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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]
  • Pharmacy Medicines not Subject to Medical Prescription: Compatible Access
           and Security

    • Authors: Ema Paulino
      Pages: 495 - 496
      Abstract: Keywords: Community Pharmacy Services; Nonprescription Drugs; Portugal; Safety; Self Medication.
      PubDate: 2016-09-30
      Issue No: Vol. 29, No. 9 (2016)
  • Overuse of Medical Tests: A New Health Risk Factor'

    • Authors: Carlos Martins
      Pages: 497 - 498
      Abstract: Keywords: Medical Overuse; Practice Patterns, Physicians; Risk Factors; Risk Reduction Behavior.
      PubDate: 2016-09-30
      Issue No: Vol. 29, No. 9 (2016)
  • Diabetes Knowledge Test Feasibility in Portugal

    • Authors: Constança Azevedo, Luiz Santiago
      Pages: 499 - 506
      Abstract: Introduction: Given the rising incidence of type 2 diabetes and taking into account that much of its control depends on the patient’s attitude towards his illness, loomed the need to equip health professionals with capable tools to determine the educational needs of their patients, allowing a more personalized intervention to correct habits that could be harmful to the diabetics’ health.
      Objective: Verify the Diabetes Knowledge Test reliability in Portugal. Analysis of socio-demographic and pathologic variables’ correlation
      with the number of correct answers in the test.
      Material and Methods: Application of the translated version of Diabetes Knowledge Test to a convenience sample of a primary care center in Covilhã.
      Results: In general, the questions obtained a Cronbach’s alpha > 0.800. Diabetics with better results in the survey proved to be more compliant, with a positive relationship between knowledge and diabetes’ control. However, only 9.2% of diabetics have good knowledge about their disease, and the majority (65.8%) shows an average one. The insulin treated patients show the worst results (77.6% with low knowledge). The variables ‘treatment route’ and ‘complications’ show statistical impact on the level of knowledge that diabetics have about their pathology (p values 0.00 and 0.048, respectively). Inhabitants of rural areas, without complications secondary to diabetes and treated orally, proved to be more compliant and to have better knowledge about the disease.
      Discussion: Contrary to previous studies, variables such as age and educational level showed no relation with the performance in the survey. Inhabitants of the rural area and diabetics treated orally obtained better results than what had been previously advocated.
      Conclusion: It has been proved the moderate to high psychometric reliability of the test, as its value establishing a correlation between
      diabetes knowledge and control. It is expected that its future application will help identifying the reasons for uncontrolled diabetics, allowing a more individualized intervention by the health professionals.
      PubDate: 2016-09-30
      Issue No: Vol. 29, No. 9 (2016)
  • Adult Acne: Prevalence and Portrayal in Primary Healthcare Patients, in
           the Greater Porto Area, Portugal

    • Authors: Diogo Semedo, Filipa Ladeiro, Mariana Ruivo, Carlos d'Oliveira, Filipa de Sousa, Mariana Gayo, Clara Lima, Frederico Magalhães, Rui Brandão, Maria Branco, Isabel da Silva, Joana Batista, João Amado, António Massa, João Neves-Amado
      Pages: 507 - 513
      Abstract: Introduction: Though typically found in adolescents, acne frequently affects the adult population. In Portugal, no representative studies
      about acne prevalence in greater populational areas are known. This study had the following objectives: calculate acne prevalence in primary healthcare patients; its characteristics, including risk factors for onset and worsening; collect information concerning selfmedication and/or prescribed treatment.
      Material and Methods: Application of a questionnaire and physical examination into a convenience sample, composed by adults from
      20 - 60 years old that visited, in random days, five primary healthcare centers of the Greater Porto area.
      Results: From the 1,055 evaluated adults, acne prevalence was estimated at 61.5%. Only 36.8% of acne suffering adults was aware
      of their condition. More than half of tobacco users (62.3%) had acne. Just 25% of acne sufferers sought treatment. The most affected
      areas were the malars, differing from the younger disease form.
      Discussion: Acne prevalence was relatively higher than other studies. The results of this study have confirmed that acne seems to be related with increased calorie intake, tobacco smoking, whole milk and fat-reduced milk consumption, hirsutism, alopecia and seborrhea.
      Conclusion: In the primary healthcare set, more than half of adults were acne sufferers. These numbers show how important primary healthcare services can be in preventing and intervening when managing acne-related risk factors and psychosocial consequences.
      PubDate: 2016-09-30
      Issue No: Vol. 29, No. 9 (2016)
  • Prevalence and Risk Factors for Iron Deficiency Anemia and Iron Depletion
           During Pregnancy: A Prospective Study

