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While technical optimization focuses on maximizing the annual energy yield of utility-scale PV parks, the ultimate goal for power plant owners is to maximize investment profit. This paper aims to bridge the gap between technical and economic approaches by using simulation data from a real-case utility-scale PV park. It analyzes how changes in configuration parameters such as the DC–AC ratio and string length and PV technologies like solar tracking systems and bifacial modules impact the economic metrics of the project, i.e., net present value (NPV) and internal rate of return (IRR). PVSyst software was utilized as a simulation tool, while in-house developed software implementing appropriate technical and economic models served as a comparison platform and was used to validate the outputs generated through PVSyst. Results indicate that the commonly used horizontal single-axis tracking configuration may economically underperform compared with fixed-tilt setups. The optimal DC–AC ratio fell within the range of 1.30 to 1.35. Extending the string length from 25 to 28 modules improved economic indexes. Additionally, fixed-tilt bifacial modules can enhance project economics if a 10% cost premium compared with standard monofacial PV modules is considered. [ABSTRACT FROM AUTHOR]

The world is facing many challenges to keep up with growing energy demand and greenhouse gas and pollutant emissions. A possible solution is to integrate renewable energy sources (RESs) into residences and create energy management systems (EMSs) that reduce consumption and relieve the main grid in critical hours. This paper is focused on analyzing different EMSs using solar photovoltaic (PV) modules and three energy storage systems (ESSs) to increase savings without affecting the user's needs, with thirty-three power consumption profiles and three energy tariffs over a 25-year investment to compare which solution presents the best economic result in each of the 297 analyzed scenarios. The results show that the higher the overall daily consumption values, the greater the profits for all EMSs. The lowest demand profiles lead to the best self-consumption and self-sufficiency results. PV-only systems with a tri-hourly tariff have the best overall results. In the case of battery operation, each case should be carefully analyzed in order to choose the correct technologies and tariff. The results also allowed us to verify that even though having more PV modules generates more energy, it can make a project less economically desirable. [ABSTRACT FROM AUTHOR]

Every country has objectives for climate change, and public policies are implemented to achieve those commitments. This paper aims to review the different public policies used to promote the integration of photovoltaic technology into smart grids, taking the case of Portugal as reference. An analysis of previous supporting policies is performed both in Portugal and some European countries; these policies consist of feed-in tariffs, feed-in premiums, green certificates, electricity compensation, direct capital subsidies, and tax credits. The policies currently in force in Portugal no longer aim to support the technology; instead, they intend to promote it. Energy communities, local markets, and solar auctions are examples of public policies that are currently being used, not only to promote PV power but also the development of microgrids. Finally, the Portuguese solar auctions of 2019 and 2020 are analyzed and compared. It is concluded that auctions are a very effective way of expanding the installed capacity of the PV technology in the country and have more weight on promoting the technology than other promoting policies currently being used. [ABSTRACT FROM AUTHOR]

The European Union has been allocating funds for the energy transition to meet escalating global energy demands while minimising the environmental impact. This paper focuses on the impact of post-pandemic policies on photovoltaic technology in Italy and Portugal, specifically analysing self-consumption schemes and energy communities. A techno-economic assessment identified optimal PV systems for four families in each country, considering financial incentives. Italy offers Superbonus 110 and Ecobonus schemes, while Portugal provides access to the Environmental Fund. Profitable PV systems with storage are feasible in Italy but not in Portugal. Superbonus 110 favours smaller systems, Ecobonus supports larger ones, and Portuguese policies prioritise smaller systems. Simulations of energy communities for the same families showed that in Italy, the best configurations consist of families acting as producers with larger PV capacities and smaller batteries. In contrast, in Portugal, the policies favour smaller PV systems without batteries, resulting in optimal configurations where families are solely consumers. This research underscores diverse national approaches to post-pandemic energy policies and their nuanced impacts on PV technology in Italy and Portugal. It can be concluded that energy communities offer greater profitability than individual self-consumption schemes. This is because individual households continue to prioritise self-consumption and personal savings while selling their excess energy at a more favourable price than what they would receive from the grid. • In Italy, there are financial incentives and in Portugal, electricity cost reductions. • The models used the Net Present Value and the Internal Rate of Return as indicators. • In Italy, Superbonus 100 favours smaller systems, while Ecobonus supports larger ones. • Smaller systems without batteries for self-consumption are more profitable in Portugal. • Energy communities are more economically viable in both countries. [ABSTRACT FROM AUTHOR]

