Publications by authors named "Tiago Judas"

11 Publications

  • Page 1 of 1

Time course of lung ultrasound findings in patients with COVID-19 pneumonia and cardiac dysfunction.

Ultrasound J 2022 Jul 7;14(1):28. Epub 2022 Jul 7.

Critical Care Department, Hospital Garcia de Orta E.P.E, Av. Torrado da Silva, 2805-267, Almada, Portugal.

Background: Lung ultrasound (LUS) is a valuable tool to predict and monitor the COVID-19 pneumonia course. However, the influence of cardiac dysfunction (CD) on LUS findings remains to be studied. Our objective was to determine the effect of CD on LUS in hospitalized patients with COVID-19 pneumonia.

Material And Methods: Fifty-one patients with COVID-19 pneumonia participated in the study. Focused echocardiography (FoCUS) was carried out on day 1 to separate patients into two groups depending on whether they had FoCUS signs of CD (CD+ vs CD-). LUS scores, based on the thickness of the pleural line, the B-line characteristics, and the presence or not of consolidations, were obtained three times along the patient's admission (D1, D5, D10) and compared between CD+ and CD- patients. A correlation analysis was carried out between LUS scores and the ratio of the arterial partial pressure of oxygen to the fraction of the inspired oxygen (P/F ratio).

Results: Twenty-two patients were CD+ and 29 patients were CD-. Among the CD+ patients, 19 were admitted to the intensive care unit (ICU), seven received invasive mechanical ventilation (IMV), and one did not survive. Among the CD- patients, 11 were admitted to the ICU, one received IMV and seven did not survive. CD+ patients showed a significantly lower P/F ratio than CD- patients. However, LUS scores showed no between-group differences, except for fewer subpleural consolidations in the upper quadrants of CD+ than on CD- patients.

Conclusion: In patients with COVID-19, CD contributed to a worse clinical course, but it did not induce significant changes in LUS. Our findings suggest that pathophysiological factors other than those reflected by LUS may be responsible for the differences in clinical condition between CD+ and CD- patients.
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http://dx.doi.org/10.1186/s13089-022-00278-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9261145PMC
July 2022

Protein-Losing Enteropathy Resolved by Eradication.

Eur J Case Rep Intern Med 2022 26;9(5):003312. Epub 2022 May 26.

Department of Internal Medicine, Hospital Garcia de Orta, Almada, Lisbon, Portugal.

Protein-losing enteropathy (PLGE) is an uncommon condition with a multifactorial origin, that is characterized by excessive loss of serum proteins into the gastrointestinal tract, resulting in hypoproteinaemia and oedema. The authors present the case of a 24-year-old man admitted to hospital for a 2-month history of lower extremity oedema and diarrhoea with a secretory pattern. Blood analysis revealed hypoalbuminaemia and iron deficiency anaemia. Liver disease and severe proteinuria were excluded as possible aetiologies. Upper gastrointestinal endoscopy revealed signs of chronic gastritis. After completion of eradication, the patient had complete resolution of clinical and laboratory abnormalities. The results suggest the need to consider less frequent aetiologies for peripheral oedema and hypoproteinaemia, such as PLGE, especially those caused by prevalent bacterial agents like .

Learning Points: Protein-losing enteropathy may be related to infection.Protein-losing enteropathy and its associated symptoms may be resolved by eradication.
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http://dx.doi.org/10.12890/2022_003312DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9239021PMC
May 2022

Stroke and refractory hypoxaemia: complications of pulmonary embolism.

BMJ Case Rep 2021 Sep 22;14(9). Epub 2021 Sep 22.

Department of Internal Medicine, Hospital Garcia de Orta, Almada, Portugal

Acute pulmonary embolism is one of the main causes of cardiovascular mortality. Treatment should be guided according to mortality risk stratification, but an individualised and multidisciplinary approach is often required. Concomitant persistent hypoxaemia can be present in cases of intracardiac shunt. In this report, we describe a 46-year-old woman with a history of surgery, presenting with pulmonary embolism with refractory hypoxaemia and simultaneous ischaemic stroke. Fibrinolysis was successfully performed, and the patient made a full recovery. Additional investigations identified a patent foramen ovale, which was later closed. She had no recurrent thrombotic events.
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http://dx.doi.org/10.1136/bcr-2021-244284DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8461279PMC
September 2021

Pleural Sarcoidosis and Occult Lymphatic Anthracosis: An Unusual Symptomatic Association.

