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The purpose of this study was to conduct a survey examining the impact of inflammatory bowel disease (IBD) on patients' and their caregivers' daily activities. Questionnaires were distributed to patients registered in the APDI (Portuguese Association for IBD) database and their respective caregivers in 2007. Of 422 patient respondents, 251 had Crohn's disease (CD) and 171 had ulcerative colitis (UC), with the majority of patients being women (58.1%) and aged over 40 years (37.4%). The number of disease flares experienced by IBD patients was slightly higher for patients with CD than for patients with UC (2.64 vs. 2.34), and surgery was more often required in CD patients as compared to UC patients (42.4 vs. 7%). Sixty percent (60%) of patients reported having no problems with mobility, daily activities, or personal hygiene; however, over half of all patients experienced some pain and anxiety. Adult patients and children and adolescents respectively experienced time off work or school due to their disease but caregivers were not affected in this regard. The caregivers life (N=324) was affected by anxiety, with the major concern reported as the risk of the patient developing cancer. Both IBD patients and caregivers thought that the provision of information on new drugs and contact time with a doctor would have the biggest impact on improving care. The symptoms and complications of IBD have a considerable impact on the lives of patients and their caregivers, and several actions could be taken to improve their care. [ABSTRACT FROM AUTHOR]

The Guadiana River flows through the Southwest area of the Iberian Peninsula crossing from the Spanish provinces of Extremadura and Andalucia to the southern region of Portugal. Preliminary studies on the presence and distribution of toxic cyanobacteria led to the identification of several cyanobacterial species in the Guadiana River itself as well as in the freshwater reservoirs established along its course. The objectives of this paper were the identification and quantification of planktonic cyanobacteria in freshwater reservoirs from the Guadiana River, with different applications (human consumption, agriculture purposes and recreational uses), and determination of their toxicity. After the isolation of cyanobacterial strains, the characterisation of their toxicological profile was carried out using immunoadsorbent assays (ELISA) and chromatographic techniques (HPLC-UV). Monitorization studies revealed that predominant species were Microcystis aeruginosa , Anabaena spp. and Aphanizomenon flos-aquae . Some strains of M. aeruginosa were responsible for microcystins production. The toxicity observed in ISACYA 10B was low. The strain ISACYA 2C produces high amounts of microcystins, and probably these toxins were responsible for the toxicity of the cyanobacterial bloom detected in these waters. [ABSTRACT FROM AUTHOR]

The long-term effects of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection on sleep remain poorly known. We evaluated the association between probable post-COVID-19 condition and changes in sleep quality and quantity before and after SARS-CoV-2 infection in a consecutive sample of non-hospitalized adults. Individuals were identified with SARS-CoV-2 infection in 2020 at the central laboratory of a tertiary hospital in Porto and followed as outpatients. We included patients diagnosed with SARS-CoV-2 infection ≥3 months before this evaluation, with no missing data on key variables (n = 2445). Participants completed a questionnaire that included sociodemographic, clinical, and infection-related questions. We computed changes in sleep-related parameters referred to 1 month before diagnosis and 1 week before the questionnaire. Multinomial logistic regression models were fitted to compute crude and adjusted odds ratios and 95% confidence intervals (95% CIs). Compared to the pre-infection period, those with probable post-COVID-19 condition reported a greater decrease in hours of sleep, had a 2.60 (95% CI 2.02-3.34) higher adjusted odds of perceiving their sleep quality as worsened and experienced a significant increase in number of days with sleeping disturbances as defined according to multiple items. The association between post-COVID-19 condition and indicators of poor sleep health requires special attention from healthcare professionals and services. It is essential that appropriate multidisciplinary care is provided to mitigate the physical, psychological, social, and professional impact of sleeping problems in these already burdened patients., (© 2024 The Authors. Journal of Sleep Research published by John Wiley & Sons Ltd on behalf of European Sleep Research Society.)

