LAPAROSCOPIC METASTASECTOMY OF ADRENAL MASS: A THERAPEUTIC OPTION. CASE REPORT AND LITERATURE REVIEW.

Invasive ductal breast carcinoma (IDC) metastasizes to several organs, but it does not usually affect the adrenal glands. In our knowledge, the cases described in the literature are few. A 60-year-old woman diagnosed with ductal breast carcinoma, was found to have adrenal metachronous metastasis during follow-up. While treatment is unclear, laparoscopic adrenalectomy could be a treatment option with curative intention. In our patient, we decided transperitoneal laparoscopic adrenalectomy, with favourable evolution after surgery.

Rhabdomyolysis Following Administration of Comirnaty®

Introduction: Vaccination against COVID-19 is essential to control the pandemic. The vaccines developed so far have good safety profiles but full knowledge of adverse effects will only be acquired with time and through case reports. Case Description: We present the case of a man admitted with rhabdomyolysis 3 days after receiving his first dose of the Pfizer coronavirus vaccine Comirnaty® Other traumatic, infectious, endocrine, electrolyte disturbance and autoimmune causes of rhabdomyolysis were excluded. The temporal relationship between vaccine administration and disease onset indicated possible causality. The patient had a favourable evolution after receiving fluids and completely recovered. To our knowledge, there have been only 69 reports of rhabdomyolysis following Comirnaty® administration in Europe, as stated by the European Medicines Agency, and this is the first case report in Portugal. Discussion: When a patient presents with rhabdomyolysis without an obvious traumatic or exertional cause, other aetiologies need to be excluded. Drug use is one of the most common causes of rhabdomyolysis in adults. Conclusion: We present a case compatible with an adverse effect of Comirnaty® in order to raise awareness of this condition in vaccinated patients.

Suspected Plasmodium falciparum resistance to artesunate in Cameroon: A case report

Malaria in pregnancy is associated with adverse maternal and perinatal outcomes. The first-line treatment for severe malaria in the second and third trimesters of pregnancy is parenteral artesunate, according to WHO recommendations. Resistance of Plasmodium falciparum to artesunate has not yet been noted in our country. We report a case highly suspicious of such. A pregnant woman presented with the clinical signs of malaria. After paraclinical confirmation of the diagnosis, she was admitted and injectable artesunate was given for 72 h at the recommended dosage, with antipyretic without any improvement. Artesunate was therefore replaced by parenteral quinine, with favourable evolution. Resistance of Plasmodium falciparum to artesunate might be present in our country. This patient provides a warning about possible artesunate resistance, and this calls for careful monitoring of other cases of malaria been treated with this drug to ascertain the possibility of resistant cases.

Extensive right-sided infectious endocarditis due to Streptococcus pneumoniae

Streptococcus pneumoniae is a rare cause of infectious endocarditis. Most cases have an acute and aggressive evolution, with a high mortality rate. We report the case of a 36-year-old man, with a history of unrepaired ventricular septal defect, who came to the emergency department with fever, cough and asthenia with 3 months of evolution. Blood cultures were positive for Streptococcus pneumoniae. Echocardiogram showed large vegetation on septum, free wall and outflow tract of the right ventricle. Thoracic CT revealed septic pulmonary embolism. Antimicrobial therapy and surgical treatment was performed and the patient presented a favourable evolution.

Flecainide toxicity associated with the use of goji berries: a case report

Background Goji berries (GB), usually marketed as a ‘superfruit’, are a widely used herbal supplement. As with other herbal remedies, the use of GB might be associated with herb–drug interactions, increasing plasma levels of other drugs and causing adverse events. Here, we present the case of a patient that developed flecainide toxicity secondary to an herb–drug interaction, associated with the use of GB to prevent COVID-19. Case summary A 75-year-old female presented to the emergency department with fainting. She was taking flecainide for the treatment of atrial extrasystoles diagnosed 2 years previously, and she was using a tea of GB for the prevention of COVID-19. The admission electrocardiogram showed a wide complex polymorphic tachycardia that was considered and treated as flecainide toxicity. The patient had a favourable evolution and was discharged 48 h after admission. Discussion Flecainide toxicity is uncommon and needs timely recognition and treatment; it is usually secondary to overdose and renal or hepatic failure. In our case, toxicity was associated with GB use, probably by inhibition of CYP2D6 which is the main enzyme associated with the metabolism of flecainide. Clinicians need to be aware of the possible interactions between herbal remedies (in this case used for the prevention of COVID-19) and cardiovascular drugs that are used to treat chronic cardiovascular diseases.