    • Authors: Ana Gomes da Costa, Sara Vargas, Nuno Clode, Luís M. Graça
      Pages: 514 - 518
      Abstract: Introduction: Anemia and iron deficiency during pregnancy are a worldwide concern and are more frequent among women of reproductive age, pregnant women, and young children. The aim of this study was to assess the prevalence of iron deficiency anemia and the risk factors for iron depletion during the first half of pregnancy, in a Portuguese population.
      Material and Methods: A prospective study was conducted at a tertiary hospital and included pregnant women, until the 20th week of gestation. Data was collected regarding demographic and pregnancy features and hemoglobin and serum ferritin concentrations were determined. A multivariate logistic regression was performed to identify potential risk factors for iron deficiency.
      Results: Two hundred and one women were included, from which five (2.49%) presented anemia. Additionally, 77 (38.3%) exhibited iron deficiency and 22 (10.9%) revealed severe iron depletion. Maternal age was the only risk factor identified. The odds ratio (OR) was equal to 12.99 (95% CI 2.41 - 70.0) for women under twenty years of age and 2.09 (95% CI 1.05 - 4.14) for women older than thirty years of age.
      Discussion and Conclusion: The prevalence of maternal anemia in the first half of pregnancy was lower than in other studies. However, more than one-third of the women exhibited iron deficiency. With the exception of maternal age, no other risk factors were identified.
      PubDate: 2016-09-30
      Issue No: Vol. 29, No. 9 (2016)
  • Schwannoma of the Upper Extremity: Retrospective Analysis of 17 Cases

    • Authors: Ângelo Sá, Leandro Nobre Azevedo, Luísa Cunha
      Pages: 519 - 524
      Abstract: Introduction: Schwannoma or neurilemmoma is a benign peripheric nerve tumor that usually presents as a slow growing single lesion; it has origin in Schwann cells proliferation. Although it represents a small percentage of the benign tumors of the upper arm, it is the most frequent of neural origin. We present a retrospective study of upper limb schwannomas; our aim is establish the appropriate preoperative approach, to recognise the efficiency of the treatment and the pos-operative follow-up.
      Material and Methods: Review of 17 patients treated between 2007 and 2014 with upper limb schwannoma and characterization as to age, gender, location in the upper limb, signs and symptoms, pre-operative studies, histologic diagnosis and postoperative surveillance.
      Results: In four of them the schwannoma was localized on the arm, three on the forearm, four on the wrist and 6 on the hand or fingers. We proceed to careful microsurgical dissection in a bloodless field to optimize the functional final result. The enucleation without fascicular lesion was achieved in 12 patients. In five patients we performed the excision of the fascicles involved by the mass. Nine patients developed paresthesias in the immediate postoperative period, with five of them improving in 12 months. One patient presented motor deficit of the radial nerve with partial recover at 12 monts.
      Discussion: Schwannomas are rare tumours with well circumscribed morphology. Occasionally it appears in upper limb. The preoperative
      diagnosis is rarely, so normally the diagnosis is established only after excision and histologic study.
      Conclusion: Schwannoma should be considered as a diagnostic hypothesis when evaluating subcutaneous nodes associated with
      neurologic symptoms. It is important to query the presence of paresthesias and perform the Tinel sign, both typical of this condition.
      Imagiological exams have a scarce contribute in the diagnosis. To improve the final result, the preoperative study must be insightful, being advisable to consider the benefits of the surgery compared to the potential iatrogenic damage to the nerve.
      PubDate: 2016-09-30
      Issue No: Vol. 29, No. 9 (2016)
  • Peritoneal Dialysis in the First Two Years of Life: Experience of a
           Nephrology and Renal Transplantation Pediatric Unit