Emerging technologies are helping to accelerate the ongoing energy transition. At the forefront of these new technologies is blockchain, which has the potential to disrupt energy trading markets. This article explores this potential by presenting an innovative multilevel transactive energy (TE) optimization model for the scheduling of distributed energy resources (DERs) within connected virtual power plants (VPPs). The model allows for energy transactions within a given VPP as well as between connected VPPs. A blockchain-based smart contract layer is applied on top of the TE optimization model to automate and record energy transactions. The model is formulated to adhere to the new regulations for the self-generation and self-consumption of energy in Portugal. This new set of regulations can ease barriers to entry for consumers and increase their active participation in energy markets. Results show a decrease in energy costs for consumers and increased generation of locally produced electricity. This model shows that blockchain-based smart contracts can be successfully integrated into a hierarchical energy trading model, which respects the novel energy regulation. This combination of technologies can be used to increase consumer participation, lower energy bills, and increase the penetration of locally generated electricity from renewable energy sources. [ABSTRACT FROM AUTHOR]

A large variation in the severity of disease symptoms is one of the key open questions in coronavirus disease 2019 (COVID-19) pandemics. The fact that only a small subset of people infected with severe acute respiratory syndrome coronavirus 2 develops severe disease suggests that there have to be some predisposing factors, but biomarkers that reliably predict disease severity have not been found so far. Since overactivation of the immune system is implicated in a severe form of COVID-19 and the immunoglobulin G (IgG) glycosylation is known to be involved in the regulation of different immune processes, we evaluated the association of interindividual variation in IgG N-glycome composition with the severity of COVID-19. The analysis of 166 severe and 167 mild cases from hospitals in Spain, Italy and Portugal revealed statistically significant differences in the composition of the IgG N-glycome. The most notable difference was the decrease in bisecting N -acetylglucosamine in severe patients from all three cohorts. IgG galactosylation was also lower in severe cases in all cohorts, but the difference in galactosylation was not statistically significant after correction for multiple testing. [ABSTRACT FROM AUTHOR]

As energy system will increasingly become renewable, they will face new challenges that mainly arise due to the varying output by many renewable energy technologies. An issue that is especially prominent for countries with high shares of hydropower in their electricity generation is the varying yearly output of these technologies. This work aims to propose a techno-economically optimized energy system for such a country, using Portugal as example. For this purpose the current situation is analyzed and an energy demand model for 2050 created. The energy system is optimized for years with different outputs of hydropower to analyze the system's behavior using the simulation tool EnergyPLAN. As the tool does not possess inherent optimization capabilities it was coupled with the gray wolf optimization algorithm using Matlab. Subsequently, a system is proposed that is able to cover Portugal's expected energy demand under all circumstances. The future system will rely strongly on wind and solar power as they are expected to cover around 75% of Portugal's electricity demand. Furthermore, the analysis showed that Portugal needs to build up electrolyzer capacities of 4.2 GW and SynGas capacities of 2.4 GW as the SynGas will be used to balance supply in demand, especially in years with lower hydropower output. The system's cost will be between 22 and 35% cheaper than the created reference model. Furthermore, the primary energy demand is expected to decrease from 253 TWh to around 150 TWh while the electricity demand rises from 49 TWh to around 110 TWh. • We propose an optimized 100% renewable energy system for countries with high shares of hydropower. • The proposed system can cover Portugal's expected energy demand in 2050. • Wind and solar power are expected to cover around 75% of Portugal's electricity demand. • Portugal needs to build up electrolyzer capacities of 4.2 GW and SynGas capacities of 2.4 GW. • The system's cost will be between 22 and 35% cheaper than the created reference model. [ABSTRACT FROM AUTHOR]