Eur J Case Rep Intern Med 2020 17;7(5):001479. Epub 2020 Mar 17.

Department of Internal Medicine, Hospital Garcia de Orta, Almada, Portugal.

Sarcoidosis is a chronic multisystemic inflammatory disease of unknown aetiology. Virtually any organ or system can be involved, resulting in a wide range of clinical presentation. Pleural sarcoidosis is rare. Pleural effusion can only be attributed to pleural sarcoidosis in the presence of pleural non-caseating epithelioid granulomas and after excluding other granulomatous diseases. Anthracosis is a pneumoconiosis associated with thoracic adenopathies and bronchial disease, and it is usually asymptomatic. The authors present a case of a middle-aged man hospitalized due to cough, right-sided pleuritic chest pain and trepopnoea.

Learning Points: To pursue a systematic and exhaustive investigation of pleuraleffusion until a definitive diagnosis is established.To recognize atypical presentations of sarcoidosis with a high degree of suspicion whenever the initial investigation is inconclusive.
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http://dx.doi.org/10.12890/2020_001479DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7213820PMC
March 2020

Pericardial Effusion as an Initial Presentation of Panhypopituitarism.

Eur J Case Rep Intern Med 2020 24;7(4):001478. Epub 2020 Feb 24.

Department of Internal Medicine, Hospital Garcia de Orta, Almada, Portugal.

Pericardial effusion has a broad spectrum of clinical presentation, ranging from an incidental finding on imaging to a potentially fatal emergency such as pericardial tamponade, the most severe presentation. The authors present a case of a middle-aged male hospitalized due to shortness of breath. Initial work-up was positive for massive pericardial effusion with haemodynamic compromise. Additional study revealed panhypopituitarism. The acromegalic phenotype was suggestive of acromegaly secondary to pituitary adenoma, which had probably evolved to apoplexy. Hormone replacement was started with clinical improvement. At the 3-year follow-up, there was no evidence of recurrence of pericardial effusion. Panhypopituitarism is a relatively rare entity, but can lead to life-threatening complications such as adrenal crisis, coma and myxoedema-associated cardiac failure. Pericardial effusion is an extremely rare manifestation of secondary hypothyroidism.

Learning Points: To recognize the clinical presentation of cardiac tamponade.To recognize atypical causes of pericardial effusion, such as severe panhypopituitarism.Hormonal replacement is efficient in treating panhypopituitarism.
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http://dx.doi.org/10.12890/2020_001478DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7162561PMC
February 2020

Methicillin-sensitive bacterial endarteritis associated with vascular closure device.

BMJ Case Rep 2020 Jan 19;13(1). Epub 2020 Jan 19.

Department of Internal Medicine, Hospital Garcia de Orta, Almada, Portugal

Percutaneous endovascular procedures (PEPs) are increasingly common in clinical practice. Percutaneous closure devices (PCD) ensure safe and immediate haemostasis, reducing the length of hospitalisation and improving patient comfort. Infectious complications are rare. We present the case of a 65-year-old man who was admitted to hospital because of fever and weight loss. He had a history of carotid arterial disease, having been submitted to a PEP 3 weeks before. On admission, he presented feverishly. Anaemia and elevated inflammatory parameters were detected on basic chemistry. Blood cultures isolated methicillin-sensitive and antibiotic therapy was started. He maintained fever and developed signs of right lower limb ischemia. Bacterial endocarditis was ruled out. Positron emission tomography (PET)-scan revealed inflammatory activity involving the right femoral artery (RFA). Bacterial femoral endarteritis was confirmed on surgical exploration, which documented the presence of infected PCD and occlusion of RFA. After surgery, apyrexia and improvement of ischaemic signs were achieved.
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http://dx.doi.org/10.1136/bcr-2019-232885DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7035850PMC
January 2020

Marantic endocarditis and paraneoplastic pulmonary embolism.

BMJ Case Rep 2017 Jul 14;2017. Epub 2017 Jul 14.

Department of Internal Medicine, Hospital Garcia de Orta, Almada, Portugal.

