Update of the recommendations of the Sociedade Portuguesa de Cuidados Intensivos and the Infection and Sepsis Group for the approach to COVID-19 in Intensive Care Medicine.

Introduction: The Sociedade Portuguesa de Cuidados Intensivos and the Infection and Sepsis Group have previously issued health service and management recommendations for critically ill patients with COVID-19. Due to the evolution of knowledge, the panel of experts was again convened to review the current evidence and issue updated recommendations.

Methods: A national panel of experts who declared that they had no conflicts of interest regarding the development of the recommendations was assembled.

Chest Wall Trauma Surgery Review.

Rib fractures are frequent in trauma patients, being most of them managed on a non-surgical way. However, in selected cases, it is advocated. Chest wall stabilization (CWS) only recently has been best characterized.

Gastrointestinal Fistula as First Presentation of Lung Cancer.

The initial manifestation of lung cancer as gastrointestinal tract metastasis is an extremely rare event. In most cases, these metastases are diagnosed after the primary lung tumor, when potentially life-threatening complications develop, often requiring emergency surgery. Regardless of treatment, these patients have a poor prognosis, due to the advanced stage of their disease.

Hospital admissions of adults with community-acquired pneumonia in Portugal between 2000 and 2009.

Recent studies in the USA and northern Europe have shown an increase in community-acquired pneumonia (CAP). In southern Europe, this increase has not yet been documented. We carried out a retrospective analysis from encoded information from the Portuguese database for hospital admissions that included all individuals aged ≥18 years, with a primary diagnosis of pneumonia, who were discharged between 2000 and 2009.

Adverse reactions to antituberculosis drugs in in-hospital patients: Severity and risk factors.

Introduction: Given Mycobacterium tuberculosis's characteristics, the treatment of tuberculosis (TB) infection is administered over a long period of time (for six months or more) with a combination of several drugs which could cause adverse reactions (AR). These can cause significant morbidity and compromise tuberculosis treatment regimens.

Aim: To determine the incidence and severity of and risk factors for major adverse reactions to antituberculosis drugs in in-hospital patients treated for active tuberculosis.

[Musculoskeletal tuberculosis - a clinical case report].

Tuberculosis of the chest wall constitutes 1% to 5% of all cases of musculoskeletal TB. Abscesses of the chest wall are rare tuberculous locations. Because of the resurgence of the tuberculosis associated to AIDS, that diagnosis must be considered more frequently.

[Pulmonary epithelioid hemangioendothelioma - rarity, diagnosis and treatment difficulties].

The authors report a case of a primary pulmonary epithelioid haemangioendothelioma (EHE) in a 51 year-old man, a mechanic, who complained of a dry cough followed by constitutional symptoms and dyspnoea. Patient underwent a series of diagnostic exams including surgical biopsy and pulmonary tuberculosis was diagnosed. He was prescribed tuberculosis drugs for three weeks.

[Tobacco smoking treatment strategy in COPD].

Smoking cessation is one of the most important ways of improving the prognosis of COPD patients. Based on currently available evidence professional health workers should take a proactive and continuous role with smokers, motivating them to stop smoking and providing treatment to aid smoking cessation. The treatment should include pharmacotherapy in addition to behavioural support and should be part of management of the patient's chronic respiratory condition, as the COPD National Prevention and Treatment Programme recommends.

[Update in pulmonary thromboembolic disease].

Pulmonary embolism is part of venous thromboembolism, an important health problem which leads to significant mortality and morbidity with high economic and social burden. A prompt diagnosis and treatment as well as an appropriate prophylaxis are determinant factors in prognosis. This disease continues to demand particular attention namely in the investigation of risk factors, clinical probability algorithms development, diagnostic work-up evaluation, characterization of new therapeutic strategies and thromboprophylaxis recommendations.

[Alpha-1 antitrypsin deficiency. The experience of Pulido Valente Hospital with augmentation therapy].

Alpha-1 antitrypsin (AAT) is synthesised in the liver and has half-life of 4-5 days. AAT has antiprotease activity, with particular affinity for neutrophil elastase. Its deficiency leads to a lack of effective lung protection against activated neutrophil enzymes.

[Shouldn't the Achilles' heel be on the foot - regarding a clinical case].