Because wind has a high volatility and the respective energy produced cannot be stored on a large scale because of excessive costs, it is of utmost importance to be able to forecast wind power generation with the highest accuracy possible. The aim of this paper is to compare 1‐h‐ahead wind power forecasts performance using artificial intelligence‐based methods, such as artificial neural networks (ANNs), adaptive neural fuzzy inference system (ANFIS), and radial basis function network (RBFN). The latter was implemented using three different learning algorithms: stochastic gradient descent (SGD), hybrid, and orthogonal least squares (OLS). The application dataset is the injected wind power in the Portuguese power systems throughout the years 2010–2014. The network architecture optimization and the learning algorithms are presented. An initial data analysis showed data seasonality; therefore, the wind power forecasts were performed according to the seasons of the year. The results showed that ANFIS was the best performer method, and ANN and RBFN‐OLS also showed strong performances. RBFN‐Hybrid and RBFN‐SGD performed poorly. In general, all methods outperformed persistence. [ABSTRACT FROM AUTHOR]

Direct‐acting antiviral drugs (DAAs) have recently changed the paradigm of hepatitis C therapy, significantly improving treatment response rates, patient life expectancy and quality of life. In Portugal, sofosbuvir (SOF) and SOF/ledipasvir (SOF/LDV) were fully reimbursed by the National Health System since early 2015 and generalized use of interferon‐free DAA based regimens became current practice. During 2016, the remaining DAAs were sequentially added and covered by the same health access policy. The Portuguese Study Group of Hepatitis and HIV Co‐infection (GEPCOI) collected data from 15 clinical centres in Portugal, pertaining to the HCV treatment experience with DAA regimens. A cohort of 2133 patients was analysed, representing one of the largest DAA treated HCV/HIV co‐infected individuals. The global sustained virologic response (SVR) achieved was 95% in this real‐life cohort setting. Linear regression analysis showed significant differences in treatment response rates when using SOF plus ribavirin (RBV) combination in genotype 2 or 3 infected individuals (P <.002) and in those with liver cirrhosis (P <.002). These findings corroborate that early treatment is mandatory in HIV/HCV co‐infected patients, as response rates may be negatively influenced by higher fibrosis stages and suboptimal DAA regimens. The current national Portuguese health policy should continue to promote wider treatment access and individualized therapy strategies, aiming at the elimination of HCV infection in this high‐risk co‐infected population. [ABSTRACT FROM AUTHOR]

Background: Random biopsies are recommended to identify individuals at risk of gastric adenocarcinoma. Cumulative evidence suggests that narrow-band imaging (NBI) can be used to grade gastric intestinal metaplasia (GIM). We aimed to externally validate a classification of endoscopic grading of gastric intestinal metaplasia (EGGIM).Methods: Consecutive patients in two centers were submitted to high resolution white-light gastroscopy followed by NBI to estimate EGGIM - a score (0 - 10) resulting from the sum of endoscopic assessments of GIM, scored as 0, 1, or 2 for no GIM, ≤ 30 %, or > 30 % of the mucosa, respectively, in five areas (lesser and greater curvature of both antrum and corpus, and incisura). If GIM was endoscopically suspected, targeted biopsies were performed; if GIM was not noticeable, random biopsies were performed according to the Sydney system to estimate the operative link on gastric intestinal metaplasia (OLGIM; the gold standard).Results: 250 patients (62 % female; median age 55 years) were included. GIM was staged as OLGIM 0, I, II, III, IV in 136 (54 %), 15 (6 %), 52 (21 %), 34 (14 %), and 13 (5 %) patients, respectively. All patients with GIM except three were identifiable with targeted biopsies. For the diagnosis of OLGIM III/IV, the area under the ROC curve was 0.96 (95 % confidence interval [CI] 0.93 - 0.98) and by using the cutoff > 4, sensitivity, specificity, and positive likelihood ratio were 89 %, 95 %, and 16.5, respectively; results were similar (91 %, 95 %, and 18.1) when excluding patients with foveolar hyperplasia.Conclusions: For the first time, an endoscopic approach was externally validated to determine the risk of gastric cancer without the need for biopsies. This can be used to simplify and individualize the management of patients with gastric precancerous conditions. [ABSTRACT FROM AUTHOR]

