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Disparidade de Género nas Classificações dos Médicos Internos de Neurologia em Portugal
No full textImplicit bias has been linked to gender disparities in medical careers, impacting not only access to leadership positions but also early career opportunities. We aimed to evaluate if there were differences in the assessment of Neurology residents according to gender. We collected publicly available grades and rankings of two major evaluations that residents are submitted to, one at the beginning and another at the end of the neurology residency program, the National Board Exam and neurology examination, respectively. The National Board Examination is a multiple-choice gender-blinded evaluation, while the neurology examination is an oral gender-unblinded evaluation. We found that 36.5% of women and 21.6% of men were in the first quartile of the National Board Examination ranking, which reflects a similar representation among top classifications when assessed through a gender-blinded examination. On the other hand, the percentage of men who were in the top classification of NE, a gender-unblinded evaluation, was more than twice as high compared to women (37.8% vs 18.3%, p < 0.05). The findings of the present study may imply that there could be a disparity in women's career progression among neurology residents in Portugal, although the recruitment seems balanced between genders.O preconceito implícito tem sido associado a disparidades de género nas carreiras médicas, influenciando o acesso a cargos de liderança e oportunida-des ao longo da carreira. Pretendeu-se avaliar se existiriam diferenças na avaliação de médicos internos de neurologia de acordo com o género. Foram comparadas as classificações disponíveis publicamente de dois momentos de avaliação aos quais os médicos internos de neurologia são submetidos, no início e final do internato de neurologia, respetivamente: a Prova Nacional de Acesso à Formação Especializada e o exame final de neurologia. A Prova Nacional de Seriação é uma avaliação de escolha múltipla, com ocultação de género na atribuição da classificação. O exame final de neurologia é uma avaliação oral sem ocultação de género na atribuição da classificação. Verificou-se que 36,5% das mulheres e 21,6% dos homens estavam no quartil superior de classificação na Prova Nacional de Seriação, o que reflete uma representação semelhante entre classificações superiores quando a avaliação é dependente de um exame com ocultação de género. Pelo contrário, a percentagem de homens no quartil superior de classificação no exa-me final de neurologia, uma avaliação sem ocultação de género, foi mais do dobro das mulheres (37,8% vs 18,3%). Os resultados do presente estudo podem implicar que existe uma disparidade na progressão na carreira das mulheres entre os médicos internos de neurologia em Portugal
Issue 2 - "Update on Adverse Respiratory Effects of Indoor Air Pollution" Part 1): Indoor Air Pollution and Respiratory Diseases: A General Update and a Portuguese Perspective.
No full textObjective: To quantify the impact of different air pollutants on respiratory health based on robust estimates based on international data and to summarise the evidence of associations between indoor exposure to those pollutants and respiratory morbidity in the Portuguese population.
Results: Several systematic reviews and meta-analyses (MA) at the world level demonstrate the impact of indoor air quality on respiratory health, with indoor particulate matter and gasses exerting a significant effect on the airways. Volatile organic compounds (VOC) have been related to asthma and lung cancer. However, only meta-analyses on biomass use allowed documentation of long-term respiratory effects. While early publications concerning Portuguese-based populations mainly focused on indoor exposure to environmental tobacco smoke, later studies relocated the attention to relevant exposure environments, such as day care buildings, schools, residences and nursing homes. Looking at the pooled effects from the reviewed studies, high levels of carbon dioxide and particulate matter in Portuguese buildings were significantly associated with asthma and wheezing, with VOC and fungi showing a similar effect in some instances.
Conclusions: Despite the significant reduction of indoor air pollution effects after the 2008 indoor smoking prohibition in public buildings, studies show that several indoor air parameters are still significantly associated with respiratory health in Portugal. The country shares the worldwide necessity of standardisation of methods and contextual data to increase the reach of epidemiological studies on household air pollution, allowing a weighted evaluation of interventions and policies focused on reducing the associated respiratory morbidity
Persistence With Medical Glaucoma Therapy in Newly Diagnosed Patients.
No full textBackground: Monotherapy, age, and side effects are significant risk factors for the discontinuation of antiglaucoma therapy. Long-term therapy persistence is crucial for slowing disease progression and preventing irreversible blindness. Therefore, it is essential to identify patients at higher risk of discontinuation. In this study, we aimed to evaluate the real-world persistence of antiglaucoma therapy in patients diagnosed with glaucoma in the primary healthcare units of the Lisbon and Tagus Valley regions.
