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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]
  • Conclusions from the Small Working Groups Included in the 5th Symposium
           Acta Médica Portuguesa

    • Authors: Conselho Editorial
      Pages: 681 - 682
      Abstract: N/a
      PubDate: 2016-11-30
      Issue No: Vol. 29, No. 11 (2016)
  • Ischemic Stroke: Increasing the Number of Patients Submitted to Acute
           Specific Therapy and Estimating the Individual Benefits

    • Authors: Miguel Viana-Baptista
      Pages: 683 - 683
      Abstract: N/a
      PubDate: 2016-11-30
      Issue No: Vol. 29, No. 11 (2016)
  • Portuguese Medical Students’ Knowledge and Attitudes Towards

    • Authors: Lucas Lopes, Jorge Gato, Manuel Esteves
      Pages: 684 - 693
      Abstract: Introduction: Lesbian, gay, bisexual and transgender people still face discrimination in healthcare environments and physicians often report lack of knowledge on this population’s specific healthcare needs. In fact, recommendations have been put forward to include lesbian, gay, bisexual and transgender health in medical curricula. This study aimed to explore factors associated with medical students’ knowledge and attitudes towards homosexuality in different years of the medical course.
      Material and Methods: An anonymous online-based questionnaire was sent to all medical students enrolled at the Faculty of Medicine - University of Porto, Portugal, in December 2015. The questionnaire included socio-demographic questions, the Multidimensional Scale of Attitudes Toward Lesbians and Gay Men (27 items) and a Homosexuality Knowledge Questionnaire (17 items). Descriptive statistics, ANOVAs, Chi-square tests and Pearson’s correlations were used in the analysis.
      Results: A total of 489 completed responses was analyzed. Male gender, religiosity and absence of lesbian, gay or bisexual friends were associated with more negative attitudes towards homosexuality. Attitudinal scores did not correlate with advanced years in medical course or contact with lesbian, gay or bisexual patients. Students aiming to pursue technique-oriented specialties presented higher scores in the ‘Modern Heterosexism’ subscale than students seeking patient-oriented specialties. Although advanced years in medical course correlated significantly with higher knowledge scores, items related with lesbian, gay or bisexual health showed the lowest percentage of correct answers.
      Conclusion: There seems to be a lack of exploration of medical students’ personal attitudes towards lesbians and gay men, and also a lack of knowledge on lesbian, gay or bisexual specific healthcare needs. This study highlights the importance of inclusive undergraduate curriculum development in order to foster quality healthcare.
      PubDate: 2016-11-30
      Issue No: Vol. 29, No. 11 (2016)
  • Pain Intensity and Time to Death of Cancer Patients Referred to Palliative

    • Authors: Pedro Barata, Filipa Santos, Graça Mesquita, Alice Cardoso, Maria Paula Custódio, Marta Alves, Ana Luísa Papoila, António Barbosa, Peter Lawlor
      Pages: 694 - 701
      Abstract: Introduction: Pain is a common symptom experienced by cancer patients, especially in those with advanced disease. Our aim was to describe pain intensity in advanced cancer patients, referred to the palliative care unit, the factors underlying moderate to severe pain and its prognostic values.
      Material and Methods: This was a prospective observational study. All patients with mestastatic solid tumors and with no specific oncologic treatment were included. Pain intensity was accessed using the pain scale from Edmonton Symptom Assessment Scale, rated from 0 to 10 on a numerical scale, where zero = no pain and 10 = worst possible pain.
      Results: Between October 2012 and June 2015, a total of 301 patients participated in the study. The median age was 69 years, (37 - 94); most of the patients were men (57%) and 64.8% had a performance status of 3/4. About 42% reported pain severity ≥ 4 and 74% were medicated with opioids. Multivariate analysis indicated a correlation between performance status and reported pain (OR: 1.7; IC 95%: 1.0 - 2.7; p = 0.045). Median overall survival was 37 days (IC 95%: 28 - 46). Patients reporting moderate to severe pain (pain severity ≥ 4) had a median survival of 29 days (IC 95%: 21 - 37), comparing with those who had no or moderate pain with median survival of 49 days (IC 95%: 35 - 63) (p = 0.022).
      Discussion: The performance status was associated with more intense pain. The performance status, hospitalization, intra-abdominal metastization and opioid analgesia were associated with shorter time to death in advanced cancer patients referred to palliative care.
      Conclusion: Cancer pain continues to be a major clinical problem in advanced cancer patients.
      PubDate: 2016-11-30
      Issue No: Vol. 29, No. 11 (2016)
  • Neurodevelopmental Outcomes of Very Preterm or Very Low Birth Weigth
           Infants: Comparison of Monochorionic and Dichorionic Twins with Singletons