A progressive implementation of renewable microgeneration, mainly small sized Photovoltaics, in low voltage distribution networks is ongoing. In this context, self-consumption with storage allows to highlight the prosumer concept, bearing in mind that this strategy may be interesting both from a technical and economical perspectives. The intelligent network environment or Smart Grid comes close to this new model and may have a critical relevance in the management of intelligent power distribution networks, in the framework of a Smart Environment. This paper intends to give an additional contribution on the subject by investigating the economic profitability of different residential PV systems configurations. These include traditional “injects all into the network/consumes all from the network”, self-consumption, storage and net-metering. The joint operation of self-consumption and battery storage is particularly focused as it presents the current trend in residential PV systems. The results of the performed economic analysis point to the conclusion that self-consumption is already attractive, but storage is not a profitable solution, because battery investment is still too high, despite the cost reduction witnessed in recent years. [ABSTRACT FROM AUTHOR]

Despite the fact that the current level of energy supply security in Europe is quite satisfactory, new challenges present a potential risk of jeopardising the current state of affairs. Among others, key challenges are related to the strengthening of the market framework (in the context of deregulation and unbundling as imposed by EU directives) and the increasing penetration of renewable energy sources in the generation mix (with inherently greater variability). Under these circumstances, assessing the value of lost load (VoLL) is useful to support energy decision-making, including benefit-cost analysis and the design of suitable regulatory frameworks. This paper develops VoLL estimation using a macroeconomic technique, namely the production-function approach. The VoLL determines the foregone value added due to electricity outage. The production-function method is applied to the Portuguese case and an average VoLL of 5.12 €/kWh is found. The paper also presents the VoLL results obtained for various economic sectors as well as households. Moreover, the temporal variation of the VoLL along typical weekdays and weekend, in winter and in summer, and for the most relevant sectors (manufacturing, retail services, and households) is demonstrated and discussed. [ABSTRACT FROM AUTHOR]

This study aims to explore the impact of light-duty passenger (LdP) electric vehicle (EV) charging on the Portuguese national load profile (LP) in 2030. The goal is to identify EV charging strategies that enable a sustainable configuration of the Portuguese LP under different potential levels of LdP EV penetration in 2030. The research offers Portuguese utilities and policymakers information regarding potential threats and solutions of different EV charging strategies on the national grid infrastructure in 2030. Furthermore, it proposes a methodology that can also be adopted in other countries to analyse similar problems. Low, medium, and high penetration scenarios were designated based on the number of LdP EVs. The low and medium penetration scenarios indicate that an intelligent grid is not necessary to perform charging activities. However, coordinating EV charging in the evening via a smart grid (SG) is imperative in the high penetration scenario, as unsustainable levels of power demand will otherwise be reached, compared with the current production and distribution capacity. Moreover, morning charging sessions must also be addressed, as they may induce new peaks of daily consumption given the significant amount of charging activity taking place within that period. • The impact of light-duty passenger EV charging on the Portuguese load profile (LP) in 2030 is explored. • EV charging strategies enabling a sustainable LP for different levels of penetration are identified. • Three scenarios of EV penetration: low, medium, and high. • An intelligent grid is not required to perform EV charging for low and medium penetration. • EV charging in the morning and evening through a Smart-Grid is imperative for high penetration. [ABSTRACT FROM AUTHOR]

The paper describes the integration between what used to be a passive element of the energy value chain – the grid – and both upstream and downstream elements. The evolution of communications among the elements has permitted a more robust and adaptable structure that already is being implemented: the Smart Grid. The paper relates the evolution of EU policy concerning both the development and the rolling-out of solutions to exploit the potential of the Smart Grid concept and describes what has been done by the regulators of three countries that share the same goal but seek to attain it via distinct paths. The article starts with a justification of the need for more integrated networks and a definition of the Smart Grid. A second part covers the risks and difficulties of implementation within an established network, introducing the role of the regulator. The third part describes EU policy response and three different approaches by regulators in the UK, Italy and Portugal, showing how in each case policy is influenced by characteristics of their respective national electricity markets in terms of competition dynamics. [ABSTRACT FROM AUTHOR]