Methods: We conducted a retrospective longitudinal study by collecting data from the prescription records of new antiglaucoma drug users diagnosed with glaucoma between 2012 and 2013 in the Primary Health Care Units of the Lisbon and Tagus Valley Region. These patients were followed over 3 years. Therapy persistence was measured as the proportion of patients remaining on any antiglaucoma drug, regardless of any modifications or switching of drugs over time. Persistence was assessed at three time points: the end of the first, second, and third years of the observation period.
Results: A total of 2138 patients treated using new antiglaucoma drugs (867 [40.6%] male patients; 1271 [59.4%] female patients) were included in the study. Over the observation period, the overall persistence rate decreased from 91.9% (n = 1965) in the first year to 67.3% (n = 1439) in the third year. Older patients (≥ 65 years) showed higher persistence rates, although there was a decrease over the 3-year follow-up period (from 1481 [92.7%] to 1124 [70.4%]). Additionally, participants initially treated with monotherapy showed higher persistence rates, ranging from 92.4% (n = 1186) in the first year to 70.2% (n = 901) in the third year.
Conclusions: The findings highlight the importance of patient follow-up over time, as almost one in three new antiglaucoma therapy users completely discontinued treatment, potentially risking disease progression. This could be mitigated with proper use of these drugs. Further studies should utilize recent health information systems to explore the impact of medication adherence and persistence on the functional and structural outcomes in patients with glaucoma
Contraception in Transgender People Who Were Assigned a Female Sex at Birth – A Narrative Review
No full textBackground and Purpose: Transgender people often experience suboptimal contraception counseling due to clinicians’ insufficient experience in this topic, and practitioners themselves report lack of satisfactory training. We aim to summarize the current literature on contraception counselling in transgender men and nonbinary people assigned female at birth.
Methods: The present article is a narrative review. Searches were performed in Pubmed and Google Scholar databases using the terms ‘transgender’, ‘transmen’, ‘contraception’, ‘family planning’, ‘reproductive care’. Only English and Portuguese written articles published in the last six years were considered. A manual search of references from identified studies was also conducted and international guidelines were searched for information of interest.
Results: Existing literature suggests that transgender men and nonbinary people assigned female at birth experience significant barriers to health services that can compromise their reproductive health. Regarding contraceptive options, all methods can be offered, according to the same eligibility criteria used for cisgender women. Nevertheless, specificities must be considered: differential acceptance of side effects, potential emotional and physical discomfort inherent to pelvic examination. Both patients and their healthcare providers may be unaware of the fact that ovulation may occur
during testosterone treatment, even if the person is in amenorrhea. Hence, it should not be considered for effective contraception. Also, it has known teratogenic effects, which highlights the need for preventing unplanned pregnancies. Until date, there is no evidence that testosterone use is a contraindication to any contraceptive method, therefore, transmen on this medication should be offered all options.
Conclusions: All contraceptive methods can be offered to transgender men and nonbinary individuals assigned female at birth, but the specific needs and concerns of these individuals should be considered in counseling. Literature on this field is still scarce and more studies are needed to evaluate preferences and satisfaction rates
An Interactive Dashboard for Statistical Analysis of Intensive Care Unit COVID-19 Data
No full textBackground: COVID-19 caused a pandemic, due to its ease of transmission and high number
of infections. The evolution of the pandemic and its consequences for the mortality and morbidity of
populations, especially the elderly, generated several scientific studies and many research projects.
Among them, we have the Predictive Models of COVID-19 Outcomes for Higher Risk Patients
Towards a Precision Medicine (PREMO) research project. For such a project with many data records,
it is necessary to provide a smooth graphical analysis to extract value from it. Methods: In this paper,
we present the development of a full-stack Web application for the PREMO project, consisting of a
dashboard providing statistical analysis, data visualization, data import, and data export. The main
aspects of the application are described, as well as the diverse types of graphical representations
and the possibility to use filters to extract relevant information for clinical practice. Results: The
application, accessible through a browser, provides an interactive visualization of data from patients
admitted to the intensive care unit (ICU), throughout the six waves of COVID-19 in two hospitals
in Lisbon, Portugal. The analysis can be isolated per wave or can be seen in an aggregated view,
allowing clinicians to create many views of the data and to study the behavior and consequences of
different waves. For instance, the experimental results show clearly the effect of vaccination as well
as the changes on the most relevant clinical parameters on each wave. Conclusions: The dashboard
allows clinicians to analyze many variables of each of the six waves as well as aggregated data for all
the waves. The application allows the user to extract information and scientific knowledge about
COVID-19’s evolution, yielding insights for this pandemic and for future pandemics
Consumo de Álcool na Perturbação de Hiperatividade e Défice de Atenção
No full textA Perturbação de Hiperatividade e Défice de Atenção (PHDA) é uma doença do neurodesenvolvimento cujos sintomas e neurobiologia podem conferir risco aumentado de para o consumo abusivo de substâncias tóxicas incluindo o álcool.