    • Authors: Adelaide Taborda, Guiomar Oliveira
      Pages: 702 - 710
      Abstract: Introduction: Twins are associated with a delayed development and cerebral palsy. The purpose of this work was to compare the neurologic morbidity in very preterm or very low birth weight dichorionic and monochorionic twins with singletons.
      Material and Methods: We conducted a retrospective cohort study of livebirths lowest through 32 weeks of gestation or very low weight infants admitted to Neonatal Intensive Care Unit of a level III hospital, between 2006 and 2010. Development was evaluated with the Growing Skills II Scale at 24 months of age. Cerebral palsy was defined by predetermined criteria by Surveillance of Cerebral Palsy in Europe. Infants were analyzed as twins and singletons cohort. Within the twin category the infants were further separated as dichorionic and monochorionic and were compared with singletons infants. Logistic regression models were used to control for demographic and clinical factors.
      Results: The cohort of infants who were assessed for neurodevelopmental impaired, consisted of 194 singletons infants and 89
      twins (50 dichorionic; 39 monochorionic). Monochorionic twins, when compared with the singletons, showed an increased risk of severe developmental delay in these areas: locomotion (adjusted OR 12.2) language (adjusted OR 6.5) and autonomy (adjusted OR 7.2). Cerebral palsy was diagnosed in 4.1% of singleton infants and 15.4% of monochorionic twins. The adjusted risk of severe developmental delay and cerebral palsy in monochorionic twins was 3.6 and 4.2, respectively.
      Discussion: This work showed higher rate of moderate and severe neurodevelopment delay including cerebral palsy in monochorionic twins compared to singletons infants. Analysis by groups stratified according to gestational age and comparison of monochorionic and dichorionic twins displayed the role of chorionicity for these neurodevelopmental disorders.
      Conclusions: In our sample the monochorionic twins are associated with an independent risk of neurodevelopmental delay.
      PubDate: 2016-11-30
      Issue No: Vol. 29, No. 11 (2016)
  • Fibrinolytics in the Treatment of Complicated Pleural Effusions

    • Authors: Ana Coelho, Margarida Coelho, Joana Pereira, Vasco Lavrador, Lurdes Morais, Fátima Carvalho
      Pages: 711 - 715
      Abstract: Introduction: The treatment of complicated pleural parapneumonic effusions with intrapleural instillation of fibrinolytics, has shown similar results as surgical treatment. The present study aimed to evaluate the results of the use of intrapleural instillation of fibrinolytics in the treatment of complicated pleural parapneumonic effusions, in patients followed in our hospital.
      Material and Methods: A retrospective review of all the patients (aged between one month and 18 years) diagnosed with complicated parapneumonic effusions, which had chest drain insertion with intrapleural instillation of fibrinolytic, between January 2005 and
      December 2013, was undertaken.
      Results: A total of 37 patients were identified. Mean duration of hospital stay was 17 ± 7.60 days. Chest drain was placed in the first 48 h of hospital admission in most of the patients (89.2%), with a mean of six days of drainage. Treatment failure was reported in 2.7% of cases and was related with effusion recurrence. This patient underwent video-assisted thoracoscopic surgery with the need to convert to open thoracotomy. A favorable outcome was achieved in 96.9 % of cases.
      Discussion: In our review, therapeutic success rate was as expected, with a failure rate below those reported in literature. We present intrapleural instillation of fibrinolytics and video-assisted thoracoscopic surgery as part of the same protocol, in which fibrinolytic therapy is the first-line treatment.
      Conclusion: The therapeutic option presented shows a low failure rate and avoids a more aggressive surgical procedure. We consider this an effective treatment option, with low sequelae rate.
      PubDate: 2016-11-30
      Issue No: Vol. 29, No. 11 (2016)
  • Professional Satisfaction within Family Health Units of Central Region