• Design of a non-intrusive device to intelligently control electric water heaters. • Development of a machine-learning tool to forecast residential hot water demand. • Details and results of a six-month pilot study where the device was implemented. • Heating demand reduced by an average of 26.43% and cost saving of 35.54% per device. • Device is cost-effective and can reduce the need for imported fossil-fuel generation. Water heating accounts for approximately 25% of household energy use in developed countries. Therefore, the optimal control of water heating through the deployment of intelligent residential Electric Water Heaters (EWH) brings significant benefits. This paper presents an innovative design and implementation of an easy-to-use device for intelligent residential water heating. The device relied upon machine learning techniques to forecast a consumer's hot water demand and optimize the operation of an EWH using a novel data collection process that relied on non-intrusive vibration data alone. The device was deployed in a six-month pilot project on the island of São Miguel, Portugal. The major difficulties were the novel use of vibration data to forecast the volume of hot water used and the uncertain behavior of the consumers. The challenges of only using vibration data were solved by careful data collection and artificial intelligence methods. To tackle the issue of uncertain consumer behavior, an innovative 'heat now' function was incorporated into the device to override the novel control framework. Results show that the device could accurately forecast hot water demand and optimally operate the EWH to meet this demand. The results showed an average reduction of 1.33 kWh/day per consumer, which equates to an average decrease of 35.5% in water heating costs. Calculations show that these devices can reduce the total energy used by 2832 kWh daily or 0.21% of total electricity generated. Furthermore, a fleet of these devices could reduce thermal generation by 0.37%, reducing emissions by 693.31 tons of CO 2 per year. The results from the consumer survey show that the device did not affect the consumer's comfort, validating the benefits and efficacy of the proposed device. Hence, the paper shows that a simple-to-use, novel device using an innovative forecasting algorithm based on non-intrusive vibration data brings numerous quantifiable benefits to actual consumers and electrical utilities. [ABSTRACT FROM AUTHOR]

The final step that Portugal is taking to reach a fully liberalized electricity market is the deregulation of the retail market by phasing-out regulated electricity prices and reducing the administrative burdens in this area. These attempts are done to promote the entrance of companies into the retailing business and to actively engage the end-users in the market. This analysis shows that despite high consumer switching rates during the 2013–2015 period, the retail market in Portugal is still highly concentrated. The retail rates are also not following the changes in the wholesale market price. [ABSTRACT FROM AUTHOR]

Introduction: HIV late presentation (LP) remains excessive in Europe. We aimed to analyze the factors associated with late presentation in the MSM population newly diagnosed with HIV in Portugal between 2014 and 2019., Methods: We included 391 newly HIV-1 diagnosed Men who have Sex with Men (MSM), from the BESTHOPE project, in 17 countrywide Portuguese hospitals. The data included clinical and socio-behavioral questionnaires and the viral genomic sequence obtained in the drug resistance test before starting antiretrovirals (ARVs). HIV-1 subtypes and epidemiological surveillance mutations were determined using different bioinformatics tools. Logistic regression was used to estimate the association between predictor variables and late presentation (LP)., Results: The median age was 31 years, 51% had a current income between 501-1,000 euros, 28% were migrants. 21% had never been tested for HIV before diagnosis, with 42.3% of MSM presenting LP. 60% were infected with subtype B strains. In the multivariate regression, increased age at diagnosis, higher income, lower frequency of screening, STI ever diagnosed and higher viral load were associated with LP., Conclusion: Our study suggests that specific subgroups of the MSM population, such older MSM, with higher income and lower HIV testing frequency, are not being targeted by community and clinical screening services. Overall, targeted public health measures should be strengthened toward these subgroups, through strengthened primary care testing, expanded access to PrEP, information and promotion of HIV self-testing and more inclusive and accessible health services., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision., (Copyright © 2024 Abrantes, Pimentel, Miranda, Silva, Diniz, Ascenção, Piñeiro, Koch, Rodrigues, Caldas, Morais, Faria, Gomes da Silva, Teófilo, Monteiro, Roxo, Maltez, Rodrigues, Gaião, Ramos, Costa, Germano, Simões, Oliveira, Ferreira, Poças, Saraiva da Cunha, Soares, Fernandes, Mansinho, Pedro, Aleixo, Gonçalves, Manata, Mouro, Serrado, Caixeiro, Marques, Costa, Pacheco, Proença, Rodrigues, Pinho, Tavares, Correia de Abreu, Côrte-Real, Serrão, Sarmento e Castro, Nunes, Faria, Baptista, Simões, Mendão, Martins, Gomes, Pingarilho, Abecasis and the BESTHOPE Study Group.)

