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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]
  • Analysis of the Cochrane Review: Anti-vascular Endothelial Growth Factor
           for Prevention of Postoperative Vitreous Cavity Hemorrhage after
           Vitrectomy for Proliferative Diabetic Retinopathy. Cochrane Database Syst
           Rev. 2015;8:CD008214.

    • Authors: David Cordeiro Sousa, Inês Leal, João Costa, António Vaz-Carneiro
      Pages: 513 - 516
      Abstract: Postoperative vitreous hemorrhage is a complication following vitrectomy for proliferative diabetic retinopathy, delaying visual recovery and making fundus examination and disease follow-up more difficult. Anti-vascular endothelial growth factor drugs such as bevacizumab, when injected in the vitreous cavity, reduce vascular proliferation and their use has been proposed to reduce the incidence of postoperative vitreous hemorrhage. The authors of this Cochrane systematic review evaluated all randomized controlled trials on the pre- or intraoperative use of anti-vascular endothelial growth factor to reduce postoperative vitreous hemorrhage occurrence after vitrectomy in patients with proliferative diabetic retinopathy. The results suggested that the use of intravitreal bevacizumab was effective in reducing early postoperative vitreous hemorrhage (i.e. at four weeks) occurrence, with a good safety profile. This work aims to summarize and discuss the findings and clinical implications of this Cochrane systematic review.
      PubDate: 2017-08-31
      Issue No: Vol. 30, No. 7-8 (2017)
  • Treatment of Anorexia Nervosa: The Importance of Disease Progression in
           the Prognosis

    • Authors: Rodrigo Andrade, Manuel Gonçalves-Pinho, António Roma-Torres, Isabel Brandão
      Pages: 517 - 523
      Abstract: Introduction: Anorexia nervosa is a severe, usually chronic, life-threatening disease of complex etiology characterized by food restriction, overestimation of the importance of body weight and image, intense fear of weight gain and distortion of body image. Anorexia nervosa is associated with high rates of mortality, suicide and decreased quality of life. Our aim is to present an anorexia nervosa treatment program offered in a major university hospital in Portugal, and to determine the impact of illness duration before admission on the outcome. Our hypothesis is that patients with greater disease longevity may have worse prognosis and poorer outcome.
      Material and Methods: The sample included data from case records of 169 patients seen consecutively and for the first time at Centro Hospitalar São João, between 2010 and 2015. We performed a retrospective observational study which included data collected at admission and from later follow-up years.
      Results: From the initially selected patients, 14.8% reached total remission, 16% accomplished partial remission and 14.2% ended up with exacerbation/stagnation of the disease. The dropout rate was of 55% throughout our study period. We found significant differences on outcome rates between distinct illness duration groups (p = 0.007).
      Discussion: There are several factors frequently associated with poor outcome for anorexia nervosa. The interpretation of outcome findings was limited by the high rate of dropout and lack of consistent definition criteria.
      Conclusion: Our results support the idea that illness duration has an important role on the outcome and prognostic features of these patients.
      PubDate: 2017-08-31
      Issue No: Vol. 30, No. 7-8 (2017)
  • Epidemiology of Internet Use by an Adolescent Population and its Relation
           with Sleep Habits

    • Authors: Carla Ferreira, Helena Ferreira, Maria João Vieira, Mónica Costeira, Liliana Branco, Ângela Dias, Liliana Macedo
      Pages: 524 - 533
      Abstract: Introduction: In the last decades, the great technological development increased Internet popularity, emerging the concern about its overuse. The objectives of this study were to assess and characterize Internet use in adolescence, determine Internet addiction and clarify its association with sleep disorders and excessive daytime sleepiness.
      Material and Methods: It was performed an observational, cross sectional and community-based study. The target were students attending 7th and 8th grades, to whom was applied an online self-report questionnaire to assess sociodemographic features, Internet use, Internet dependence, sleep characteristics and excessive daytime sleepiness.
      Results: A total of 727 adolescents were included with a mean age 13 ± 0.9 years. Three-quarters of teenagers use Internet daily and 41% do it for three or more hours/day, mainly at home. The phone and laptop were the main devices used. Online games and social networks use were the main activities performed. Internet dependence was observed in 19% of adolescents, and it was associated with male gender, social networks use, mainly Twitter and Instagram use, self-perceived sleep problems, initial and middle insomnia and excessive daytime sleepiness (p < 0.05).
      Discussion: The results confirm the highlight that Internet has in adolescents routine, who prioritize in their use access to social networks and online games, using single devices, less subject to parental control.
      Conclusion: The Internet addiction rate observed and its association with sleep alterations and daytime sleepiness emphasizes the importance of this issue.
      PubDate: 2017-08-31
      Issue No: Vol. 30, No. 7-8 (2017)
  • Prevalence of Hepatitis A Virus Antibody in Portuguese Travelers: A New

