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Guidelines for the Diagnosis and Treatment of Uncomplicated (NonLymphogranuloma Venereum) Chlamydia trachomatis Infection in Portugal
No full textChlamydia trachomatis infection is the most prevalent sexually transmitted bacterial infection in the world. Being associated with a large number of asymptomatic carriers, the diagnosis is frequently challenging and requires appropriate laboratory testing. In Portugal, the incidence of the disease has been consistently increasing in recent years, meaning that special awareness is required for case identification, contact tracing and application of appropriate treatments. These recommendations result from the adaptation of the international consensuses on the diagnosis and treatment of Chlamydia trachomatis infection to the Portuguese healthcare setting, with the aim of standardizing the clinical and laboratory approach to symptomatic and nonsymptomatic carriers of the disease.info:eu-repo/semantics/publishedVersio
Strategies for Research Capacity Building by Family Physicians in Primary Healthcare: a Scoping Review Protocol
No full textIntroduction: The qualities of primary healthcare (PHC) make it a very relevant environment for research; however, there is still work to be done to enhance the research capabilities of family physicians in healthcare units. Considering there is no ongoing review that specifically addresses this objective, the proposed goal of this scoping review is to determine the depth of the literature on the current strategies that support research capacity building among family physicians in the context of PHC.
Methods and analysis: The scoping review will include studies from PubMed, Scopus, Web of Science, Cochrane Library and grey literature, published from 2008 to 2023, that address strategies to promote research capacity building among family physicians in the context of PHC. Only studies published in English, Portuguese or Spanish will be considered. All study designs, including quantitative, qualitative and mixed-methods studies, will be eligible for inclusion. The literature search will be performed from January to March of 2024 and data charting will employ a descriptive-analytical method, systematically summarising study objectives, methodologies, findings and implications. This protocol follows the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols and the review will employ the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews.
Ethics and dissemination: This review does not need ethical approval. Peer-reviewed publications, policy summaries, presentations at conferences and involvement with pertinent stakeholders are all part of our outreach approach.info:eu-repo/semantics/publishedVersio
Cold Agglutinin Syndrome and Hemophagocytic Lymphohistiocytosis: An Unusual Combination Caused by Epstein–Barr Virus Infection
No full textAutoimmune hemolytic anemia (AIHA) and hemophagocytic lymphohistiocytosis (HLH) are rare complications of infectious mononucleosis. The authors describe a 12-year-old male with acute infectious mononucleosis, hepatitis, cholestasis, and an autoimmune hemolytic disorder caused by cold agglutinins IgM (anti-i specificity). Clinical deterioration with persistent fever, anemia, and hepatosplenomegaly was consistent with cold AIHA plus concomitant HLH. The patient was treated with corticosteroids and acyclovir, with an uneventful recovery. Although rare, cold agglutinin syndrome and HLH can complicate infectious mononucleosis and should be considered in a patient with clinical deterioration. Corticosteroids are the mainstay treatment of HLH and may be beneficial in infection-associated cold agglutinin syndrome.info:eu-repo/semantics/publishedVersio
Comparação do Custo de Lentes de Desfocagem e Atropina Manipulada no Tratamento da Miopia no Contexto Português
No full textINTRODUCTION: The rising prevalence of myopia poses a substantial global concern. Low concentration atropine and defocus spectacle lens (DSL) are the most widely used myopia prevention treatment in Portugal. Atropine drops must be compounded in pharmacies, because there is still no commercial low concentration atropine approved in Portugal. There are no studies with enough evidence to prefer one treatment over the other, so cost might be a decisive factor. Our purpose was to compare the costs between DSL and compound atropine for myopia progression prevention in Portugal.
METHODS: We collected data on compound atropine from different pharmacies in Portugal, monofocal (MF) lenses prices from the four most common brands in Portugal and DSL price from brand representatives. Cost estimates were done per year of four consecutive years of myopia prevention treatment, considering different scenarios according to the need of spectacle lens exchange. We compared costs of low dose compound atropine plus MF lens versus DSL in the different scenarios.
RESULTS: Atropine treatment proved more cost-effective than DSL treatment only when there was a requirement for lens exchange every 6 months or less (609.25€ for atropine versus 780.00€ for DSL per year of treatment). When myopia progression prevention is more effectiveand the need of lens exchange is equal or greater than 12 months, DSL treatment showed to be less expensive than mean values of atropine treatment plus MF lens (390.00€ for DSL vs 464.59€ for atropine, per year of treatment).
