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Journal Cover   Acta Médica Portuguesa
  [SJR: 0.155]   [H-I: 11]   Follow
  This is an Open Access Journal Open Access journal
   ISSN (Print) 0870-399X - ISSN (Online) 1646-0758
   Published by Ordem dos Médicos Homepage  [1 journal]
  • Analysis of the Cochrane Review: Electronic Cigarettes for Smoking
           Cessation and Reduction. Cochrane Database Syst Rev. 2014,12: CD010216.

    • Authors: António Vaz-Carneiro, João Costa
      Abstract: Smoking is one of the most important risk factors for various cardiovascular, cancer and respiratory diseases. There are a number of smoking cessation techniques involving psychological, pharmacological and behavioral interventions, with varying effectiveness and different costs. The electronic cigarettes are devices which produce a nicotine aerosol but without the toxic products of tobacco smoke, and they have become popular as a potential intervention for smoking cessation. The present review analyzed the evidence published of this approach for the treatment of tobacco dependence and concluded that there is reasonable evidence of its clinical effectiveness. We present and discuss the findings of this systematic review, with practical contextualization.
      PubDate: 2015-05-21
      Issue No: Vol. 28 (2015)
  • Normative Database of Optical Coherence Tomography Parameters in Childhood

    • Authors: Tatiana Queirós, Cristina Freitas, Sandra Guimarães
      Abstract: Introduction: Optical coherence tomography is a technology that allows obtaining high resolution images of tissues in vivo, enabling the measurement of ocular structures, including the retinal nerve fiber layer and macular thickness. As a noninvasive test it’s particularly useful in children, but its applicability is limited by the existence of normative values for adults only.
      Purpose: To establish the pediatric normative values of retinal nerve fiber layer thickness and macular thickness and to investigate its relationship with sex, age, refraction, eye side and ocular dominance.
      Material and Methods: Ophthalmologic examination and Cirrus HD-optical coherence tomography (Carl Zeiss Meditec) were carried out on 153 children aged 4 to 17 years old.
      Results: We obtained a mean retinal nerve fiber layer average thickness of 97.90 μm. No significant differences were detected between genders, however the eye side and ocular dominance had significant influence on retinal nerve fiber layer thickness. Retinal nerve fiber layer thickness increased significantly with more positive refraction. With the Macular Cube 512 x 128 protocol we found that the average central subfield showed the smallest thickness (250.35 μm) and boys had higher macular thickness.
      Discussion: The values of the retinal nerve fiber layer thickness and macular thickness obtained are comparable to recent studies. The distribution of retinal nerve fiber layer thickness in quadrants is in agreement with the normal distribution of retinal nerve fiber layer. Macular thickness proved to be higher in males (center field and inner ring), data consistent with previous studies.
      Conclusion: We establish the normative retinal nerve fiber layer thickness and macular thickness in healthy Portuguese children. These data enhance the evaluation and interpretation of parameters obtained by optical coherence tomography in the diagnosis of pediatric disorders in clinical practice.
      PubDate: 2015-04-30
      Issue No: Vol. 28 (2015)
  • AMP Student: Vision and Point of View

    • Authors: Henrique Cabral, Pedro Câmara Pestana
      Abstract: Keywords: Periodicals as Topic; Portugal; Publishing; Students, Medical; Writing.
      PubDate: 2015-04-30
      Issue No: Vol. 28 (2015)
  • Ten Achievements for 35 years of the Portuguese National Health Service
           (1979-2015): Looking Back, Planning the Future

    • Authors: Rui Tato Marinho, Pedro Câmara Pestana
      Abstract: Keywords: Infant mortality; Life Expectancy; National Health Programs; Portugal; Vital Statistics.
      PubDate: 2015-04-30
      Issue No: Vol. 28 (2015)
  • Complex Congenital Heart Disease: The Influence of Prenatal Diagnosis

