Browsing by Author "Pacheco, P"
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- Abdominal tuberculosis: an old disease surprising young doctors.Publication . Sousa, M; Batista, J; Pacheco, P; Nunes, VTuberculosis remains a worldwide public health concern. Atypical extrapulmonary presentations may delay the diagnosis and treatment. We present the case of an adult woman admitted to the emergency department with bowel obstruction. The putative intraoperative diagnostic hypothesis was ovarian cancer with peritoneal dissemination. Histopathological analysis showed a chronic granulomatous inflammatory disease with acid-fast bacilli. The patient was started on an alternative parenteral antituberculosis drug combination until oral feeding was available. Currently, 5 months after surgery, she is asymptomatic. Abdominal tuberculosis is the most frequent extrapulmonary site with a wide range of clinical presentations. Emergency laparotomy may be necessary in patients who present with acute abdomen. Bowel obstruction due to adhesions and strictures is not infrequent. However, tuberculous abdominal cocoon presentation as in our patient is rare. Treatment with parenteral alternative drug regimens for tuberculosis is mandatory until the oral route is available.
- Abordagem Diagnóstica e Terapêutica da Diabetes Mellitus no Doente com Infeção pelo Vírus da Imunodeficiência HumanaPublication . Gomes, F; Vasconcelos, P; Pacheco, PA terapêutica antirretroviral levou a uma redução significativa da morbi e mortalidade nos doentes infetados pelo vírus da imunodeficiência humana. No entanto, as complicações cardiometabólicas do tratamento e o envelhecimento desta população têm alargado a complexidade de cuidados para a gestão de comorbilidades cardiovasculares. O aumento da insulinorresistência e da prevalência da diabetes mellitus tipo 2 nestes doentes é já conhecida há alguns anos, sendo, deste modo, importante conhecer as particularidades do rastreio e da abordagem terapêutica desta doença metabólica. O presente trabalho tem como objetivo rever a abordagem diagnóstica e terapêutica da diabetes mellitus no doente com infeção pelo vírus da imunodeficiência humana, assim como as interações farmacológicas entre a terapêutica antirretroviral e os antidiabéticos, visto que a literatura é escassa neste tema, que consideramos ser útil na prática clínica.
- Artemether/Lumefantrine for the Treatment of P. malariae in a Patient on HemodialysisPublication . Patrocínio-Jesus, R; Cunha, J; Trigo, D; Flor-de-Lima, B; Pacheco, PThe combination of artemether/lumefantrine is indicated for the treatment of acute uncomplicated Plasmodium falciparum malaria. There have been no clinical trials to assess the efficacy of this medication in patients with renal impairment. While it is unlikely that artemether/lumefantrine would be removed during dialysis, clinical experience regarding drug use in this setting is limited. In this article, the authors report successful treatment of Plasmodium malariae malaria on a patient with end-stage kidney disease undergoing hemodialysis.
- Clinical experience in invasive fungal infectionsPublication . Pacheco, P; Ventura, A; Branco, T; Gonçalves, L; Carvalho, CLung infections caused by invasive filamentous fungi are very rare conditions in AIDS, but must be considered in patients with profound immune suppression especially in the presence of additional risk factors, such as hematologic malignancies, corticosteroid therapy, neutropenia, and chemotherapy. The authors report a case of dual lung infection caused by Aspergillus and Mucor, which occurred in a 34-year-old AIDS patient who was treated with chemotherapy for oral plasmablastic lymphoma. The case presented clinically with low grade fever and pulmonary cavitation, which suggested tuberculosis. After extensive investigation the diagnosis of mucormycosis was established and the patient was treated sequentially with liposomal amphotericin B and posaconazole. Despite a reduction in the size of the pulmonary cavitation, improvement of the lung interstitial infiltrates and clinical recovery, the patient was submitted to cardiothoracic surgery given the aggressive behavior of this invasive fungus. Histology of the surgical specimen showed numerous hyphae with a morphologic pattern compatible with Aspergillus as well as hyphae that were suggestive of Mucor.
