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Journal Cover Acta Médica Portuguesa
  [SJR: 0.148]   [H-I: 15]   [0 followers]  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]
  • Challenges in Diagnosis and Treatment of Pediatric Multiple Sclerosis

    • Authors: Rita Lopes Silva
      Pages: 419 - 420
      Abstract: Keywords: Child; Demyelinating Autoimmune Diseases, CNS; Encephalomyelitis, Acute Disseminated; Multiple Sclerosis/diagnosis; Multiple Sclerosis/therapy.
      PubDate: 2016-08-31
      Issue No: Vol. 29, No. 7-8 (2016)
  • Analysis of the Cochrane Review: Portion, Package or Tableware Size for
           Changing Selection and Consumption of Food, Alcohol and Tobacco. Cochrane
           Database Syst Rev. 2015;09: CD011045.

    • Pages: 421 - 424
      Abstract: Some of the main causes of mortality and morbidity among the developed countries – such as the cardiovascular, neurological
      and oncologic diseases – are deeply associated with modifiable risk factors. Primordial/primary prevention strategies that alter our environment can have an impact on these risk factors. The authors of this Cochrane systematic review sought evidence from randomized controlled trials to study the effect of the size of portions, packages, dishes and cups, as well as their respective formats, on the consumption and selection of food, alcoholic and non-alcoholic beverages and tobacco products. Overall, this review concludes that the choice of larger portions results in an increased consumption in food, non-alcoholic beverages and tobacco.
      PubDate: 2016-08-31
      Issue No: Vol. 29, No. 7-8 (2016)
  • Pediatric Multiple Sclerosis in Portugal: A Multicentre Study

    • Pages: 425 - 431
      Abstract: Introduction: Multiple sclerosis is most often diagnosed among young adults but less frequently it may present during childhood or adolescence. In Portugal, there has been only one previous single-center, pediatric multiple sclerosis study. The main objective was the evaluation of the demographic, clinical, laboratorial and neuroradiological characteristics of patients with pediatric-onset multiple sclerosis in Portugal. The secondary objectives were to compare the characteristics of childhood-onset multiple sclerosis and adolescent-onset multiple sclerosis and to characterize the treatments prescribed.
      Material and Methods: We performed a retrospective observational, multicentric study. We reviewed data of all patients with multiple sclerosis younger than 18 years at the onset of their first multiple sclerosis symptoms.
      Results: There were 46 patients (72% female) included with a mean age at diagnosis of 16.1 years. Six cases had childhood-onset and 40 cases had adolescence-onset. The median value of Expanded Disability Status Scale was two. Relapsing-remitting multiple sclerosis was most prevalent (98% of cases). In the cerebrospinal fluid study, 74% of patients had positive oligoclonal bands. Brain magnetic resonance imaging studies showed a predominant supratentorial involvement (98% of cases), whereas the cervical segment was the most frequently affected in the spinal cord. All the patients enrolled in the study underwent immunomodulatory therapy, 75% of
      patients with beta-interferon. Concerning differences between the childhood and the adolescent groups, we found a greater proportion of male patients and of individuals with cerebrospinal fluid pleocytosis among the childhood-onset group.
      Discussion: This study provides new data on pediatric multiple sclerosis characteristics in Portugal and our results are similar to previously reported data in other parts of the world
      Conclusion: This is the first multicentric study characterizing pediatric multiple sclerosis in Portugal. The mechanisms underlying the particularities of pediatric multiple sclerosis remain largely unknown and further studies are required.
      PubDate: 2016-08-31
      Issue No: Vol. 29, No. 7-8 (2016)
  • Pulmonary Embolism in Portugal: Epidemiology and In-Hospital Mortality