A Perturbação de Uso de Álcool (PUA) e PHDA partilham fatores de risco e vários mecanismos neurobiológicos, não sendo de admirar que surjam frequentemente em comorbilidade familiar e no mesmo indivíduo. Por isso, recomenda-se o screening de PHDA nos doentes que procuram ajuda por abuso de substâncias e mesmo PUA.
Nos doentes com PHDA, a PUA inicia-se mais precocemente e associa-se a piores outcomes clínicos e de tratamento. O tratamento da PUA em comorbilidade com a PHDA deve englobar preferencialmente uma abordagem fármaco e psicoterapêutica dirigida a ambas as patologiasAttention Deficit and Hyperactivity Disorder (ADHD) is a disease of neurodevelopment which symptoms and neurobiology may raise the risk of toxic substance abuse, including alcohol abuse.
ADHD and Alcohol Use Disorder (AUD) share risk factors and several neurobiological mechanisms, and are frequently found in comorbility, whether
in the same person or within family members. Therefore, the screening of ADHD is recommended in patients who present to healthcare services with Substance and Alcohol Use Disorders. In people with ADHD, AUD is associated with earlier age and worst clinical and treatment outcomes.
Treatment plan should preferably include both pharmacologic and psychotherapeutic strategies directed at both disorder
Diffusion-Weighted Imaging for Determining Response to Neoadjuvant Therapy in Pancreatic Cancer: a Systematic Review and Meta-Analysis.
No full textObjectives: To determine the role of diffusion-weighted imaging (DWI) for predicting response to neoadjuvant therapy (NAT) in pancreatic cancer.
Materials and methods: MEDLINE, EMBASE, and Cochrane Library databases were searched for studies evaluating the performance of apparent diffusion coefficient (ADC) to assess response to NAT. Data extracted included ADC pre- and post-NAT, for predicting response as defined by imaging, histopathology, or clinical reference standards. ADC values were compared with standardized mean differences. Risk of bias was assessed using the Quality Assessment of Diagnostic Studies (QUADAS-2).
Results: Of 337 studies, 7 were included in the analysis (161 patients). ADC values reported for the pre- and post-NAT assessments overlapped between responders and non-responders. One study reported inability of ADC increase after NAT for distinguishing responders and non-responders. A correlation with histopathological response was reported for pre- and post-NAT ADC in 4 studies. DWI's diagnostic performance was reported to be high in three studies, with a 91.6-100% sensitivity and 62.5-94.7% specificity. Finally, heterogeneity and high risk of bias were identified across studies, affecting the domains of patient selection, index test, reference standard, and flow and timing.
Conclusion: DWI might be useful for determining response to NAT in pancreatic cancer. However, there are still too few studies on this matter, which are also heterogeneous and at high risk for bias. Further studies with standardized procedures for data acquisition and accurate reference standards are needed.
Clinical relevance statement: Diffusion-weighted MRI might be useful for assessing response to neoadjuvant therapy in pancreatic cancer. However, further studies with robust data are needed to provide specific recommendations for clinical practice.
Key points: •The role of DWI with ADC measurements for assessing response to neoadjuvant therapy in pancreatic cancer is still unclear. •Pre- and post-neoadjuvant therapy ADC values overlap between responders and non-responders. •DWI has a reported high diagnostic performance for determining response when using histopathological or clinical reference standards; however, studies are still few and at high risk for bias
Bi-Allelic Variants in COQ8B, a Gene Involved in the Biosynthesis of Coenzyme Q10, Lead to Non-Syndromic Retinitis Pigmentosa.
No full textRetinitis pigmentosa (RP) is a Mendelian disease characterized by gradual loss of vision, due to the progressive degeneration of retinal cells. Genetically, it is highly heterogeneous, with pathogenic variants identified in more than 100 genes so far. Following a large-scale sequencing screening, we identified five individuals (four families) with recessive and non-syndromic RP, carrying as well bi-allelic DNA changes in COQ8B, a gene involved in the biosynthesis of coenzyme Q10. Specifically, we detected compound heterozygous assortments of five disease-causing variants (c.187C>T [p.Arg63Trp], c.566G>A [p.Trp189Ter], c.1156G>A [p.Asp386Asn], c.1324G>A [p.Val442Met], and c.1560G>A [p.Trp520Ter]), all segregating with disease according to a recessive pattern of inheritance. Cell-based analysis of recombinant proteins deriving from these genotypes, performed by target engagement assays, showed in all cases a significant decrease in ligand-protein interaction compared to the wild type. Our results indicate that variants in COQ8B lead to recessive non-syndromic RP, possibly by impairing the biosynthesis of coenzyme Q10, a key component of oxidative phosphorylation in the mitochondria
Chronic Nonbacterial Osteomyelitis in Neuroradiology - Behavior and Evolution of Vertebral and Mandibular Lesions on Imaging
No full textBackground: Chronic nonbacterial osteomyelitis (CNO) is a rare non-infectious inflammatory musculoskeletal disease where imaging plays a key diagnostic role. Vertebral and mandibular lesions are frequent manifestations, meaning their awareness is crucial for the neuroradiologist to avoid delays in diagnosis and treatment.