CONCLUSION: DSL take a cost advantage in prevention of myopia progression, in situations when there is a need of lens exchange within once a year or less frequently. However, atropine plus MF lenses might be a less expensive in cases whenever there is a need of lens exchange every 6 months or more frequently. It is essential to conduct further studies focusing on the costeffectiveness of different treatment options for preventing myopia progressioninfo:eu-repo/semantics/publishedVersio
Robotic Colorectal Surgery: Analysis of the First Three Years of Activity in a Hospital of the Portuguese National Health Service
No full textIntrodução: A utilização da cirurgia minimamente invasiva no tratamento da patologia colorretal é hoje cientificamente aceite e o seu uso na prática clínica diária tem vindo a aumentar de forma sustentada. Diversos estudos indicam que a abordagem robótica pode trazer vantagens sobre a laparoscopia ‘convencional’, especialmente na cirurgia do reto. Este trabalho descreve e analisa os resultados dos primeiros três anos de cirurgia robótica na Unidade de Patologia Colorretal da Unidade Local de Saúde S. José.
Métodos: Foram definidas as variáveis a analisar e construída uma base de dados prospetiva com os dados referentes aos doentes operados consecutivamente por três cirurgiões colorretais, acreditados internacionalmente na utilização do sistema Da Vinci Xi®, entre novembro de 2019 e outubro de
2022. A base de dados foi convertida numa versão anonimizada e foi sobre essa mesma que se procedeu à análise de dados. Foram analisados os dados de todos doentes operados nesse período.
Resultados: Foram incluídos 80 doentes, 47 homens, mediana de idade de 70 anos e de IMC de 26 kg/m2. O score ASA era II em 53,7% e III em 41,3% dos doentes. Do total, 97,6% apresentavam doença maligna ou potencialmente maligna. Realizaram-se 34 colectomias proximais ao ângulo esplénico, 20 distais e 26 ressecções anteriores do reto. Houve ressecção síncrona de metástases hepáticas em dois casos. Foram analisados os resultados peri-operatórios a curto prazo e histopatológicos: duração (mediana): 300 minutos; perda hemática estimada (mediana): 50 mL; taxa de conversão: 2,5%; dias até retomar trânsito intestinal (mediana): três dias; dias de internamento (mediana): seis dias; taxa de complicações pós-operatórias: 20%,
das quais 5% Clavien III e 0% Clavien IV/V; taxa de deiscência anastomótica: 2,5%; taxa de reintervenção: 2,5%; taxa de readmissão pós-alta: 1,3%; gânglios linfáticos ressecados (mediana): 20; taxa de ressecção R0: 100%; taxa de integridade mesorretal: 95,8% completo/quase completo.
Conclusão: Os nossos resultados mostram que a introdução da cirurgia colorretal robótica no nosso centro foi segura e garantiu resultados clínicos a curto prazo e histopatológicos semelhantes ou favoráveis face aos descritos na literatura.Introduction: Minimally invasive surgery has been increasingly accepted and used in colorectal surgery. Several studies report that robotic surgery may provide advantages over 'conventional' laparoscopy, namely in rectal surgery. This paper provides an account of the first three years of experience with robotic surgery in the Unidade de Patologia Colorretal of the Unidade Local de Saúde S. José.
Methods: Variables were defined to develop a prospective database containing the data of consecutive patients operated by three internationally certified colorectal surgeons using the Da Vinci Xi® system between November 2019 and October 2022. The database was converted into an anonymized version that was used for this study. The analysis was performed on the data of all the patients operated during this period.
Results: Eighty patients were included, 47 male, median age 70 years, and median BMI 26 kg/m2 . ASA score was II in 53.7% and III in 41.3% of pa- tients. Of the total, 97.6% had malignant or potentially malignant disease. Operative procedures consisted of 34 colectomies proximal to the splenic flexure, 20 distal colectomies and 26 anterior resections. There were two synchronous resections of liver metastases. Early perioperative outcomes and histopathological results were analyzed: median operative time: 300 minutes; median estimated blood loss: 50 mL; conversion rate: 2.5%; median days until first bowel movement: three days; median length of hospital stay: six days; complication rate: 20%, of which 5% were Clavien III and 0% Clavien IV/V; anastomotic leak rate: 2.5%; 30-day readmission rate: 1.3%; median lymph nodes resected: 20; R0 resection rate: 100%; mesorectal integrity rate: 95,8% complete/near complete.