Introduction: Exit-site infection (ESi) prevention is a key factor in lowering the risk of peritonitis. This study aimed to evaluate the associations between exit-site (ES) care protocols and the annual incidence rates of ESi and peritonitis in Portugal., Methods: We performed a national survey using two questionnaires: one about the incidence of catheter-related infections and the other characterizing patients' education and ES care protocols., Results: In 2017 and 2018, 14 Portuguese units followed 764 and 689 patients. ESi incidence rate was 0.41 episodes/year, and the peritonitis incidence rate was 0.37. All units monitor catheter-related infections on a yearly basis, use antibiotic prophylaxis at the time of catheter placement, and treat nasal carriage of S. aureus, although with different approaches. Screening for nasal carriage of S. aureus is performed by 12 units, and daily topical antibiotic cream is recommended by 6 out of 14 of the units. We did not find statistical differences in ESi/peritonitis, comparing these practices. The rate of ESis was lower with nonocclusive dressing immediately after catheter insertion, bathing without ES dressing, with the use of colostomy bags in beach baths and was higher with the use of bath sponge. The peritonitis rate was lower with bathing without ES dressing and if shaving of the external cuff was performed in the presence of chronic ESi., Conclusions: We found potential proceedings associated with ESi and peritonitis. A regular national audit of peritoneal dialysis units is an important tool for clarifying the best procedures for reduction of catheter-related infections., (© 2023 S. Karger AG, Basel.)

Objectives: To assess the value of endoscopic grading of gastric intestinal metaplasia (EGGIM), operative link on gastritis assessment (OLGA) and operative link on gastric intestinal metaplasia (OLGIM) on risk stratification for early gastric neoplasia (EGN) and to investigate other factors possibly associated with its development., Design: Single centre, case-control study including 187 patients with EGN treated endoscopically and 187 age-matched and sex-matched control subjects. Individuals were classified according to EGGIM, OLGA and OLGIM systems. EGN risk according to gastritis stages and other clinical parameters was further evaluated., Results: More patients with EGN had EGGIM of ≥5 than control subjects (68.6% vs 13.3%, p<0.001). OLGA and OLGIM stages III/IV were more prevalent in patients with EGN than in control subjects (68% vs 11%, p<0.001, and 61% vs 3%, p<0.001, respectively). The three systems were the only parameters significantly related to the risk of EGN in multivariate analysis: for EGGIM 1-4 (adjusted OR (AOR) 12.9, 95% CI 1.4 to 118.6) and EGGIM 5-10 (AOR 21.2, 95% CI 5.0 to 90.2); for OLGA I/II (AOR 5.0, 95% CI 0.56 to 44.5) and OLGA III/IV (AOR 11.1, 95% CI 3.7 to 33.1); for OLGIM I/II (AOR 11.5, 95% CI 4.1 to 32.3) and OLGIM III/IV (AOR 16.0, 95% CI 7.6 to 33.4)., Conclusion: This study confirms the role of histological assessment as an independent risk factor for gastric cancer (GC), but it is the first study to show that an endoscopic classification of gastric intestinal metaplasia is highly associated with that outcome. After further prospective validation, this classification may be appropriate for GC risk stratification and may simplify every day practice by reducing the need for biopsies., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: Surveillance of Lynch syndrome (LS) is recommended to reduce cancer-risk. There is an increased awareness that cancer-risk may vary with mismatch-repair mutation and family history. However, gene-specific and family-specific surveillance are not recommended. Therefore, we aimed to estimate the cumulative incidence of lesions and to assess the cancer-risk by family history and mismatch-repair mutation (MMR). Methods: Single-centre retrospective cohort of all individuals ( n  = 241) in a specialized institution was conducted. Results: Forty-eight percent of individuals inherited MSH2 mutations, 32% MLH1, 15% MSH6 and 5% PMS2. The calculated cumulative incidence for any cancer increased with age. By age 70, the cumulative incidence for low-risk, high-risk adenomas and CRC was estimated at 66.6%, 57.7% and 25.7%, respectively. By age 70, the cumulative incidence of endometrial cancer (EC), gastric cancer and urinary tract cancer was estimated at 17.3%, 3.3% and 12.6%, respectively. MLH1 and MSH2 mutation carriers had lower mean age of CRC diagnosis than MSH6 and PMS2 [MLH1:44(CI95% 38-50); MSH2:43(CI95% 40-47); MSH6:52(CI95% 45-59); PMS2:46(CI95% 35-57)]. The risk of EC was higher when family history was present (RR = 2.39, CI95%[1.3;4.6]). MSH6 mutation carriers had higher risk of EC comparative to other MMR mutation carriers (RR = 1.9, p  = .09). The risk of urinary tract cancer was higher with MSH2 (RR = 8.4, CI95%[2.7;25.9]) and positive family history (RR = 10.8, CI95%[1.4;82.8]). Conclusion: This cohort demonstrates the effectiveness of LS surveillance and suggests possible tailored surveillance strategies by gene mutation and family history.