    • Authors: Marta Correia, Fabiana Fortunato, Duarte Martins, Ana Teixeira, Graça Nogueira, Isabel Menezes, Rui Anjos
      Abstract: Introduction: Complex congenital heart disease is a group of severe conditions. Prenatal diagnosis has implications on morbidity and mortality for most severe conditions. The purpose of this work was to evaluate the influence of prenatal diagnosis and distance of residence and birth place to a reference center, on immediate morbidity and early mortality of complex congenital heart disease.
      Material and Methods:: Retrospective study of complex congenital heart disease patients of our Hospital, born between 2007 and 2012.
      Results:: There were 126 patients born with complex congenital heart disease. In 95%, pregnancy was followed since the first trimester, with prenatal diagnosis in 42%. There was a statistically significant relation between birth place and prenatal diagnosis. Transposition of great arteries was the most frequent complex congenital heart disease (45.2%), followed by pulmonary atresia with ventricular septal defect (17.5%) and hypoplastic left ventricle (9.5%). Eighty-two patients (65.1%) had prostaglandin infusion and 38 (30.2%)were ventilated before an intervention. Surgery took place in the neonatal period in 73%. Actuarial survival rate at 30 days, 12 and 24 months was 85%, 80% and 75%, respectively. There was no statistically significant relation between prenatal diagnosis and mortality.
      Discussion:: Most patients with complex congenital heart disease did not have prenatal diagnosis. All cases with prenatal diagnosis were born in a tertiary center. Prenatal diagnosis did not influence significantly neonatal mortality, as already described in other studies with heterogeneous complex heart disease.
      Conclusion:: prenatal diagnosis of complex congenital heart disease allowed an adequate referral. Most patients with complex congenital heart disease weren’t diagnosed prenatally. This data should be considered when planning prenatal diagnosis of congenital heart disease.
      PubDate: 2015-04-30
      Issue No: Vol. 28 (2015)
  • SAIMI Study - Health and Health Care Access by Immigrants from the Indian
           Subcontinent in Lisbon: What Recommendations for Equitable and Culturally
           Adequate Health Care'

    • Authors: Inês Campos Matos, Violeta Alarcão, Elisa Lopes, Carla Oiko, Mário Carreira
      Abstract: Introduction: The growth of the immigrant population in Portugal has been consistent over the past decades. Nevertheless, information on the health of immigrant populations is scarce. This research uses data collected from the population from the Indian subcontinent living in the district of Lisbon to produce recommendations for the provision of culturally adapted health services.
      Material and Methods: Cross-sectional study with the immigrant community of the Indian subcontinent (Bangladesh, India and Pakistan) living in Lisbon, selected based on a snowball sampling technique and using privileged access interviewers. The questionnaire focused on health, health care access, lifestyle and attitudes towards death. The data were subject to a descriptive analysis and an
      age-standardized comparison between the three nationalities was made.
      Results: Surveys were administered to 1011 individuals with a participation rate of 97%. Most participants were adult males. Indian immigrants most frequently reported barriers to use of health services and had a higher frequency of chronic diseases. Pakistani immigrants had worse lifestyle indicators.
      Discussion: The immigrant population from the Indian subcontinent tends to report more language difficulties in health care access when compared with other immigrant populations. Based on recommendations of the World Health Organization, it was possible to adapt this knowledge to produce recommendations adapted to the Portuguese context.
      Conclusion: There are several aspects in the management of health services in Portugal that can be better adapted to the immigrant population from the Indian subcontinent.
      PubDate: 2015-04-30
      Issue No: Vol. 28 (2015)
  • Comparing the Application of Hema-Obs RSS to 250 Pregnancies from
           Obstetrics/Hematology Consultation in Centro Hospitalar São
           João, Portugal with the Application of Galit Sarig RSS to 90
           Pregnancies from Rambam Health Care Campus, Israel