    • Authors: Sofia Deuchande, Tânia Mano, Cristina Novais, Rute Machado, Rosário Stone, Margarida Almeida
      Pages: 525 - 532
      Abstract: Introduction: Peritoneal dialysis is the dialytic method of choice in chronic end-stage renal disease in children. This study main purpose
      was to characterize the long-term survival of a pediatric population who began peritoneal dialysis within the first two years of life.
      Material and Methods: A descriptive and retrospective study was performed in a portuguese nephrology and renal transplantation pediatric unit, between January 1991 and August 2014. End-stage renal disease etiology, mortality, comorbidities and complications of peritoneal dialysis and end-stage renal disease, growth and psychomotor development were evaluated.
      Results: Twenty children started peritoneal dialysis within the first two years of life. There were six deaths, but no deaths of children with primary chronic kidney disease were registered over the past decade. The 14 living children were characterized; 13 were males. Congenital abnormalities of the kidney and urinary tract were the leading etiology of chronic kidney disease (45%). The average age start of peritoneal dialysis was 6.1 months; six children started before 30 days of life. Peritonitis was the most frequent cause of hospitalization. Ten children were transplanted at an average age of 5.3 years. All of the children who are still in peritoneal dialysis have short stature, but nine of the transplanted have final height within the expected for their mid-parental height target range. Nine (64%)
      had some type of neurodevelopmental delay.
      Discussion: Peritoneal dialysis is a technique possible and feasible since birth, as evidenced in the study, as more than half of children successfully started it before 6 months of life. It allows long-term survival until the possibility of renal transplantation despite the associated morbidity, including peritonitis and complications of chronic renal disease. The ten transplanted children improved their growth, recovered from chronic anemia and improved dyslipidemia, compared with the period of dialysis. However, the average waiting time until the renal transplant was 5.3 years higher than other international centers.
      Conclusion: These data support the use of peritoneal dialysis from birth, but complications and the worst growth reflect the need to develop strategies to optimize care relating to nutrition, growth and development and to reduce pre-transplant time.
      PubDate: 2016-09-30
      Issue No: Vol. 29, No. 9 (2016)
  • Sexual Dysfunction in Breast Cancer Survivors: Cross-Cultural Adaptation
           of the Sexual Activity Questionnaire for Use in Portugal

    • Authors: Filipa Alves da Costa, Manuel Castro Ribeiro, Sofia Braga, Elisabete Carvalho, Fátima Francisco, Ana da Costa Miranda, António Moreira, Lesley Fallowfield
      Pages: 533 - 541
      Abstract: Introduction: The increasing survivor population of breast cancer has shifted research and practice interests into the impacts of the disease and treatment in quality of life aspects. The lack of tools available in Portuguese to objectively evaluate sexual function led to the development of this study, which aimed to cross-culturally adapt and validate the Sexual Activity Questionnaire for use in Portugal.
      Material and Methods: The questionnaire was translated and back-translated, refined following face-to-face interviews with seven breast cancer survivors, and then self-administered by a larger sample at baseline and a fortnight later to test validity and reliability.
      Results: Following cognitive debriefing (n = 7), minor changes were made and the Sexual Activity Questionnaire was then tested with 134 breast cancer survivors. A 3-factor structure explained 75.5% of the variance, comprising the Pleasure, Habit and Discomfort scales, all yielding good internal consistency (Cronbach’s α > 0.70). Concurrent validity with the FACt-An and the BCPT checklist was good (Spearman’s r > 0.65; p-value < 0.001) and reliability acceptable (Cohen’s k > 0.444). The Sexual Activity Questionnaire allowed the identification of 23.9% of sexually inactive women, for whom the main reasons were lack of interest or motivation and not having a partner.
      Discussion: Patient-reported outcomes led to a more comprehensive and improved approach to cancer, tackling areas previously abandoned. Future research should focus on the validation of this scale in samples with different characteristics and even in the overall population to enable generalizability of the findings.
      Conclusion: The adapted Sexual Activity Questionnaire is a valid tool for assessing sexual function in breast cancer survivors in Portugal.
      PubDate: 2016-09-30
      Issue No: Vol. 29, No. 9 (2016)
  • Pharmacy Medicines Not Subject to Medical Prescription in Portugal: An
           Underused Access Opportunity'

    • Authors: Ana Paula Martins, Elizabete Gonçalves, Ana Marcelo, Sergio Vilão, José Aranda Silva
      Pages: 542 - 548
      Abstract: Introduction: In 2013 medicinal products for human use not subject to medical prescription dispensed exclusively in pharmacy, a subcategory of products not subject to medical prescription was introduced in Portugal. This category of medicinal products promotes the accessibility to treatment, ensuring safety and efficacy, with benefits to public health. This article analyzed the medicines classified as medicinal products for human use not subject to medical prescription dispensed exclusively in pharmacy or equivalent in seven European countries, United Kingdom, Denmark, Sweden, Norway, Italy, Czech Republic and Portugal, and proposes a preliminary list of common international names/ medicines that possess the characteristics that justify their inclusion in Portugal, in this category.
      Material and Methods: For the selection, common international names /medicines approved in the considered countries were selected if, in at least one of the countries considered, they are classified as medicinal products for human use not subject to medical prescription dispensed exclusively in pharmacy or equivalent, and/ or have the classification of medicinal products subject to medical prescription in Portugal and medicinal products not subject to medical prescription in one of the considered countries.
      Results: The preliminary list obtained contains 271 different common international names / presentations. About 19% of the selected common international names do not have a valid marketing authorization in Portugal and the majority (42%) is classified in Portugal as medicinal products not subject to medical prescription, a lower percentage (35%) as medicinal products subject to medical prescription, and only 4% as medicinal products for human use not subject to medical prescription dispensed exclusively in pharmacy.
      Conclusion: Safety is one of the main aspects to be considered in the context of the reclassification of medicines regarding their supply to the public. The results obtained promote a reflection on the relevance of extending the availability of medicines with the classification of medicinal products for human use not subject to medical prescription dispensed exclusively in pharmacy in Portugal, which, due to their characteristics and indications, would benefit from an access without a medical prescription, ensuring the safety in its use.
      PubDate: 2016-09-30
      Issue No: Vol. 29, No. 9 (2016)
  • Quality of Life in Children with Obsessive-Compulsive Disorder

