Whipple’s disease-A typical endoscopic finding of a rare disease

A 49-year-old female presented with a 5-month course of diarrhoea, nocturn abdominal pain, asthenia, and weight loss of 30% of her body mass in three months. The patient had also a four-year medical history of bilateral mechanic gonalgy and arthralgias of the metacarpophalangeal and interphalangeal joints, despite treatment with prednisolone. On examination the patient had hyperpigmentation of the face and thorax, low-grade fever, and a BMI of 15,8 Kg/m2. Diarrhoea was documented with watery stools seven times per day despite loperamide, brownish, with no visible blood or mucous. Since the upper GI endoscopy and colonoscopy had no macroscopic abnormalities, the patient underwent a capsule endoscopy, which revealed continuous mucosal lesion with lymphangiectasia, oedema, villous atrophy and areas of denudation with hematinic punctate from the duodenum to the ileum. Diagnosis of Whipple’s Disease was made with typical histology findings in duodenum material and a positive PCR for Tropheryma whipplei. (AU)

Whipple's disease - A typical endoscopic finding of a rare disease.

A 49-year-old female presented with a 5-month course of diarrhoea, nocturn abdominal pain, asthenia, and weight loss of 30% of her body mass in three months. The patient had also a four-year medical history of bilateral mechanic gonalgy and arthralgias of the metacarpophalangeal and interphalangeal joints, despite treatment with prednisolone. On examination the patient had hyperpigmentation of the face and thorax, low-grade fever, and a BMI of 15,8 Kg/m2. Diarrhoea was documented with watery stools seven times per day despite loperamide, brownish, with no visible blood or mucous. Since the upper GI endoscopy and colonoscopy had no macroscopic abnormalities, the patient underwent a capsule endoscopy, which revealed continuous mucosal lesion with lymphangiectasia, oedema, villous atrophy and areas of denudation with hematinic punctate from the duodenum to the ileum. Diagnosis of Whipple's Disease was made with typical histology findings in duodenum material and a positive PCR for Tropheryma whipplei.

Culture-Negative Endocarditis and Cerebral Demyelination: A Challenging Case of Whipple's Disease.

Whipple's disease is a rare condition that, when not recognized and properly treated, can be fatal. A 49-year-old female presented with a five-month history of diarrhoea with watery stools seven times per day, nocturnal abdominal pain, asthenia, and a weight loss of 30% of her body mass in three months. The patient had a four-year medical history of bilateral mechanic gonalgia, arthralgia of the metacarpophalangeal and interphalangeal joints, and anaemia. The examination was remarkable for hyperpigmentation, along with a body mass index (BMI) of 15.8 kg/m2. The diagnosis of Whipple's disease was made with upper gastrointestinal endoscopy, with typical histologic findings and a positive PCR for Tropheryma whipplei. Investigations also revealed cerebral demyelination and endocarditis in three valves. Treatment with intravenous ceftriaxone for four weeks and oral cotrimoxazole for one year resulted in complete resolution of the symptoms and endocarditis. This case report shows uncommon features of the disease and debates the challenging decisions toward diagnosis and effective treatment.

Cumprimento da norma de procedimento de enfermagem da punção venosa periférica / Compliance with the peripheral venipuncture nursing procedure standard

A Punção Venosa Periférica é um procedimento invasivo de alta ocorrência no quotidiano da profissão de enfermagem principalmente no âmbito hospitalar. Destina-se à administração de medicamentos, soros, antibióticos, sangue e derivados. A segurança na execução desta técnica apoia-se em sólidos princípios científicos, sendo fundamental a manipulação asséptica do cateter. Este estudo do tipo quantitativo, descriti-vo e correlacional tem como objectivo verificar o cumprimento da Norma de Procedimento de Enfermagem da Punção Venosa Periférica pelos enfermeiros do serviço de urgência e se o cumprimento observado corresponde ao cumprimento percepcionado e referido pelos enfermeiros, e ainda se existe relação entre o cumprimento da norma e alguns factores como: tempo de exercício profissional; categoria profissional; prioridade atribuída ao doente; conhecimento da norma referida pelos enfermeiros. Os dados foram obtidos através da observação estruturada baseada numa lista de verificação tipo check-list e de um questionário ambos elaborados para o efeito com base na Norma de Procedimento de Enfermagem da Punção Venosa Periférica ou Norma de Procedimento de Enfermagem Nº2. A amostra em estudo foi constituída por 63 enfermeiros do serviço de urgências que foram observados uma única vez na execução do procedimento da Punção Venosa Periférica, nas várias áreas de atendimento e com os mais diversos graus de prioridade. Os resultados evidenciaram que existem itens do procedimento que não foram executados correctamente podendo constituir factores de risco, salientando-se: fazer a higiene do local a puncionar (76,19%), fazer tricotomia se necessário (53,97%), posicionar correctamente o doente (19,04%), colocar o garrote para observação e palpação e retirá-lo posteriormente (76,19%). As hipóteses de investigação foram rejeitadas, visto não se verificar relações estatisticamente significativas entre as variáveis em estudo.