    • Authors: Ana Salselas, Inês Pestana, Francisco Bischoff, Mariana Guimarães, Joaquim Aguiar Andrade
      Abstract: Introduction: Pregnant women with thromboembolic diseases, previous thrombotic episodes or thrombophilia family history were supervised in a multidisciplinary Obstetrics/ Hematology consultation in Centro Hospitalar São João EPE, Porto, Portugal. For the evaluation and medication of these women, a risk stratification scale was used.
      Purposes: The aim of this study was to validate a Risk Stratification Scale and thromboprophylaxis protocol by means of comparing it with a similar scale, developed and published by Sarig.
      Material and Methods: We have compared: The distribution, by risk groups, obtained through the application of the two scales on pregnant women followed at Centro Hospitalar São João, Porto, Portugal, consultation; the sensibility and specificity for each one of the scales (DeLong scale, applied to Receiver Operating Characteristic) curves; the outcomes in pregnancies followed in Hospital São João, Porto, Portugal
      Results: According to our Hema-Obs risk stratification scale, 29% were allocated to low-risk, 47% to high-risk and 24% to very-high-risk groups. According to Galit Sarig risk stratification scale, 24% were considered low-risk, 53% moderate, 16% high-risk and 7% as very high-risk group. In our study we observed 9% of spontaneous abortions, in comparison with 18% in the Galit Sarig cohort. From the application of Receiver Operating Characteristic curve to both risk stratification scales, the results of the calculated areas were 58,8% to our Hema-Obs risk stratification scale and 38,7% to Galit Sarig risk stratification scale, with a Delong test significancie of p = 0.0006.
      Conclusions: We concluded that Hema-Obs risk stratification scale is an effective support for clinical monitoring of therapeutic strategies.
      PubDate: 2015-04-30
      Issue No: Vol. 28 (2015)
  • Bone Fractures in a Neonatal Intensive Care Unit

    • Authors: Ângela Machado, Gustavo Rocha, Ana Isabel Silva, Nuno Alegrete, Hercília Guimarães
      Abstract: Introduction: Fractures during the neonatal period are rare. Some fractures, especially long bones, may occur during birth. Moreover, neonates hospitalized in the Neonatal Intensive Care Unit have an increased risk of fractures for several reasons.
      Objective: To evaluate the incidence and characterize fractures in newborns admitted in a tertiary Neonatal Intensive Care Unit.
      Material and Methods: A retrospective analysis of the newborns admitted to the Neonatal Intensive Care Unit with a diagnosis at discharge of one or more bone fractures from January 1996 to June 2013.
      Results: Eighty neonates had one or more fractures. In 76 (95%) infants the fractures were attributed to birth injury. The most common fracture was the clavicle fracture in 60 (79%) neonates, followed by skull fracture in 6 (8%). In two (2.5%) neonates, extremely low birth weight infants, fractures were interpreted as resulting from osteopenia of prematurity. Both had multiple fractures, and one of them with several ribs.
      Conclusion: A change in obstetric practices allied to improvement premature neonate’s care contributed to the decreased incidence of fractures in neonatal period. But in premature infants the diagnosis may be underestimated, given the high risk of fracture that these infants present.
      PubDate: 2015-04-30
      Issue No: Vol. 28 (2015)
  • Career Satisfaction of Medical Residents in Portugal

