus acerifolia (11.4%), Tilia cordata (11.4%) moulds mixture (11.2%), Plantago lanceolata (10.6%), dog dander (10.4%), and Pinus radiata (7.5%). The sensitisation to indoor aeroallergens, was similar in all age groups and it was less important than that of pollens. The prevalence of sensitisation to grasses was the greatest in all ages and the house dust mites sensitization was the second most prevalent. The highest pollens counts in this region could explain the early sensitisation even in young children.
- Airway involvement in interstitial lung diseasePublication . Robalo-Cordeiro, CPURPOSE OF REVIEW: After briefly discussing several ways to approach airway involvement in interstitial lung diseases - by diagnostic methodologies used to assess it, considering different topographical involvement, related to its presence in the diffuse lung diseases with higher prevalence, or from a causal point of view - the author describes in more detail, taking into account recent literature, new proposed entities combining airways (at different levels) and interstitial damage, like airway-centered interstitial fibrosis and acute fibrinous organizing pneumonia. RECENT FINDINGS: These proposed patterns are being discussed, as possible autonomic interstitial lung disease disorders, and also from the perspective of its relationship with the main differential diagnosis, within known interstitial pictures. SUMMARY: Thus, airway-centered interstitial fibrosis and acute fibrinous organizing pneumonia may widen the spectrum of the yet described long list of interstitial lung diseases, and its diagnosis may be considered, under specific circumstances, when there is airway involvement associated with interstitial damage.
- Avaliação da densidade mineral óssea em doentes com fibrose quísticaPublication . Cemlyn-Jones, J; Gamboa, F; Loureiro, M; Baganha, MFPatients with cystic fibrosis (CF) have an increasing life span and osteoporosis has become a more recognised problem in these patients. The pathogenesis of low bone mineral density (BMD) in CF seems to be multifactorial and the aim of this study was to assess the prevalence of low BMD in a group of CF outpatients and to relate the findings with the variables studied. The study included 22 patients aged between 14 and 45 years (mean age 26.3). Two of the subjects were lung transplant patients. BMD was assessed by dual-energy X-ray absorptiometry (DEXA) at the lumbar spine (LS) and femoral neck (FN). This data was correlated with serum 25-hydroxy vitamin D (25-OHD) levels, BMI and the forced expiratory volume in one second (FEV1). BMD (Z-score and T-score) ranged from 0.6 to -6 and from 0.5 to -6.7 at LS; at FN the scores ranged from 0.6 to -3.9 and from 0.6 to -4.1. The mean serum 25-OHD concentration (12,57 ng/ml) was at the low end of the normal range (10-60 ng/ml). On average patients did not present with malnutrition, however BMI ranged from 15.2 to 33.7 kg/m2. Lung function status was assessed by FEV1; 64% of patients had FEV1 below 80% and within this group four patients had a FEV1 under 40%. There was a positive correlation between low BMD and 25-OHD concentrations and also between BMD and FEV1. There was no linear correlation between BMD and BMI.
- Bronchoalveolar lavage in occupational lung diseasesPublication . Robalo-Cordeiro, C; Cemlyn-Jones, J; Alfaro, TM; Ferreira, AJOccupational lung diseases (OLDs) are related to the exposure and inhalation of organic, inorganic, and synthetic particles, fumes, gases, or infectious agents. From the long list of OLDs this article focuses the discussion on bronchoalveolar lavage (BAL) in parenchymal immunoinflammatory conditions, such as hypersensitivity pneumonitis (HP) and pneumoconiosis. Several antigens may cause HP, including products of plant or animal origin, aerosolized microorganisms, and organic chemicals. BAL is used not only to assess the pathogenesis of these diseases but also to identify the typical pattern of intense lymphocytic alveolitis, usually with a CD4:CD8 ratio below normal and frequently with the presence of mast cells, plasma cells, and foamy macrophages. Pneumoconioses are chronic interstitial lung diseases caused by the inhalation of mineral and metallic inorganic particles/dusts in an occupational setting, showing a decreasing prevalence in recent years. BAL is a useful tool not only to express the complex pathogenic mechanisms of these entities but also in excluding other diagnoses and causes of alveolitis, and to document specific exposures, such as the identification of asbestos bodies (ABs) in asbestosis or the proliferative response of BAL lymphocytes to beryllium in chronic beryllium disease (CBD).
