Prolonged arthralgias in Whipple's disease - A common but often overlooked symptom of a rare disease.

Whipple's disease is a multisystemic chronic infectious condition caused by Tropheryma whipplei (T. whipplei). Though characterised often by insidious weight loss, diarrhoea, and arthralgia, three other distinct manifestations can be observed, namely localised disease, acute infection and asymptomatic carriage. The diagnosis relies on histopathological examination of duodenal biopsies and polymerase chain reaction analysis of the 16S rRNA gene for T. whipplei. We report the case of a middle-aged man admitted for etiologic investigation of prolonged, migrating, and inflammatory arthralgias and subsequent development of gastrointestinal symptoms. Despite its reputation as a great mimicker of many different illnesses, the difficulty in diagnosis probably lies with its rarity rather than its masking.

Cast the bait in human fishing: an expected esophageal foreign body.

An 82-year-old woman with a medical history of dementia was admitted to the emergency department with a line under tension by lead weights through her mouth, suspecting inadvertent swallowing of a fishhook. The chest X-ray was normal. An emergent endoscopy revealed the hook imprisoned in the middle esophagus. The sharped end of the hook was carefully detached into the esophageal lumen using a rat tooth forceps and safely removed with an esophageal overtube. The esophageal defect at the impaction site was closed with the placement of two 11-mm through-the-scope metal clips, without intercurrences. Ingestion of foreign bodies is relatively rare in adults and typically pass without intervention. Their extraction is a therapeutic challenge dependent on the type and location of the object, the time since ingestion, and the probability of associated complications, such as obstruction or perforation. Endoscopic management is the first choice in the treatment of esophageal foreign bodies as a safe, effective, and minimally invasive technique, as it allows to maintain control of the object during extraction and minimize the risk of additional damage. This case report represents a successful retrieval of an unusual foreign body specially designed in a sharped shape to be ingested by fish during fishing with an esophageal overtube avoiding surgery with significant morbidity and mortality.

Duodenal variceal bleeding as a presentation of hepatocellular carcinoma.

A 79-year-old man with alcoholic liver cirrhosis without regular medical follow-up, presented at the emergency room with hematemesis. An upper endoscopy revealed a varix at the anterior wall of bulb with a red wale sign, indicating recent bleeding. An injection N-butyl-2 cyanoacrylate plus metacryloxisulfolane was successfully performed. The abdominal computed tomography angiography scan revealed a 29x26-mm nodule consistent with hepatocellular carcinoma (HCC), tumoral portal vein thrombosis (and communicating collateral from the superior mesenteric vein feeding the duodenal varix with no splenorenal shunt. After endoscopic therapy, the patient remained asymptomatic without rebleeding. Given HCC stage D (Barcelona Clinic Liver Cancer), after multidisciplinary discussion, the patient was evaluated for best supportive care. Ectopic varices are clinically challenging causes of portal hypertensive bleeding associated with significant mortality, requiring a high index of suspicion and multimodal diagnostic and therapeutic approaches. The management includes endoscopic therapy, interventional radiology techniques (TIPS with variceal embolization, balloon occluded retrograde transvenous obliteration and percutaneous transhepatic obliteration) or surgery. The best endoscopic treatment modality remains unclear because there are no studies directly comparing the different endoscopic techniques. In setting of ectopic varices, abdominal imaging is mandatory to exclude splanchnic vein thrombosis, HCC and to map portosystemic collaterals to guide further treatments.

[Alcohol Drinking in Higher Education Students from Coimbra and the Impact of Academic Festivities]. / Consumo de Álcool nos Estudantes do Ensino Superior de Coimbra e o Impacto das Festas Académicas.

INTRODUCTION: The international and national literature as well as studies carried out in universities in Portugal show there is excessive alcohol consumption and binge drinking. However, no relation with alcohol consumption and college parties has yet been established. The aim of this study was to assess the association between alcohol consumption and binge drinking with college parties, and also to understand specific patterns of alcohol consumption by gender and years of university attendance. MATERIAL AND METHODS: A survey comprised of the "Alcohol Use Disorders Identification Test - Consumption" (AUDIT-C) and the question "What is your most consumed drink?" referring to months without and with college parties, was disseminated in the University of Coimbra Facebook® page to students of the University of Coimbra and of the Polytechnic Institute of Coimbra seventeen years old and over. RESULTS: The AUDIT-C score in college party months is higher than in months without such parties with strong, positive and significant correlation (ρ = 0.711; ρ < 0.001). In months without college parties, 41.8% of females and 24.0% of males have a positive AUDIT-C. In months with college parties, 73.8% of females and 56.3% of males have a positive AUDIT-C. In months with college parties, females have higher risk of excessive consumption (ρ< 0.001) and drink a higher amount of spirits / shots. There is a significant difference in the most consumed drinks between genders (ρ < 0.001). DISCUSSION: Alcohol consumption is higher in those with less years in college attendance, but college parties seem to have a proportional impact regardless of the number of years of college attendance. In a month with college parties, there is more binge drinking and higher consumption than the daily maximum recommended amount. Males consume a higher amount of spirits / shots. CONCLUSION: College parties allow for more opportunities of pre-existing binge drinking. The way young people face alcohol consumption is a major problem to be addressed.

Introdução: Na literatura internacional, nacional e em estudos no ensino superior em Portugal os jovens apresentam consumos alcoólicos excessivos e binge drinking. Contudo, não se encontra estabelecida qualquer relação entre o consumo e as festas académicas. O objectivo deste estudo foi compreender a associação entre consumo de bebidas alcoólicas e festas académicas, estabelecendo uma relação entre estes momentos e um padrão específico de consumo, bem como perceber a ocorrência de padrões específicos de consumo de acordo com o sexo e os anos de frequência escolar.Material e Métodos: Foi elaborado um questionário, constituído pelo "Alcohol Use Disorders Identification Test ­ Consumption" (AUDIT-C) e apresentando a questão "Qual a bebida mais consumida?" num mês com festas académicas e num mês sem que se realizassem. O questionário dirigido a alunos da Universidade de Coimbra e do Instituto Politécnico de Coimbra, foi divulgado na página de Facebook® da Universidade de Coimbra.Resultados: Na amostra de estudantes do ensino superior de Coimbra, com idade igual ou superior a dezassete anos (n = 503), o AUDIT-C em mês com festas académicas é superior ao mês sem festas, verificando-se correlação positiva forte e significativa (ρ = 0,711; ρ < 0,001). Em mês sem festas académicas, 41,8% do sexo feminino e 24,0% do sexo masculino apresentam AUDIT-C positivo. Em mês com festas académicas 73,8% do sexo feminino e 56,3% do sexo masculino apresentam AUDIT-C positivo. O sexo feminino apresenta maior risco de consumo excessivo (ρ < 0,001) e bebe mais bebidas espirituosas / shots. Há diferença significativa entre sexos quanto à bebida mais consumida (ρ < 0,001).Discussão: O consumo de alcool é superior nos primeiros anos, embora as festas académicas pareçam ter um impacto proporcional independente do número de matrículas. Em mês com festas académicas, há maior frequência de binge drinking e de consumo superior ao máximo diário recomendado. O sexo masculino revela aumento do consumo de bebidas espirituosas / shots. Conclusão: As festas académicas fomentam as ocasiões de binge drinking pré-existentes, residindo o problema na forma como os jovens abordam o consumo de álcool.