    • Authors: Maria João Martins, Inês Laíns, Bruno Brochado, Manuel Oliveira-Santos, Pedro Pinto Teixeira, Mariana Brandão, Rui João Cerqueira, Ricardo Castro-Ferreira, Carlos Bernardes, Miguel Nobre Menezes, Bernardo Soares Baptista, Ricardo Ladeiras-Lopes, Mariana Cruz Rei, Gilberto Pires da Rosa, José Luís Martins, Maria Mendonça Sanches, Manuel J. Ferreira-Pinto, Margarida Rato, Miguel Costa e Silva, Catarina Policiano, João Beato, João Barbosa-Breda, João Pimentel Torres, Inês Leal, Sílvia Aguiar Rosa, Bárbara Carvalho Ribeiro, Francisco Rego Costa, Carolina Palmela, Tiago Cúrdia Gonçalves, Luis Morais, Tiago Reis Marques
      Abstract: Introduction: The satisfaction with the medical profession has been identified as an essential factor for the quality of care, the wellbeing of patients and the healthcare systems’ stability. Recent studies have emphasized a growing discontent of physicians, mainly as a result of changes in labor relations.
      Objectives: To assess the perception of Portuguese medical residents about: correspondence of residency with previous expectations; degree of satisfaction with the specialty, profession and place of training; reasons for dissatisfaction; opinion regarding clinical practice in Portugal and emigration intents.
      Material and Methods: Cross-sectional study. Data collection was conducted through the “Satisfaction with Specialization Survey”, created in an online platform, designed for this purpose, between May and August 2014.
      Results: From a total population of 5788 medical residents, 804 (12.25 %) responses were obtained. From this sample, 77% of the responses were from residents in the first three years. Results showed that 90% of the residents are satisfied with their specialty, 85% with the medical profession and 86% with their place of training. Nevertheless, results showed a decrease in satisfaction over the final years of residency. The overall assessment of the clinical practice scenario in Portugal was negative and 65% of residents have plans to emigrate after completing their residency.
      Conclusion: Portuguese residents revealed high satisfaction levels regarding their profession. However, their views on Portuguese clinical practice and the results concerning the intent to emigrate highlight the need to take steps to reverse this scenario.
      PubDate: 2015-04-30
      Issue No: Vol. 28 (2015)
  • Pharmacovigilance in Portugal: Activity of the Central Pharmacovigilance

    • Authors: Francisco Batel-Marques, Diogo Mendes, Carlos Alves, Ana Penedones, Patricia Dias, Angelina Martins, Luiz Miguel Santiago, Carlos Fontes-Ribeiro, Margarida Caramona, Tice Macedo
      Abstract: Introduction: The aim of this study was to characterize the spontaneous reports of adverse events that were received by the Central Portugal Regional Pharmacovigilance Unit.
      Material and Methods: Spontaneous reports received between 01/2001 and 12/2013 were considered. The annual reporting ratios were estimated. The cases were characterized according to their seriousness, previous description, causality assessment, origin and professional group of the reporter, type of adverse event and pharmacotherapeutic groups of the suspected drugs most frequently reported.
      Results: The Pharmacovigilance Unit received 2408 reports that contained 5749 adverse events. In 2013, the reporting rate was estimated at 171 reports per million inhabitants. Fifty-five percent of the reports were assessed as serious. Ninety percent of the cases were assessed as being at least possibly related with the suspected drug. The suspected drugs most frequently reported were antiinfectives for systemic use (n = 809, 33%). The most frequently reported adverse events were “Skin and subcutaneous tissue disorders” (n = 1139, 20%). There were 154 (6.4%) reports resulting in life-threatening situations and/or death, and 88 (3.6%) containing at least one adverse event assessed as serious, unknown and certain or probable.
      Discussion: The present results are in line with those found in other studies, namely the seriousness and type of the adverse eventsand the pharmacotherapeutic groups of the most frequently reported suspected drugs.
      Conclusion: In the last years, the Central Portugal Regional Pharmacovigilance Unit has registered a growth in the reporting rate in general, as well as an increase in the reporting of unknown and serious adverse drug reactions.
      PubDate: 2015-04-30
      Issue No: Vol. 28 (2015)
  • Obesity: Paradigm of Endothelial Dysfunction in Paediatric Age Groups