Pathogen genome sequencing during epidemics enhances our ability to identify and understand suspected clusters and investigate their relationships. Here, we combine genomic and epidemiological data of the 2022 mpox outbreak to better understand early viral spread, diversification and transmission dynamics. By sequencing 52% of the confirmed cases in Portugal, we identified the mpox virus sublineages with the highest impact on case numbers and fitted them into a global context, finding evidence that several international sublineages probably emerged or spread early in Portugal. We estimated a 62% infection reporting rate and that 1.3% of the population of men who have sex with men in Portugal were infected. We infer the critical role played by sexual networks and superspreader gatherings, such as sauna attendance, in the dissemination of mpox virus. Overall, our findings highlight genomic epidemiology as a tool for the real-time monitoring and control of mpox epidemics, and can guide future vaccine policy in a highly susceptible population., (© 2023. The Author(s).)

Up to 27 May 2022, Portugal has detected 96 confirmed cases of monkeypox. We describe 27 confirmed cases (median age: 33 years (range: 22-51); all males), with an earliest symptom onset date of 29 April. Almost all cases (n = 25) live in the Lisbon and Tagus Valley health region. Most cases were neither part of identified transmission chains, nor linked to travel or had contact with symptomatic persons or with animals, suggesting the possible previously undetected spread of monkeypox.

Purpose: To investigate the prognostic value of interim PET (PETi) in adult HL patients, comparing visual with semiquantitative analysis., Material and Methods: Retrospective analysis of Hodgkin's lymphoma (HL) patients diagnosed between 2012 and 2016 in the Onco-hematology Department of Instituto Português de Oncologia - Porto (median follow-up: 46.5 months [2.6-66.4]). Fifty-eight patients with available PET at diagnosis (PET0) and PETi data were included. PETi scans were analyzed according to Deauville 5-point scale (5-PS), and cut-off values for changes in maximum standardized uptake value [SUVmax], peak SUV [SUVpeak], metabolic tumour volume [MTV] and total lesion glycolysis index [TLG] between PETi and PET0 were computed using ROC analysis. Visual and semiquantitative data were compared with each other in the prediction of patient outcomes., Results: Semiquantitative analysis obtained a higher sensitivity for persistent/relapsed disease compared to the 5-PS (70% vs. 10%, respectively), but lower specificity. It also demonstrated better predictive performance for response to first-line therapy (negative predictive value >92%). The positive predictive value was similar for all five measurements. At 60 months of follow-up, there was a significant difference between the progression free survival (PFS) curves of patients with positive and negative PETi according to ΔSUVmax (56.9% vs. 88.0%, p<0.05), ΔSUVpeak (55.9% vs. 88.1%, p<0.05), ΔMTV (35.3% vs. 88.7%, p<0.05), and ΔTLG (42.4% vs. 88.1%, p<0.05). Statistical significance was not reached when considering 5-PS results., Discussion: PETi interpretation according to a semiquantitative approach appears to discriminate HL patients better than the visual 5-PS analysis. This could allow better detection of persistent or early relapsed disease, while a negative PETi result could support de-escalating therapy intensity., (Copyright © 2020 Sociedad Española de Medicina Nuclear e Imagen Molecular. Published by Elsevier España, S.L.U. All rights reserved.)

Field epidemiology and viral sequencing provide a comprehensive characterization of transmission chains and allow a better identification of superspreading events. However, very few examples have been presented to date during the COVID-19 pandemic. We studied the first COVID-19 cluster detected in Portugal (59 individuals involved amongst extended family and work environments), following the return of four related individuals from work trips to Italy. The first patient to introduce the virus would be misidentified following the traditional field inquiry alone, as shown by the viral sequencing in isolates from 23 individuals. The results also pointed out family, and not work environment, as the primary mode of transmission.

Objectives: Autoimmune gastritis (AIG) is a chronic inflammatory condition of the gastric mucosa, mainly described in adults presenting with pernicious anemia. It results from antibody-mediated destruction of parietal cells, but the precise initiating event is unknown. The pathogenicity of Helicobacter pylori (H pylori) has been suggested but not established. This study aimed to better characterize AIG in pediatric patients and to address the possible role of H pylori infection., Methods: Descriptive single-center study, retrospectively describing 20 patients with a diagnosis of AIG based on positivity for anti-parietal cell autoantibodies, in addition to analytical and/or histological findings of oxyntic mucosa atrophy., Results: In the majority (18/20), AIG diagnosis was suggested during investigation of refractory iron-deficient anemia. One patient had dyspepsia and none of the others had gastrointestinal symptoms. Fifty-five percent (11/20) were H pylori positive, but there were no significant differences regarding mean hemoglobin values at presentation (10.6 ± 2.5 vs 9.5 ± 1.0 g/dL, P > 0.05), analytical indicators of gastric atrophy (gastrin, 564.4 ± 184 vs 721.2 ± 220.6 pg/mL, P > 0.05), or in the presence or the grade of oxyntic mucosa atrophy., Conclusions: Our findings highlight that AIG may have an age-dependent presentation; thus, we can consider a pediatric phenotype that in contrast to adults, is manifested by refractory iron-deficient anemia and associated with parietal cell autoantibody positivity, but not intrinsic factor autoantibodies. A correlation between H pylori and AIG was not evident in the current study and it is still unclear whether H pylori is a trigger for AIG.

