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Journal Cover Acta Médica Portuguesa
  [SJR: 0.155]   [H-I: 11]   [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]
  • AMP-Student: Challenges for Scientific Publishing

    • Pages: 159 - 160
      Abstract: N/A
      PubDate: 2016-03-31
      Issue No: Vol. 29, No. 3 (2016)
  • Morphine Manifesto

    • Pages: 161 - 163
      Abstract: N/A
      PubDate: 2016-03-31
      Issue No: Vol. 29, No. 3 (2016)
  • Analysis of the Cochrane Review: Antihistamines for the Common Cold.
           Cochrane Database Syst Rev. 2015;11:CD009345.

    • Pages: 164 - 167
      Abstract: The common cold is an acute, self-limiting inflammation of the mucosa of the upper airways, which may involve one or all the sinuses, nasopharynx, oropharynx and larynx. It is common to have at least one episode per year. Common cold symptoms, which may include sore throat, sneezing, nasal congestion, runny nose, headache, malaise and mild fever usually disappear within a few days without treatment. The causative agent of most colds is rhinovirus. Although not associated with mortality, common cold is associated with significant morbidity. There is no vaccine or cure for common cold and, therefore, their treatment is centered on relieving the symptoms. This Cochrane review aimed to synthesize the existing evidence about the clinical benefit of antihistamines, used as monotherapy, compared with placebo or no treatment in children and adult patients with common cold. A total of 18 randomized clinical trials with 4342 participants were included. Main results were: 1) Antihistamines have a small (days one and two) beneficial effect in the short term on the severity of overall symptoms in adult patients, although this effect is not present in the medium to long term; 2) antihistamines were not associated with a clinically significant beneficial effect on the individual symptoms (nasal congestion, rhinorrhea, and sneezing); 3) Antihistamines are not associated with an increased risk of adverse effects; 4) No conclusion can be made about the effectiveness of antihistamines in pediatric populations. Our interpretation of the results is that the available evidence is insufficient to support the prescription or buying OTC antihistamines to relieve the symptoms of common cold without allergic component.
      PubDate: 2016-03-31
      Issue No: Vol. 29, No. 3 (2016)
  • Autism and Early Neurodevelopmental Milestones

    • Pages: 168 - 175
      Abstract: Introduction: Autism spectrum disorder, also referred to in this study as autism, is a neurodevelopmental chronic disease that manifests early in childhood by impairment in social interaction, communication and repetitive behavior. Since there are no specific biomarkers available, the diagnosis is based exclusively on clinical criteria. The purpose of the present study is to determine which are the early psychomotor development or neurodevelopmental milestones that present a significant correlation with the severity of the main symptoms of autism, development quotients, and adaptive function.
      Material and Methods: We performed a retrospective study on a sample of 1572 individuals with a diagnosis of autism that were monitored at Hospital Pediátrico do Centro Hospitalar e Universitário de Coimbra, in the Neurodevelopment and Autism Unit. We analyzed six early psychomotor developmental milestones: age of acquisition of ‘walking’, ‘first words’, ‘first phrases’, ‘daytime control of bladder sphincter’, ‘night-time control of bladder sphincter’, and age of first complaints. Afterwards, we divided the sample in three subgroups regarding clinical severity, according to the Childhood Autism Rating Scale, and we analyzed significant differences among each other concerning the six milestones established beforehand.
      Results: The milestone ‘age of first phrases’ was, from the six milestones, the one with a stronger correlation with the variables of clinical manifestations of autism, development/intelligence quotients, and adaptive function. In division of the sample into subgroups of clinical severity, it was the most severe that showed later ages of acquisition of the neurodevelopmental milestones and earlier ages of first complaints.
      Discussion: This study proves the clinical utility to know the age of achievement of early psychomotor developmental skills, since they act as predictors of clinical severity of autism, cognition, and adaptive function of a wide population with autism. Therefore, this data contribute for prognostic and prediction of autism progression.
      Conclusion: Taking into account the results of this study, it is strongly recommended to all clinicians who have contact with autistic children, to record the ´age of acquisition of first phrases´.
      PubDate: 2016-03-31
      Issue No: Vol. 29, No. 3 (2016)
  • Type 2 Diabetes Mellitus, Depression and Eating Disorders in Patients
           Submitted to Bariatric Surgery

