Fatores de risco para complicações pósoperatórias da hidradenite supurativa: artigo de revisão / Risk factors for postoperative complications of Hidradenitis Suppurativa: a review article

Introdução: a hidradenite supurativa é uma doença inflamatória crônica e recidivante. Altas taxas de recorrência podem persistir mesmo após ampla excisão cirúrgica local. Objetivo: avaliar os principais fatores de risco para complicações pós-operatórias da hidradenite supurativa. Metodologia: foram utilizadas referências em artigos científicos nas bases de dados Google, PubMed, LILACS e SciELO nas línguas portuguesa e inglesa, no período de 2000 a 2021. Resultados: os principais fatores que influenciam os resultados pós-operatórios estão relacionados a técnica cirúrgica empregada, gravidade da doença, comorbidades dos pacientes e terapia clínica adjuvante

Introduction: Hidradenitis Suppurativa is a chronic inflamatory and relapsing disease. High levels of recurrence can persist even after wide local excision. Objective: Identify the main risk factors for postoperative complications of Hidradentis Suppurativa. Methods: We included journal articles with data from Google, Pubmed, Lilacs, and Scielo, in Portuguese and English, from 2000 to 2021. Results: The main risk factors that influence postoperative outcomes are related to surgical technique, disease severity, comorbidities, and adjuvant clinical therapy

Case Report: A Case of Pediatric Catatonia: Role of the Lorazepam Challenge Test.

A case of a 12-year-old boy who developed catatonia is presented. He had no previous psychiatric history but has a family history of affective disorder. An extensive medical workup was negative. Despite a negative lorazepam challenge test, lorazepam was titrated up to 24 mg/day, with resolution of most catatonic symptoms. The case highlights an important point in the management of catatonia that may be a source of confusion, i.e., a positive lorazepam challenge test corroborates the diagnosis of catatonia; however, a negative lorazepam challenge test does not negate the diagnosis of catatonia, and subsequent focused benzodiazepine treatment may still be effective.

[In the Child's Best Interest: The Contribution of Child and Adolescent Psychiatry]. / No Superior Interesse da Criança: Os Contributos da Pedopsiquiatria.

INTRODUCTION: Child and Adolescent Forensic Psychiatry involves a multidisciplinary assessment at the courts' requested to assist them in the process of justice delivery. MATERIAL AND METHODS: Retrospective study which included 233 forensic requests to two child and adolescent psychiatrists from Coimbra's HP-CHUC Child and Adolescent Psychiatry Department between 1998 and 2012. RESULTS: Biographic, psychopathology, social and family aspects were analyzed. The response time throughout the process, the origin and nature of the request's and the type of process which originated the request were also assessed. The authors identified the involved professionals and whether they needed to go to court. When there were questions, they evaluated the capacity to answer them, the forensic difficulties and solutions found, and the presence of recommendations. DISCUSSION: The obtained results met the clinical experience and literature regarding demography and psychopathology. As for the difficulties, there were a number of aspects which could be improved by both parts, aiming to ameliorate the articulation between Health and Justice. CONCLUSION: With this study it was possible to reflect on the authors forensic practice, in order to develop a closer partnership with the courts to promote the real 'best interests' of children/adolescents and their families.

Introdução: A atividade médico-legal, no âmbito da Pedopsiquiatria, consiste numa avaliação por solicitação dos Tribunais, para os assessorar no exercício da Justiça da família / da criança. Material e Métodos: Estudo retrospetivo, que englobou 233 pedidos de exames periciais e informações clínicas de dois pedopsiquiatras do Serviço de Pedopsiquiatria do Hospital Pediátrico do Centro Hospitalar e Universitário de Coimbra, entre 1998 - 2012. Resultados: Foram analisados aspetos biográficos, psicopatologia subjacente e contexto sociofamiliar. Foram avaliados também os tempos de resposta nos diferentes momentos do processo, a proveniência e a natureza dos pedidos, bem como o tipo de processo que lhes deu origem. Os autores identificaram, para cada caso, os profissionais envolvidos no processo e a eventual necessidade de comparência em Tribunal. Perante a existência de quesitos, avaliaram a capacidade de resposta aos mesmos, as dificuldades periciais e respetivas soluções encontradas, bem como a existência ou não de recomendações. Discussão: Os resultados obtidos foram ao encontro da literatura e experiência clínica relativamente aos dados demográficos e psicopatologia. Quanto às principais dificuldades sentidas, identificaram-se diversos aspetos passíveis de aperfeiçoamento, por ambas as partes, com vista a uma melhor articulação entre a Saúde e a Justiça. Conclusão: Com este trabalho foi possível refletir acerca da atividade forense dos autores, visando facilitar a articulação da Pedopsiquiatria com os Tribunais, em prol do verdadeiro superior interesse das crianças/adolescentes e suas famílias.

Silicosis - brief review and experience of a pulmonology ward.