    • Authors: Rui Passadouro, Pedro Lopes Ferreira
      Pages: 716 - 725
      Abstract: Introduction: Job satisfaction, as an organizational climate indicator, is a complex and subjective phenomenon. It is prone to individual variation, social settings and suitable to multiple explanatory theories. It can impact productivity and absenteeism, predict well-being, and it is associated with mental health, self-esteem and perception of physical health. It is comprised as one of the National Health Service evaluation criteria. This study aimed to assess the level of job satisfaction in family health units of Central Region of the country.
      Material and Methods: This was an observational, cross-sectional study with a descriptive analysis model and a correlational component. The Centro de Estudos e Investigação em Saúde da Universidade de Coimbra’s Professional Satisfaction Assessment Instrument was selected as data collection instrument. Among a universe of 809 health professionals, a total of 774 professionals participated in this study population.
      Results: The observed response rate was 66.4% at the Professional Satisfaction Assessment Instrument, corresponding to 514 professionals. Eighty two per cent of the respondents were female and 18% male. From the total subjects, 64.8% worked in model A units and the remaining 35.2% in model B units. Regarding professional categories, 34.2% were nurses, 39.8% were doctors and 26.0% clinical secretaries. The global level of satisfaction was 71.5% being 67.4% with the quality of the work setting, 78.3% with the quality of the care provided and 80.7% with the continuous improvement of quality.
      Discussion: The sample was predominantly composed by female subjects (82%), in line with current gender distribution of professionals. Found levels of job satisfaction (71.5%) were 5.4% lower than previously recorded in 2009.
      Conclusion: We recommend systematic evaluation of job satisfaction in contracting regimens, similarly to user satisfaction.
      PubDate: 2016-11-30
      Issue No: Vol. 29, No. 11 (2016)
  • Treatment of Gastroenteropancreatic Neuroendocrine Tumors with
           177Lu-DOTA-TATE: Experience of the Portuguese Institute of Oncology in

    • Authors: Inês Lucena Sampaio, Henrique Vara Luiz, Liliana Sobral Violante, Ana Paula Santos, Luís Antunes, Isabel Torres, Cristina Sanches, Isabel Azevedo, Hugo Duarte
      Pages: 726 - 733
      Abstract: Introduction: The purpose of this article is to report the experience of Instituto Português de Oncologia do Porto in the treatment of gastroenteropancreatic neuroendocrin tumors with 177Lu-DOTA-TATE, regarding the safety and efficacy of this treatment modality.
      Material and Methods: A retrospective analysis of clinical reports of patients with gastrentheropancreatic neuroendocrine tumors undergoing treatment with 177Lu-DOTA-TATE between April 2011 and November 2013 was performed.
      Results: Thirty six cases were reviewed and 30 completed all 3 cycles of 177Lu-DOTA-TATE (83.3%). In these patients it was registered: acute side effects in 8.9% of cycles; grade 3 CTCAE liver toxicity in 13.3% of patients (all with previous abnormal liver function); absence of significant renal or hematologic toxicity; symptomatic improvement in 71.4% of patients; median overall time to progression of 25.6 months; median overall survival from diagnosis of 121.7 months. Patients with higher expression of somatostatin receptors had longer progression-free survival and overall survival times (p < 0.05).
      Discussion: Peptide receptor radionuclide therapy with 177Lu-DOTA-TATE is an effective, secure and well-tolerated treatment, as evidenced in our study by the following findings: symptomatic improvement in most patients and increased time to disease progression and survival (especially in those with higher sstr expression), with acute and significant subacute/chronic side effects reported only in a minority of cases.
      Conclusion: Peptide receptor radionuclide therapy with 177Lu-DOTA-TATE is a promising treatment for patients with gastrentheropancreatic neuroendocrin tumors, with demonstrated benefits in terms of safety and efficacy.
      PubDate: 2016-11-30
      Issue No: Vol. 29, No. 11 (2016)
  • The Impact of Electronic Monitoring on Healthcare Associated Infections:
           The Role of the HViTAL Platform

    • Authors: Rita Fontes de Oliveira, Lídia Castro, José Pedro Almeida, Carlos Alves, António Ferreira
      Pages: 734 - 741
      Abstract: Introduction: In Portugal, 9.8% of patients admitted were inflicted with healthcare associated infections, corresponding to a prevalence of 11.7%. The Hospital de São João has developed a business intelligence platform able to supervise (the patients), monitor (the clinical condition) and notify (the healthcare personnel): HViTAL. This study aims to assess the impact of electronic monitoring on healthcare associated infections since the year of HViTAL implementation.
      Material and Methods: We evaluated data since January 2008 (moment from which computerized records exist) until December 2011, comparing them with subsequent data, those corresponding to January 2012 (implementation date of HViTAL) until 19 October 2015.
      Results: There was an upward trend of infection parameters in the 2008 - 2011 period. Since January 2012 and October 2015, all parameters of the infection indicator showed a negative linear trend.
      Discussion: The results are very suggestive that the HVITAL may have had an impact on improving parameters associated to
      healthcare associated infections. Basic measures of infection control were highlighted since 2005, with an increasing number of health professional awareness campaigns, a fact which, although not analyzed in this report, may also have contributed to the observed improvement. Our study did not include other variables such as investment in human capital.
      Conclusion: There was a clear improvement in all areas characterizing the healthcare associated infections, with obvious positive impact with the introduction of HViTAL.
      PubDate: 2016-11-30
      Issue No: Vol. 29, No. 11 (2016)
  • Magnetic Resonance Imaging Conversion Predictors of Clinically Isolated
           Syndrome to Multiple Sclerosis

