ObjectivesTo report a case of mechanical aortic prosthesis Brucella endocarditis successfully treated with antibiotics alone.Materials and methods: We describe a clinical case and present a review of the literature.ResultsA 60-year-old female farmer with a mechanical aortic prosthetic valve presented with low back pain and fever. She was diagnosed with prosthetic valve Brucella mellitensis endocarditis and was cured with antibiotic therapy alone. Few cases of successfully treated prosthetic valve Brucella endocarditis without surgery have been reported.ConclusionProsthetic valve Brucella endocarditis usually requires surgical valve replacement. However, selected patients may be successfully treated with antibiotic therapy alone.LEARNING POINTSBrucella endocarditis is responsible for most fatal cases of brucellosis.Brucellosis relapse after treatment in patients with a cardiac valve prosthesis should arouse suspicion for endocarditis.Long-term medical treatment alone can be successful in selected patients with Brucella endocarditis, even in those with prosthetic valve endocarditis..
The authors present a case of phantom tumour of the lung. This is a type of pleural effusion where fluids accumulate in the interlobar fissures, typically in the transverse fissure. Its prompt recognition avoids additional, unnecessary or expensive examination and treatment mistakes.
Non-islet cell tumor hypoglycemia is a rare paraneoplastic condition caused by an extra-pancreatic tumor. We report a rare case of hypoglycemia caused by a relapsing pelvic solitary fibrous tumor associated with Big-IGF-2 production. A 72-year-old woman was admitted to our hospital because of loss of consciousness and hypoglycemia. She had a history of ovarian solitary fibrous tumor, which has relapsed. From investigation, serum levels of insulin and C-peptide were suppressed; IGF-1 was slightly reduced and IGF-2 was within the normal range, but the IGF-2: IGF-1 ratio was elevated, indicating the presence of Big-IGF-2 secreting non-islet cell tumor. Contrast-enhanced computed tomography (CT) showed a large pelvic mass. She was then submitted to surgical resection of the mass, which histologically proved to be a solitary fibrous tumor. Three months later, she remains asymptomatic. Non-islet cell tumor hypoglycemia should be considered in the differential diagnosis of patients presenting with tumors and recurrent hypoglycemia.
Introdução: A gripe constitui uma ameaça global para a saúde pública agravada pelo aumento da esperança de vida. É responsável por inúmeras hospitalizações, mortes e gastos no setor da saúde todos os anos. Objetivos: Caracterizar e determinar o perfil analítico da amostra com diagnóstico de gripe num Hospital Central, durante o mês de janeiro de 2018. Analisaram-se as seguintes variáveis: idade, género, diagnóstico na alta, tempo de internamento e alterações analíticas. Material e métodos: Estudo observacional, retrospetivo, com recolha de informação do processo clínico (ALERT e SClinico) e tratamento de dados em Microsoft Excel®. Foram selecionados 131 pacientes como Kit Xpert FLU (GeneXpert®) positivo com idade ≥18 anos. Resultados: 58,8% dos pacientes pertenciam ao sexo feminino e a média de idades foi de 67,1 anos. 20.6% eram Gripe do tipo A, destes 9% são H1N1 e 79,4% Gripe do tipo B. A nível analítico: 63,6% dos doentes não apresentavam alterações dos leucócitos na admissão (mas destes 62,8% apresentavam neutrofilia e 65,1% linfopenias relativas) e 46,5% trombocitopenia. Discussão: O presente estudo permitiu também avaliar a abordagem diagnóstica da gripe e estabelecer um perfil analítico de suspeição do doente com gripe. Conclusão: O perfil analítico permite juntamente com a clínica, uma orientação de suspeição para gestão dos recursos de diagnósticos virológico rápido, importante para o início de terapia antiviral, implementação de medidas de controle de infeção e prevenção para pacientes com gripe. A positividade implicou um elevado número de internamentos em isolamento
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