    • Authors: Joana Vieira, Filipa Ramalho e Silva
      Pages: 549 - 555
      Abstract: Introduction: Obsessive-compulsive disorder is a psychiatric disorder stated as one of the most debilitating diseases in the developed
      world. However, not much is known about how this disease impairs patients’ quality of life in children.
      Material and Methods: We conducted a research in PubMed and Thomson Reuters Web Of Science using the following terms: ‘Quality of life’, ‘Obsessive-compulsive disorder’, ‘Child’, ‘Pediatrics’ and ‘Adolescent’. Of the 138 papers retrieved with this search, five articles corresponded to the aim of this review. We analyzed quality of life in children with obsessive-compulsive disorder comparing with general population and searching the relation with other clinical variables such as sex, age, comorbidities, symptoms dimension, symptoms severity, family accommodation and quality of life.
      Results: Albeit studies results not being concordant regarding the different dimensions analyzed, our findings pointed to an overall decrease of quality of life in children with obsessive-compulsive disorder. The presence of co-morbidities, symptoms severity and obsessions with harm/aggression content are the variables that have a higher influence in quality of life levels.
      Discussion: The small number of articles found and the fact that their methodology was extremely heterogeneous made it difficult to state robust conclusions. Despite that, our findings agree with other studies in adults.
      Conclusion: Quality of life in children and adolescents with obsessive-compulsive disorder must be better explored in future researches. We suggest the introduction of quality of life as a routinely used instrument in patient’s assessment and in treatment response evaluation.
      PubDate: 2016-09-30
      Issue No: Vol. 29, No. 9 (2016)
  • Management and Treatment of Glucocorticoid-Induced Hyperglycemia

    • Authors: Sílvia Paredes, Marta Alves
      Pages: 556 - 563
      Abstract: Introduction: Glucocorticoids have been associated to several side effects, specially a diabetogenic action, the most common and representative effect. Glucocorticoid-induced hyperglycemia is a common medical condition, with general associated morbidity and
      Material and Methods: It was performed a literature review about the management and treatment of glucocorticoid-induced hyperglycemia.
      Results: Through numerous not quite fully understood mechanics, glucocorticoids promote hyperglycemia in non-diabetic patients and
      worsen diabetes control in diabetic individuals. Glucocorticoid-induced hyperglycemia presents key patterns, enhanced in the postprandial period and scheduled-dependent. Despite the existence of guidelines for hyperglycemia treatment in non-critic hospitalized and non-hospitalized patients, there are no guidelines respecting glucocorticoid-induced hyperglycemia. Nevertheless, it is known that glucocorticoid-induced hyperglycemia is complex and demanding, requiring a specific approach. Indeed, glucocorticoid-induced hyperglycemia treatment depends on the glucocorticoid used, its dose, frequency and schedule. Furthermore, the scheme of treatment previously used by diabetic individuals also influences the choice of the new scheme.
      Discussion and Conclusion: The authors reviewed the glucocorticoid induced-hyperglycemia thematic and propose strategies to approach and treat glucocorticoid induced-hyperglycemia in diabetic and non-diabetic individuals. This review is expected to be useful in different settings and crosswise to all medical specialties.
      PubDate: 2016-09-30
      Issue No: Vol. 29, No. 9 (2016)
  • Extensive Myelitis as a Manifestation of Neuroborreliosis

