Non-polio enteroviruses are ubiquitous viruses responsible for a wide spectrum of disease in people of all ages, although infection and illness disproportionately affect infants and young children. Hand-foot-mouth disease (HFMD) is an enteroviral clinical syndrome most frequently caused by coxsackievirus-A16 and enterovirus-A71. Since 2008, a novel coxsackievirus-A6 genotype has been associated with more severe HFMD in both children and adults, presenting with a unique constellation of findings, and whose prevalence has been increasing over the last few years. In this case report, an atypical clinical picture of confirmed enterovirus HFMD is described in an immunocompetent adult, with exuberant clinical findings, clinically consistent with coxsackievirus-A6 infection. This case report highlights the importance of awareness of the clinical presentation of this increasingly common infection in adults.
Sclerosing angiomatoid nodular transformation was first described as a solitary angioma-like disease of the spleen by Martel et al. in 2004. It is a relatively new rare benign lesion. The authors present a clinical case of an asymptomatic, 48-year-old female. SANT has been an incidental finding in an abdominal ultrasound. Histological appearance and the immunohistochemical staining after spleen biopsy confirmed the diagnosis. As suggested in previously published articles, a splenectomy was performed for definitive treatment. This case contributes to the differential diagnosis of splenic tumors, its treatment and clinical impact.
Os biossimilares consistem em complexas proteínas de elevado peso molecular, produzidas e purificadas a partir de produtos biológicos, comparando com a habitual definição de medicamento genérico pode-se afirmar que biossimilares são medicamentos biologicamente semelhantes ao produto de referência enquanto um genérico é quimicamente idêntico ao produto original. Neste trabalho debruçamo-nos sobre os biossimilares das várias heparinas de baixo peso molecular e pretende- se demonstrar quais as medidas a tomar para assegurar a eficácia e segurança dos mesmos aquando da sua autorização de introdução no mercado, comparando as recomendações elaboradas por várias sociedades científicas com as guidelines elaboradas pela Agência Europeia do medicamento e os critérios utilizados por esta para assegurar estes objetivos. Verificou-se que a avaliação destes medicamentos se baseou em análises laboratoriais da atividade biológica e de estudos de imunogenicidade com valor estatístico insignificante, sendo que os vários riscos a eles inerentes foram extrapolados a partir de uma comparação com o medicamento de referência. Por este motivo, a sua utilização pode acarretar um risco humano que não é aceitável e um risco económico elevado, uma vez que o custo que pode advir das complicações rapidamente suplanta o benefício de um preço de aquisição relativamente mais baixo.
Superior mesenteric artery syndrome (SMA syndrome) or Wilkie’s syndrome is a rare etiology of duodenal obstruction due to compression of the third portion of the duodenum between the superior mesenteric artery and the aorta. Physical and laboratory findings are often non-specific but imaging methods are useful for diagnosing the condition. A 46-year-old female patient presented to the outpatient clinic of our internal medicine department with a 2-year history of epigastric pain, nausea, early satiety and weight loss of 15 kg. Previous studies were inconclusive. The patient underwent computed tomography enterography and its findings were consistent with SMA syndrome. Currently the patient is being followed by General Surgery and Nutrition and is under nutritional measures in order to optimize her body mass index to decrease possible surgical complications.This case report emphasizes the importance of clinical suspicion and careful investigation when considering less common etiologies for frequent gastrointestinal symptoms.
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