    • Authors: António Pires, Eduardo Castela, Cristina Sena, Raquel Seiça
      Abstract: Introduction: Obesity is considered a global epidemy with important public health issues as it is an independent risk factor in the development of cardiovascular disorders.
      Material and Methods: Approximately 10% of the world’s paediatric population has excess weight or obesity and 40% of these will be obese adults. Obesity is characterized by a chronic, low grade, pro-inflammatory process that ultimately results in endothelial dysfunction, the trigger lesion leading to adult cardiovascular disease. This leads to an imbalance in the synthesis of mediators that normally regulate vascular homeostasis, particularly nitric oxide bioavailability, favoring a pro-atherosclerotic status, the hallmark of cardiovascular
      Results: These changes begin early in childhood and anatomopathological studies in children with excess weight or obesity have shown endothelial changes that represent the precursors of the atherosclerotic lesion.
      Discussion: Endothelial dysfunction is the earliest manifestation of the atherosclerotic lesion. It is evident in obese children and, as such, it potentially contributes towards cardiovascular disease in the adult.
      Conclusion: Although the clinical impact of these changes rarely manifest themselves in infancy, the presence of related biomarkers as well as vascular morphological changes can, at this early stage, be found and assessed.
      PubDate: 2015-04-30
      Issue No: Vol. 28 (2015)
  • Prostate Cancer: The Role of Multiparametric Magnetic Resonance Imaging

    • Authors: João Lopes Dias, João Magalhães Pina, Raquel João, Joana Fialho, Sandra Carmo, Cecília Leal, Tiago Bilhim, Rui Mateus Marques, Luís Campos Pinheiro
      Abstract: Multiparametric Magnetic Resonance Imaging has been increasingly used for detection, localization and staging of prostate cancer over the last years. It combines high-resolution T2 Weighted-Imaging and at least two functional techniques, which include Dynamic Contrast–Enhanced Magnetic Resonance Imaging, Diffusion-Weighted Imaging, and Magnetic Resonance Imaging Spectroscopy. Although the combined use of a pelvic phased-array and an Endorectal Coil is considered the state-of-the-art for Magnetic Resonance Imaging evaluation of prostate cancer, Endorectal Coil is only absolute mandatory for Magnetic Resonance Imaging Spectroscopy at 1.5 T. Sensitivity and specificity levels in cancer detection and localization have been improving with functional technique implementation, compared to T2 Weighted-Imaging alone. It has been particularly useful to evaluate patients with abnormal PSA and negative biopsy. Moreover, the information added by the functional techniques may correlate to cancer aggressiveness and therefore be useful to select patients for focal radiotherapy, prostate sparing surgery, focal ablative therapy and active surveillance. However, more studies are needed to compare the functional techniques and understand the advantages and disadvantages of each one. This article reviews the basic principles of prostatic mp-Magnetic Resonance Imaging, emphasizing its role on detection, staging and active surveillance of prostate cancer.
      PubDate: 2015-04-30
      Issue No: Vol. 28 (2015)
  • Bilateral Optic Disc Edema Secondary to Amiodarone: Manifestation of an
           Iatrogenic Optic Neuropathy

    • Authors: Carlos Andrade, Olinda Faria, Joana Guimarães
      Abstract: A 69-years-old male patient was treated with amiodarone 200mg/day over the passed two months for atrial fibrillation. He presented a sudden, painless and unilateral visual loss. Ophthalmologic evaluation revealed a bilateral optic disc edema. Neurological examination was otherwise unremarkable. After properly excluding increased intracranial pressure and giant cell arteritis, the main differential diagnosis was between nonarteritic anterior ischemic optic neuropathy and optic neuropathy secondary to amiodarone. The latter diagnosis was favored due to a presence of bilateral and simultaneous optic disc edema, gradual improvement of symptoms after discontinuation of the drug, and, mostly, by persistence of optic disc edema beyond 6 weeks. Of note, an acute presentation of this disorder is common. Amiodarone optic neuropathy is a rare but potentially serious cause of optic nerve dysfunction, and its discontinuation is usually warrant.
      PubDate: 2015-04-30
      Issue No: Vol. 28 (2015)
  • Rickets: Emerging From the Past