Objectives: Vaccination of healthcare workers (HCWs) was made a high priority during the phase six pandemic of the novel influenza A H1N1 (pH1N1) virus. We surveyed adherence to pH1N1 vaccination and the incidence of pH1N1 infection between vaccinated and unvaccinated HCWs., Methods: Employees at the S. João Hospital in Porto, Portugal, were offered pH1N1 vaccinations free of charge. Pandemrix(®) was the vaccine administered. As part of the pandemic plan, employees with influenza-like symptoms (ILS) were called upon to take an RT-PCR H1N1 test. If the test results were positive, they had to stay off work for at least 7 days. Sociodemographic data, vaccination status, contact with infectious patients, ILS and pH1N1 test results were documented in a standardised manner., Results: The survey population comprised 5,592 employees. The vaccination rate was 30.8% (n = 1,720) for pH1N1 and 50.4% (n = 2,819) for the 2009/2010 seasonal trivalent inactivated influenza vaccine (TIV). One mild anaphylactic reaction occurred after pH1N1 vaccination. Minor local side effects occurred more often after pH1N1 vaccination than after 2009/2010 seasonal TIV (38.0% vs. 12.3%). Pandemic H1N1 infection was diagnosed in 97 HCWs (1.7%). Compared to employees with no regular patient contact, nurses (2.8%) had the highest risk of pH1N1 infection (adjusted OR 3.8; 95% CI 1.2-6.8). Vaccination reduced the pH1N1 infection risk (OR 0.12; 95% CI 0.05-0.29). Vaccine effectiveness was 90.4% (95% CI 73.5-97.3%)., Conclusion: Vaccination reduced the pH1N1 infection risk considerably. The pandemic plan to contain the pH1N1 infection was successful. Nurses had the highest risk of pH1N1 infection and are therefore a target group for vaccination measures.

Background: In view of the close relationship of Portugal with African countries, particularly former Portuguese colonies, the diagnosis of malaria is not a rare thing. When a traveller returns ill from endemic areas, malaria should be the number one suspect. World Health Organization treatment guidelines recommend that adults with severe malaria should be admitted to an intensive care unit (ICU)., Methods: Severe cases of malaria in patients admitted to an ICU were reviewed retrospectively (1990-2011) and identification of variables associated with in-ICU mortality performed. Malaria prediction score (MPS), malaria score for adults (MSA), simplified acute physiology score (SAPSII) and a score based on WHO's malaria severe criteria were applied. Statistical analysis was performed using StataV12., Results: Fifty nine patients were included in the study, all but three were adults; 47 (79,6%) were male; parasitaemia on admission, quantified in 48/59 (81.3%) patients, was equal or greater than 2% in 47 of them (97.9%); the most common complications were thrombocytopaenia in 54 (91.5%) patients, associated with disseminated intravascular coagulation (DIC) in seven (11.8%), renal failure in 31 (52.5%) patients, 18 of which (30.5%) oliguric, shock in 29 (49.1%) patients, liver dysfunction in 27 (45.7%) patients, acidaemia in 23 (38.9%) patients, cerebral dysfunction in 22 (37.2%) patients, 11 of whom with unrousable coma, pulmonary oedema/ARDS in 22 (37.2%) patients, hypoglycaemia in 18 (30.5%) patients; 29 (49.1%) patients presented five or more dysfunctions. The case fatality rate was 15.2%. Comparing the four scores, the SAPS II and the WHO score were the most sensitive to death prediction. In the univariate analysis, death was associated with the SAPS II score, cerebral malaria, acute renal and respiratory failure, DIC, spontaneous bleeding, acidosis and hypoglycaemia. Age, partial immunity to malaria, delay in malaria diagnosis and the level of parasitaemia were not associated with death in this cohort., Conclusion: Severe malaria cases should be continued monitored in the ICUs. SAPS II and the WHO score are good predictors of mortality in malaria patients, but other specific scores deserve to be studied prospectively.

