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Journal Cover Acta Médica Portuguesa
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  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]
  • Thank You, Reviewers of Acta Médica Portuguesa

    • Authors: José Manuel Silva, Rui Tato Marinho
      Pages: 1 - 4
      Abstract: N/A.
      PubDate: 2017-01-31
      Issue No: Vol. 30, No. 1 (2017)
  • Public Health Ethics and Conflict of Interests

    • Authors: António Jácomo
      Pages: 5 - 6
      Abstract: N/A.
      PubDate: 2017-01-31
      Issue No: Vol. 30, No. 1 (2017)
  • Analysis of the Cochrane Review: Non-medical Prescribing versus Medical
           Prescribing for Acute and Chronic Disease Management in Primary and
           Secondary Care. Cochrane Database Syst Ver. 2016;11:CD011227.

    • Authors: Gonçalo Silva Duarte, Ricardo Martins Delgado, João Costa, António Vaz-Carneiro
      Pages: 7 - 11
      Abstract: In countries with diverse socioeconomic levels, in order to address the health care demands, the consideration of a wide array of strategies is needed; among these, non-medical prescription can be included. The objective of this revision was to ascertain whether non-medical prescription results in comparable clinical and patient-related outcomes to medical prescription. This systematic review was conducted in compliance with the standard Cochrane methodology. Clinical outcomes were compared between prescription carried out by non-medical health professionals and doctors, provided that the non-medical health professional prescribed with a high degree of autonomy, both in hospital and community practice, in countries with low, medium and high socioeconomic level. The review included 46 clinical trials, with different designs, with 37 337 participants overall. Most studies were based on the management of chronic disease in higher income countries, where the evidence supports comparable outcomes for the markers of disease relative to high blood pressure (moderate-certainty of evidence), diabetes control (high-certainty of evidence); high cholesterol (moderatecertainty
      of evidence), among others. Prescription by pharmacists and nurses with different levels of undergraduate, specific and postgraduate education could provide comparable outcomes to medical prescription, specifically with regards to adherence to therapy, adverse events, overall satisfaction, quality of life, and resource utilisation (hospitalisations, visits to the emergency department, and consultations). Non-medical prescribers frequently had medical support available to facilitate a collaborative practice. With appropriate training and support, non-medical prescription by nurses and pharmacists can be as effective as when carried out by doctors.
      PubDate: 2017-01-31
      Issue No: Vol. 30, No. 1 (2017)
  • Perinatal Outcome in Relation to Chorionicity in Twin Pregnancy

    • Authors: Marta Machado, Elsa Lima Teixeira, Lígia Maria Ferreira, Filipa Rodrigues, Raquel Henriques, Eulália Afonso
      Pages: 12 - 16
      Abstract: Introduction: The incidence of multiple gestations is increasing worldwide and many studies have shown higher perinatal morbidity and mortality rates in monochorionic twins compared to dichorionic. The aim of this study was to assess the twin population born at a tertiary center and to evaluate the impact of chorionicity on perinatal outcomes of twin pregnancies.
      Material and Methods: Retrospective study of all twins born in a tertiary center from January 2004 to December 2013.
      Results: In this period, 1051 twins were born, related to 540 gestations (26.7% monochorionic; 73.3% dichorionic). There was no statistical significant difference between the groups concerning obstetric complications. The monochorionic group had a higher incidence of intrauterine growth restriction (20.5 vs 11.3%, p < 0.001), lower mean maternal age (29.9 vs 31.9 years, p < 0.001), lower mean gestational age (33.4 vs 34.3 weeks, p < 0.05) and lower mean birth weight (1943 vs 2147 g, p < 0.001). Monochorionic twins had a higher incidence of hyaline membrane disease (7 vs 4%, p < 0.05), sepsis (10.3 vs 5.8%, p < 0.05) and anemia (9.5 vs 5.4%, p < 0.05). There were no statistical significant differences concerning necrotizing enterocolitis, intraperiventricular hemorrhage or retinopathy of prematurity. Perinatal mortality was higher in the monochorionic group (5.2 vs 2.9%, p < 0.05).
      Discussion: Monochorionic twins represent considerable challenges to both obstetricians and neonatologists and should be monitored and delivered at tertiary centers.
      Conclusion: Currently gemelarity has a major impact on total births. It would be interesting to develop protocols to standardize clinical approach to twins.
      PubDate: 2017-01-31
      Issue No: Vol. 30, No. 1 (2017)
  • The Portuguese Version of the European Deprivation Index: An Instrument to
           Study Health Inequalities

