Fulminant hepatitis in a patient with secondary syphilis.

Despite the increasing incidence of syphilis and due to its wide variety of clinical manifestations, syphilis remains an under-diagnosed condition. We report an unusual case of secondary syphilis presenting with acute hepatitis and skin lesions, confirmed based on positive treponemal and non-treponemal assays. Despite adequate diagnosis and treatment, the patient developed fulminant hepatitis and brain death. This atypical presentation emphasizes the importance of high clinical suspicion in recognizing syphilis as an etiology for unexplained acute hepatitis, allowing early diagnosis and treatment and possibly avoiding severe complications such as fulminant hepatic failure.

Seborrheic Keratoses as the First Sign of Bladder Carcinoma: Case Report of Leser-Trélat Sign in a Rare Association with Urinary Tract Cancer.

Introduction. Skin disorders can be the first manifestation of occult diseases. The recognition of typical paraneoplastic dermatoses may anticipate the cancer diagnosis and improve its prognosis. Although rarely observed, the sudden appearance and/or rapid increase in number and size of seborrheic keratoses can be associated with malignant neoplasms, known as the sign of Leser-Trélat. The aim of this report is to unveil a case of a patient whose recently erupted seborrheic keratoses led to investigation and consequent diagnosis of bladder cancer. Case Presentation. A 67-year-old man was admitted to the intensive care unit due to an exacerbation of chronic obstructive pulmonary disease (COPD). On physical examination, multiple seborrheic keratoses on the back of the hands, elbows, and trunk were observed; the patient had a 4-month history of these lesions yet was asymptomatic. The possibility of Leser-Trélat syndrome justified the investigation for neoplasia, and a bladder carcinoma was detected by CT-scan. The patient denied previous hematuria or any other related symptoms. Many of the lesions regressed during oncologic treatment. Conclusion. Despite the critics on the validity of the sign of Leser-Trélat, our patient fulfills the description of the disease, though urinary malignancy is a rare association. That corroborates the need of further investigation when there is a possibility of paraneoplastic manifestation.

Medication reconciliation at patient admission: a randomized controlled trial.

OBJECTIVE: To measure length of hospital stay (LHS) in patients receiving medication reconciliation. Secondary characteristics included analysis of number of preadmission medications, medications prescribed at admission, number of discrepancies, and pharmacists interventions done and accepted by the attending physician. METHODS: A 6 month, randomized, controlled trial conducted at a public teaching hospital in southern Brazil. Patients admitted to general wards were randomized to receive usual care or medication reconciliation, performed within the first 72 hours of hospital admission. RESULTS: The randomization process assigned 68 patients to UC and 65 to MR. LHS was 10±15 days in usual care and 9±16 days in medication reconciliation (p=0.620). The total number of discrepancies was 327 in the medication reconciliation group, comprising 52.6% of unintentional discrepancies. Physicians accepted approximately 75.0% of the interventions. CONCLUSION: These results highlight weakness at patient transition care levels in a public teaching hospital. LHS, the primary outcome, should be further investigated in larger studies. Medication reconciliation was well accepted by physicians and it is a useful tool to find and correct discrepancies, minimizing the risk of adverse drug events and improving patient safety.

Medication reconciliation at patient admission: a randomized controlled trial

Objective: To measure length of hospital stay (LHS) in patients receiving medication reconciliation. Secondary characteristics included analysis of number of preadmission medications, medications prescribed at admission, number of discrepancies, and pharmacists interventions done and accepted by the attending physician. Methods: A 6 month, randomized, controlled trial conducted at a public teaching hospital in southern Brazil. Patients admitted to general wards were randomized to receive usual care or medication reconciliation, performed within the first 72 hours of hospital admission. Results: The randomization process assigned 68 patients to UC and 65 to MR. LHS was 10±15 days in usual care and 9±16 days in medication reconciliation (p=0.620). The total number of discrepancies was 327 in the medication reconciliation group, comprising 52.6% of unintentional discrepancies. Physicians accepted approximately 75.0% of the interventions. Conclusion: These results highlight weakness at patient transition care levels in a public teaching hospital. LHS, the primary outcome, should be further investigated in larger studies. Medication reconciliation was well accepted by physicians and it is a useful tool to find and correct discrepancies, minimizing the risk of adverse drug events and improving patient safety (AU)