    • Authors: Margarida Valério, Sara Pimentel Marcos, Conceição Santos, Maria João Leiria
      Abstract: In the past decade rickets has re-emerged in developed countries due to changes in lifestyles and dietary habits. We describe a case of a 28-month-old black infant with failure to thrive. He was exclusively breastfed until nine months of age, without vitamin supplementation, and never ingested milk products due to alleged cow’s milk intolerance. His examination revealed bowlegs, rachitic rosary and wide wrists. Alkaline phosphatase and intact parathyroid hormone levels were elevated, and calcidiol was decreased. Radiographic images showed bone demineralization, fraying and cupping of the distal radius and ulna. Nutritional rickets was considered and treatment with colecalciferol and calcium carbonate was initiated, with clinical, laboratory and radiologic improvement. In this case, a group of factors contributed to severe nutritional rickets, alerting to the re-emergence of this disease.
      PubDate: 2015-04-30
      Issue No: Vol. 28 (2015)
  • Carcinoma Erysipeloides

    • Authors: Helena Toda-Brito, Ermelindo Tavares, Eduarda Clemente
      Abstract: Keywords: Breast Neoplasms; Erysipeloid; Skin Neoplasms.
      PubDate: 2015-04-30
      Issue No: Vol. 28 (2015)
  • Tips for a Title

    • Authors: Helena Donato, Rui Tato Marinho
      Abstract: Keywords: Periodicals as Topic; Writing.
      PubDate: 2015-04-30
      Issue No: Vol. 28 (2015)
  • Health Communication: Preventing the Spread of Ebola Virus Disease in the
           Portuguese Spoken African Countries - Methodology KISS & KEYWORDS

    • Authors: Isabel De Santiago, José Pereira Miguel, Francisco Antunes
      Abstract: In this work, Health Communication is considered as an important discipline in medicine and health sciences for his role as true determinant of health. We highlight their contribution to health promotion and disease prevention. Thus, the Health Communication Plan (PCS): Preventing the spread of Ebola virus disease in the Portuguese Speaking African Countries - KISS & KEYWORDS methodology is a tool that aims to minimize the risk of infection by Ebola virus in the Portuguese Speaking African Countries and also train for a general
      improvement of health conditions of the local populations. In the PCS design are especially considered the social and cultural contexts of the target populations, especially the customs, traditions and religion. Health Communication is considered as an Essential Function of Public Health and its main is to provide a population-based approach. The target of communication actions are population groups in addition to the individual communication, target-audiences are people without access to the media, in Guinea Bissau, Cape Verde and Sao Tome and Principe. Under the communication plan uses the methodology, models and practices both by media professionals as health. A proximity approach and cultural mediation, previously identified key facts, are defined objectives; outlines to the Plan in concrete and its implementation methodology (target-audience and following intervention, materials to be used and key-messages and partners to mobilize) following the World Health Organisation standards.
      PubDate: 2015-04-27
      Issue No: Vol. 28 (2015)
  • Fiability Study of Diabetes Empowerment Scale: Short Version

    • Authors: Marcelo Aveiro, Luiz Miguel Santiago, Pedro Lopes Ferreira, José Augusto Simões
      Abstract: Purpose: To compare the final score of the scale to the levels of HbA1c.
      Material and Methods: Cross-sectional observational study by applying the Diabetes Empowerment Scale - Short Form to diabetics at three primary care units in the central region of Portugal. The test-retest (in writing first and, five minutes later, orally) was performed to access Cronbach‘s alpha in 20 patients not studied in the next phase. Then, the scale was applied to diabetic patients after nursing consultation and prior to entering the medical consultation. Descriptive and inferential statistics after checking for the normality of the data were performed.
      Results: In the first phase Cronbach’s alpha was 0.90 to 1.00 in all of eight scale items. The average result obtained in the written phase was 3.78 ± 0.71 and in the oral 3.79 ± 0.64, p = 0.629. The sample of the second stage was of 81 diabetic patients, 55.6% male. Sample’s mean age was 68.5 ± 1.1 years, mean HbA1c of 6.8 ± 0.2 and mean time from diagnosis of 9.2 ± 0.9 years. The average final score of the scale was 4.1 ± 0.8. There was significant correlation between the final score and HbA1c levels (ρ = -0.114; p = 0.312).
      Conclusion: The Portuguese version of the Diabetes Empowerment Scale – Short Form proved to be a reliable scale to measure empowerment in diabetic patients in Portugal. It was evident the presence of a statistically significant correlation between the results obtained at the end of the scale and HbA1c.
      PubDate: 2015-03-30
      Issue No: Vol. 28 (2015)
  • The Epidemiology of Dementia and Alzheimer Disease in Portugal:
           Estimations of Prevalence and Treatment-Costs

