Abstract Body

Background

Covid-19 infection poses a serious challenge for immune-compromised patients with inflammatory autoimmune systemic diseases.We present a case which occurred during the covid-19 pandemic,in which an infection of Sars-Cov-2 has an impact on the diagnostic hypothesis.

Case Description

A 63 years old female patient with history of allergic rhinitis and asthma,began with dyspnoea,cough,nausea and fatigue in April 2020.Due to worsening of her clinical condition,she was admitted to the hospital.She presented lymphopenia.SarsCov2 swab with a negative result. The lung computed tomography(CT) described aspects of bronchopneumonic infectious process suggestive of sar-cov-2 infection. She started hydroxychloroquine therapy and she repeated the SarsCov2 swab with negative result. In May 2020 she went to the emergency department presenting with fever and musculoskeletal symptoms with migrant arthralgia associated with edema of hands and legs. She presented elevated serum creatine kinase(CK),aspartate aminotransferase(AST),alanine aminotransferase(ALT),and was discharged with diagnostic hypothesis of Arthritis/Reactive Myositis of unclear aetiology, and treated with anti-inflammatory therapy. Due to maintenance of the clinical situation with myalgia, arthralgia, persistent fatigue and dyspnoea for small efforts, she was admitted to the hospital a month later.She needed a supplementary supply of O2 during hospitalization. At the electromyography and magnetic resonance of the pelvis the result was compatible with an inflammatory myopathy.The lung CT described worsening of multifocal opacities configuring geographic areas of peribronovascular and subpleural ground glass. A muscle biopsy was performed and the diagnosis was definitive: Autoimmune polymyositis with positive antiJo1 and antiSSA with interstitial lung disease.The patient began corticotherapy with symptomatic improvement.

Results/Conclusions

This case alerts the physicians about autoimmune diseases which can mimic COVID-19 infection.

Abstract Body

Background and purpose: Rapidly progressive dementias are a heterogeneous group of diseases that present with cognitive, behavioural and/or motor disturbance. A detailed workup is essential since there are treatable causes.

Methods: Descriptive case presentation

Clinical Case: A previously healthy 58-year-old woman presented with episodes of confusion, disorientation and forgetfulness, with a progressive worsening in the previous 6 months. In the past month, she had persecutory delirium and visual hallucinations, with mood swings.

She answered with circumstantial speech, always turning to her son for support and clues when asked direct questions. She denied any health problem. Her mini mental state examination showed problems in all areas but language, with a score of 12 (12 years of schooling). Her laboratory workup and head CT were normal.

She was then seen by Neurology and Psychyatry and was started on medication, assuming a mixed episode in a bipolar spectrum disorder.

She kept worsening for another month and was admitted to the Neurology inpatient department. An extensive investigation was performed excluding reversible causes of dementia. After 2 months she was transferred to a continued care unit, requiring help for most basic daily activities. She died of pneumonia before a definitive diagnosis was reached.

Conclusions: This case is an example of a cognitive disorder that presented in a young patient and required a multidisciplinary approach. However, even with an inpatient investigation, the etiology was never identified after 10 months since the initial symptoms, reminding us of the limitations we still have in current medical care.

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Background and purpose: Tuberculosis is an airborne infection caused by Mycobacterium Tuberculosis. Extrapulmonary involvement occurs in about a fifth of all tuberculosis cases. Genitourinary tuberculosis (GUTB) is uncommon, with only 20% of cases and with testicular location accounting only for 3%, making a differential diagnosis with epididymo-orchitis.

Methods: Descriptive case presentation.

Clinical Case: A 73 years old male, with a history of smoking habits, hypertension, and bladder cancer in 2007, presented himself in consultation with fever and acute right testicular pain. The physical exam revealed inflammatory signs without masses; he was treated with cefuroxime. The patient returned after four months with testicular pain and swelling, increased frequency of urination and fatigue. He had a recent ultrasound showing inflammation of the spermatic cord and also the urine culture came back negative. He was treated with trimethoprim/sulfamethoxazole and reevaluated after 20 days. By then, he also referred pelvic pain, and the testicular ultrasound revealed a bilateral exuberant suppurative process and prostatic inflammatory focus.

The patient was seen in Urology and started ceftriaxone, aztreonam and ciprofloxacin. The abcess was drained. He kept the abcess and a right orchidectomy was performed. The pathological anatomy gave the final diagnosis of epididymal and testicular tuberculosis. The patient was referred to pulmonology, pulmonary involvement was excluded and he started anti bacillary treatment.