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Avaliação da profilaxia medicamentosa do tromboembolismo venoso / Assessment of drug prophylaxis of venous thromboembolism

JUSTIFICATIVA E OBJETIVOS: De acordo com o Projeto Diretrizes sobre Profilaxia do Tromboembolismo Venoso da Associação Médica Brasileira (AMB) e do Conselho Federal de Medicina (CFM), mais da metade dos pacientes que sofrem tromboembolismo venoso (TEV) sintomático possuem afecções clínicas. Partindo deste princípio, o estudo em questão teve por objetivo avaliar a realização da profilaxia medicamentosa do TEV em pacientes clínicos internados, abordando qual a terapia usada e se a maneira de realizá-la está correta. MÉTODO: Trata-se de um estudo quantitativo observacional transversal. Foi realizada busca ativa de dados em prontuários eletrônicos e complementação destes dados através da aplicação de um questionárioa os pacientes da enfermaria do Hospital da Cruz Vermelha do Paraná. O questionário utilizou como base o algoritmo preconizado pela AMB e pelo CFM e foi aplicado pelos pesquisadores. RESULTADOS: A amostragem obtida foi de 156 pacientes, sendo 53,8% do sexo masculino. Todos os pacientes possuíam algum fator de risco adicional, sendo que 34% apresentavam pelo menos 2 fatores concomitantes. Entre eles os mais prevalentes foram infarto agudo do miocárdio (IAM) prévio (32,7%), insuficiência venosa (27,6%) e tabagismo (24,4%). A profilaxia medicamentosa foi realizada em 48,1% dos casos. Apenas 14,7% do total de pacientes tinham contraindicação formal ao uso de anticoagulantes, e, no entanto, 37,2% dos internados não obtiveram o tratamento profilático adequado ficando desprotegidos durante a internação (IC 95% 33,2%-45,4%). CONCLUSÃO: Apesar do conhecimento da importância do correto manuseio frente a um paciente clínico com fatores de risco para TEV, muitos deles, ainda permanecem sem essa proteção.

BACKGROUND AND OBJECTIVES: According to the Project and Guidelines of Prophylaxis of Venous Thromboembolism, from the Brazilian Medical Association (AMB) and the Brazilian Federal Council of Medicine (CFM), more than half of patients who suffer from symptomatic venous thromboembolism (VTE) have clinical conditions. On this basis, this study has the objective of evaluating the performance of drug prophylaxis of VTE in hospitalized medical patients, considering which therapy was used, and whether the way to do it is correct. METHOD: This is an observational cross-sectional quantitative study. An active search of data in electronic medical records was performed and those data were complemented through the application of questionnaires to patients from the ward of Hospital da Cruz Vermelha of the state of Paraná. The questionnaire used the algorithm recommended by AMB and CFM as basis and it was applied by the researchers. RESULTS: The sample was obtained from 156 patients. Of those, 53.8% were male. All patients had some additional risk factor, with 34% having at least two concomitant factors. Among them, the most prevalent were previous acute myocardial infarction (32.7%), venous insufficiency (27.6%) and smoking (24.4%). Drug prophylaxis was performed in 48.1% of cases. Only 14.7% of patients had a formal contraindication to the use of anticoagulants; however, 37.2% of the admitted patients did not receive adequate prophylactic treatment, remaining unprotected during hospitalization (95% CI 33.2% to 45.4%). CONCLUSION: Despite the knowledge of the importance of proper management in a clinical patient with risk factors for VTE, many of them still remain without this protection.