Studies on the effectiveness and efficiency of palliative care (PC) services that use a methodology similar to that used by studies in other medical specialties face serious limitations, since the goals of PC are substantially different. Qualitative research methods can make an important contribution to our understanding of the features of palliative care (PC) that are most relevant to patients and their relatives. The goal of this study was to understand the reasons behind the gratitude shown in letters from bereaved relatives sent to two PC units, one in Spain and one in Portugal. A thematic analysis of the content of the letters was independently carried out by three researchers, who later collaborated to write up the results. Relatives appeared grateful primarily for the humane attitude, professional treatment, and emotional support that their loved ones received from the PC team; they thanked the team for creating a special atmosphere and offering holistic care, and they talked about the contrast between PC and other forms of care. The unsolicited gratitude expressed in their letters constitutes a valid and particularly rich source of information about the contribution that a PC team can make.

Aim: The aim of our study was to evaluate the inadequacy of voluntary energy and nutrient intake on the first day of hospital admission., Patients and Methods: A cross-sectional study was carried out in two terciary care hospitals, with a probabilistic sample of 50% of in-patients. Dietary intake was evaluated by a 24-hour dietary recall, and undernutrition was screened through the Nutritional Risk Screening 2002 tool. The overall frequency of inadequate energy and nutrient intake was estimated using Dietary Reference Intakes., Results: Energy and nutrient intakes from 258 patients showed very low values for both men and women. No significant differences were found for energy and nutrient intakes across age groups (< 65 years and > or = 65 years). When the proportion of study subjects with inadequate nutrient intakes was analysed, a high degree of inadequacy was found. The degree of inadequacy was higher for fibre, niacin, folate, vitamin B12, magnesium and zinc. No significant differences were found for energy and nutrients studied and for intakes below 1/3 of dietary recommendations from nutritionally-at-risk (n = 89) and well nourished (n = 169) patients., Conclusion: Voluntary nutrient and energy intakes in the first 24 hour of hospital admission are highly inadequate. No differences were found between undernourished and well-nourished patients or patients < 65 years and > or = 65 years.

A tumour bank is a consequence of the modern medicine to follow the knowledge of bio-pathology of pre-neoplastic and neoplastic diseases in order to define diagnostic criteria and accurate therapy. It can be an independent unit but it should depend on a real or virtual net in the country or in connection between different states. The informed agreement of the patient and law are integrally followed according with each country legislation and medical ethics is never overtaken for the accomplishment of diagnosis in the departments of pathology. A tumour bank works in the department of pathology, depends on trained technicians and pathologists and requires specific equipment for the different types of re-collecting, after dealing with confidentiality and law determinations. There are already some tumour bank nets in Europe (Spain, Croatia, Holland, UK, Germany) and Portugal is starting now its way.

Background: NOD2/CARD15 was described as the first susceptibility gene to Crohn's disease (CD). Polymorphisms in the TNFA gene and in the IL1 gene cluster, which are associated with an enhanced chronic inflammatory response, may also play a role in the development of CD. The aim of this study was to determine the association of polymorphisms in the CARD15, TNFA, IL1B, and IL1RN genes with risk of development of CD and with the clinicopathological profile of CD patients., Methods: In a case-control study including 235 CD patients and 312 controls (929 controls for TNFA genotyping), the CARD15 (R702W, G908R, and 1007fs), TNFA (-308G/A and -857C/T), IL1B (-511C/T), and IL1RN (intron 2 variable number of tandem repeats) polymorphisms were genotyped., Results: We observed a significant association between CD and the CARD15 polymorphisms, with an odds ratio (OR) of 2.9 [95% confidence interval (CI), 1.9 to 4.6] for carriers of 1 variant allele and an OR of 11.8 (95% CI, 3.5 to 40.4) for carriers of 2 variant alleles. Patients with CARD15 polymorphisms had more frequently ileal or ileocolonic disease location, stricturing phenotype, abdominal surgery, and no extraintestinal manifestations. The TNFA-308A/A genotype was associated with susceptibility to CD with an OR of 3.0 (95% CI, 1.2 to 7.2). TNFA-308A/A homozygotes showed a higher frequency of erythema nodosum and arthritis, colonic disease location, and absence of abdominal surgery. No associations were found with the TNFA-857, IL1B-511, and the IL1RN VNTR polymorphisms., Conclusions: These findings suggest that CARD15 and TNFA-308 genetic polymorphisms are associated with increased risk of CD displaying distinct clinicopathological profiles.