    • Pages: 432 - 440
      Abstract: Introduction: In Portugal, the epidemiology of acute pulmonary embolism is poorly understood. In this study, we sought to characterize the pulmonary embolism from the hospital data and evaluate its in-hospital mortality and respective prognostic factors.
      Material and Methods: The study used diagnostic related groups data from National Health System hospitals from 2003 to 2013 and National Statistics Institute population data to establish the evolution of admissions with the diagnosis of pulmonary embolism, their inhospital mortality rates and the population incidence rates. Diagnosis-related group microdata were used in a logit regression modeling in-hospital mortality as a function of individual characteristics and context variables.
      Results: Between 2003 and 2013 there were 35,200 episodes of hospitalization in patients with 18 or more years in which one of the diagnoses was pulmonary embolism (primary diagnosis in 67% of cases). The estimated incidence rate in 2013 was 35/100,000 population (≥ 18 years). Between 2003 and 2013, the annual number of episodes kept increasing, but the in-hospital mortality rate decreased (from 31.8% to 17% for all cases and from 25% to 11.2% when pulmonary embolism was the main diagnosis). The probability of death decreases when there is a computerized tomography scan registry or when patients are females and increases with age and the presence of co-morbidities.
      Discussion: In the last decade there was an increased incidence of pulmonary embolism likely related to an increased number of dependents and bedridden. However, there was a in-hospital mortality reduction of such size that the actual mortality in the general population was reduced. One possible explanation is that there has been an increase in episodes of pulmonary embolism with incrementally lower levels of severity, due to the greater capacity of diagnosis of less severe cases. Another possible explanation is greater effectiveness of hospital care. According to the logistic regression analysis, improvements in hospital care effectiveness in recent years are primarily responsible for the mortality reduction.
      Conclusion: About 79% of the reduction of in-hospital mortality of pulmonary embolism between 2003 and 2013 can be attributed to greater effectiveness of hospital care and the rest to the favorable change in patient characteristics associated with risk of death.
      PubDate: 2016-08-31
      Issue No: Vol. 29, No. 7-8 (2016)
  • Short and Long-Term Efficacy of Laparoscopic Ovarian Diathermy in Women
           with Polycystic Ovary Syndrome

    • Pages: 441 - 448
      Abstract: Introduction: Polycystic ovary syndrome is the most frequent cause of anovulatory infertility and management involves a multistep approach. Laparoscopic ovarian diathermy is accepted as a second-line treatment of patients who failed to respond to clomiphene citrate. The aims of this study were to determine the efficacy of this technique at short and long-term and to perform an analysis of predictive factors of spontaneous pregnancy.
      Material and Methods: This retrospective study involved 76 women who underwent laparoscopic ovarian diathermy between 2004 and 2013 in a university hospital. Main outcomes were cycle regularity and pregnancy. Short-term outcomes recorded during followup in our centre were reviewed and long-term outcomes were evaluated by a telephone interview to all women whose surgery was undertaken more than three years ago. Clinical and biochemical data were analysed as predictive factors of spontaneous conception
      in patients without other infertility factors.
      Results: Menstrual cycle regularity was initially achieved in 53 (70%) women and in the long-term follow-up subgroup, 52% (12/23) had regular periods. In general, 53 (70%) women conceived and 77 pregnancies were achieved, 60% of which were spontaneous. The only prognostic factor found to be significantly associated with spontaneous conception was a shorter duration of infertility (< 3 years) (p < 0.05).
      Discussion: Laparoscopic ovarian diathermy showed pregnancy rates comparable to other ovulation induction treatments with the advantage of having a long lasting beneficial effect in menstrual regularity and fertility.
      Conclusion: Laparoscopic ovarian diathermy is a safe and effective treatment option for anovulatory infertility in women with polycystic ovary syndrome.
      PubDate: 2016-08-31
      Issue No: Vol. 29, No. 7-8 (2016)
  • Main Causes of Occupational Allergic Contact Dermatitis: A Three Year
           Study in the Center of Portugal