    • Authors: Isabel Santana, Filipa Farinha, Sandra Freitas, Vítor Rodrigues, Álvaro Carvalho
      Abstract: Introduction: The incidence and prevalence of global dementia and Alzheimer’s disease (AD) increase with age, almost doubling every five years after the sixth decade of life. Demographic aging is a reality in Portugal, being expectable that the number of dementia cases also increases. Even so, dementia-epidemiological data in Portugal is scarce and cost-of-illness studies are almost inexistent. Our aims were to obtain up-to-date information about the prevalence of dementia/ Alzheimer’s disease in Portugal, to estimate the
      number of cases effectively diagnosed as Alzheimer’s disease and to determine illness-costs with specific dementia treatment.
      Material and Methods: The numbers of age-adjusted prevalence of dementia obtained for Occidental Europe (Alzheimer’s Disease International study), where applied to the resident population in Portugal (2013). Estimations related to diagnosis and treatment-costs were based in data provided by the Intercontinental Marketing Services Health (IMSH) – 2013.
      Results: The estimated number of Portuguese people with dementia among those aged ≥ 60 years, is 160287, representing 5.91% of this population-stratum. Knowing Alzheimer’s disease is responsible for 50-70% of all cases, we might conclude there are between 80144 and 112201 patients. According to IMSH-data, 76250 receive anti-dementia drugs and the costs of this kind of medication is 37 M€/year.
      Conclusions: As a consequence of the demographic aging, also the number of dementia cases increases. Aparentely, not all Alzheimer’s disease patients receive the recommended medication, suggesting this condition is still under-diagnosed. However, figures indicate a positive progression with an increment of treated cases and a reduction of medication-costs.
      PubDate: 2015-03-30
      Issue No: Vol. 28 (2015)
  • Disciplinary Actions in Gynecology and Obstetrics in the North of Portugal
           from Year 2008 to 2012

    • Authors: Francisco Silva, Manuel Rodrigues e Rodrigues, João Bernardes
      Abstract: Introduction: Disciplinary actions may have a significant impact in medical doctors’ and patients’ lives. The objective of this study was the assessment of the disciplinary actions in Obstetrics and Gynecology that occurred in the north of Portugal in years 2008 to 2012.
      Material and Methods: Retrospective descriptive study based on the anonymized data contained in the annual activity reports of Conselho Disciplinar da Seção Regional Norte da Ordem dos Médicos from 2008 to 2012. We calculated the proportion of disciplinary actions in Obstetrics and Gynaecology over the total number of registered specialists in that speciality. We also analysed the type of complainers, accused, institutions, complaints and decisions. For statistical inference proportions with 95% confidence intervals were estimated.
      Results: From years 2008 to 2012, we registered 1040 complaints in all medical specialities in the north of Portugal. Obstetrics and Gynecology was the forth most affected specialty, with a total of 54 complaints. Forty-three complaints were related with medical malpractice and if we only consider this type of complaint Obstetrics and Gynecology was the most affected specialty. The most frequent complainers and accused were, respectively, patients themselves and female physicians, with 41 to 60 years of age. Fifty-two complaints were archived without punishment while two still await conclusion.
      Discussion: The overall results of this study are in agreement with those reported by other authors.
      Conclusions: Obstetrics and Gynecology was the forth speciality with highest risk for any disciplinary action in the north of Portugal in years 2008 to 2012 and the first one in relation with alleged negligence. All presented and already concluded complaints were archived without penalty, except two that are still under evaluation.
      PubDate: 2015-03-30
      Issue No: Vol. 28 (2015)
  • The Hell: Some Reflexions on Moral and Deontology