The discipline of Clinical Anatomy, as introduced in the Medical School of Porto in academic year 1995/96, involved major changes in the way we teach anatomy to medical students, by adopting a clinically oriented approach. A questionnaire was designed to evaluate the opinion of second-year medical students enrolled in the program concerning main aspects of the discipline in two consecutive years; 84% of the students returned the questionnaire in 1996/97, and 70% in 1997/98. Students were asked about the level of their approval of the organization of the discipline, the role of the teaching staff, lectures, practical sessions, educational media, and continuous and summative assessments. For items replicated in both academic years, the means of the sum of scores in each year were compared (Student's t-distribution). Whenever a significant difference was found, changes in individual items were tested (chi-square distribution). The evaluation of the discipline in each of the two years was highly favorable for most of the parameters analyzed., (Copyright 2002 Wiley-Liss, Inc.)

We have evaluated the students' response to the practical teaching sessions in Clinical Anatomy in our Medical School using an action-research method. The aim was to identify problems and to introduce changes that might improve both the program and the performance of the teaching staff. At the end of each section of the program, each student completed a "target type" questionnaire with eight different components. As each one quarter of the whole class had its own teacher, we used an analysis of variance to evaluate the target questions in the various sections of the program, and the performance of the four teachers. This research method gave us feedback on the students' responses while the program was in progress. The results emphasize the importance of action-research in assessing and improving a developing program in a basic discipline of the medical curriculum., (Copyright 2002 Wiley-Liss, Inc.)

Handouts were developed to support the program of Clinical Anatomy in the Medical School of Porto, and since 1996/97 alterations have been made to improve their format and content with our educational objectives in mind. A questionnaire was designed to evaluate the opinion of second-year medical students enrolled in the program. Students were asked about their approval of the way handouts were organized and their usefulness, especially for lectures and practical sessions on physical examination, sectional and imaging anatomy, anatomical variations and malformations and case studies. Of 152 students, 138 (90.8%) returned the questionnaire. To describe the relationship between the value of handouts and several aspects of their organization and adequacy, the Spearman rank correlation coefficient was used for lectures, and canonical correlation for the various practical sessions. Students fully approved the way the handouts of lectures and practical sessions were organized (81.8% and 87%, respectively), their presentation (74.6% and 86.2%), relevance (88.3% and 85.5%), usefulness in understanding the lectures (77.6%) and their value in preparing for practical sessions (83.3%). Handouts were considered highly useful for case studies (90%), physical examination (81.9%) and sectional anatomy (65.7%). Students stating a higher degree of utility of the handouts emphasized that they were useful-indeed essential-in preparing for sessions, and noted their objectivity. The evaluation of the handouts was highly favorable and showed that they can be used as a guide through the complexities of an innovative program of Clinical Anatomy., (Copyright 1999 Wiley-Liss, Inc.)

