Diarreia de Causa Particular num Indivíduo Imunocompetente?

A colite a citomegalovírus em imunocompetentes é rara. Existe evidência que causa morbilidade e mortalidade nos imunocomprometidos. Os autores descrevem o caso de uma doente de 75 anos, admitida por diarreia com sangue, com 4 semanas de evolução com antecedentes de Diabetes Mellitus, Insuficiência cardíaca e renal crónica. Ao exame objectivo apresentava-se descorada, desidratada, hipotensa, com insuficiência cardíaca descompensada, abdómen indolor. Laboratorialmente verificou-se anemia, insuficiência renal crónica agudizada com acidose metabólica e aumento da proteína C reactiva. Após estabilização procedeu-se a investigação tendo realizado vários exames dos quais colonoscopia total que mostrou: mucosa de aspecto edemaciado e hiperemiado com úlceras de diferentes tamanhos, com distribuição segmentar, atingindo todo o cólon. O exame anatomo-patológico revelou: colite a citomegalovírus. A doente realizou terapêutica com ganciclovir com melhoria clínica, endoscópica e histológica.

Impacto da Idade no Tratamento e Resultados Após Enfarte Agudo do Miocárdio em Particular nos Muito Idosos

INTRODUCTION: The elderly population admitted for acute myocardial infarction is increasing. This group is not well studied in international trials and is probably treated with a more conservative approach. OBJECTIVES: To evaluate the presentation and treatment of myocardial infarction according to age, particularly in very elderly patients. METHODS: We studied 1242 consecutive patients admitted with acute myocardial infarction, assessing in-hospital, 30-day and one-year mortality during follow-up for each age-group. Patients were divided into four groups according to age: <45 years (7.6%); 45-64 years (43.3%); 65-74 years (23.4%); and ≥75 years (25.7%). RESULTS: Elderly patients had a worse risk profile (except for smoking), more previous history of coronary disease and a worse profile on admission, with the exception of lipid profile, which was more favorable. With regard to treatment of the elderly, although less optimized than in other age-groups, it was significantly better compared to other registries, including for percutaneous coronary angioplasty. Both complications and mortality were worse in the older groups. In elderly patients (≥75 years), adjusted risk of mortality was 4.9-6.3 times higher (p<0.001) than patients in the reference age-group (45-64 years). In these patients, the independent predictors of death were left ventricular function and renal function, use of beta-blockers being a predictor of survival. CONCLUSIONS: Elderly patients represent a substantial proportion of the population admitted with myocardial infarction, and receive less evidenced-based therapy. Age is an independent predictor of short- and medium-term mortality.