    • Authors: Ana Isabel Ribeiro, Alexandra Mayer, Ana Miranda, Maria de Fátima de Pina
      Pages: 17 - 25
      Abstract: Introduction: Tackling socioeconomic health inequalities is a big public health challenge and ecological deprivation indexes are essential instruments to monitor and understand them. In Portugal, no standard ecological deprivation index exists, contrasting with other countries. We aimed to describe the construction of the Portuguese version of a transnational deprivation index, European Deprivation Index.
      Material and Methods: The European Deprivation Index was developed under the Townsend theorization of deprivation. Using data from the European Union - Statistics on Income and Living Conditions Survey, we obtained an indicator of individual deprivation. This indicator became the gold-standard variable, based on what we selected the variables at aggregate level (census) to be included in the European Deprivation Index, a total of eight. The European Deprivation Index was produced for the smallest area unit possible (n = 16 094, mean/area = 643 inhabitants) and resulted from the weighted sum of the previous variables. It was then classified into quintiles.
      Results: The first quintile (least deprived) comprised 20.9% national population and the fifth quintile (most deprived) 18.0%. The European Deprivation Index showed a clear geographic pattern – most deprived areas concentrated in the South and in the inner North and Centre of the country, and the least deprived areas in the coastal areas of North and Centre and in the Algarve.
      Discussion: The development of the European Deprivation Index was grounded on a solid theoretical framework, individual and aggregate variables, and on a longitudinal Europe-wide survey allowing its replication over the time and in any European country.
      Conclusion: Hopefully, the European Deprivation Index will start being employed by those interested in better understand health inequalities not only in Portugal but across Europe.
      PubDate: 2017-01-31
      Issue No: Vol. 30, No. 1 (2017)
  • Differences in the Students’ Perceptions on the Teaching of Neuroanatomy
           in a Medical Curriculum Organized by Disciplines and an Integrated Medical

    • Authors: Mavilde Arantes, Joselina Barbosa, Maria Amélia Ferreira
      Pages: 26 - 33
      Abstract: Introduction: On the subject of curriculum reform, most European medical schools are moving away from an educational approach consisting of discipline-based courses to an integrated curriculum. The aim of this study was to compare, in the Faculty of Medicine of the University of Porto, Portugal, the teaching of neuroanatomy in a medical curriculum organized by disciplines and in an integrated medical curriculum.
      Material and Methods: Two hundred sixty one students who completed the Curricular Unit with a discipline-based approach (Neuroanatomy) and 202 students who completed it with an integrated approach (Morphophysiology of the Nervous System) were asked to complete a questionnaire on their perceptions about the Curricular Unit.
      Results: Our study showed that students of the Curricular Unit with a discipline-based approach had higher grades and evaluated it higher than students who followed the integrated approach. However, it also showed that students’ grades had a significant effect on the evaluation of the curricular unit, with students with higher grades evaluating higher than students with lower grades. Besides, the majority of the students of the Curricular Unit with an integrated approach appreciated this curriculum model and highlighted as a positive point the successful integration of contents covered in the three components of the curricular unit.
      Discussion: The curriculum reform led to the integration of neuroanatomy with other disciplines and resulted in a reduction of the teaching hours, a redefinition of the syllabus contents and the students’ learning objectives, the introduction of new educational methods and changes in the evaluation system.
      Conclusion: Our study could not prove conclusively the supremacy of one pedagogic approach to neuroanatomy over the other. Future initiatives to explore different pedagogical models in medical education are needed and should be of major concern to the medical faculty.
      PubDate: 2017-01-31
      Issue No: Vol. 30, No. 1 (2017)
  • Motivation to Quit Smoking after Acute Coronary Syndrome

