Giant meningioma in paranasal sinuses: an atypical nasal occupation

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COPD : a stepwise or a hit hard approach?

Open Access funded by Sociedade Portuguesa de Pneumologia Under a Creative Commons license. © 2016 Sociedade Portuguesa de Pneumologia. Published by Elsevier España, S.L.U. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).Current guidelines differ slightly on the recommendations for treatment of Chronic Obstructive Pulmonary Disease (COPD) patients, and although there are some undisputed recommendations, there is still debate regarding the management of COPD. One of the hindrances to deciding which therapeutic approach to choose is late diagnosis or misdiagnosis of COPD. After a proper diagnosis is achieved and severity assessed, the choice between a stepwise or "hit hard" approach has to be made. For GOLD A patients the stepwise approach is recommended, whilst for B, C and D patients this remains debatable. Moreover, in patients for whom inhaled corticosteroids (ICS) are recommended, a step-up or "hit hard" approach with triple therapy will depend on the patient's characteristics and, for patients who are being over-treated with ICS, ICS withdrawal should be performed, in order to optimize therapy and reduce excessive medications. This paper discusses and proposes stepwise, "hit hard", step-up and ICS withdrawal therapeutic approaches for COPD patients based on their GOLD group. We conclude that all approaches have benefits, and only a careful patient selection will determine which approach is better, and which patients will benefit the most from each approach.Funding for this paper was provided by Novartis Portugal. Funding was used to access all necessary scientific bibliography and cover meeting expenses. Novartis Portugal had no role in the collection, analysis and interpretation of data, in the writing of the paper and in the decision to submit the paper for publication.info:eu-repo/semantics/publishedVersio

Resultados e grau de satisfação após redução amigdalina por Radiofrequência em idade pediátrica

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Evaluation Rainfall Regime at the Hydroelectric Power Plant Toward Climate Change

The hydroelectric plants are first in the Brazilian energy matrix, so irregularities in the rainfall regime can affect the energy generation, thus evidencing the need to know the rainfall distribution in the studied area. This work aimed to evaluate possible analysis of the impacts of climate change on the rainfall regime in the Machadinho hydroelectric region. For the research development, the IPCC-AR5 pessimistic scenario was used, representing a scenario with a continuous population growth and high carbon dioxide emissions. From the historical series and organized projections, precipitation anomalies were calculated. Analyzing the difference between the average of the month and the climatological normal, it was inferred that the model used presented a positive trend for precipitation in the period from 2026 - 2100, projecting anomalies between 25 and 200 mm per month. A greater amplitude is observed in the precipitation of 2076-2100, indicating an increase in the occurrence of extreme events of precipitation, mainly in the spring period. Considering that the rains in the Machadinho hydroelectric region are increasing in the scenarios analyzed, the average water level in the reservoir of the plant tends to increase

PFAPA syndrome - Clinical case

Introdução - A Síndrome PFAPA (periodic fever, aphtous stomatitis, pharyngitis, cervical adenitis) caracteriza-se por episódios recorrentes de febre elevada, estomatite aftosa, adenite cervical e faringite que ocorre maioritariamente em crianças com idade inferior a cinco anos. A etiopatogenia é desconhecida e o diagnóstico é clínico e de exclusão. Com este trabalho pretendemos realizar uma revisão de literatura - clínica, diagnóstico e tratamento - complementada com a apresentação de um caso clínico. Materiais e métodos – Pesquisa bibliográfica e análise documental realizada através da base de dados da Medline, Pubmed e Ovid. Resultados - O uso de antibióticos ou cimetidina é ineficaz, enquanto a corticoterapia e a amigdalectomia, com ou sem adenoidectomia, reduzem a sintomatologia. Conclusões - A síndrome PFAPA é uma patologia rara, cujo reconhecimento pode ser difícil. O tratamento médico mais eficaz é a corticoterapia que, porém, não previne futuras recorrências. A terapêutica mais eficaz na resolução a longo prazo da sintomatologia é a amigdalectomia

Tratamiento de la ingestión de cuerpos extranos ˜ en una unidad de urgencias de otorrinolaringología: estudio prospectivo de 204 casos

AIMS: To determine how often ingested foreign bodies are found and what parameters may predict their retrieval. METHODS: During 1 year, we prospectively studied all patients referred to our Ear Nose and Throat Emergency Unit because of foreign body ingestion. RESULTS: During the study, 204 (median age-42 years [10 months-84 years]) patients were admitted because of ingested foreign body. The most common was fish bone (88%). Most patients were admitted <24-hour after ingestion (72%) and complained of symptoms above the cricoid cartilage (79%). A foreign body was removed by Ear Nose and Throat team in 108 (53%) patients. Twenty-three (11%) patients were referred to Gastroenterology. In 9 (39%) of these patients, a foreign body was identified by esophagogastroscopy, always from the esophagus. Predictive variables for retrieval of foreign body by Ear Nose and Throat team were ingested fish bone (P=.000; odds ratio [OR]=17.3), short duration (<6hours) of symptoms (P=.001; OR=2.3) and symptoms above or at the level of cricoid cartilage (P=.000; OR=8.9). In patients with symptoms below the cricoid cartilage the rate of retrieval of foreign body by Ear Nose and Throat team (11%) was significantly increased by Gastroenterology (41%; P=.03). CONCLUSIONS: Patients with ingestion of foreign body who ingest fish bone, present within the first 6hours or complain of symptoms at or above cricoid cartilage deserve greater investment in terms of time and resources for retrieval of ingested foreign body by Ear Nose and Throat team

Disfonia como sintoma de apresentação de cancro cérvico-torácico

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