Clinical suspicion is the bedrock of a thorough clinical work-up, and a review of the clinical files with no definitive diagnosis is a must. Such a review can uncover rare diagnoses, such as Waldenstrom's macroglobulinaemia, a proliferative B-cell disease characterised by medular infiltration and monoclonocal IgM production. 1% of these are biclonal.

Pemetrexed in second line treatment of non-small cell lung cancer - The portuguese experience.

Until 2004, docetaxel in monotherapy was the standard for second-line treatment of non-small cell lung cancer (NSCLC). Pemetrexed (P) has shown similar activity in this setting with a better adverse event profile. In Portugal, it was introduced in October of 2004.

Inspiratory muscle training in COPD patients.

Aim: The aim of this study was to evaluate the impact a specific inspiratory muscle training (IMT) protocol had on dyspnoea, lung function, respiratory muscle pressure, tolerance to exercise and quality of life in a group of patients with chronic obstructive pulmonary disease (COPD) POPULATION: We studied 13 patients with moderate to very severe COPD divided into a control group (n=5) with an average FEV1 43.9 +/- 10.1% of predicted value and an IMT group (n=8) with FEV1 57.

Endobronchial ultrasound: practical aspects and clinical applications.

Endobronchial ultrasound (EBUS) has become a major advance in bronchoscopy. Substantial scientific evidence has confirmed its usefulness in lung cancer diagnosis and staging, as well as in other clinical settings. It is of growing importance that endoscopists perform and interpret this imaging method accurately, in order to optimize diagnosis and treatment of their patients.

[Multi-drug resistant tuberculosis and the red queen - diagnosis speed is crucial].

The multi-drug resistant Tuberculosis (MDRTB) is a huge menace to Tuberculosis control. The early detection of MDRTB is essential to best appropriate measures. The detection methods for drug resistance based in evaluation of the genetic determinants (genotypic methods), instead of phenotypic methods, allows for faster results, the possibility of direct application in clinical samples and simultaneous identification of Mycobacterium tuberculosis complex.

[In-patient smoker? - Providing appropriate intervention].

Tobacco use is the most avoidable cause of death. Other than provoking multiple diseases requiring hospitalisation, Tobacco Use is also a disease requiring management in the hospital setting, not only in terms of controlling the withdrawal symptoms of the patient, who has been abruptly prohibited from smoking, but also for fulfilling legislation which prohibits tobacco use in the health services, the only efficient way of preventing exposure of non-smokers to environmental tobacco smoke. Treating the in-patient smoker in an appropriate way also provides a window of opportunity for promoting not just a temporary but a complete smoking cessation.

[Rhodococcus equi pneumonia in an HIV+ patient: An uncommon association].

The human infection by Rhodococcus equi, even in the presence of HIV infection, remains a rare disease. The authors present a case report of pneumonia, occurring in a HIV+ man. After identifying Pneumocystis jiroveci in the BAL, despite proper medication, the patient didn't improve.

Anomalous origin of the circumflex coronary artery--two case reports.

As shown in many series, congenital coronary artery anomalies are found in 0.6 to 1.5% of patients undergoing coronary angiography.

[Interstitial idiopathic pneumonias--a literature review].

Interstitial idiopathic pneumonias are a group of diseases whose rarity and variety of clinical, radiological and pathological descriptions creates difficulties in study and management. An example of this is the classification method for this group, with only 2002 seeing some consensus. The aim of this article is to review the main literature to contribute to an understanding of this subject.

Helicobacter pylori and laryngopharyngeal reflux in chronic rhinosinusitis.

Objective: Investigation of the potential role of several laryngopharyngeal reflux contents in sinus disease.

Study Design And Setting: A controlled cohort analysis of Helicobacter pylori, pepsin and pepsinogen I in inflamed and non-inflamed sinonasal tissue. Fifteen patients, selected for surgery due to chronic medically refractory rhinosinusitis, had their pathologic sinus tissue analyzed for polymerase chain reaction detection of H.

Does Helicobacter pylori play a role in upper respiratory tract inflammation? A case report.

Persistent isolated inflammation of the sphenoid sinus, an entity that is not diagnosed very often, poses a challenge to clinicians and researchers alike. Its features tend to suggest that its etiopathogenesis is different from that of more common forms of chronic rhinosinusitis. We report the case of a 54-year-old woman who had a history of distressing chronic postnasal drip and a globus sensation with opacification of the sphenoid sinus.