    • Authors: Vânia Rocha, Marina Guerra, Marina Lemos, Júlia Maciel, Geoffrey Williams
      Pages: 34 - 40
      Abstract: Introduction: Self-Determination Theory explores the process through which a person acquires motivation to initiate new behaviours related to health and to maintain them over time. This study aimed to determine the overall fit of Self-Determination Theory Model for Health Behavior to the data obtained from a sample of smokers hospitalized with acute coronary syndrome, and to identify the predictors of smoking status six months after clinical discharge.
      Material and Methods: The sample included 110 participants, regular smokers, hospitalized due to acute coronary syndrome. Questionnaires were administered to assess autonomous self-regulation, perceived competence, family support, depressive symptoms and meaning in life. Participants were asked if they were currently smokers six months after clinical discharge.
      Results: The results showed that the process variables specified by Self-Determination Theory fit the data well. Perceived competence predicted abstinence from smoking six months after clinical discharge.
      Discussion: Our findings have similar characteristics to other international samples in which Self-Determination Theory models have
      been tested. It is important to facilitate perceived competence, as the patients who continue to smoke have shorter length of life.
      Conclusion: This study highlights the importance of considering clinical interventions based on Self-Determination Theory to facilitate
      smoking cessation.
      PubDate: 2017-01-31
      Issue No: Vol. 30, No. 1 (2017)
  • Tuberculosis in Liver Transplant Recipients: A Report of Eight Cases
           During a Five Year Period

    • Authors: Diana Póvoas, João Machado, Rui Perdigoto, Ana Morbey, Júlio Veloso, Helena Glória, Élia Mateus, Américo Martins, Fernando Maltez, Eduardo Barroso
      Pages: 41 - 46
      Abstract: Introduction: Tuberculosis incidence in Portugal ranged from 20 to 22 cases per 100 000 inhabitants between 2010 and 2014. Tuberculosis incidence in liver transplant recipients is not precisely known, but it is estimated to be higher than among the general population. Tuberculosis in liver transplant recipients is particularly challenging because of the atypical clinical presentation and side effects of the antibacillary drugs and their potential interactions with immunosuppressive therapies.
      Material and Methods: We retrospectively reviewed the clinical records of liver transplant recipients with post-transplant tuberculosis occurring from January 2010 to December 2014 at a liver transplantation unit in Lisbon, Portugal. Demographic data, baseline and clinical features, as well as treatment regimen, toxicities and outcomes, were analyzed.
      Results: Among 1005 recipients, active tuberculosis was diagnosed in eight patients between January 2010 and December 2014 (frequency = 0.8%). Late onset tuberculosis was more frequent than early tuberculosis. Mycobacterium tuberculosis complex was isolated from cultures in almost every case (7; 87.5%). Extra-pulmonary involvement and disseminated tuberculosis were frequent. Two patients developed rejection without allograft loss. Crude mortality was 37.5%, with 2 deaths being related to tuberculosis.
      Discussion: Despite the uncertainty regarding treatment duration in liver transplant recipients, disease severity, as well as number of active drugs against TB infection, should be taken into account. There was a need for a rifampin-free regimen and immunosuppression adjustment in patients who experienced acute graf rejection.
      Conclusion: Although the number of cases of tuberculosis is low, its post-transplant frequency is significant and the observed mortality rate is not to be neglected. The cases of hepatotoxicity and graft rejection seen in this case series demonstrate the challenges associated with tuberculosis diagnosis in liver transplant recipients and management of the interactions between immunosuppressors and rifampin. This study strengthens the recommendation of latent tuberculosis infection screening and treatment in liver transplant candidates or recipients.
      PubDate: 2017-01-31
      Issue No: Vol. 30, No. 1 (2017)
  • Portuguese Version of the EORTC QLQ-OES18 and QLQ-OG25 for Health-Related
           Quality of Life Assessment