    • Authors: Sara Peixoto, Pedro Abreu
      Pages: 742 - 748
      Abstract: Introduction: Clinically isolated syndrome may be the first manifestation of multiple sclerosis, a chronic demyelinating disease of the central nervous system, and it is defined by a single clinical episode suggestive of demyelination. However, patients with this syndrome, even with long term follow up, may not develop new symptoms or demyelinating lesions that fulfils multiple sclerosis diagnostic criteria. We reviewed, in clinically isolated syndrome, what are the best magnetic resonance imaging findings that may predict its conversion to multiple sclerosis.
      Material and Methods: A search was made in the PubMed database for papers published between January 2010 and June 2015 using the following terms: ‘clinically isolated syndrome’, ‘cis’, ‘multiple sclerosis’, ‘magnetic resonance imaging’, ‘magnetic resonance’ and ‘mri’.
      Results: In this review, the following conventional magnetic resonance imaging abnormalities found in literature were included: lesion load, lesion location, Barkhof’s criteria and brain atrophy related features. The non conventional magnetic resonance imaging techniques studied were double inversion recovery, magnetization transfer imaging, spectroscopy and diffusion tensor imaging.
      Discussion: The number and location of demyelinating lesions have a clear role in predicting clinically isolated syndrome conversion to multiple sclerosis. On the other hand, more data are needed to confirm the ability to predict this disease development of non conventional techniques and remaining neuroimaging abnormalities.
      Conclusion: In forthcoming years, in addition to the established predictive value of the above mentioned neuroimaging abnormalities,
      different clinically isolated syndrome neuroradiological findings may be considered in multiple sclerosis diagnostic criteria and/or change its treatment recommendations.
      PubDate: 2016-11-30
      Issue No: Vol. 29, No. 11 (2016)
  • Neuroimaging and Blood Biomarkers in Functional Prognosis after Stroke

    • Authors: João Paulo Branco, Joana Santos Costa, João Sargento-Freitas, Sandra Oliveira, Bruno Mendes, Jorge Laíns, João Pinheiro
      Pages: 749 - 754
      Abstract: Introduction: Stroke remains one of the leading causes of morbidity and mortality around the world and it is associated with an important long-term functional disability. Some neuroimaging resources and certain peripheral blood or cerebrospinal fluid proteins can give important information about etiology, therapeutic approach, follow-up and functional prognosis in acute ischemic stroke patients. However, among the scientific community, there is currently more interest in the stroke vital prognosis over the functional prognosis. Predicting the functional prognosis during acute phase would allow more objective rehabilitation programs and better management of the available resources. The aim of this work is to review the potential role of acute phase neuroimaging and blood biomarkers as functional recovery predictors after ischemic stroke.
      Material and Methods: Review of the literature published between 2005 and 2015, in English, using the terms “ischemic stroke”, “neuroimaging” e “blood biomarkers”.
      Results: We included nine studies, based on abstract reading.
      Discussion: Computerized tomography, transcranial doppler ultrasound and diffuse magnetic resonance imaging show potential predictive value, based on the blood flow study and the evaluation of stroke’s volume and localization, especially when combined with the National Institutes of Health Stroke Scale. Several biomarkers have been studied as diagnostic, risk stratification and prognostic tools, namely the S100 calcium binding protein B, C-reactive protein, matrix metalloproteinases and cerebral natriuretic peptide.
      Conclusion: Although some biomarkers and neuroimaging techniques have potential predictive value, none of the studies were able to support its use, alone or in association, as a clinically useful functionality predictor model. All the evaluated markers were considered insufficient to predict functional prognosis at three months, when applied in the first hours after stroke. Additional studies are necessary to identify reliable predictive markers for functional prognosis after ischemic stroke.
      PubDate: 2016-11-30
      Issue No: Vol. 29, No. 11 (2016)
  • Thyroid Metastasis as the Initial Presentation of an Asymptomatic Clear
           Cell Renal Carcinoma