    • Authors: Ana Brás, Nuno Marques, Beatriz Santiago, Anabela Matos, Fradique Moreira
      Pages: 564 - 566
      Abstract: Neurological manifestations of Lyme disease are reported in 3% - 12% of patients, with the most common form of presentation being meningoradiculitis. Other symptoms involving the central nervous system, such as myelitis or encephalitis, are rare (< 5 %). We report a case of a 66-year-old male, with a subacute extensive transverse myelitis, secondary to Borrelia burgdorferi infection. The patient underwent antibiotic therapy filed for neuroborreliosis with a good clinical outcome. The rareness in clinical symptoms and imaging presentation, based on a treatable infectious disease, highlights the importance of the inclusion of neuroborreliosis in the differential diagnosis of longitudinally extensive transverse myelitis.
      PubDate: 2016-09-30
      Issue No: Vol. 29, No. 9 (2016)
  • Acute Pancreatitis and Posterior Reversible Encephalopathy Syndrome: A
           Case Report

    • Authors: Vítor Magno Pereira, Luís Marote Correia, Tiago Rodrigues, Gorete Serrão Faria
      Pages: 567 - 571
      Abstract: The posterior reversible encephalopathy syndrome is a neurological syndrome characterized by headache, confusion, visual disturbances and seizures associated with identifiable areas of cerebral edema on imaging studies. The authors report the case of a man, 33 years-old, leukodermic with a history of chronic alcohol and tobacco consumption, who is admitted to the emergency department for epigastric pain radiating to the back and vomiting with about six hours of evolution and an intense holocranial headache for two hours. His physical examination was remarkable for a blood pressure of 190/100 mmHg and tenderness in epigastrium. His analytical results revealed emphasis on amylase 193 U/L and lipase 934 U/L. During the observation in the emergency department,
      he presented a generalized tonic-clonic seizure. Abdominal ultrasonography was performed and suggestive of pancreatitis without
      gallstones signals. Head computed tomography showed subarachnoid haemorrhage and a small right frontal cortical haemorrhage. The brain magnetic resonance imaging done one week after admission showed areas of a bilateral and symmetrical T2 / FLAIR hyperintensities in the subcortical white matter of the parietal and superior frontal regions, suggesting a diagnosis of posterior reversible encephalopathy syndrome. Abdominal computed tomography (10 days after admission) demonstrated a thickened pancreas in connection with inflammation and two small hypodense foci in the anterior part of the pancreas body, translating small foci of necrosis. The investigation of a thrombophilic defect revealed a heterozygous G20210A prothrombin gene mutation. The patient was discharged without neurological sequelae and asymptomatic. The follow-up brain magnetic resonance imaging confirmed the reversal of the lesions, confirming the diagnosis.
      PubDate: 2016-09-30
      Issue No: Vol. 29, No. 9 (2016)
  • Severe Thyroid-associated Ophtalmopathy and Hashimoto´s Thyroiditis
           in Euthyroid Patient

    • Authors: Raquel Espírito Santo, Teresa Sabino, Ana Agapito
      Pages: 572 - 572
      Abstract: Keywords: Graves Ophthalmopathy; Hashimoto Disease; Hashimoto´s thyroiditis; Thyroid Hormones.
      PubDate: 2016-09-30
      Issue No: Vol. 29, No. 9 (2016)
  • One of the Last Cases of Plombage

    • Authors: Madalena Reis, Alcina Tavares, Luís Ferreira
      Pages: 573 - 573
      Abstract: Keywords: Collapse Therapy; Tuberculosis, Pulmonary/surgery; Tuberculosis, Pulmonary/therapy.
      PubDate: 2016-09-30
      Issue No: Vol. 29, No. 9 (2016)
  • Portuguese Position Paper on the Use of Biosimilars in Psoriasis

    • Authors: Tiago Torres, Ana Ferreira, Paulo Ferreira, Martinha Henriques, Luiz Leite, Sofia Magina, Gabriela Marques Pinto, Hugo Oliveira, Artur Sousa Basto, Rui Tavares Bello, Paulo Varela, Antonio Massa, Manuela Selores, Paulo Filipe, On behalf of The Portuguese College of Dermatology, On behalf of The Portuguese Society of Dermatology; Venereology
      Pages: 574 - 577
      Abstract: Keywords: Biological Agents; Biosimilar Pharmaceuticals; Portugal; Psoriasis/drug therapy.
      PubDate: 2016-09-30
      Issue No: Vol. 29, No. 9 (2016)
  • Letter to the Editor Concerning the Evaluation of Mupirocin Resistance in
           Methicillin-Resistant Staphylococcus aureus Strains

    • Authors: Margarida Monteiro, Antónia Read, Filipa Carneiro, Maria João Soares, Valquíria Soares
      Pages: 578 - 578
      Abstract: Keywords: Drug Resistance, Bacterial; Methicillin-Resistant Staphylococcus aureus; Mupirocin; Staphylococcal Infections.
      PubDate: 2016-09-30
      Issue No: Vol. 29, No. 9 (2016)
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Heriot-Watt University
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