    • Pages: 176 - 181
      Abstract: Introduction: Obesity is associated with a great number of complications, including type 2 diabetes mellitus and psychiatric pathology. Bariatric surgery is the best solution to weight loss and improvement of complications in morbid obese patients. This study aims to analyze the evolution of type 2 diabetes mellitus and psychopathologic variables before and after bariatric surgery and assess the importance of different variables in weight loss.
      Material and Methods: This is a longitudinal study, which evaluates 75 patients before and after bariatric surgery (47 - LAGB – laparoscopic adjustable gastric band; 19 – RYGB – Roux-en-Y gastric bypass; 9 - sleeve) with a follow-up time between 18 and 46 months. A clinical interview and self report questionnaires were applied - Eating Disorder Examination questionnaire – EDE-Q and Beck Depression Inventory – BDI.
      Results: Results show an improvement in type 2 diabetes mellitus after surgery (χ2 (1) = 26.132, p < 0.001). There was not a significant improvement among psychiatric pathology when we controlled the analysis for the type of surgery. It was verified that type 2 diabetes mellitus, depression and eating disorders in post-operative period are associated with less weight loss. This model explains 27% of weight variance after surgery (R2 = 0.265) and it is significant F (3.33) = 2.981, p = 0.038.
      Discussion: Type 2 diabetes mellitus, psychiatric pathology and eating disorders after surgery influenced weight loss. It was not clear in what way this relation was verified, neither the relation that these metabolic and psychological variables may have during the postoperative period.
      Conclusion: Type 2 diabetes mellitus improved after surgery. Type 2 diabetes mellitus, depression and eating disorders influenced weight loss in the postoperative period. These variables did not influence weight loss in the preoperative period.
      PubDate: 2016-03-31
      Issue No: Vol. 29, No. 3 (2016)
  • PET/CT with 18F-Fluorocholine in Patients with Prostatic Cancer in
           Biochemical Recurrence

    • Pages: 182 - 192
      Abstract: Introduction: In prostate cancer, after therapy with curative intent, biochemical recurrence frequently occurs. The purpose of this study was to evaluate the impact of PET/CT with 18F-fluorocholine in restaging these patients and in their orientation, and to analyze the effect of the risk stratification, the values of PSA and the hormone suppression therapy, in the technique sensitivity.
      Material and Methods: Retrospective analysis of 107 patients with prostate carcinoma in biochemical recurrence who underwent PET/CT with 18F-fluorocholine in our hospital, between December 2009 and May 2014.
      Results: The overall sensitivity was 63.2% and 80.0% when PSA > 2 ng/mL. It was possible to identify distant disease in 28% of the patients. The sensitivity increased from 40.0%, in patients with low and intermediate risk, to 55.2% in high-risk patients. Without hormonal suppression therapy, the sensitivity was 61.8%, while in the group under this therapy, was 67.7%.
      Discussion: PET/CT with 18F-fluorocholine provided important information even in patients with low levels of PSA, however, with significantly increased sensitivity in patients with PSA > 2 ng/mL. Sensitivity was higher in high-risk patients compared with low and intermediate risk patients, however, without a statistically significant difference. The hormone suppression therapy does not appear to influence uptake of 18F-fluorocholine in patients resistant to castration.
      Conclusions: In this study, PET/CT with 18F-Fluorocholine showed good results in restaging patients with prostate cancer biochemical recurrence, distinguishing between loco regional and systemic disease, information with important consequences in defining the therapeutic strategy.
      PubDate: 2016-03-31
      Issue No: Vol. 29, No. 3 (2016)
  • Hypertension Control at the Primary Health Care: A Comparison Among
           Portuguese Natives and Portuguese Speaking African Coutries Immigrants