    • Authors: Nuno Félix da Costa
      Abstract: Keywords: Ethics; Morals; Paintings.
      PubDate: 2015-03-30
      Issue No: Vol. 28 (2015)
  • Freedom of Choice in the National Health Service - the Case of HIV

    • Authors: Julian Perelman
      Abstract: Keywords: Patient Rights; HIV Infections/therapy; Portugal; National Health Programs; Decision Making.
      PubDate: 2015-01-26
      Issue No: Vol. 28 (2015)
  • Deep Vein Thrombosis Prophylaxis in Patients with Traumatic Brain Injury

    • Authors: Vinícius Trindade Gomes da Silva, Ricardo Iglesio, Wellingson Silva Paiva, Mario Gilberto Siqueira, Manoel Jacobsen Teixeira
      Abstract: Introduction: The risk of deep vein thrombosis is increased in patients with head trauma, but the prophylaxis against this event is confronted with the possible risk of worsening hemorrhagic injuries. In this article, we present an overview about deep vein thrombosis prophylaxis in patients with head trauma and we propose a practical protocol for clinical management of deep vein thrombosis prophylaxis.
      Material and Methods: We reviewed relevant papers cited in the Medline/PubMed, Cochrane, and Scielo databases from January 1998 to January 2014. Based on a search with the following search expression: “deep venous thrombosis and prophylaxis and traumatic brain injury”, we found 44 eligible articles. Twenty-three papers were selected using criteria as published in English or Portuguese, patients in acute phase of moderate and severe traumatic brain injury and noninvasive mechanical prophylaxis or chemistry.
      Results: Head trauma alone is a risk factor for deep vein thrombosis. The chance of deep vein thrombosis is 2.59 times higher in patients with head trauma. The prevalence of deep vein thrombosis and pulmonary embolism in patients who have suffered head trauma is 20% in the literature, reaching 30% in some studies.
      Discussion and Conclusion: Head trauma alone is a risk factor for deep vein thrombosis and pulmonary thromboembolism and the risks inherent in this disease requires methods of prevention for these complications. Clinical trials are needed to establish the efficacy of prophylaxis and the best time to start medication for deep vein thrombosis in patients with traumatic brain injury.
      PubDate: 2015-01-16
      Issue No: Vol. 28 (2015)
  • Bronchopleurocutaneous Fistula: A Rare Complication of Pulmonary

    • Authors: Ana Sofia José Montez, Daniel Coutinho, Jorge Velez, Filomena Freitas, Célia Oliveira
      Abstract: Introduction: Multiple complications can occur in tuberculosis. Bronchopleurocutaneous fistula is a pathological communication between bronchus, pleural space and skin.
      Clinical Case: We present a 47 year-old male patient, schizophrenic, who presented with complaints of pleuritic chest pain, cough and weight loss. The patient was cachectic with purulent drainage from an orifice in the antero-lateral left chest wall. In this drainage acidfast bacilli were identified and chest radiograph showed bilateral infiltrates. He was admitted to the Infectious Diseases Department with the diagnosis of fistulized pulmonary tuberculosis, confirmed by visualization of acid-fast bacilli, positive polymerase chain reaction and cultures for Mycobacterium tuberculosis in the sputum. The patient was started on quadruple antituberculosis therapy and had a
      favorable outcome.
      Conclusions: Bronchopleurocutaneous fistula is a rare complication of pulmonary tuberculosis. Despite pulmonary tuberculosis being a common condition in our country, the rarity of this complication prompted the authors to present it.
      PubDate: 2015-01-16
      Issue No: Vol. 28 (2015)
  • Endotracheal Kaposi’s Sarcoma

    • Authors: Tiago M. Alfaro, Cláudia Nazareth, Carlos Robalo-Cordeiro
      Abstract: Keywords: HIV Infections; Sarcoma, Kaposi; Trachea.
      PubDate: 2015-01-16
      Issue No: Vol. 28 (2015)
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