- Doença por legionellaPublication . Trigo, D; Batista, J; Pacheco, P
- Hipertensão pulmonar na infecção VIH/SIDA: uma doença raraPublication . Cardoso, C; Trigo, D; Pacheco, PA Hipertensão pulmonar (HTP) é uma patologia rara mas que condiciona elevada morbilidade e mortalidade. É conhecida a sua associação com o Vírus da Imunodeficiência Humana (VIH), mas muitos dos mecanismos implicados na sua patogénese bem como o impacto da terapêutica antiretroviral (TARV) no tratamento e prognóstico desta doença ainda se encontram por definir. Apresenta-se um caso clínico de uma doente de 62 anos com infecção VIH internada por um quadro interpretado inicial- mente como infecção respiratória. A má evolução e os exames adicionais permitiram o diagnóstico de Hipertensão pulmonar grave que viria a determinar o falecimento da doente em poucos dias. Atendendo à elevada prevalência de doentes com infecção VIH, é expectável o aumento do número de casos de Hipertensão pulmonar, pelo que se chama a atenção para a necessidade de um diagnóstico precoce antes da evolução da mesma.
- Non-AIDS-related comorbidities in people living with HIV-1 aged 50 years and older: The AGING POSITIVE study.Publication . Serrão, R; Piñero, C; Velez, J; Coutinho, D; Maltez, F; Lino, S; Sarmento, E; Castro, R; Tavares, AP; Pacheco, P; Lopes, MJ; Mansinho, K; Miranda, AC; Neves, I; Abreu, R; Almeida, J; Pássaro, LOBJECTIVE: To characterize the profile of non-AIDS-related comorbidities (NARC) in the older HIV-1-infected population and to explore the factors associated with multiple NARC. METHODS: This was a multicentre, cross-sectional study including HIV-1-infected patients aged ≥50 years, who were virologically suppressed and had been on a stable antiretroviral therapy (ART) regimen for at least 6 months. A multiple regression model explored the association between demographic and clinical variables and the number of NARC. RESULTS: Overall, 401 patients were enrolled. The mean age of the patients was 59.3 years and 72.6% were male. The mean duration of HIV-1 infection was 12.0 years and the median exposure to ART was 10.0 years. The mean number of NARC was 2.1, and 34.7% of patients had three or more NARC. Hypercholesterolemia was the most frequent NARC (60.8%), followed by arterial hypertension (39.7%) and chronic depression/anxiety (23.9%). Arterial hypertension and diabetes mellitus were the most frequently treated NARC (95.6% and 92.6% of cases, respectively). The linear regression analysis showed a positive relationship between age and NARC (B=0.032, 95% confidence interval 0.015-0.049; p=0.0003) and between the duration of HIV-1 infection and NARC (B=0.039, 95% confidence interval 0.017-0.059; p=0.0005). CONCLUSIONS: A high prevalence of NARC was found, the most common being metabolic, cardiovascular, and psychological conditions. NARC rates were similar to those reported for the general population, suggesting a larger societal problem beyond HIV infection. A multidisciplinary approach is essential to reduce the burden of complex multi-morbid conditions in the HIV-1-infected population.
- Sarcoma de Kaposi oralPublication . Gomes, F; Pires, J; Pacheco, PO sarcoma de Kaposi é a neoplasia maligna mais frequente nos doentes seropositivos para o vírus da imunodeficiência humana, com envolvimento da cavidade orofaríngea num quarto dos doentes. Descreve-se o caso de uma doente com infeção pelo vírus da imunodeficiência humana, que se apresenta com uma massa vascularizada na base da língua, como primeira manifestação de sarcoma de Kaposi.
- Severe Rifampicin-Induced Thrombocytopenia in a Patient With Miliary TuberculosisPublication . Maurício, J; Flor-de-Lima, B; Pacheco, P