RESUMO
Nocardiosis is a rare opportunistic infection caused by the bacteria Nocardia spp. It may present as a localized cutaneous infection or as an invasive infection (pulmonary, central nervous system or disseminated). The authors describe a 65-years-old woman, without a known cause of immunosuppression, admitted with fever, respiratory and constitutional symptoms. After an exhaustive etiological study, it was diagnosed a disseminated nocardiosis (pulmonary and central nervous system), in a probable context of immunosuppression secondary to a previously undiagnosed systemic lupus erythematosus. Nocardiosis is a serious infection with a variable and non-specific presentation making its diagnosis a challenge
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Assuntos
Humanos , Feminino , Idoso , Nocardiose/etiologia , Lúpus Eritematoso Cutâneo/complicações , Pneumonia Necrosante/etiologia , Infecções Oportunistas/diagnóstico , Infecções Oportunistas/etiologia , Terapia de Imunossupressão/efeitos adversos , Nocardiose/diagnóstico por imagem , Pneumonia Necrosante/diagnóstico , Tomógrafos Computadorizados , Biópsia com Agulha de Grande Calibre , Ultrassonografia , Evolução FatalAssuntos
Hematoma/complicações , Osteomielite/diagnóstico , Infecções dos Tecidos Moles/diagnóstico , Coxa da Perna , Antibacterianos/uso terapêutico , Diagnóstico Tardio , Drenagem , Feminino , Hematoma/diagnóstico por imagem , Humanos , Linezolida/uso terapêutico , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Músculo Esquelético/lesões , Osteomielite/complicações , Osteomielite/tratamento farmacológico , Ácido Penicilânico/análogos & derivados , Ácido Penicilânico/uso terapêutico , Piperacilina/uso terapêutico , Infecções dos Tecidos Moles/complicações , Infecções dos Tecidos Moles/tratamento farmacológico , Tazobactam , Coxa da Perna/irrigação sanguíneaRESUMO
Protein-calorie malnutrition is a transversal condition to all stages of chronic liver disease. Early recognition of micro or macronutrient deficiencies is essential, because the use of nutritional supplements reduces the risk of complications. The diet of patients with chronic liver disease is based on a standard diet with supplements addition as necessary. Restrictions may be harmful and should be individualized. Treatment management should aim to maintain an adequate protein and caloric intake and to correct nutrient deficiencies. The large majority of patients with grade I/II hepatic encephalopathy can tolerate a regular diet. Protein restriction can aggravate malnutrition and is not recommended, except in cases of hepatic encephalopathy unresponsive to optimized therapy.
A desnutrição calórico-proteica é transversal a todos os estadios da doença hepática crónica. A deteção precoce de deficiências de micro ou macronutrientes é essencial, pois a utilização de suplementos nutricionais reduz o risco de complicações.A dieta dos doentes com doença hepática crónica baseia-se numa dieta geral com a adição de suplementos, conforme necessário. As restrições dietéticas podem ser prejudiciais e devem ser individualizadas. Os objetivos do tratamento passam por permitir a ingestão de uma quantidade adequada de proteínas e calorias, bem como, corrigir as deficiências nutricionais.A grande maioria dos doentes com encefalopatia hepática grau I/II consegue tolerar uma dieta normal. A restrição proteica pode agravar a desnutrição e não é recomendada, exceto em casos de encefalopatia hepática que não respondam a uma terapêutica otimizada.
RESUMO
OBJECTIVE: Prealbumin is one of the best indicators of nutritional status. We previously showed that prealbumin predicted in-hospital mortality in heart failure (HF) patients. We evaluated if a low discharge prealbumin after admission with acute HF would predict morbidity and mortality. METHODS: We conducted a prospective observational study. Patients admitted with a primary diagnosis of HF were studied. Follow-up was up to 6â months. Endpoints analysed were: all-cause and HF-death; all-cause and worsening HF hospitalisation. Patients with discharge prealbumin ≤15.0â mg/dL and those with prealbumin >15â mg/dL were compared. A Cox-regression analysis was used to evaluate the prognostic impact of low prealbumin. RESULTS: We studied 514 patients. Mean age was 78â years and 45.7% were male. During follow-up, 101 patients died (78 for HF) and 209 patients were hospital readmitted (140 for worsening HF). Median prealbumin was 20.1 (15.3-25.3) mg/dL. Patients with lower prealbumin were more often women, older aged and with non-ischaemic HF; they had lower albumin, haemoglobin and total cholesterol; and higher glomerular filtration rate, C-reactive protein, B-type natriuretic peptide and length of hospital stay. Lower prealbumin associated with less ß-blocker and statin use. Patients with discharge prealbumin ≤15â mg/dL had a multivariate adjusted HR of 6-month all-cause and HF death of 1.67 (1.00 to 2.80) and 2.12 (1.19 to 3.79) respectively and of all-cause and HF readmission of 1.47 (1.01 to 2.14) and 1.58 (1.01 to 2.47). CONCLUSIONS: Patients with discharge prealbumin ≤15â mg/dL have an higher risk of 6â months morbidity and mortality. The unbalance between protein-energy demands and its availability predicts ominous HF outcome.
Assuntos
Causas de Morte , Insuficiência Cardíaca/sangue , Insuficiência Cardíaca/mortalidade , Mortalidade Hospitalar/tendências , Pré-Albumina/análise , Doença Aguda , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Feminino , Insuficiência Cardíaca/terapia , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Readmissão do Paciente/estatística & dados numéricos , Portugal , Valor Preditivo dos Testes , Prognóstico , Estudos Prospectivos , Medição de Risco , Índice de Gravidade de Doença , Análise de SobrevidaAssuntos
Insuficiência Cardíaca/sangue , Insuficiência Cardíaca/mortalidade , Mortalidade Hospitalar , Pré-Albumina/metabolismo , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Feminino , Insuficiência Cardíaca/diagnóstico , Mortalidade Hospitalar/tendências , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Adulto JovemRESUMO
Aortic stenosis (AS) is the most prevalent valvular heart disease in developed countries. Diagnosis, risk stratification and monitoring are usually based on clinical and echocardiographic parameters. Complementary methods are needed to improve management and outcome, particularly in patients with severe asymptomatic AS, whose management remains controversial. Natriuretic peptides (NPs) have established value as biomarkers in heart failure, coronary heart disease and pulmonary hypertension. This review discusses the usefulness and prognostic value of natriuretic peptides in AS. B-type natriuretic peptide (BNP) and its prohormone (NT-proBNP) correlate with disease severity, development of symptoms and prognosis, but before they can be routinely used in clinical practice, additional prospective studies are needed.