From the Deep: Overlap of Neutrophilic Dermatoses Disorders Associated With Acute Myeloid Leukemia.

We report the case of a man in his 50s with refractory acute myelomonocytic leukaemia (AML) who presented with neck swelling, fever, and elevated levels of C-reactive protein (CPR) after venous punctures. An infected haematoma was presumed, but the patient showed no signs of improvement under broad-range antibiotics, and microbiological results were negative. The subsequent development of a rapidly evolving erythematous-violaceous plaque around a site that had previously punctured on the extensor surface of the right arm prompted us to reconsider the clinical setting as a whole and consider the hypothesis of deep neutrophilic dermatosis (ND) associated with haematologic malignancy. A biopsy of the arm lesion showed an aseptic neutrophilic infiltrate, confirming this diagnosis. The patient was initially treated with high-dose intravenous corticosteroids, resulting in a dramatic improvement of the skin lesions.

Bedside ultrasound to detect bone flap infections: A case image.

Ultrasound showing an anechoic collection with interspersed echogenic foci (blue arrows - gas bubbles) proximal to the hyperechoic bone flap (red asterisk; post-decompressive craniectomy). Serratia marcescens was isolated from the collected fluid. Bedside ultrasound can be a reliable and effective tool to aid in the diagnosis of bone flap infections.

[Delirium: The 7th Vital Sign?] / Delirium: O 7º Parâmetro Vital?

INTRODUCTION: Delirium is an acute, transient and fluctuating neuropsychiatric syndrome that is common in medical wards, particularly in the geriatric and palliative care population. MATERIAL AND METHODS: We present a brief literature review of the definition, pathophysiology, aetiology, diagnosis, prevention and treatment of delirium and its social and economic impact. RESULTS AND DISCUSSION: Delirium is under-recognized, especially by health professionals, and is associated with higher morbidity, mortality and economic burden. Moreover, the presence of delirium interferes with the evaluation and approach to other symptoms. Furthermore, it causes significant distress in patient's families and health professionals. The best treatment for delirium is prevention which is based on multidisciplinary interventions that addresses the main risk factors. The scientific evidence for the treatment of delirium is scarce. Non-pharmacological approaches are usually the first choice, and includes environmental, behavioural and social strategies. Pharmacological options, mainly antipsychotics, are a second-line treatment used essentially to prevent self harm. CONCLUSION: The recognition and prevention of delirium are crucial. Health professional education and training, patient clinical monitoring and families support are mandatory. Considering the impact of delirium on patients, relatives, health services and professionals we must be more aware of delirium and, why not, make it the 7th vital sign.

Introdução: O delirium é uma síndrome neuropsiquiátrica transitória e flutuante com início súbito frequente nos doentes internados, em particular na população geriátrica e paliativa. Material e Métodos: Através de uma breve revisão da literatura, os autores propuseram-se a sistematizar a definição, fisiopatologia e etiologia do delirium, principais ferramentas para o seu diagnóstico, prevenção e tratamento, bem como o seu impacto socio-económico.Resultados e Discussão: O delirium é uma entidade pouco reconhecida pelos profissionais de saúde, que se associa a maior morbi-mortalidade e custos, interfere com a avaliação e abordagem da dor e de outros sintomas e acarreta elevado distress nos doentes, famílias e profissionais de saúde. O melhor tratamento do delirium é a prevenção, que se baseia em intervenções multidisciplinares sob os principais fatores de risco para o seu desenvolvimento. A evidência científica para o tratamento do delirium existe, mas é escassa, sendo a terapêutica preferencial a não farmacológica, com implementação de estratégias ambientais, comportamentais e sociais. O tratamento farmacológico é de segunda linha e deverá ser instituído de forma a prevenir que o doente se coloque em risco, nomeadamente através do uso de antipsicóticos. Conclusão: O reconhecimento e prevenção do delirium são essenciais, pelo que é fundamental a educação e formação dos profissionais de saúde, bem como o acompanhamento e apoio aos familiares. É por todo o impacto que tem nos serviços de saúde, nos profissionais e, sobretudo, nos doentes e seus familiares, que sugerimos maior atenção ao delirium e, porque não, passar a considerá-lo como o 7º sinal vital.