    • Authors: Miguel Relvas-Silva, Rui Almeida Silva, Mário Dinis-Ribeiro
      Pages: 47 - 52
      Abstract: Introduction: Health-related quality of life assessment is increasingly important as it can help both clinical research and care for patients, particularly among oncological patients. Quality of Life Questionnaire – OES18 (esophageal module) and Quality of Life Questionnaire – OG25 (esophagogastric module) are the European Organization for Research and Treatment of Cancer modules for the evaluation of quality of life in patients with esophageal and esophagogastric cancers, respectively. The aim of our study was to translate, to culturally adapt and to perform a pilot testing to create the Portuguese version of both questionnaires.
      Material and Methods: The European Organization for Research and Treatment of Cancer guidelines were followed for translation, cultural adaptation and pilot testing of Quality of Life Questionnaire – OES18 (esophageal module) and Quality of Life Questionnaire – OG25 (esophagogastric module). The Quality of Life Questionnaire – OG25 (esophagogastric module) went through a process of forward (English → Portuguese) and backward (Portuguese → English) translation, by independent native speaker translators. After review, a preliminary version was created to be pilot tested among Portuguese patients. As a Brazilian version was already available for Quality of Life Questionnaire – OES18 (esophageal module), the questionnaire was simply culturally adapted and pilot tested. Both cancer and non-cancer patients were included.
      Results: Overall, 30 patients completed the Portuguese version of each questionnaire. Afterwards, a structured interview was conducted to find and report any problematic items. Troublesome items and wording were changed according to the pilot testing results. The final versions were sent to the European Organisation for Research and Treatment of Cancer Quality of Life Group and approved.
      Conclusion: The Portuguese versions of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire – OES18 (esophageal module) and OG25 (esophagogastric module) questionnaires are useful, reliable and valid tools for measuring health-related quality of life in patients with esophageal and esophagogastric cancers, respectively. They can now be used in clinical setting and for scientific purposes.
      PubDate: 2017-01-31
      Issue No: Vol. 30, No. 1 (2017)
  • Superiority of 18F-FNa PET/CT for Detecting Bone Metastases in Comparison
           with Other Diagnostic Imaging Modalities

    • Authors: Paula Lapa, Tiago Saraiva, Rodolfo Silva, Margarida Marques, Gracinda Costa, João Pedroso Lima
      Pages: 53 - 60
      Abstract: Introduction: The 18F-NaF positron emission tomography/computed tomography is being considered as an excellent imaging modality
      for bone metastases detection. This ability was compared with other imaging techniques.
      Material and Methods: We retrospectively evaluated 114 patients who underwent 18F-NaF positron emission tomography/ computed tomography. Of these, 49 patients also had bone scintigraphy, 61 18F-FDG positron emission tomography/computed tomography and 10 18F-FCH positron emission tomography/computed tomography. We identified the technique that detected the largest number of bone metastases. For the detection of skeletal metastases with the 18F-NaF positron emission tomography/computed tomography study,
      the contribution of the positron emission tomography component was compared with the contribution of the computed tomography component. Cases in which 18F-NaF positron emission tomography/computed tomography and bone scintigraphy required further additional tests for diagnosis clarification were registered.
      Results: The 18F-NaF positron emission tomography/computed tomography was superior to bone scintigraphy in 49% of the patients
      (p < 0.001); it was superior to 18F-FDG positron emission tomography/computed tomography in 59% of the patients (p < 0.001) and it was superior to 18F-FCH positron emission tomography/computed tomography in 40% of the patients (p < 0.001). None of the compared imaging techniques were superior to 18F-NaF positron emission tomography/computed tomography. The positron emission tomography component was superior to computed tomography in 35% of the cases (p < 0.001). Further investigation was suggested in only 3.5% of patients who underwent 18F-NaF positron emission tomography/computed tomography (45% for bone scintigraphy) (p < 0.001).
      Discussion: As with other authors, our experience also confirms that 18F-NaF positron emission tomography/computed tomography is an excellent imaging modality for the detection of bone metastases, detecting lesions in more patients and more lesions per patient.
      Conclusion: The 18F-NaF positron emission tomography/computed tomography showed a superior ability for the detection of bone metastases when compared with bone scintigraphy, 18F-FDG positron emission tomography/computed tomography and 18F-FCH positron emission tomography/computed tomography.
      PubDate: 2017-01-31
      Issue No: Vol. 30, No. 1 (2017)
  • Symptomatic Control in End-of-Life Patients

    • Authors: Mariana Alves, Rita Abril, Isabel Galriça Neto
      Pages: 61 - 68
      Abstract: End-of-life patients present a variety of symptoms that cause suffering for them and their respective families. Health professionals throughout their university, internship and medical careers are ill-prepared to manage and improve the quality of life of these patients. This article aims to provide basic skills in the symptomatic management of end-of-life patients, focusing in particular on the control of pain, dyspnoea, fatigue, nausea, vomiting and anorexia. It also aims to draw attention to basic concepts of control concerning refractory symptoms and palliative sedation.
      PubDate: 2017-01-31
      Issue No: Vol. 30, No. 1 (2017)
  • The Relationship Between Immunodepression and the Development of Skin