Cancer is frequently associated with a hypercoagulable state. Almost 15% of patients with cancer will suffer a thromboembolic event during their clinical course. The aetiology of this hypercoagulable state is multifactorial and includes procoagulant factors associated with malignancy as well as the host's inflammatory response. Cancer-associated thrombophilia can present as venous thromboembolism, migratory superficial thrombophlebitis, arterial thrombosis, disseminated intravascular coagulation, thrombotic microangiopathy and rarely non-bacterial thrombotic endocarditis (NBTE). In this paper, we will describe an uncommon presentation of lung cancer on a non-smoker middle-aged woman, with recent diagnosis of pulmonary embolism, who develops malignant recurrent pleural effusion, NBTE with cutaneous and neurological manifestations, with a rapid evolution into shock, culminating in death. Diagnosis of NBTE requires a high degree of clinical suspicion. The mainstay of treatment is systemic anticoagulation to prevent further embolisation and underlying cancer control whenever is possible.
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http://dx.doi.org/10.1136/bcr-2017-220217DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5534972PMC
July 2017

Scleredema associated with Sjögren's syndrome.

An Bras Dermatol 2015 May-Jun;90(3 Suppl 1):81-3

Garcia de Orta Hospital, Almada, PT.

Scleredema adultorum of Buschke is a rare disorder characterized by diffuse swelling and non-pitting induration of the skin usually involving the face, neck, arms and upper trunk. It has been associated with previous infectious diseases, diabetes, paraproteinemia and, more rarely, malignant neoplasms or autoimmune disorders. We report the case of a 30-year-old man who presented with a 2-year history of scleredema. Further investigation led to the diagnosis of primary Sjögren's syndrome. The association between scleredema and autoimmune disorders has been rarely seen. To our knowledge, there are no other reports describing the association between primary Sjögren's syndrome and scleredema adultorum of Buschke.
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http://dx.doi.org/10.1590/abd1806-4841.20153779DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4540515PMC
January 2016

Giant left atrial thrombus: an unexpected finding.

Rev Port Cardiol 2011 Jun;30(6):621-6

Serviço de Medicina do Hospital Garcia de Orta, Almada, Portugal.

The incidence of left atrial thrombi is higher in patients with mitral valve stenosis. Its presence and location have important implications in deciding on the therapeutic approach, particularly the need for valve repair. We describe the case of a 63-year-old patient, with asymptomatic moderate mitral stenosis, hospitalized due to community-acquired pneumonia, in whom investigation to exclude pulmonary thromboembolism revealed a giant left atrial thrombus, which required urgent surgery.
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June 2011

Intraventricular gradients and acute coronary syndromes: a case report.

Rev Port Cardiol 2010 Apr;29(4):711-6

Serviço de Cardiologia do Hospital do Espírito Santo, Evora, Portugal.

Left ventricular outflow tract obstruction (LVOTO) has traditionally been associated with hypertrophic obstructive cardiomyopathy, but can occur in other clinical scenarios such as acute myocardial infarction (AMI). In some patients, LVOTO is absent at rest, being detectable only with provocation tests such as stress echocardiography. Timely diagnosis of this phenomenon is very important, as it has therapeutic implications, and relies on clinical suspicion and on recognizing substrates in which LVOTO can occur. We report a case of syncope and AMI associated with LVOTO with systolic anterior motion of the mitral valve and a significant intraventricular gradient.
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April 2010

[Inflammatory myopathy with an unusual evolution].

Acta Reumatol Port 2010 Apr-Jun;35(2):254-8

Interna do Internato Complementar de Endocrinologia, Serviço de Medicina do Hospital Garcia de Orta E.P.E., Almada.

Inflammatory myopathies are a heterogeneous group of conditions characterized by proximal muscle weakness, nonsuppurative inflammation of skeletal muscle, with elevated muscle enzyme levels and characteristic electromyography and muscle biopsy findings. The authors describe a clinical case of a young woman, admitted with a four day history of bilateral thigh myalgia. She was afebrile and without skin, mucosal or joint involvement. Thigh muscle palpation was painful. Complete blood count revealed leukopenia and thrombocytopenia. High levels of creatine kinase, serum aminotransferases and myoglobin were detected. Metabolic, toxic and drug-related causes were excluded as well as infectious diseases, malignant tumours and endocrine myopathies. Auto-antibodies for connective diseases were negative. Magnetic resonance imaging and electromyography of lower limbs were suggestive of inflammatory myopathy. Generalized muscle weakness and dysphagia were reported subsequently. Clinical and laboratorial improvement was seen after corticotherapy. Muscle biopsy revealed myopathy signs without inflammatory changes or vasculitis. After prednisolone reduction, presently without treatment, she remains asymptomatic with normal laboratorial findings. The authors emphasize in this case of inflammatory myopathy the unusual clinical and laboratory evolution and the importance of a cautious differential diagnosis.
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December 2010
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