Ahead of Print

  • Há Mais “Vida” para Além da COVID-19

    There is More (to) Life than COVID-19

    Jaime Oliveira, Ana Rita Cerqueira, Joana Silva Monteiro, Maria Manuel Marques

    COVID-19 has become the main diagnostic hypothesis in many consultations. This case highlights the need to maintain the holistic approach, characteristic of General Practice/Family Medicine. A 43-year-old woman, with history of adjustment disorder, fibromyalgia and uterine fibroids, usually medicated with: duloxetine; lorazepam; desogestrel. She was evaluated in “ADR-Comunidade” for headache, nausea, dysgeusia, odynophagia, cough, dyspnea, myalgias and asthenia, without fever. She was prescribed test for COVID-19 and recommended isolation. She was contacted within the scope of “Trace COVID-19®”, noting forgetfulness in taking contraceptive and amenorrhea. A pregnancy was considered, which the patient denied. The test for COVID-19 was negative, however, there was a symptomatic worsening that justified referral to emergency department, where an 11-week pregnancy was diagnosed.
    COVID-19 mimics several clinical situations. The devaluation of amenorrhea and a directed approach in “ADR” led to diagnostic delay, making voluntary termination of pregnancy impossible although the unwanted pregnancy.

    Date: 2022-01-17
  • Renal Neoformation: A Diagnosis to Consider

    Neoformação Renal: Um Diagnóstico a Considerar

    João Miranda, Paula Coelho, Céu Rosinha, Eduarda Marques

    Renal granulomas related to suture material are rare and usually accidental findings in imagiological studies. A 12-year-old boy, followed-up after Anderson-Hynes pyeloplasty 7 years before, was submitted to an ultrasonography that described a solid nodular lesion, possibly in the dependence of the left kidney. Subsequently, magnetic resonance imaging was performed, which reported a lesion with non-specific features, suggesting neoformation with predominant fibrous peripheric component and myxomatous center. Percutaneous biopsy was morphologically compatible with chronic xanthogranulomatous inflammatory process. Anatomopathological examination of the surgical excised lesion described histiocytic cells with frequent participation of foreign body type giant cells and granulomatous reaction in relation to exogenous suture-like material. He remains asymptomatic since then. Foreign body granulomatous pseudotumors are difficult to diagnose regarding the absence of specific imagiological features distinctive from neoplasms, requiring histological examination to confirm the diagnosis.

    Date: 2022-01-17
  • Reconciliação Terapêutica: Um Processo Complexo

    Medication Reconciliation: A Complex Process

    Ana Campos de Sousa

    Demographic aging, multiple pathologies and polymedication reinforce the importance of medication reconciliation: a complex and continuous process that aims to keep the medication list updated and complete during the various transitions between patient care. Patient safety is a main goal of medication reconciliation, which implies the prevention of medication errors, risks and possible injury associated with them, such as duplication, omission or drug interactions. This article is a reflection on the importance of medication reconciliation, its implications for the patient's health, the risks associated with its non-compliance as well as possible solutions and adaptations of health care required to quality in health.

    Date: 2022-01-14
  • Síndrome da Artéria Mesentérica Superior: Uma Causa Rara de Oclusão Intestinal

    Superior Mesenteric Artery Syndrome: A Rare Cause of Intestinal Obstruction

    Andreia Machado Ribeiro, Joana Tavares Pereira, Carla Tonel

    A síndrome da artéria mesentérica superior (AMS) é uma causa rara de oclusão intestinal alta. [...]

    Date: 2022-01-14
  • An Unlikely Coronavirus Reinfection with Devastating Consequences: Interpreting Dynamic SARS-CoV-2 Test Result Through a Case Report

    Uma Improvável Reinfeção por Coronavírus com Consequências Devastadoras: Interpretando os Resultados Dinâmicos do Teste ao SARS-CoV-2 Através de um Caso Clínico

    João Lázaro Mendes, Cristina Mendes dos Santos, Mário Rui Salvador, Carla Lima, Joana Cardoso, Isabela Almeida

    A 40-year-old woman was admitted to hospital with fever and cough during the pandemic of COVID-19. Past medical was notable for advanced chronic kidney disease. On admission, nucleic acid testing of a nasopharyngeal swab was positive for SARS-CoV-2. After 11 days she was considered cure with two negative tests in a row. Eight weeks later, she was going to receive a kidney transplant from a deceased donor, but she was tested again for SARS-CoV-2 and the result came out positive. After that, surgery was cancelled. In our opinion, this test should not have been performed. Through this case we overview the knowledge about infectivity, reinfection and reactivation of SARS-CoV-2. We believe who has been considered cured in the last three months should undertake immunosuppression treatment in case of transplant or cancer treatment. In these cases, benefits outweigh the eventual risks for most patients.

    Date: 2022-01-14
  • Aspirina, Clopidogrel e Hemorragia Gastrointestinal: Qual a Evidência?

    Aspirin, Clopidogrel and Gastrointestinal Hemorrhage: What is the Evidence?

    Eduarda Ferreira-Alves, Joana Lamas, Mariana Rocha-Cruz

    INTRODUCTION: The acetylsalicylic acid (ASA), frequently designated as aspirin, is widely used in the secondary prevention of cardiovascular events. Clopidogrel is another platelet antiaggregant used with the same purpose. It is well known the association between ASA and an increased risk of gastrointestinal (GI) complications. On the other hand, there is some evidence that suggests a reduction of this risk using clopidogrel, in comparison to ASA. As a result, it is common the substitution of ASA for clopidogrel in bleeding related situations. Our aim was to evaluate if clopidogrel is superior in the reduction of GI bleeding risk in patients with secondary cardiovascular prevention comparing with ASA.
    METHODS: A research was carried out of all the articles published between January of 2000 and August of 2020, in English and Portuguese language and indexed in PubMed, Cochrane, DARE, National Guideline Clearinghouse, Canadian Medical Association Practic Guidelines Infobase and Evidence Based Medicine Online. The MeSH terms used were “Clopidogrel”, “Aspirin” and “Gastrointestinal hemorrhage”. The levels of evidence and strength of recommendation attributed were based in the Strength of Recommendation Taxonomy (SORT).
    RESULTS: Initial research found 278 articles. Ten were included in this review: one systematic review, four randomized clinical studies, three cohort retrospective studies, one cohort prospective study and one prospective case-control study.
    CONCLUSION: Studies with higher quality of evidence point to the non-superiority of clopidogrel in comparison with ASA about the risk of GI complications (SORT B). Other studies suggest that the use of ASA associated with proton-pump inhibitors reduces the risk in comparison to clopidogrel alone. Since there is no consensus between different studies, we suggest that new ones should be carried out, targeting specifically this topic, ideally randomized clinical trials.

    Date: 2022-01-12