Síndrome de Lemierre: um relato de caso e revisão de literatura / Lemierre's syndrome: a case report and literature review

A Síndrome de Lemierre (SL) foi descrita pela primeira vez em 1936 por André Lemierre, em uma publicação com 20 relatos de casos de pacientes com quadro de faringoamigdalite com sintomas graves e mortalidade que chegava a 90%. Apresenta uma prevalência maior em pacientes jovens entre 14 e 24 anos, com apresentação clínica correspondente a quadro de faringoamigdalite que após cerca de sete dias evolui com febre, prostração e dor em região cervical anterior, podendo levar posteriormente a comprometimento pulmonar e de outros órgãos. Neste estudo, trazemos o relato de uma paciente com a síndrome atendida no Hospital Municipal Moysés Deutsch localizado em São Paulo-SP, no ano de 2022. Além disso, foi realizada revisão bibliográfica de sua etiopatogenia, manifestações clínicas e tratamentos, com ênfase em atualizações quanto ao uso da terapia anticoagulante nesta patologia, visto que ainda necessitamos de estudos controlados randomizados em busca de evidências mais consolidadas em relação ao seu uso.

Comparing the Prevalence of Polypharmacy and Potential Drug-Drug Interactions in Nursing Homes and in the Community Dwelling Elderly of Emilia Romagna Region.

Backround: We aimed at assessing the prevalence of polypharmacy and potential drug-drug interactions (DDIs) with clinical relevance in elderly patient on Emilia Romagna area. Both outpatients and residents in nursing homes were assessed, with only partially overlapping strategies. Methods: We defined a list of 190 pairs of potentially interacting drugs, based on literature appraisal and availability of therapeutic alternatives. January-June 2018 data on drug use in patients over 65 years-old were collected from nine Local Health Authorities of Emilia Romagna: data on community-dwelling subjects were extracted from archives of reimbursed prescriptions, while drug use in a sample of nursing homes was recorded from clinical charts in one index day within the same semester. The frequency of polypharmacy (at least five or at least 10 concurrent drugs) and of each DDI was calculated. Results: In line with different rates of polypharmacy (80% vs 16%), the risk of exposure to at least one interaction was 53.7% in nursing homes and 26.4% in outpatients. Among DDIs, in nursing homes antidepressants-anxiolytics (11.9%) ranked first, followed by antidepressants-aspirin (7.4%). In outpatients, ACE-inhibitors-non-steroidal anti-inflammatory drugs (NSAIDs) reached 7.2% followed by the calcium channel blockers-α-blockers (2.4%). Discussion: Polypharmacy and risk of DDIs appeared very different in the two settings, due to both technical and clinical reasons. In order to reduce use of benzodiazepines, NSAIDs, antidepressants and relevant DDIs, 1) defining alternative options for pain relief in elderly outpatients, and 2) implementing non-pharmacological management of insomnia and anxiety in nursing homes should be prioritized.