Conclusion: Our results show that the adoption of robotic colorectal surgery in our center was safe and resulted in similar or improved short-term clinical outcomes and histopathological results when compared to those described in the literature.info:eu-repo/semantics/publishedVersio
When a Child Refuses to Play: A Rare Myopathy.
No full textIdiopathic inflammatory myopathies (IIM) are a rare group of systemic diseases characterized by progressive proximal muscle weakness and skeletal muscle inflammation. We describe a clinical report of a seven-year-old boy presenting with myalgia and proximal muscle weakness beginning three weeks earlier, with laboratory, MRI, and muscle biopsy findings consistent with IIM. The patient was treated with corticosteroids, methotrexate, immunoglobulin, and intensive motor rehabilitation, with favorable evolution. Diagnosis of Juvenile Polymyositis was confirmed. Three years later, we assisted a relapse of muscle weakness and muscle cytolysis with the onset of bilateral eyelid skin microulcers compatible with dermatomyositis. This report intends to highlight the importance of early diagnosis and treatment in IIM due to the significant burden associated with this group of diseases. In this case, the late onset of the skin lesion contributed to the challenge in this diagnosis
Ensaios Clínicos em Portugal: Passado e Futuro. Posicionamento dos Colégios de Farmacologia Clínica e de Medicina Farmacêutica
No full textComparison of Outcomes of Immunosuppressive Therapy with Rabbit versus Horse Antithymocyte Globulin and Cyclosporine a in Children with Acquired Severe Aplastic Anemia.
No full textAn Unusual Case of Overlapping Immunoglobulin G4-Related Disease and Systemic Lupus Erythematosus.
No full textImmunoglobulin G4-related disease (IgG4-RD) and systemic lupus erythematosus (SLE) are multisystemic autoimmune disorders that can present with renal manifestations. Overlapping cases of these diseases are extremely rare and present both diagnostic and therapeutic challenges. We report the case of a 70-year-old male with a history of autoimmune pancreatitis, who was admitted with fatigue, weight loss, and worsening kidney function. Laboratory tests revealed anemia with a positive Coombs test, leucopenia, elevated IgG4, hypocomplementemia, and positive results for ANA, anti-double-stranded DNA (dsDNA), anti-nucleosome, anti-RP11 antibodies, and rheumatoid factor. A spot urine sample showed subnephrotic proteinuria without hematuria. The patient met the criteria for both SLE and possible IgG4-RD, but the cause of the worsening renal function remained unclear, prompting a kidney biopsy. The biopsy revealed a lymphoplasmacytic infiltrate, storiform fibrosis, and IgG4-positive staining, consistent with IgG4-related tubulointerstitial nephritis, but without evidence of lupus nephritis. The patient was treated with prednisolone, resulting in improvement of both his symptoms and kidney function. However, significant leukopenia, anemia, and elevated anti-dsDNA titers persisted, which were presumed to be secondary to the overlapping SLE. Hydroxychloroquine and azathioprine were added to the treatment regimen, leading to improvement in cytopenias at the three-month follow-up. This case underscores the importance of kidney biopsy in suspected overlapping autoimmune diseases for identifying kidney involvement and guiding treatment, although evidence regarding optimal therapy remains limited
Mapping the Landscape: Simulation Centers in Portugal.
No full textIntroduction: Simulation-based training has emerged as a vital component of healthcare education. This study aims to characterize Portuguese simulation centers concerning their geographic distribution and key features, providing stakeholders with valuable insights to inform strategic decisions.
Methods: A cross-sectional survey-based study was conducted over two years (2021-2023) to investigate the geographical dispersion and characteristics of simulation centers in Portugal. Descriptive statistics and thematic analysis were used to analyze data.
Results: Twenty-three Portuguese simulation centers were included. Major urban areas and coastal regions bring together 20 simulation centers (86.96%). A large percentage (71.93%) of centers were affiliated with academic institutions, while five centers (21.74%) were clinically affiliated. Emergency care, Anesthesiology
and Intensive Medicine, Pediatrics, and Gynecology and Obstetrics were identified as the national key areas of intervention.
Discussion: Significant geographical disparity raises concerns about unequal access to professional training opportunities using simulation. Centers should be encouraged to incorporate developing technologies and innovative pedagogical methodologies and to expand their training repertoire into relatively uncharted territories.
Conclusion: Several issues have been identified within the national simulation network. Stakeholders and policymakers should prioritize equitable access, bolster the prevalence of clinical affiliated centers, foster innovation, and facilitate strategic coordination