    • Authors: Maria Mendonça Sanches, Ana Rita Travassos, Luis Soares-de-Almeida
      Pages: 69 - 72
      Abstract: The effects of immunodepression on several disease states have constituted an important area of research, leading to the identification of relevant associations between immunodepression and a vast set of comorbidities, including infectious diseases, cardiovascular diseases and cancer. Research on the effects of immunodepression has mostly been conducted in individuals under immunodepression by the human immunodeficiency virus and transplant recipients under pharmacological immunosuppression, due to the difficulties in obtaining relevant samples sizes in other contexts of immunodepression. Overall, immunosuppressed individuals tend to show increased incidence of malignancies, but only transplant recipients show significantly increased incidence of skin cancer; human immunodeficiency virus-infected individuals only show increased incidence of malignancies of infectious origin. This paper presents a literature review on the effects of immunodepression in the development of tumours in humans, with special emphasis on the development of the different types of skin cancer.
      PubDate: 2017-01-31
      Issue No: Vol. 30, No. 1 (2017)
  • Trauma Patient with Fat Embolism Detected on Computed Tomography

    • Authors: Isabel Sousa, João Janeiro, Paula Campos, Isabel Távora
      Pages: 73 - 76
      Abstract: Fat embolism is frequent following fractures of long bones, however the development of the clinical syndrome of fat embolism (characterized by progressive respiratory distress, mental status depression and petechial rash) is rare, but relevant because of its potential severity. We report a case of a trauma patient with multiple fractures of the right lower limb in whom an emergency computed tomography scan showed fat emboli within the lumen of the homolateral common femoral vein. The imaging detection of macroscopic fat emboli should alert the clinician to the potential for subsequent fat embolism syndrome.
      PubDate: 2017-01-31
      Issue No: Vol. 30, No. 1 (2017)
  • Behavior Changes and Gait Unsteadiness: The Value of Imaging and Prompt
           Neurosurgical Intervention

    • Authors: Andreia Costa, Cláudia Marques-Matos, Carina Reis, Marta Carvalho, Madalena Pinto
      Pages: 77 - 79
      Abstract: Cavernous angiomas are central nervous system malformations. Most common manifestations are seizures and acute focal neurological deficits. We present a case report of a seventy-one year-old man with a two-month history of behavior changes, attention deficit and indifference followed by gait unsteadiness. Neuropsychological evaluation showed severe cognitive impairment and executive dysfunction. Head computed tomography depicted a supraventricular hydrocephaly. Magnetic resonance imaging revealed a small hemorrhage, contiguous to a mesencephalic cavernous angioma, obstructing the Sylvius aqueduct, causing secondary hydrocephalus. Four months after endoscopic ventriculocisternostomy, neuropsychological evaluation showed improvement and the patient regained autonomy. Parenchyma cavernous angiomas causing direct hemorrhage and subsequent obstruction of the Sylvian aqueduct are uncommon. Sub-acute behavior and mental state abnormalities are rare first manifestations of cavernous angioma and requires high clinical suspicion for its correct diagnosis. Magnetic resonance imaging evaluation is crucial in the detection of such patients as prompt neurosurgical intervention may substantially improve cognitive function.
      PubDate: 2017-01-31
      Issue No: Vol. 30, No. 1 (2017)
  • Aortic Dissection Mimicking ST Elevation Myocardial Infarction

    • Authors: Ricardo Costa Rodrigues, Nuno Santos, Décio Pereira
      Pages: 80 - 80
      Abstract: N/A.
      PubDate: 2017-01-31
      Issue No: Vol. 30, No. 1 (2017)
  • Scrotal Cystocele by Computed Tomography and Ultrasound

    • Authors: Diana Penha, Erique Guedes Pinto, Ana Costa
      Pages: 81 - 81
      Abstract: N/A.
      PubDate: 2017-01-31
      Issue No: Vol. 30, No. 1 (2017)
  • Letter to the Editor: Comments to Training and Medical Education

    • Authors: Henrique Carmona da Mota
      Pages: 82 - 83
      Abstract: N/A.
      PubDate: 2017-01-31
      Issue No: Vol. 30, No. 1 (2017)
School of Mathematical and Computer Sciences
Heriot-Watt University
Edinburgh, EH14 4AS, UK
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Fax: +00 44 (0)131 4513327
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