    • Pages: 449 - 455
      Abstract: Introduction: Allergic contact dermatitis, along with irritant contact dermatitis and immediate contact reactions, contact urticarial, are the most frequent dermatological occupational disease, but seldom reported to the National authorities.
      Material and Methods: We performed a 3-year retrospective study at the allergology section in the Dermatology Clinic of the University Hospital of Coimbra to evaluate the main occupations diagnosed as occupational allergic contact dermatitis, most common allergens and the effect of the modification of the work station in the evolution of the disease.
      Results: During 2012 - 2014 among the 941 patch tested patients, 77 (8.2%) were diagnosed with occupational allergic contact dermatitis, with 169 positive patch tests related to occupational exposure, 55 detected within the baseline and 114 in complementary test series. In most cases allergic contact dermatitis involved the hands (88.3%), main professional activities were nail estheticians and hairdressers due to the manipulation of (meth)acrylates, the most common allergen in the study. After the diagnosis, 27.3% abandoned
      the work, 23.4% changed the work station, 49% avoided exposure to the responsible allergen. Contact dermatitis resolved in 39% of the patients, improved in 39% but had no change in the remaining 22%.
      Discussion: This study, although including only patients from the center of Portugal, evaluates a large sample of patients with different occupations studied with a larger variety of allergens. Apart from classical allergens and professions responsible for occupational allergic contact dermatitis that we found in lower numbers (thiuram mix, paraphenylenodiamine, chromium and cobalt in health care workers, hairdressers and in the building industry), (meth)acrylates tested outside the European and Portuguese Baseline Series were the main cause of occupational allergic contact dermatitis, namely in nail estheticians. Methylisothiazolinone, the second more frequent
      occupational contact allergen in the present study was identified in different occupations as a result of the widespread use of this preservative that is causing a real ‘epidemics’ of allergic contact dermatitis all over Europe in the last years.
      Conclusion: Nail estheticians are not usually referred as an occupation with a high risk of developing allergic contact dermatitis. Nevertheless, the current fashion combined with professionals poorly informed about the risk of their activity and the high sensitizing potential of (meth)acrylates, leads to a higher frequency of allergic contact dermatitis in recent years.
      PubDate: 2016-08-31
      Issue No: Vol. 29, No. 7-8 (2016)
  • Intratechal Chemotherapy Treatment Through an Ommaya Reservoir Catheter
           for Meningeal Carcinomatosis: A Single-Centre Experience

    • Pages: 456 - 460
      Abstract: Introduction: Meningeal carcinomatosis is defined as tumour cells infiltration of leptomeninges and subarachnoid space. It is normally related with poor survival (2 - 5 months). The best multidisciplinary treatment for this condition is a matter of discussion. Patient’s condition and the natural history of the disease should be considered in the decision making process.
      Material and Methods: Retrospective cohort analysis of patients submitted to Ommaya Reservoir placement due to systemic solid tumour meningeal carcinomatosis between 2006 and 2014.
      Results: Twenty three patients were included (19 females, four males) with median age of 56.1 ± 2.2 years. The primary tumour was: breast – 16 patients, lung – four patients, stomach, bladder and cervix – one patient each. No complications were seen (infection, intracranial haematoma or CSF fistula). The median survival was 26.4 ± 7.7 weeks, range between nine days and 118 weeks (21/23 patients). Male gender was related to poor prognosis in crude analysis (p value = 0.0032). Breast adenocarcinoma was related with better prognosis in adjust analysis (p value = 0.036, HR: 4.36 ± 3.06; 95% IC: 1.10 - 17.25). Longer time between initial tumour and meningeal carcinomatosis diagnosis was related to a better outcome but without statistical significance.
      Discussion: Despite the low complication rate of Ommaya reservoir placement, the poor response to chemotherapy and the disease prognosis should be considered in patients with poor functional status. The relationship observed between the primary tumour and the overall survival supports that meningeal carcinomatosis should not be considered a disease by itself but always in the context of a systemic disease. The low incidence of breast cancer in male population might be related with it poorer prognosis.
      Conclusion: Meningeal carcinomatosis has a poor prognosis. Breast adenocarcinoma, longer time between initial tumour and
      meningeal carcinomatosis diagnosis, and age < 60 years were related with longer survival.
      PubDate: 2016-08-31
      Issue No: Vol. 29, No. 7-8 (2016)
  • Prevalence of Dental Caries in Type 1 Diabetic Patients Treated with
           Insulin Pump