    • Authors: Sónia Rocha, Sandra Tejo, Eugénia Ferreira, Luís Trindade, Eduardo Rabadão, Nuno Marques, José Saraiva da Cunha
      Pages: 534 - 540
      Abstract: Introduction: In Portugal, the prevalence of hepatitis A virus infection has decreased in the past decades, especially in young adults. The aim of this study was to detect the prevalence of antibody to hepatitis A virus in a population observed in our Travel Clinic.
      Material and Methods: Antibodies against hepatitis A, hepatitis B, hepatitis C and human immunodeficiency virus were tested using standard enzyme immunoassay in patients older than 18. The exclusion criteria were: prior vaccination for hepatitis A virus, previous diagnosis of infection with hepatitis B virus, hepatitis C virus and/or human immunodeficiency virus, foreign travelers and long-term expatriates. We applied an epidemiological survey and data was statistically analyzed with SPSS® 18.0.
      Results: In the 665 travelers studied, natural immunity to hepatitis A virus was present in 57.6% (n = 383). They were stratified into 8 age groups and for each one hepatitis A immunity was clarified: 5.0% (n = 1) in 18 - 25 years, 32.3% (n = 21) in 26 - 30 years, 40.9% (n = 47) in 31 - 35 years, 45.8% (n = 54) in 36 - 40 years, 68.7% (n = 79) in 41 - 45 years, 70.1% (n = 68) in 46 - 50 years, 80.8% (n = 63) in 51 - 55 years and 87.7% (n = 50) over 56 years old. In those who accepted further screening, positivity for hepatitis B core antibody was found in 0.6% (n = 3) travelers, hepatitis C virus infection in 1.1% (n = 6) and human immunodeficiency virus infection in 0.5% (n = 3) whose previous status was unknown. The most frequent travel destination was sub-Saharan Africa (72.6%; n = 483).
      Discussion: We found 49.1% (n = 260) travelers under 50 years old susceptible to hepatitis A virus infection and for those between 40 and 50 years, 30.7% (n = 65) still need vaccine protection.
      Conclusion: Across age groups there is a trend towards lower prevalence of hepatitis A virus antibody, in particular among youngsters, when compared with older Portuguese studies.
      PubDate: 2017-08-31
      Issue No: Vol. 30, No. 7-8 (2017)
  • Long-Term Outcomes of the Calcaneo-Stop Procedure in the Treatment of
           Flexible Flatfoot in Children: A Retrospective Study

    • Authors: Francisca Pinho Costa, Gilberto Costa, Manuel Santos Carvalho, António Mendes Moura, Rui Pinto, João Torres
      Pages: 541 - 545
      Abstract: Introduction: Flexible flatfoot is common amongst children, although treatment is rarely indicated. The calcaneo-stop procedure has been reported to be effective in short-term studies. We aim to evaluate the long-term outcomes of the calcaneo-stop procedure in the treatment of flexible flatfoot in children.
      Material and Methods: Twenty-six calcaneo-stop procedures performed between 1995 and 2006 on 13 patients were evaluated clinically and using photopodoscopy, and the FAOS questionnaire was applied for both feet.
      Results: Of the 26 feet evaluated, 22 presented with heel valgus, 13 had forefoot supination and 11 had abnormal footprints. Median FAOS questionnaire score was 97.22 for ‘Pain’, 92.86 for ‘Other symptoms’, 98.53 for ‘Function in daily living’, 100 for ‘Function in sports and recreation’ and 93.75 for ‘Foot and ankle-related quality of life’.
      Discussion: The calcaneo-stop procedure is the least invasive and most simple surgical treatment for symptomatic flexible flatfoot in children. Short-term studies report excellent clinical and radiographic results. The authors report alterations in clinical parameters in a large proportion of patients. These findings can be due to biomechanical alterations in the years following removal of the screw. Patient foot and ankle-related satisfaction data is promising, although hard to evaluate given the absence of preoperative data.
      Conclusion: Larger, prospective, controlled studies are required to better evaluate the long-term success of this procedure.
      PubDate: 2017-08-31
      Issue No: Vol. 30, No. 7-8 (2017)
  • Morbidity in the Dependent Elderly Cared by Home-Teams of the National
           Network of Continued Integrated Care in the Lisbon and Tagus Valley:
           Cross-Sectional Study

