Hansen's disease - a forgotten disease?

Hansen's disease, also known as leprosy, is an infection caused by the bacteria Mycobacterium leprae. The authors present the case of a 52-year-old man, born in Tondela and living in Espinho, with no pathological antecedents. The clinical picture began in April 2017, when macular lesions appeared in the lower limbs and rapidly progressed to the trunk and upper limbs, associated with complaints of pruritus but without alterations in the analytical study. After several topical and systemic treatments with glucocorticoids, antifungals, antibacterials and unsuccessful antihistamines, he was referred to an external consultation of Dermatology. He performed a biopsy of one of the lesions that revealed the definitive diagnosis: "Lepromatous Leprosy". After the biopsy result, he started triple treatment with rifampicin, clofazimine and dapsone with improvement of the condition.

Prehospital Anticholinergic Burden Is Associated With Delirium but Not With Mortality in a Population of Acutely Ill Medical Patients.

OBJECTIVES: Anticholinergic drugs have several side effects, and they have been associated with adverse outcomes, particularly in older patients. The aim of this study was to analyze anticholinergic burden and its relationship to delirium and mortality in older acutely ill medical patients. DESIGN: Cohort study. SETTING AND PARTICIPANTS: Patients 65 years of age and older who were admitted to an Internal Medicine ward between August 1 and December 31, 2016. METHODS: Anticholinergic drug use, outpatient and inpatient, was assessed using the Anticholinergic Cognitive Burden Scale (ACB). Prevalent delirium was diagnosed by the Short Confusion Assessment Method (Short-CAM). RESULTS: Of the 198 patients, 28.3% developed delirium. Mortality rate was 13.6% in-hospital and 45.6% at 12 months. In multivariate analysis, outpatient ACB was associated with delirium, with an odds ratio (OR) of 1.65 [95% confidence interval (CI) 1.09-2.51]. Those with delirium had longer hospital stays (median 13 vs 8 days; P = .01), received more drugs (median 18 vs 15; P = .02), and presented a higher inpatient ACB (mean 3.9 vs 3.1; P = .034). No increased risk was found for in-hospital or 12-month mortality with drug use, ACB, or delirium. DISCUSSION: In the population studied, we found an association between anticholinergic burden as measured by the ACB and the presence of delirium, but not with mortality at 12 months. A very high 12-month mortality rate might have been an obstacle for association recognition. CONCLUSIONS AND IMPLICATIONS: Clinician awareness of possible drug side effects, especially in older populations, is crucial. As part of medication reconciliation at the time of hospitalization, ACB of prehospitalization medications should be routinely calculated by inpatient pharmacy services and made available to medical teams.

Antibiotic Clinic: Two Years' Experience in Outpatient Parenteral Antimicrobial Therapy in a Portuguese Hospital.

INTRODUCTION: Outpatient antimicrobial therapy programs have been in place for more than four decades. They provide safe and effective treatment for a selected group of patients while reducing costs. In Europe in general, and in Portugal in particular, these programs are still a relatively new phenomenon. The aim of this study is to describe our center's two years' experience with such a program (Antibiotic Clinic). MATERIAL AND METHODS: The cohort of treatments administered by the Antibiotic Clinic in its first two years of existence (September 12th 2016 to September 11th 2018) was analyzed and data pertaining to patients, infections, infectious agents, antimicrobials and outcomes (infection resolution, adverse events and death) were characterized. RESULTS: The Antibiotic Clinic treated 231 patients in 250 episodes, providing a total of 2357 days of antibiotic treatment. The urinary tract was the most common site (39.2%) and Enterobacteriaceae the most common agents (63.7% of isolates). Infections were resolved in 90.8% of treatments (95.6% of patients), adverse events were few (1.2%) and direct mortality was not found. The dropout rate was 1.6%. DISCUSSION: Infection resolution and adverse event rates were comparable to other centers. High treatment and low dropout rates point to high physician and patient acceptance. CONCLUSION: Our experience with this program suggests it is a safe and effective alternative to inpatient admission. This is in line with current literature which suggests efforts should be made to expand this treatment modality.

Introdução: Os programas de administração de antimicrobianos parentéricos em ambulatório (outpatient parenteral antimicrobial therapy) iniciaram-se há mais de quatro décadas. Para além de proporcionarem tratamento seguro e eficaz num grupo selecionado de doentes, permitem também a redução de custos. Na Europa, e em particular em Portugal, a implementação destes programas é um fenómeno recente. O objetivo deste estudo é descrever dois anos de experiência de Clínica do Antibiótico. Material e Métodos: Foram incluídos todos os doentes tratados na Clínica do Antibiótico nos dois primeiros anos de existência (12 de setembro de 2016 a 11 de setembro de 2018), sendo descritas variáveis relativas à população, infeções, agentes infeciosos, tratamentos e outcomes (resolução de infeção, eventos adversos e morte). Resultados: A Clínica do Antibiótico tratou 231 doentes em 250 episódios, garantindo 2357 dias de antibioterapia. O local de infeção mais comum foi o trato urinário (39,2%) e os agentes mais comuns foram as Enterobacteriaceae (63,7% dos isolamentos). Obteve-se resolução da infeção em 90,8% dos tratamentos (95,6% dos doentes), ocorreram poucos eventos adversos (1,2%) e a mortalidade direta foi nula. Houve uma taxa de abandono de 1,6%. Discussão: As taxas de resolução e de complicações foram comparáveis às de outros centros. Elevado número de tratamentos e baixa taxa de abandono apontam para boa aceitação por médicos e doentes. Conclusão: A nossa experiência sugere ser uma alternativa eficaz e segura ao tratamento em internamento. Estes resultados estão de acordo com a literatura, sugerindo que esforços deverão ser feitos para expandir a utilização destes programas.