    • Pages: 461 - 467
      Abstract: Introduction: Type 1 diabetes mellitus and oral health are strictly related on a reciprocal basis, and an increased susceptibility to a wide variety of oral diseases is recognised in these patients. The aim of the present study was to establish a relationship between the prevalence of dental caries in Type 1 diabetic patients treated with insulin pump and that of non-diabetic patients.
      Material and Methods: An observational clinical study of analytical and cross-sectional nature was conducted. The sample consisted of 30 adults with diabetes mellitus treated with insulin pump (selected from the Coimbra Hospital and Universitary Centre) and 30 nondiabetic adults (selected from the ones accompanying the diabetic patients). One dentist evaluated all of the patients between January and May of 2015 in the Faculty of Medicine of the University of Coimbra. During the clinical evaluation a case report form adapted to the objectives of the investigation was completed. Data analysis was performed and the significance level was set at 5%.
      Results: Diabetic patients showed similar levels on the caries and plaque index to non-diabetic patients. There were no statistically significant differences between the two groups as regards oral hygiene habits and frequency of visits to the dentist.
      Discussão: Although diabetics’ diet is less abundant in carbohydrates, which provides a smaller exposure to cariogenic food, the regularity of meals can increase the risk of caries since the critical pH for demineralization is reached frequently throughout the day. However, the existence of a chronic condition may determine a high concern for general preventive care, resulting in an overall improvement of their oral health, which could justify the results.
      Conclusion: Type 1 diabetic patients treated with insulin pump don’t have a higher prevalence of dental caries.
      PubDate: 2016-08-31
      Issue No: Vol. 29, No. 7-8 (2016)
  • Causes of Death in an Acute Psychiatric Inpatient Unit of a Portuguese
           General Hospital

    • Pages: 468 - 475
      Abstract: Introduction: Psychiatric patients are at increased risk of death from a number of natural and unnatural causes. This study examines the mortality causes of all psychiatric inpatients of an acute psychiatric unit at a general hospital in Portugal for sixteen years (1998 to 2013).
      Material and Methods: Twenty-one inpatients died at the inpatient unit between 1998 and 2013 (average 1.3 per year). A retrospective study through case-file review was carried to collect demographic characteristics, medical and psychiatry diagnosis. Patients transferred to other wards during their admission were not included.
      Results: Circulatory system diseases were the most prevalent causes of death, occurring in 2/3 of patients and include pulmonary embolism (n = 6), acute stroke (n = 3), cardiac arrhythmia (n = 2), acute myocardial infarction (n = 1), abdominal aortic aneurysm rupture (n = 1) and heart failure (n = 1). Two patients died with pneumonia and in four cases the cause of death was undetermined. Only one case of suicide was registered.
      Discussion: Circulatory conditions were the most frequent causes of death in our inpatient unit. Albeit a relatively rare event, inpatient suicide does occur and, in addition to its complex consequences on staff, family and patients should remain a focus for continued prevention.
      Conclusion: Mortality studies are important for determining quality of health care and to create recommendations for preventive measures.
      PubDate: 2016-08-31
      Issue No: Vol. 29, No. 7-8 (2016)
  • Molecular Mechanisms for Adhesion and Colonization of Human Gastric Mucosa
           by Helicobacter pylori and its Clinical Implications

    • Pages: 476 - 483
      Abstract: Introduction: Helicobacter pylori infection is very prevalent worldwide and is associated with the progression of the gastric
      carcinogenesis cascade, being one of the main risk factors for the development of gastric carcinoma. Several factors are determinant for the infection and for the development of gastric disease, including environmental factors, host genetic factors and virulence factors of the bacteria.
      Material and Methods: In this review, we present an overview of the current knowledge on the determinants of the infection and on the recently described molecular mechanisms of Helicobacter pylori adhesion to the gastric mucosa, as well as its possible future therapeutic application.
      Results: The adhesion of Helicobacter pylori to the gastric epithelium is critical for gastric pathogenesis, allowing bacterial access to nutrients and the action of bacterial virulence factors, promoting recurrence of the infection and the progression of the gastric carcinogenesis pathway.
      Discussion: Eradication of Helicobacter pylori infection is the best preventive strategy available against gastric cancer, mainly if it is achieved before the development of pre-neoplastic lesions. The increase in antibiotics resistance, together with the eradication failures in some patients, has promoted the development of alternative treatments.
      Conclusion: The new therapeutic strategies, focused on the molecular mechanism of Helicobacter pylori adhesion, are very promising; however, future studies are needed to evaluate its in vivo efficiency and toxicity.
      PubDate: 2016-08-31
      Issue No: Vol. 29, No. 7-8 (2016)
  • Infectious Postpartum Sacroiliitis: The Importance and Difficulty of Early