Psychological adjustment and psychopathological morbidity issues during rehabilitation of patients with spinal cord injury, have been documented in international literature. However, most authors are faced with methodological difficulties, and results are contradictory. In this prospective study, the first to be made in the Portuguese population, a sample of 65 patients being treated in a rehabilitation unit during the years of 1993, 1994 and 1995, was obtained. The authors study the type of psychological response, when it does occur, which personality traits point to less suffering, which coping mechanisms are used by the better adjusted patients and the differences between the scores of paraplegic and quadriplegic patients. Two assessments were made. The following assessment instruments were used: an anamnestic data questionnaire, the SCL-90-R (Derogatis, 1983), the EPI (Eysenck & Eysenck, 1984), the Coping Styles Evaluation Scale (Figueira, 1990). The second assessments were carried out with the SCL-90-R only. The findings indicate that psychopathological scores consistent with depression occurred in 60% of patients if we consider any evaluation. Sleep disturbances, suicide ideation and guilt occurred in the same proportion. In 33% of them, we found persistent depressive scores in the two assessments. The authors find a highly significant positive correlation between psychopathology and neuroticism. On the contrary, the extroversion dimensions of EPI seem to be a good prognosis predictive factor as far as the occurrence of psychopathology is concerned. No differences in the psychopathological response were found concerning the paraplegic-quadriplegic situation.

This study was to determine the prevalence of unplanned pregnancy in a national sample of Portuguese puerperae and to define a risk profile for women with unplanned pregnancy. We also evaluated the independent effect of unplanned pregnancy in prenatal care utilisation and in the prevalence of preterm birth, low birth weight, and small for gestational age birth. Data was collected through a national survey proposed to the 50 major public Portuguese hospitals and answers were obtained from 41 hospitals, resulting in a sample of 1582 deliveries. Participants were classified as having a planned or unplanned pregnancy and were compared according to socio-demographic, behavioural, clinical, obstetric, and anthropometric characteristics. The prevalence of unplanned pregnancy was 39.4%. In the unplanned pregnancy group, single women aged less than 19 years and more than 34 years, those with one or more previous pregnancies, with 25% or less of the expected education for their age, and with the National Health Service as the source of were significantly more frequent. These characteristics, except the health provision, were significant and independently associated with an increased risk of unplanned pregnancy. Women with unplanned pregnancy were more likely to be unaware of prenatal care system, to have no prenatal care, late or inadequate prenatal care. Unplanned pregnancy was significantly associated with the risk of inadequate prenatal care (Odds ratio (OR) = 2.5; 95% Confidence interval (CI): 1.7-3.0), after adjusting for the effect of the confounding variables. Planning pregnancy was not significantly related with the prevalence of low birth weight or small for gestational age birth. However there was a significant relationship between unplanned pregnancy and preterm birth (Adjusted OR = 1.7; 95% CI:1.0-2.9). This study showed a high prevalence of unplanned pregnancy and that it was related with an under utilisation of prenatal care and with an independently increased risk of preterm birth, a major issue in perinatal health.

Factor VIII inhibitors arise in 5% to 15% of patients with hemophilia A in response to infusion to factor VIII concentrates and make the treatment of bleeding episodes extremely difficult. Various therapeutic approaches have been tried the decision depending on the type of haemorrhage, the antibody's titre and whether the patient has a low or high response. We report the clinical experience in 13 hemophiliacs with inhibitors to factor VIII. Prothrombin complex concentrates were administered with favorable effects in the most common haemorrhagic episodes, in the majority of patients. In two patients activated prothrombin complex concentrates were administered and in one case plasma exchange was made before high doses of factor VIII. These therapeutic approaches proved to be very effective in the control of hemostasis.

The aim of this study was to obtain an estimate of the frequency of the delta F508 mutation in the Portuguese population, and of the tightness of its association with specific haplotypes. Furthermore, the genotype/clinical phenotype relationship and the feasibility of prenatal diagnosis were also investigated. The analysis of 42 cystic fibrosis (CF) families revealed that (1) 52% of CF chromosomes carry the deletion of codon 508; (2) there seems to be a positive correlation between the occurrence of the delta F508 mutation and the severity of the disease; and (3) fully informative prenatal diagnosis can be offered in 76% of at-risk pregnancies by using both genomic and allele specific oligonucleotide probes.

The experience of 260 patients with endometrial carcinoma was reviewed. The influence of factors such as age, stage of disease, grade and degree of myometrial penetration on the survival was presented, showing that survival decreases in elderly patients, in patients with advanced stage of disease, when the tumor is undifferentiated, and when the tumor deeply penetrates the myometrium. The methods of therapy, fall into three main groups: surgery, radiotherapy, and combined therapy, the latter yielding the best 5-year survival rate, in all stages. The incidence of vaginal recurrences was low, probably due to the fact that 68.8% of the patients were treated by a combined therapeutic modality.