Tuberculosis: Cliché or Outsider?

Tuberculosis is an infectious disease with the potential for multisystemic dissemination, including the central nervous system (CNS). It is difficult to diagnose when the central nervous system is involved. Brain biopsy is the diagnostic method par excellence for diagnostic confirmation; however, as it is an invasive method and therefore not free from risks, before carrying it out, extra-CNS sites should be privileged, whenever available, through mycobacteriological culture. Here, we present a case of a 34-year-old female with chronic onset of neurologic semiology, whose diagnostic evolution culminated in the diagnosis of cerebral tuberculomas and miliary tuberculosis. Rapid commencement of antibacillaty therapy led to the resolution of the neurologic deficits. Although we face a cliché clinical presentation, in the sense that is very common, the authors consider it outsider because such a presentation is rarely seen in Portugal.

Lofgren Syndrome: Achieving an Accurate Diagnosis for Improved Patient Care.

Lofgren syndrome is a clinically distinct phenotype of sarcoidosis. It is characterized by the triad of bilateral hilar lymphadenopathy, arthritis (usually the ankles), and fever. We present the case of a 31-year-old male patient who presented with fever and edema in both lower limbs, with palpation of subcutaneous nodules. A chest contrast-enhanced computerized axial tomography (CECT) scan revealed perihilar and mediastinal lymphadenopathy. In making the diagnosis, tuberculosis and lymphoma were both ruled out. A mediastinoscopy confirmed Lofgren syndrome. In medicine, a good differential diagnosis is important, as it will help inform the best treatment for the patient.

Diagnostic Point-of-Care Ultrasound (POCUS) for Abdominal Pain: A Case of Tumefactive Sludge.

Biliary sludge is an extremely viscous sediment, consisting essentially of calcium bilirubinate granules and cholesterol crystals, which, due to its high viscosity, has poor and slow movement, leading to a mass-like configuration called tumefactive biliary sludge. Tumefactive sludge was first described with the advent of ultrasonography in the 1970s and is an uncommon intraluminal lesion of the gallbladder (GB). The differential diagnoses for an echogenic mass in the GB lumen include GB carcinoma, tumefactive sludge, and gangrenous cholecystitis. Ultrasonography is the election method for the screening of GB diseases, with diagnostic accuracy exceeding 90%. The point-of-care ultrasound (POCUS) has shown a major improvement in the evaluation of hepatobiliary diseases. POCUS allows the detection of GB wall thickness, pericholestatic fluid, sonographic Murphy's sign, and dilatation of the common bile duct. The authors present a case of abdominal pain caused by the presence of tumefactive sludge in the GB, in which POCUS helped establish the diagnosis and therapeutic guidance.

Avaliação da toxicidade aguda do extrato aquoso do pó do mesocarpo de Orbignya phalerata Mart (babaçu) / Evaluación de la toxicidad aguda de polvo de extracto acuoso de mesocarpio Orbignya phalerata Mart (babasú) / Evaluation of acute toxicity of the powder of mesocarp aqueous extract Orbignya phalerata Mart (babassu)

Objetivos: os efeitos da administração aguda oral do extrato aquoso do pó obtido do mesocarpo de Orbignya phalerata Mart foram investigados sobre parâmetros bioquímicos e hematológicos em camundongos Swiss machos. Métodos: os animais (n= 5-7/grupo) foram tratados por via oral com as doses de 1, 2 e 3 g/kg de peso corporal, observados durante 24 h e em seguida foi feita a coleta do sangue para avaliação dos parâmetros bioquímicos e hematológicos. Resultados: o tratamento com extrato aquoso do pó causou um pequeno número de mortes e baixa toxicidade nos animais. A administração do extrato aquoso do pó não alterou os parâmetros bioquímicos e hematológicos e o peso de órgãos. Para os parâmetros hematológicos, houve pequenas mudanças nas contagens de neutrófilos, linfócitos, eosinófilos e monócitos, mas estes não foram diferentes dos valores de referência. Conclusões: em conclusão, a administração aguda do extrato aquoso do pó não induziu nenhum efeito de risco na maioria dos parâmetros bioquímicos e hematológicos estudados em camundongos Swiss machos. No entanto, novos estudos com doses mais elevadas são necessários, para justificar ainda mais o uso seguro do mesocarpo do babaçu na alimentação humana.

Objetivos: los efectos de la administración oral aguda de polvo de extracto acuoso obtenido del mesocarpio de Orbignya phalerata Mart fueron investigados en los parámetros bioquímicos y hematológicos en ratones machos suizos. Métodos: los animales (n= 5-7/grupo) se trataron por vía oral con dosis de peso corporal 1, 2 y 3 g/kg, se observaron durante 24 h y luego se recogió sangre para la evaluación de los parámetros bioquímicos y hematología. Resultados: el tratamiento con polvo de extracto acuoso causó algunas muertes y baja toxicidad en animales. Su administración no alteró los parámetros bioquímicos y hematológicos ni el peso de los órganos. Para los parámetros hematológicos hubo pequeños cambios en el recuento de neutrófilos, linfocitos, eosinófilos y monocitos, pero estos no fueron diferentes de los valores de referencia. Conclusiones: la administración aguda de polvo de extracto acuoso no indujo ningún efecto de riesgo en la mayoría de los parámetros bioquímicos y hematológicos estudiados en ratones machos suizos. Sin embargo, los estudios con dosis mayores son necesarios para justificar aún más el uso seguro de mesocarpio de babasú en los alimentos.

Objectives: the effects of acute oral administration of aqueous extract powder obtained from the Orbignya phalerata Mart mesocarp were analyzed in terms of biochemical and hematological parameters in male Swiss mice. Methods: mice (n= 5-7/group) were orally treated with doses of 1, 2, and 3 g/kg body weight, they were observed for 24 h and then blood samples were collected for evaluation of biochemical and hematological parameters. Results: treatment with aqueous extract power caused the death of some animals and low toxicity. The administration did not alter either the biochemical and hematological parameters or the weight of organs. As to the hematological parameters, there were small changes in neutrophil, lymphocyte, eosinophil and monocyte counts, but these were not different from the reference values. Conclusions: the acute administration of aqueous extract powder did not induce any risky effect on most biochemical and hematological parameters studied in male Swiss mice. However, further studies with higher doses are needed to further support the safe use of babassu mesocarp in food.