Silicosis is a diffuse interstitial fibronodular lung disease, caused by the inhalation of crystalline silica. We undertook a brief review of the topic, focusing on the most important aspects and performed a retrospective analysis of 84 patients admitted to the Pulmonology Ward of the Coimbra University Hospital over a 10-year period whose main or secondary diagnosis was silicosis. We also present the most relevant clinical features and the conclusions drawn from this review. The authors assess patients' occupational history, changes in respiratory function study, the imaging findings and the associated complications.

[Lymphangioleiomyomatosis - report of three cases]. / Linfangioleiomiomatose - A propósito de três casos clínicos.

Pulmonary lymphangioleiomyomatosis (LAM) is a rare disease of unknown aetiology. It is characterized by proliferation of abnormal smooth -muscle cells throughout the peribronchial, perivascular and perilymphatic regions of the lung. LAM may occur sporadically, in association with tuberous sclerosis complex (TSC) or inheritable multiorgan hamartomatosis. In either situation, LAM occurs almost exclusively in women of reproductive age, and approximately one third of the patients with TSC have LAM2. The authors review the cases of three female patients diagnosed with LAM based on clinical and radiological findings. A brief review of the disease is then presented.

[Acute fibrinous and organizing pneumonia]. / Pneumonia aguda fibrinosa e organizante.

The histologic pattern of Acute Fibrinous and Organizing Pneumonia (AFOP), described by Beasley in 2002, is characterized by the existence of intra alveolar fibrin in the form of fibrin "balls" and diffuse organizing pneumonia. Presenting symptoms of this interstitial pulmonary disease can be acute or subacute. However, it differs from the well-recognized histologic patterns of acute pulmonary lesion - Diffuse Alveolar Damage (DAD), Organizing Pneumonia (OP) and Eosinophilic Pneumonia (EP).The authors carry out a review of the literature concerning this topic and describe the clinical case of a 44-year-old patient with unusual imaging features and outcome.

Hereditary hemorrhagic telangiectasia and pulmonary arteriovenous malformations - embolization with Amplatzer vascular plug.

Pulmonary arteriovenous malformations (PAVMs) are associated to hereditary hemorrhagic telangiectasia in about 70% of the cases. PAVMs are associated to serious neurologic complications, secondary to inherent paradoxical embolisms. Treatment of the malformations is done to prevent these complications. The authors report a clinical case of a patient with two PAVMs, with hereditary hemorrhagic telangiectasia, who was treated by embolization with an Amplatzer vascular plug, a new device increasingly used in these situations. The authors emphasise some of its characteristics and advantages when compared with other embolization techniques most commonly used.

Evaluation of bone mineral density in cystic fibrosis patients.

Patients with cystic fibrosis (CF) have an increasing life span and osteoporosis has become a more recognised problem in these patients. The pathogenesis of low bone mineral density (BMD) in CF seems to be multifactorial and the aim of this study was to assess the prevalence of low BMD in a group of CF outpatients and to relate the findings with the variables studied. The study included 22 patients aged between 14 and 45 years (mean age 26.3). Two of the subjects were lung transplant patients. BMD was assessed by dual-energy X-ray absorptiometry (DEXA) at the lumbar spine (LS) and femoral neck (FN). This data was correlated with serum 25-hydroxy vitamin D (25-OHD) levels, BMI and the forced expiratory volume in one second (FEV1). BMD (Z-score and T-score) ranged from 0.6 to -6 and from 0.5 to -6.7 at LS; at FN the scores ranged from 0.6 to -3.9 and from 0.6 to -4.1. The mean serum 25-OHD concentration (12,57 ng/ml) was at the low end of the normal range (10-60 ng/ml). On average patients did not present with malnutrition, however BMI ranged from 15.2 to 33.7 kg/m2. Lung function status was assessed by FEV1; 64% of patients had FEV1 below 80% and within this group four patients had a FEV1 under 40%. There was a positive correlation between low BMD and 25-OHD concentrations and also between BMD and FEV1. There was no linear correlation between BMD and BMI.

[Idiopathic chronic eosinophilic pneumonia--a clinical case report]. / Pneumonia eosinofílica crónica idiopática--a propósito de um caso clínico.

The eosinophilic pneumonias are a heterogeneous group of pulmonary disorders, which may compromise only the air ways, the pulmonary parenchyma, or both, characterised by alveolar eosinophils and infiltration of pulmonary tissue, with or without peripheral blood eosinophilia. Idiopathic Chronic Eosinophilic Pneumonia (ICEP), detailed description was by Carrington in 1969, is a rare eosinophilic lung disease, of unknown aetiology, characterised by peripheral blood eosinophilia, chest radiograph infiltrates and prompt response to corticosteroid therapy. ICEP most commonly affects women of middle age and usual symptoms are cough, dyspnea, fever and weight loss. The authors present a case of ICEP in a young woman, 21 years old, non-smoker and previously healthy.

Cortisol serum levels and their relationship to certain antiretroviral drugs.

We found that patients receiving antiretroviral therapy had higher cortisol levels than those untreated, with the highest levels corresponding to those taking efavirenz. Multivariate analysis revealed that only the presence of antiretroviral therapy, treatment with efavirenz and a prior diagnosis of AIDS were significantly predictive of cortisol levels.