    • Authors: Janine Carmelino, Ana Paula Tavares, Ana Crespo, José Mário Coutinho, António Lázaro, Vasco Ribeiro, Eduardo Barroso
      Pages: 755 - 758
      Abstract: Introduction: Clear cell renal carcinoma metastases to the thyroid gland are rare and only diagnosable after an immunohistochemistry analysis of the histological sample. The purpose of this article is to report a case of thyroid metastasis as the initial presentation of a clear cell renal carcinoma.
      Case Report: Male patient with a solid nodule in the left lobe of the thyroid, 5.3 cm in diameter, suspicious of malignancy, for which a total thyroidectomy with central compartment lymphadenectomy was performed. Histology revealed two clear cell renal carcinoma metastases. After evaluation of the kidney, the patient underwent radical nephrectomy four months later.
      Discussion: What makes this case interesting is that thyroid metastases as the initial presentation of renal cell carcinoma are rare, but if treated early, a ‘double surgical resection’ is possible, leading to a 5 year survival rate of 80%.
      PubDate: 2016-11-30
      Issue No: Vol. 29, No. 11 (2016)
  • Flagrant of a Clavicle Fracture as Bullfight Injury

    • Authors: Carlos Durão, Jorge Ramos
      Pages: 758 - 760
      Abstract: The Vila Franca de Xira Hospital is located in the region with the highest number of festivals and bullfighting activities of Portugal. As a natural consequence, the hospital ends up with a particular experience in the treatment of victims of bullfighting accidents. These are usually common people harvested in street celebrations during the traditional festivals of the region, but also workers such as cattle herders, foremen, ranchers and others who handle the wild cattle and in particular those who deal with the bulls, such as forcados, banderilleros, matadors and cavaleiros. Although we may refer the perforating injuries generated by the horns of bulls, the most frequent injuries are the blunt ones, among them bruises and fractures of the limbs. This work shows the typical striking of a bull horn, showing the violence of the trauma in bullfighting accidents, which in this case resulted only on the fracture of the clavicle from the member hit in the fall.
      PubDate: 2016-11-30
      Issue No: Vol. 29, No. 11 (2016)
  • Emphysematous Cholecystitis: Imaging Diagnosis of an Emergent Condition

    • Authors: Isabel Sousa, António Fernandes, Isabel Távora
      Pages: 761 - 761
      Abstract: N/a.
      PubDate: 2016-11-30
      Issue No: Vol. 29, No. 11 (2016)
  • Primary Pericardial Lymphoma: A Rare Entity

    • Authors: Sara Magalhães, Ivo Ferreira, Raquel Themudo
      Pages: 762 - 762
      Abstract: N/a.
      PubDate: 2016-11-30
      Issue No: Vol. 29, No. 11 (2016)
  • Diagnostic and Therapeutic Approach of Chronic Spontaneous Urticaria:
           Recommendations in Portugal

    • Authors: Célia Costa, Margarida Gonçalo, On behalf of GPEU – Grupo Português de Estudos de Urticária
      Pages: 763 - 781
      Abstract: Chronic spontaneous urticaria is a complex disorder, of unclear etiology, easily diagnosed although often difficult to treat. It has a significant impact on the patients’ quality of life and results in high direct and indirect costs. The diagnosis of chronic spontaneous urticaria is mainly clinical and a limited number of tests is recommended for differential diagnosis and/or for the investigation/exclusion of possible causes. In addition to the complete blood count and C-reactive protein, and/or erythrocyte sedimentation rate, additional tests must be selected according to clinical criteria. The aim of therapy is the complete clinical control of chronic spontaneous urticaria. Evolution should be documented by weekly symptom scoring – Weekly Urticaria Activity Score (UAS7) –, as well as the assessment of quality of life. The therapeutic approach is based on second-generation H1 antihistamines (anti-H1) administered continuously in the approved doses (first line), and, in the absence of a clinical response, up to four times the daily-approved dose (second line). First generation H1 antihistamines are not recommended. Approximately 30% of patients are not controlled with second line therapy, and it is recommended to add a third line therapy. Of the two options, omalizumab and cyclosporine, only omalizumab is approved for chronic spontaneous urticaria and has a better safety profile, thus being preferably recommended. In Portugal there are no national-based recommendations applicable to clinical practice. The elaboration of these recommendations is justified by the need to standardize both the diagnosis and the treatment approach of patients with chronic spontaneous urticaria in Portugal, and for the referral of patients to specialized centers, in the most severe cases.
      PubDate: 2016-11-30
      Issue No: Vol. 29, No. 11 (2016)
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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