    • Pages: 484 - 487
      Abstract: The sacroiliitis accounts for about 1.5% - 10% of all cases of septic arthritis and it is strongly associated with gynaecological infections, pelvic trauma or drug abuse (3.4% - 12.8% of cases occur during the postpartum period). Early diagnosis is difficult because the symptoms are nonspecific in pregnancy and in the postpartum period, making the delay of treatment a serious risk of irreversible damage to the joint and development of post-infectious complications. The authors describe the case of a 37-year-old puerperal woman presented to hospital, weeks after urgent caesarean section, with endometritis, post-anesthetic epidural hematoma and secondary infectious postpartum sacroiliitis. The diagnosis of sacroiliac joints pathology during pregnancy and puerperium is challenging. The pathogenesis of infectious sacroiliitis results from local contamination by contiguous infection or hematogenous spread of bacterial infections. The prognosis is usually favorable and depends on early diagnosis and treatment.
      PubDate: 2016-08-31
      Issue No: Vol. 29, No. 7-8 (2016)
  • Streptococcus agalactiae Native Valve Endocarditis: Uncommon Presentation
           of Multiple Myeloma

    • Pages: 488 - 490
      Abstract: Adults with chronic immunosuppressive conditions are at an increased risk for Streptococcus agalactiae endocarditis, which is typically characterized by acute onset, presence of large vegetations, rapid valvular destruction and frequent complications. We report a rare case of a 74 years old man presenting with fever, renal infarction, ischemic stroke and uveitis. Infective endocarditis was diagnosed and Streptococcus agalactiae was isolated in blood cultures. A multiple myeloma Ig G-K was also diagnosed. The infective endocarditis was successfully treated with a course of benzylpenicillin and gentamicin. The authors highlight the severity of vascular embolic disease present in this case and the diagnostic challenge. They also intend to remind about the association between Streptococcus agalactiae endocarditis and chronic diseases, despite its low reported prevalence.
      PubDate: 2016-08-31
      Issue No: Vol. 29, No. 7-8 (2016)
  • Congenital Butterfly Vertebra

    • Pages: 491 - 491
      Abstract: Keywords: Lumbar Vertebrae/abnormalities; Lumbar Vertebrae/radiography.
      PubDate: 2016-08-31
      Issue No: Vol. 29, No. 7-8 (2016)
  • Marjolin’s Ulcer

    • Authors: Francisco Macedo, Sandra Macedo, Filipa Drumond, Miguel Pestana
      Pages: 492 - 492
      Abstract: Keywords: Carcinoma, Squamous Cell; Skin Neoplasms; Skin Ulcer.
      PubDate: 2016-08-31
      Issue No: Vol. 29, No. 7-8 (2016)
  • Letter to the Editor regarding the article: “Burnout in Portuguese
           Healthcare Professionals: An Analysis at the National Level“ by João
           Marôco, Ana Lúcia Marôco, Ema Leite, Cristina Bastos, Maria José
           Vazão, Juliana Campos. Acta Med Port 2016;29:24-30.

    • Pages: 493 - 493
      Abstract: Keywords: Burnout, Professional; Health Personnel; Portugal.
      PubDate: 2016-08-31
      Issue No: Vol. 29, No. 7-8 (2016)
  • Errata to the Article “Burnout in Portuguese Healthcare

    • Authors: . .
      Pages: 494 - 494
      Abstract: Errata to the article “Burnout in Portuguese Healthcare Professionals: An Analysis at the National Level”, by João Marôco, Ana Lúcia Marôco, Ema Leite, Cristina Bastos, Maria José Vazão, Juliana Campos (Acta Med Port. 2016;29:24-30).
      PubDate: 2016-08-31
      Issue No: Vol. 29, No. 7-8 (2016)
School of Mathematical and Computer Sciences
Heriot-Watt University
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