Background: For the correct staging of chronic atrophic gastritis (AG) and gastric intestinal metaplasia (GIM) at least 4 biopsies are recommended: 2 from the antrum/incisura and 2 from the body sent in two different vials. As virtual chromoendoscopy with narrow-band-imaging (NBI) is valid both in the diagnosis and staging of GIM, it is reasonable to question the need to separate biopsy samples in all procedures. Aims : To evaluate if biopsy samples can be placed in the same vial without implications in the diagnosis and follow-up of the patient, if during gastroscopy no typical endoscopic pattern of GIM with NBI is observed. Methods : Multicentre prospective study of a consecutive sample of patients ( n  = 183) submitted to gastroscopy using NBI with no superficial neoplastic lesions and no suggestive areas of GIM. Biopsies of both antrum/incisure and body were performed in all patients and samples were placed in the same vial for histologic assessment [according to OLGA (operative link for gastritis assessment) and OLGIM (operative link for gastric intestinal metaplasia)], blinded to endoscopic features. Results : In all patients, OLGA and OLGIM calculation was possible as the pathologists could distinguish biopsy samples from antrum/incisure from those of gastric body. The negative predictive value was 100% for advanced stages of GIM or AG as 179 (98%) patients presented OLGIM 0 and only 4 (2%) presented OLGIM I. Regarding AG, 150 (82%) presented OLGA 0, 23 (13%) OLGA I and 10 (6%) OLGA II. Conclusion : In the absence of a typical endoscopic pattern of GIM using NBI, it is effective to place biopsies' specimens in the same vial (for Helicobacter pylori diagnosis) or even to abstain from biopsies as no single patient with significant changes seems to be missed. This change in clinical practice can have a significant impact on endoscopy costs.