- Características clínicas e polissonográficas de doentes com distúrbio respiratório do sono em REMPublication . Loureiro, CC; Drummond, M; Winck, JC; Almeida, JThere is a 10 -36% rate of obstructive sleep apnoea syndrome (OSAS) associated with rapid eye movement (REM) in the OSAS population. Prior studies have suggested an increased prevalence of psychiatric disorders and an effect of gender and age on these patients. Our aim was to study the clinical and polysomnograph (PSG) characteristics of our patients with REM- -related sleep disordered breathing (REM SDB). Inclusion criteria was the identification of REM SDB detected by PSG defined as apnea -hypopnea index (AHI) in REM sleep > or = 5h, AHI in non -REM sleep (NREM) < or = 15h and REM/NREM AHI > or = 2. Several Sleep Disorders Questionnaire (SDQ) version 1.02 parameters were analysed. The study comprised 19 patients with a mean age of 54.0 (SD+/-13.97), a mean BMI of 29.01 (SD +/- 4.10) and a 0.58 female / male ratio. The mean Epworth Sleepiness Scale score was 12.74 (SD +/-4.86). Mean AHI was 9.16/h (SD 4.09); mean AHI in REM sleep 37.08/h (SD 25.87) and mean REM -AHI/NREM- -AHI 8.86 (SD 8.63). The anxiety disorder rate was 33.3%; 44.4% in females, 16.7% in males. The average deep sleep was 20.7% (SD 10.42) and REM sleep 15.45% (SD 9.96), with a sleep efficiency of 85.3 (SD 8.70). No significant statistical correlation was found between the REM/NREM AHI index and anxiety symptoms, daytime sleepiness and sleep quality (REM and deep sleep percentages). These patients differ from the general OSAS population: on average, they are not obese, there are a greater number of females affected and they do not present a very significant diurnal hypersomnia. Reduced deep sleep and increased REM sleep were also present versus general population data, and sleep efficiency was just below the normal limit. Anxiety disorders were more prevalent in this group than described for the general population (3%) and OSAS patients.
- Deciduoid Pleural Mesothelioma - a Rare Entity in a Young WomanPublication . Santos, C; Gamboa, F; Fradinho, F; Pêgo, A; Carvalho, L; Bernardo, JDeciduoid Mesothelioma is a rare variant of epithelioid mesothelioma; it was initially thought that it only occurred in the peritoneum of young women and had nothing to do with asbestos exposure. However, since these early findings it has also been observed in the pleura and the pericardium, with possible association to asbestos. In general the prognosis is poor compared to epithelioid mesothelioma. 45 cases have been reported in the literature up to now, 22 of these were located in the pleural cavity. The authors describe a case of deciduoid pleural mesothelioma in a 40-year-old-woman who presented with right pleuritic chest pain, with no history of asbestos exposure, treated with chemotherapy followed by surgery and who died postoperatively.
- Doença associada ao Clostridium difficile – aumento dramático da incidência em doentes internadosPublication . Correia, L; Monteiro, R; Alfaro, TM; Simão, A; Carvalho, A; Nascimento-Costa, JMMany publications show an incidence increase of Clostridium difficile (CD) associated disease (CDAD), affecting both in- and outpatients being these recent infections more severe and difficult to treat. The aim of this retrospective study is to evaluate the incidence and clinical impact of CDAD in patients hospitalized from the 1st January 2004 to the 31st December 2009. Suggestive clinical manifestations and at least one of the following were the inclusion criteria: CDAD compatible colonoscopy or CD positive toxin. We identified 83 cases of CDAD (32M, 51W), in a total of 9581 patients (5198M, 4383W). Age ranging from 47 to 94 years (average 79). Five patients had CDAD acquired in the community and 78 in hospital environment. The incidence of CDAD increased almost six fold between 2004 and 2009 (4.35/1000 vs. 21.63/1000), and 77.11% developed the disease during hospitalization. The disease was more frequent in women (11.64/1000 vs. 6.16/1000). All patients had undergone prior antibiotherapy. The comorbidities, number of antibiotics used, advanced age, duration of the antibiotherapy and the length of hospitalization did not seem to justify the increase in incidence and severity. In 96% the diagnosis was confirmed by the presence of Clostridium toxin and in 4% by colonoscopy. Seventy three patients (88%) were treated with metronidazole and 30% died (the department overall mortality was 13%). Probably, it was the advanced age related with the worst severity scenario which caused the high mortality in our cases.
- Doença Pulmonar Obstrutiva Crónica em Portugal: estudoPneumobil (1995) e estudo de prevalência de 2002 revisitadosPublication . Cardoso, J; Ferreira, JR; Almeida, J; Santos, JM; Rodrigues, F; Matos, MJ; Gaspar, MBACKGROUND: Chronic Obstructive Pulmonary Disease (COPD) has been a leading cause of morbidity and mortality worldwide, over the years. In 1995, the implementation of a respiratory function survey seemed to be an adequate way to draw attention to neglected respiratory symptoms and increase the awareness of spirometry surveys. By 2002 there were new consensual guidelines in place and the awareness that prevalence of COPD depended on the criteria used for airway obstruction definition. The purpose of this study is to revisit the two studies and to turn public some of the data and respective methodologies. METHODS: From Pneumobil study database of 12,684 subjects, only the individuals with 40+ years old (n = 9.061) were selected. The 2002 study included a randomized representative sample of 1,384 individuals with 35-69 years old. RESULTS: The prevalence of COPD was 8.96% in Pneumobil and 5.34% in the 2002 study. In both studies, presence of COPD was greater in males and there was a positive association between presence of COPD and older age groups. Smokers and ex-smokers showed a higher proportion of cases of COPD. CONCLUSIONS: Prevalence in Portugal is lower than in other European countries. This may be related to lower smokers' prevalence. Globally, the most important risk factors associated with COPD were age over 60 years, male gender and smoking exposure. All aspects and limitations regarding different recruitment methodologies and different criteria for defining COPD cases highlight the need of a standardized method to evaluate COPD prevalence and associated risks factors, whose results can be compared across countries, as it is the case of BOLD project.