Objective: Characterize vertebral and mandibular CNO lesions on imaging to assist practicing neuroradiologists in better identifying this disease.
Materials and methods: Retrospective review of all CNO patients of our pediatric center, including only patients with vertebral or mandibular lesions. All imaging exams were analyzed to record lesion characteristics.
Results: We included 13 patients (six male). The mean age of onset was 12.3 years. Ten patients had only vertebral lesions, two had only mandibular lesions, and one had both. For patients with vertebral lesions, the median number of levels affected was three, 81.8% had multiple levels affected, 90.0% had dorsal spine lesions, 72.7% had platyspondyly, and 81.8% had inflammatory changes. All vertebral lesions had at least partial resolution of inflammatory findings, the mean time of lesion activity was 2.5 years, and recurrence occurred in 27.3%. Three patients had sacral lesions, all with sacroiliitis. In patients with mandibular lesions, all had unilateral lesions involving the mandibular ramus, all had hyperostosis, periosteal reaction, bone edema, and soft tissue inflammation, all had partial resolution on follow-up, and one had recurrence.
Conclusion: CNO vertebral lesions are not rare, are often multiple, predominantly affect dorsal levels, and most result in vertebral height loss. Resolution of vertebral inflammatory lesions is frequent, but so is recurrence. Sacral lesions may be present and result in sacroiliitis. The mandible may be a site of unifocal disease, typically affecting the ramus, with prominent bony changes and soft tissue inflammation
Factors Predicting Burn Unit Length-of-Stay
No full textIntrodução: A taxa de mortalidade em pacientes queimados diminuiu significativamente, tornando importante avaliar outros desfechos, como o tempo de internação, que aumenta a morbidade física e psicológica, o risco de infeção hospitalar e os custos financeiros. O objetivo deste estudo é analisar a relevância de vários fatores no tempo de internação na Unidade de Queimados.
Método: Foramincluídos neste estudo 711 pacientes admitidos entre 2011 e 2020 na Unidade de Queimados do Hospital de São José, Centro Hospitalar Lisboa Central, Lisboa, Portugal. Os dados coletados foram analisados utilizando o PSPP para Windows.
Resultados: Os pacientes eram predominantemente do sexo masculino, com idade média de 54 anos. O tempo médio de permanência hospitalar foi de 29 dias. Os fatores que prolongaram a estadia hospitalar foram relacionados à gravidade da queimadura, ao número de cirurgias e ao tempo decorrido até a primeira cirurgia, valores laboratoriais alterados tanto no perfil hematológico quanto químico durante a hospitalização, e a presença e o número de infeções documentadas.
Conclusão: Existem fatores potencialmente modificáveis que influenciam o tempo de permanência hospitalar. Nosso estudo nos permite concluir que o tempo decorrido até a primeira intervenção cirúrgica e a presença e o número de infeções documentadas prolongam significativamente esse desfecho, e ênfase deve ser dada à implementação de medidas que favoreçam a intervenção cirúrgica precoce e o controle rigoroso de infeções.Introduction: Burn patients’ mortality rate has decreased significantly, making it important to evaluate other outcomes, such as length-of-stay, which increases
physical and psychological morbidity, risk of nosocomial infection, and financial costs. The objective of this study is to analyze the relevance of several factors in the Burn Unit length-of-stay.
Material and Methods: 711 patients were included in this study, admitted between 2011 and 2020 to the Burn Unit at São José Hospital, Centro Hospitalar Lisboa Central, Lisbon, Portugal. Collected data was analyzed using PSPP for Windows. Results: Patients included in the study were predominantly males, with a mean age of 54 years. The mean length of stay was 29 days. The factors that prolonged in-hospital stay were those related to the severity of the burn, the number of surgeries
and the time elapsed until the first one, altered laboratory values in both hematologic and chemistry profile during the hospitalization, and the presence and number of documented infections. Conclusion: There are potentially modifiable factors that influence length-of-stay. Our study allows us to conclude that the time elapsed until the first surgical intervention and the presence and number of documented infections significantly prolong this outcome, and emphasis should be given to the implementation of measures that favor early surgical intervention and strict infection control