Conclusions: The epididymo-orchitis constitutes a diagnostic challenge for its multiple possible etiologies. In this case, despite an early antibiotic treatment, this patient status continued to aggravate, reminding us the importance of early reference when a clinical course is not as expected.

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Background: Food education has a major impact in childhood development and on healthy choices in adolescence and adulthood. In industrialized countries, family food habits have changed, with less time for family meals and food preparation, as also with greater availability of energetic and processed foods, providing an obesity prosperous environment. Food education starts with food diversification and progression into family meals. As Family Physicians we can educate parents and children food choices leading then into better lifestyles.

Aim and learning objectives: With this workshop we intend to explore food diversification and nutritional needs in preschool children. Our objectives are:

- Raise awareness of the importance of food education in the prevention of the obesity pandemic;

- Review of main and practical aspects of complementary feeding;

- Discussion of nutritional needs and education for each age group;

- Practical management of the main difficulties and parent’s frequent questions.

Estimated number of participants: 45-50.

Methods and timetable: The speakers will present the topics described above, using a power point presentation. This workshop intends to be interactive, and we will divide the participants into groups to discuss normal growth, food needs and education in different stages: until 12 months; age 1 to 2 years; age 2 to 6 years, allowing them to share their clinical experience and daily difficulties.

(Proposed) Results / Conclusions: With these workshop the participants will be able to offer food counseling regarding food diversification and guidance for parents towards food education and healthy choices during preschool years.

Abstract Body

Background and purpose: Tuberculosis is an airborne infection caused by Mycobacterium Tuberculosis. Extrapulmonary involvement occurs in about a fifth of all tuberculosis cases. Genitourinary tuberculosis (GUTB) is uncommon, with only 20% of cases and with testicular location accounting only for 3%, making a differential diagnosis with epididymo-orchitis.

Methods: Descriptive case presentation.

Clinical Case: A 73 years old male, with a history of smoking habits, hypertension, and bladder cancer in 2007, presented himself in consultation with fever and acute right testicular pain. The physical exam revealed inflammatory signs without masses; he was treated with cefuroxime. The patient returned after four months with testicular pain and swelling, increased frequency of urination and fatigue. He had a recent ultrasound showing inflammation of the spermatic cord and also the urine culture came back negative. He was treated with trimethoprim/sulfamethoxazole and reevaluated after 20 days. By then, he also referred pelvic pain, and the testicular ultrasound revealed a bilateral exuberant suppurative process and prostatic inflammatory focus.

The patient was seen in Urology and started ceftriaxone, aztreonam and ciprofloxacin. The abcess was drained. He kept the abcess and a right orchidectomy was performed. The pathological anatomy gave the final diagnosis of epididymal and testicular tuberculosis. The patient was referred to pulmonology, pulmonary involvement was excluded and he started anti bacillary treatment.

Conclusions: The epididymo-orchitis constitutes a diagnostic challenge for its multiple possible etiologies. In this case, despite an early antibiotic treatment, this patient status continued to aggravate, reminding us the importance of early reference when a clinical course is not as expected.

Abstract Body

Background: Food education has a major impact in childhood development and on healthy choices in adolescence and adulthood. In industrialized countries, family food habits have changed, with less time for family meals and food preparation, as also with greater availability of energetic and processed foods, providing an obesity prosperous environment. Food education starts with food diversification and progression into family meals. As Family Physicians we can educate parents and children food choices leading then into better lifestyles.

Aim and learning objectives: With this workshop we intend to explore food diversification and nutritional needs in preschool children. Our objectives are:

- Raise awareness of the importance of food education in the prevention of the obesity pandemic;

- Review of main and practical aspects of complementary feeding;

- Discussion of nutritional needs and education for each age group;

- Practical management of the main difficulties and parent’s frequent questions.

Estimated number of participants: 45-50.

Methods and timetable: The speakers will present the topics described above, using a power point presentation. This workshop intends to be interactive, and we will divide the participants into groups to discuss normal growth, food needs and education in different stages: until 12 months; age 1 to 2 years; age 2 to 6 years, allowing them to share their clinical experience and daily difficulties.

(Proposed) Results / Conclusions: With these workshop the participants will be able to offer food counseling regarding food diversification and guidance for parents towards food education and healthy choices during preschool years.