    • Pages: 193 - 204
      Abstract: Introduction: In Portugal, the frequency of patient with treated and controlled hypertension is low. It is unknown the relation of socio-economic determinants with hypertension control, particularly in African immigrants.
      Aims: To compare frequency of control in treated hypertension and to identify characteristics associated with uncontrolled and treated hypertension between Portuguese natives (Caucasian) and Portuguese Speaking African Coutries immigrants (black).
      Material and Methods: Cross-sectional study of patients with treated hypertension, 40-80 years old, randomized from Primary Health Care of Lisbon Region. We collected sociodemographic, clinical and health care data through structured interviews. We compared the frequency of patients with uncontrolled hypertension, and identified related factors through univariate and multivariate analysis.
      Results: In this study participated 786 patients with treated hypertension (participation rate: 71%): 449 natives and 337 immigrants. Of these, 46% had controlled hypertension. Diastolic blood pressure was higher in younger immigrants. Were associated with no control, in natives, male sex, low education, going to emergency and / or nursing services and not looking for the family doctor; on immigrants, being single, using the pharmacist, the number of years of illness and intentional non-adherence.
      Discussion: Treated hypertension control has been increasing for last years. Natives and immigrants differ, regarding blood pressure control, relatively to the frequency of family doctor consultation, and resorting to other services and health professionals. These differences didn´t reflect in statistically different control rates.
      Conclusions: It is needed to define strategies to control hypertension in primary health care specific for ethnic groups.
      PubDate: 2016-03-31
      Issue No: Vol. 29, No. 3 (2016)
  • Twenty Years of Autologous Stem Cell Transplantation in Diffuse Large
           B-Cell Lymphoma: A Single Portuguese Center Experience

    • Pages: 205 - 209
      Abstract: Introduction: Diffuse large B-cell lymphoma can be cured in 60% – 70% of patients. Autologous stem cell transplantation is the standard treatment for relapsed disease. This high-intensity treatment after first complete remission in patients with high International Prognostic Index remains controversial and was performed in our department during some years.
      Material and Methods: Retrospective study, review of clinical records.
      Results: This study evaluates the outcome of 113 patients transplanted between 1992 and 2012. Considering status before transplantation patients were divided in groups: a) first complete remission after 1 line of chemotherapy (n = 64); b) first complete remission after ≥ two chemotherapy lines (n = 15); c) second complete remission (n = 15); d) more advanced diseased (n = 19). Chemotherapy used in first line therapy was mainly R-CHOP (n = 71) and CHOP (n = 28). The median follow-up of patients still alive was 34 months (1 - 221). At five years, overall survival was 73% (± 5) and disease free survival was 75% (± 5).
      Conclusion: Conventional chemotherapy followed by autologous stem cell transplant is a safe and efficient option for selected patients. In our series 70% high-risk patients were free from disease with this strategy.
      PubDate: 2016-03-31
      Issue No: Vol. 29, No. 3 (2016)
  • Secondary Alveolar Bone Grafting in Orofacial Cleft: A Survey of a
           Portuguese Tertiary Hospital

    • Pages: 210 - 216
      Abstract: Introduction: Orofacial clefts are the most frequent craniofacial birth defects. In the presence of bone defect, the secondary alveolar bone grafting is the correction method most commonly accepted by clinicians. This study evaluates the result of this technique in a tertiary hospital.
      Material and Methods: Analysis of the secondary alveolar bone grafting performed between 2007 and 2014, with inclusion of cases in which the iliac crest was the donor site for the graft and the clinical and imaging information was complete. The success of the intervention was assessed radiographically using the Bergland scale (type I-IV) and correlated to variables associated with pathology and/or surgical correction.
      Results: Of the 32 secondary alveolar bone grafting performed, 29 met the inclusion criteria: 13 cases (44.8%) corresponded to complete unilateral pre-foramen clefts; four (13.8%) to complete bilateral pre-foramen clefts; eight (27.6%) to transforamen unilateral clefts and four (13.8%) to bilateral transforamen clefts. According to the scale of Bergland (applied with a mean follow-up of 8 ± 5 months) six were classified as type I, 15 as type II, five as type III and three as type IV. No association was found between the effectiveness of the surgery and the type of orofacial clefts, the presence of the incisor and the canine eruption phase. Five patients were re-operated (three of type II and two of type III at baseline).
      Discussion: In this series, the secondary alveolar bone grafting was effective in most patients (72% type I & II) regardless of the type of orofacial clefts. The relatively high proportion of failures (10.3%) and subsequent need for re-intervention (17%) justify long-term follow up and the continuation of this study.
      Conclusion: It is important to highlight the multidisciplinary involvement in order to identify previously the ideal timing for each intervention and to optimize results.
      PubDate: 2016-03-31
      Issue No: Vol. 29, No. 3 (2016)
  • Hospitals and the Public-Private Combination in the Portuguese Health

