Atencion Primaria Practica最新文献

Introduction

Analytical methods providing plasma values of thyroid hormones are vulnerable to various interferences that alter the results. An example is the presence of anti-thyroid hormone antibodies (anti-HT), common in patients with autoimmune hypothyroidism, which can disrupt the instrument signal and yield a falsely elevated hormone value in the sample. Only 50% of cases of analytical interferences are reported. These interferences can lead to misdiagnoses and inappropriate therapeutic management, resulting in harm to the patient and increased healthcare expenditure.

Case

A 72-year-old woman with autoimmune hypothyroidism on replacement therapy. Routine analysis reveals an elevation in T4 with TSH also above the reference range, when the expected outcome would be TSH suppression. This pattern is confirmed twice with the same analyzer. As the patient is asymptomatic, analytical interference is suspected. Following a protocol established by the Clinical Analysis laboratory, major known interferences are ruled out, leading to the detection of anti-HT as the cause of the false T4 value. Management changes, with medication dosage now monitored solely based on TSH levels.

Conclusions

Interferences lead to erroneous interpretations. In this case, considering overdosing of treatment and reducing the LT4 dose would induce hypothyroidism symptoms. Assuming another form of hyperthyroidism, discontinuing treatment, or initiating anti-thyroid drugs would result in similar harm. By detecting the interference, unnecessary iatrogenesis is avoided.

Tuberculosis (TB) is a chronic granulomatous disease caused by Mycobacterium tuberculosis, with extrapulmonary manifestations occurring in approximately 1% of cases. Among these, central nervous system involvement, including intracranial tuberculomas, is rare. We present the case of a 13-year-old female from Borama, Somalia, admitted with abnormal lip movements and a complex medical history, including weight loss, recurrent urinary tract infections, and a familial predisposition to TB. Neurological examination revealed left-sided facial deviation and hyperreflexia, prompting investigations that confirmed left temporal epilepsy and a right-sided tuberculoma. Treatment with levetiracetam and anti-TB medication led to significant improvement. This case underscores the importance of considering tuberculomas in the differential diagnosis of neurological presentations, even in non-HIV patients, especially in resource-limited settings like Africa.

Esophageal carcinoma during pregnancy is an extremely rare condition that presents unique challenges in terms of diagnosis and management. In this case study, we report on a 34-year-old pregnant woman from Somalia/Somaliland who presented with dysphagia and weight loss. She had previously been treated for gastroesophageal reflux disease, but her symptoms worsened over time. Upon examination, the patient exhibited cachexia, palpable cervical nodes, and basal crepitation upon admission. A CT scan of the neck revealed esophageal carcinoma with metastasis, while an ultrasonography confirmed the presence of a 24-week fetus. Due to the limited availability of chemotherapy and cancer treatment facilities, palliative care was initiated, unfortunately resulting in the unfortunate demise of both the patient and the fetus. This case highlights the significant impact of resource scarcity on disease management, as well as the ethical complexities involved in making decisions regarding palliative care for pregnant patients with cancer. It emphasizes the importance of timely diagnosis and the implementation of comprehensive, multidisciplinary approaches in addressing such rare occurrences.

Anxiety is an emotion that has accompanied humanity throughout its history; It has been the engine of change and survival, but when it appears disproportionately or in the face of wrong stimuli, it is when we are facing an anxiety disorder.

Currently, anxiety disorders are a real health problem for all health systems due to their high prevalence in the population and since the start of the COVID pandemic this situation has not improved at all.

In this article we examine the prevalence data to date, the variability that they present and their impact in the context of primary care.

We present a case report of subacute thyroiditis in a patient who exhibited symptoms indicative of thyroid storm. Initially, our patient visited her primary care physician, presenting dyspnea at rest and orthopnea, along with analytical abnormalities. Considering the epidemiological background, her PCP decided to refer her to the emergency department for optimal management and treatment. Given the high mortality and morbidity rates associated with untreated cases, it was decided to conduct a review of the management at emergency department.