Browsing by Author "Fernandes, I"
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- Catatonia como Apresentação de Doença de CreutzfeldtJakob: Um Caso ClínicoPublication . Fernandes, I; Carneiro, S; Duarte, M; Rosa, AIntrodução: A catatonia é uma síndrome neuropsiquiátrica, classicamente associada à esquizofrenia, mas mais frequentemente relacionada com outras causas psiquiátricas, neurológicas e/ou metabólicas. Caso Clínico: Um homem de 61 anos foi internado no Serviço de Psiquiatria por catatonia de etiologia a esclarecer. O electroencefalograma revelou actividade periódica trifásica e a ressonância magnética crânio-encefálica revelou atrofia cortico-subcortical de predomínio frontal e temporal interno. O doente foi transferido para o Serviço de Neurologia por provável encefalopatia espongiforme, com a detecção de um aumento da proteína 14.3.3 no líquor cefalorraquidiano. O quadro clínico agravou-se com mioclonias plurisegmentares, episódios de desvio ocular e distonia, culminando no óbito ao fim de 5 semanas. O estudo anatomopatológico confirmou o diagnóstico de Doença de Creutzfeldt-Jakob esporádica. Conclusões: Este caso reflecte a dificuldade no diagnóstico diferencial das doenças com sintomatologia neuropsiquiátrica, em particular da catatonia, e a importância da articulação e sinergismo multidisciplinar na Medicina.
- Omalizumab for Severe Asthma: Beyond Allergic Asthma.Publication . Loureiro, C; Anmaral, L; Ferreira, A; Lima, R; Pardal, C; Fernandes, I; Semedo, L; Arrobas, ADifferent subsets of asthma patients may be recognized according to the exposure trigger and the frequency and severity of clinical signs and symptoms. Regarding the exposure trigger, generally asthma can be classified as allergic (or atopic) and nonallergic (or nonatopic). Allergic and nonallergic asthma are distinguished by the presence or absence of clinical allergic reaction and in vitro IgE response to specific aeroallergens. The mechanisms of allergic asthma have been extensively studied with major advances in the last two decades. Nonallergic asthma is characterized by its apparent independence from allergen exposure and sensitization and a higher degree of severity, but little is known regarding the underlying mechanisms. Clinically, allergic and nonallergic asthma are virtually indistinguishable in exacerbations, although exacerbation following allergen exposure is typical of allergic asthma. Although they both show several distinct clinical phenotypes and different biomarkers, there are no ideal biomarkers to stratify asthma phenotypes and guide therapy in clinical practice. Nevertheless, some biomarkers may be helpful to select subsets of atopic patients which might benefit from biologic agents, such as omalizumab. Patients with severe asthma, uncontrolled besides optimal treatment, notwithstanding nonatopic, may also benefit from omalizumab therapy, although currently there are no randomized double-blind placebo controlled clinical trials to support this suggestion. However, omalizumab discontinuation according to each patient's response to therapy and pharmacoeconomical analysis are questions that remain to be answered