Objective: To characterize the profile of non-AIDS-related comorbidities (NARC) in the older HIV-1-infected population and to explore the factors associated with multiple NARC., Methods: This was a multicentre, cross-sectional study including HIV-1-infected patients aged ≥50 years, who were virologically suppressed and had been on a stable antiretroviral therapy (ART) regimen for at least 6 months. A multiple regression model explored the association between demographic and clinical variables and the number of NARC., Results: Overall, 401 patients were enrolled. The mean age of the patients was 59.3 years and 72.6% were male. The mean duration of HIV-1 infection was 12.0 years and the median exposure to ART was 10.0 years. The mean number of NARC was 2.1, and 34.7% of patients had three or more NARC. Hypercholesterolemia was the most frequent NARC (60.8%), followed by arterial hypertension (39.7%) and chronic depression/anxiety (23.9%). Arterial hypertension and diabetes mellitus were the most frequently treated NARC (95.6% and 92.6% of cases, respectively). The linear regression analysis showed a positive relationship between age and NARC (B=0.032, 95% confidence interval 0.015-0.049; p=0.0003) and between the duration of HIV-1 infection and NARC (B=0.039, 95% confidence interval 0.017-0.059; p=0.0005)., Conclusions: A high prevalence of NARC was found, the most common being metabolic, cardiovascular, and psychological conditions. NARC rates were similar to those reported for the general population, suggesting a larger societal problem beyond HIV infection. A multidisciplinary approach is essential to reduce the burden of complex multi-morbid conditions in the HIV-1-infected population., (Copyright © 2018 Merck Sharp & Dohme Corp and The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: There are no prospective studies comparing endoscopic submucosal dissection (ESD) and gastrectomy, especially evaluating patient-reported outcomes. Our aim was to compare the safety and impact on quality of life (QoL) of ESD and gastrectomy in patients with early gastric neoplasia., Methods: This prospective study included consecutive patients presenting with early gastric neoplasia in a tertiary center from January 2015 to August 2016. Data collection included curative resection, adverse events (AEs), and patient-reported outcomes (questionnaires: EORTC QLQ-C30, EORTC STO-22, EQ-5D-5 L, and Assessment of Survivor Concerns) before and after interventions (after 1 month, 3 - 6 months, and 1 year)., Results: 254 patients with early lesions were included: 153 managed by ESD and 101 by gastrectomy, the former being significantly older and with less advanced lesions. Mean procedural time and length of stay were significantly higher in the surgery group (164 vs . 72 minutes and 16.3 vs . 3.5 days; P  < 0.001). Complete resection was higher in the surgical group (99 % vs . 90 %; P  = 0.02); ESD was curative in 79 % of patients. Severe AEs and surgical re-intervention were significantly more frequent in the gastrectomy group (21.8 % vs. 7.8 % and 11 % vs . 1 %, respectively). Endoscopic treatment was associated with a positive impact on global health-related QoL at 1 year (net difference + 9.9; P  = 0.006), role function and symptom scales (fatigue, pain, appetite, eating restrictions, dysphagia, and body image). Concerns about recurrence did not differ between the groups., Conclusions: In patients with early gastric neoplasia, ESD is safer and is associated with a positive impact on health-related QoL when compared with gastrectomy, without increasing fear of recurrence and new lesions., Competing Interests: None, (© Georg Thieme Verlag KG Stuttgart · New York.)

Lyme disease is an endemic zoonosis, the most prevalent tick-transmitted infection in temperate areas of Europe, North America and Asia. It is a multisystemic disease with cutaneous, musculoskeletal, neurologic and cardiac manifestations, according to the stage of the disease. We describe a case of late neuroborreliosis in an Erasmus programme student living in Porto. We discuss the importance of the epidemiological suspicion, the clinical approach, the diagnostic criteria and the most adequate treatment.

Introduction: Patients undergoing chronic hemodialysis using tunneled cuffed catheters (TCCs) are at increased risk of metastatic infections, namely endocarditis and spondydodiscitis, and mortality is high in this group. The aim of this study was to determine the clinical features, causative organisms, its susceptibility and outcomes in patients hospitalized with these infections from a single center., Methods: All consecutive patients with TCC and endocarditis and/or spondylodiscitis treated at the authors' institution between 2005 and 2011 were selected retrospectively., Results: A total of 7 cases of endocarditis and 7 cases of spondylodiscitis were diagnosed. Concurrent infection was present in 1 patient. The mean age was 63.4 years, 53.8% were male, 23% had diabetes and 31% had previous immunosuppression. The average time on hemodialysis was 24 months. Those patients with endocarditis presented with fever, and 43% had previous valvular disease; mitral valve involvement was the most common. Early surgery was performed in 2 patients.Concerning spondylodiscitis, the median time from first symptom to diagnosis was 48 days. The first manifestation was back pain in 86% percent of patients, and 71% had an epidural or paraspinous abscess demonstrated by neuroimaging. One patient underwent surgical drainage of the abscess. Regarding both infections, staphylococcus aureus was the most common causative agent with a lower rate of negative blood cultures. All patients received intravenous antibiotics for a mean duration of six weeks. The mortality rate was 46%., Conclusions: A high index of suspicion is critical in the early recognition and management of both of these infections.

Currently, hepatitis C is a serious public health problem. It is estimated that there are 180 million people with chronic infection by hepatitis C virus (HCV) worldwide and that the prevalence of this infection in the Portuguese population ranges between 1 and 1.5%. In Portugal, there are neither up-to-date guidelines for treatment, nor recommendations for the diagnosis and management of patients with HCV and, in particular, for the endovenous drug users. The present article gathers consensus information regarding clinical practice and suggests some guidelines to the management and treatment accessibility of drug addicted patients with chronic infection by HCV, in Portugal.