Woakes’ syndrome: Case report

Woakes’ syndrome is a rare entity, defined as severe recurrent chronic rhinosinusitis with nasal polyps, which has as a consequence the deformation of the nasal pyramid, produced by the continuous pressure and the inflammation maintained by the size of the polyps. This paper reviews the main features of Woakes’ syndrome by describing a clinical case. The patient presented to the ENT Outpatient Clinic for aggravation of an obstructive nasal respiratory syndrome, associated with rhinor-rhea, headache, anosmia and deformity of the nasal pyramid. The ENT clinical examination, the nasal endoscopic examination and the craniofacial CT scan established the diagnosis of Woakes’ syndrome. Functional endoscopic sinus surgery was performed. The follow-ups performed at 10 days and later, a month after surgery, showed a favourable evolution, without signs of local recurrence and a narrowing of the nasal pyramid compared to the preoperative moment. Proper management and proper adherence to the therapeutic protocol are factors that can prevent the onset of this syndrome.

Pregnancy related breast cancer: report of three cases

Pregnancy-related breast cancer is defined as breast cancer diagnosed during pregnancy or within a year after delivery. In current report, 3 cases of breast cancer, diagnosed during pregnancy are presented. Different diagnostic challenges, different therapeutic methods and major influences of breast cancer on obstetrical outcomes are also discussed in current report. In current case series, the three patients had ages of 36, 40 and 44 years old. They were all diagnosed as having breast cancer during pregnancy. Diagnosis was achieved using imaging, and histopathology through breast biopsy. The histological type was not otherwise specified breast cancer in all three cases. Delivery was vaginal in two cases and through caesarean section in one case. Interruption of pregnancy was performed in one case. A bad prognosis was observed in one patient with death after chemotherapy and surgery, and a favourable evolution was observed in the two other cases. The management of this complex entity must be multidisciplinary.

An Unexpected Favourable Evolution of Advanced Stage Cirrhosis

The elimination of the aetiological factors causing liver injury is an important cornerstone in preventing progression and increasing survival in patients with cirrhosis. The authors present the case of a 63-year-old woman with a history of long-term alcohol abuse and consequent liver cirrhosis. Over the years, the patient presented progressive deterioration with severe malnutrition and had multiple hospital admissions due to decompensated cirrhosis, including refractory ascites, variceal bleeding and an extensive portal vein thrombosis (PVT). Anticoagulant therapy was not initiated due to a high risk of variceal bleeding. She eventually became abstinent, but PVT precluded a liver transplant. Over the following 10 years, her performance status gradually improved, with no new decompensation episodes and liver function normalization, although refractory ascites persisted. Abdominal CT showed spontaneous recanalization of the portal vein and a transjugular intrahepatic portosystemic shunt (TIPS) procedure was performed with gradual improvement of ascites. In this atypical case, an unexpected favourable evolution of advanced stage cirrhosis was observed with long-term improvement in clinical status and liver function, resulting in an estimated 10-year cumulative mortality rate of 99.98% and highlighting the importance of abstinence. Unexpectedly, spontaneous complete repermeabilization of the PVT was also observed, despite its extent and the absence of anticoagulation therapy.

The Relationship Between Entrepreneurship and Digitalization - Spotlight on the EU Countries

In the current context of the modern world, economies depend on a dynamic innovative environment, the innovation actually representing one of the main facilitators of change. The economic growth has certainly led to an exponential increase with respect to the interaction between innovation and entrepreneurship. Undoubtedly, innovation depends on the entrepreneurial context and mostly on the cooperation between the market process’ level actors. In order to implement the innovation in the entrepreneurial activities, there is a sine qua non condition of having the abilities to contribute as a promoter on spreading and adoption of innovation. The current innovations are, in certain situations, capitalized and they can be oriented towards gaining profit. The disparities in terms of development and the favourable evolution of the business environment are determined by multiple factors, at present the implementation of technologies representing one of them. The correlation between technology and economy exists and the effects it produces on the market reality are showcased in this article. Therefore, the purpose of the current research is to identify the correlations between the economic development and technologies adoption in the entrepreneurial field. For this purpose, quantitative methods have been used in order to strengthen the obtained results.

Anomalous origin of right pulmonary artery: diagnosis, treatment, and follow-up in an adult patient

Anomalous origin of a branch pulmonary artery from the aorta is a rare malformation, accounting for 0.12% of all congenital heart defects. We present the case of a 43-year-old man with an anomalous origin of the right pulmonary artery (AORPA) from the ascending aorta. Reimplantation of the right pulmonary artery was carried out successfully, with favourable evolution in the medium-term follow-up. It is the first described case that receives corrective treatment in adulthood with a favourable evolution.