    • Authors: Adalberto Campos Fernandes, Alexandre Morais Nunes
      Pages: 217 - 223
      Abstract: The Portuguese health system has been characterized by the existence of a constant relationship between public and private sector, both in providing and financing health care. In recent decades, the private sector increased their responsiveness of care, extending the engagement in the relationship with the public sector. This relationship stems from the legal framework set out in the law, developing agreements, conventions and more recently through the model of public-private partnerships. In hospital network, this new dynamic relationship contributed, in the last two decades, to accentuate the mixed characteristics of the system, through a clear strengthening of the private component in the hospital network, particularly by investing in differentiated units.
      PubDate: 2016-03-31
      Issue No: Vol. 29, No. 3 (2016)
  • Endovascular Treatment of Isolated Chronic Abdominal Aortic Dissection

    • Pages: 224 - 227
      Abstract: Isolated acute abdominal aortic dissection is a relatively rare event. Its natural history is not fully understood and its optimal treatment is not established. Open surgery represents the most described treatment but endovascular intervention has had increasing application. Isolated chronic abdominal aortic dissection  is even less described in the literature. We describe three patients with isolated chronic abdominal aortic dissection who underwent endovascular treatment in our institution. Mean age at presentation was 82 years. Indication for surgical intervention was aneurismal degeneration. Mean aortic diameter at presentation was 46.7 mm. There was no perioperative mortality or reinterventions. Mean follow-up was 5.3 years (2-12 years). Late reintervention was needed in one patient, eight years after initial surgery, due to type 1 endoleak. According to our experience, endovascular intervention represents an effective and durable treatment option in isolated chronic abdominal aortic dissection. However, long-term follow-up is mandatory. Furthermore, larger studies are still needed to understand this disease and its adequate treatment.
      PubDate: 2016-03-31
      Issue No: Vol. 29, No. 3 (2016)
  • Elastosis Perforans Serpiginosa and Wilson Disease: A Rare but Predictable
           Consequence of Long-term Therapy with D-Penicillamine

    • Pages: 227 - 230
      Abstract: Elastosis perfurans serpiginosa is a rare perforating dermatosis found primarily in adolescents and young adults, characterized by transepidermal elimination of abnormal elastic fibers. The only drug known capable of inducing elastosis perfurans serpiginosa is D-penicillamine. We report the case of a 52 year-old woman with keratotic papules arranged in an annular pattern with central clearing and centrifugal growth, located in the anterior cervical region. The patient was chronically treated with D-penicillamine for Wilson disease. Lesion biopsy showed transepidermal elimination of thickened, eosinophilic, branched, sawtooth-like elastic fibers. The clinical and pathological findings were consistent with elastosis perfurans serpiginosa secondary to D-penicillamine. It is estimated that elastosis perfurans serpiginosa occurs in 1% of patients treated with D-penicillamine. By blocking directly or indirectly the desmosine cross-links between elastin molecules, D-penicillamine leads to the synthesis of abnormal dermal and extracutaneous elastic fibers. Elastosis perfurans serpiginosa may be the first manifestation of a multisystemic degenerative process of elastic connective tissue.
      PubDate: 2016-03-31
      Issue No: Vol. 29, No. 3 (2016)
  • Condylomata Lata Mimicking Buschke-Löwenstein Tumor

    • Authors: Miguel Pinto-Gouveia
      Pages: 231 - 231
      Abstract: N/A
      PubDate: 2016-03-31
      Issue No: Vol. 29, No. 3 (2016)
  • The Delight of Rembrandt’s Painting and the Controversy around the
           Anatomical Errors of Content and Perspective: Commentary on “Dr.
           Nicolaes Tulp’s Anatomy Lesson”

    • Pages: 232 - 233
      Abstract: N/A
      PubDate: 2016-03-31
      Issue No: Vol. 29, No. 3 (2016)
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