    • Authors: Paula Broeiro-Gonçalves
      Pages: 546 - 554
      Abstract: Introduction: In Portugal, the National Network of Continuing Integrated Care’s mission is to take care of new health and social needs. The aim of the study was to know the disease burden and disability of the elderly (75 and over) cared by the integrated continuing care teams.
      Material and Methods: A cross-sectional study carried out in a sample of 230 participants, from 25 teams randomly selected in the region of Lisbon and Tagus Valley. Data were collected at the patient’s home trough caregiver’s interviewing. The variables studied were: socio-demographic; disability determinants; degree (Barthel’s scale) and duration of disability; morbidity (diagnoses, number and Charlson index).
      Results: The study population had: on average 84 years; low or no scholar degree level (88.7%); on average 9.5 problems per person and a Charlson index of 8.48; disability over 42 months (severe in 65.2%). The most frequent disability-determinants were: dementia, stroke and femur fracture. The most frequent diagnoses were: osteoarthritis, hypertension and dementia.
      Discussion: The results revealed a high disease burden (Charlson of 8.48) and disability. Although the diagnoses were those expected and comparable with the literature, their coexistence was universal, averaging 9.5 per person, affecting different organs/systems. Multimorbidity, coupled with severe disability, leads to clinical and organizational-care challenges, as well as the need for other population base studies.
      Conclusion: The population cared by the integrated continuing care teams is at risk: elderly, with low scholar degree level, with a high disease-burden and disability.
      PubDate: 2017-08-31
      Issue No: Vol. 30, No. 7-8 (2017)
  • Postoperative Haematocrit and Outcome in Critically Ill Surgical Patients

    • Authors: Ana Martins Lopes, Diana Silva, Gabriela Sousa, Joana Silva, Alice Santos, Fernando José Abelha
      Pages: 555 - 560
      Abstract: Introduction: Haematocrit has been studied as an outcome predictor. The aim of this study was to evaluate the correlation between low haematocrit at surgical intensive care unit admission and high disease scoring system score and early outcomes.
      Material and Methods: This retrospective study included 4398 patients admitted to the surgical intensive care unit between January 2006 and July 2013. Acute physiology and chronic health evaluation and simplified acute physiology score II values were calculated and all variables entered as parameters were evaluated independently. Patients were classified as haematocrit if they had a haematocrit < 30% at surgical intensive care unit admission. The correlation between admission haematocrit and outcome was evaluated by univariate analysis and linear regression.
      Results: A total of 1126 (25.6%) patients had haematocrit. These patients had higher rates of major cardiac events (4% vs 1.9%, p < 0.001), acute renal failure (11.5% vs 4.7%, p < 0.001), and mortality during surgical intensive care unit stay (3% vs 0.8%, p < 0.001) and hospital stay (12% vs 5.9%, p < 0.001).
      Discussion: A haematocrit level < 30% at surgical intensive care unit admission was frequent and appears to be a predictor for poorer outcome in critical surgical patients.
      Conclusion: Patients with haematocrit had longer surgical intensive care unit and hospital stay lengths, more postoperative complications, and higher surgical intensive care unit and hospital mortality rates.

      PubDate: 2017-08-31
      Issue No: Vol. 30, No. 7-8 (2017)
  • Diabetes: Socioeconomic Inequalities in the Portuguese Population in 2014

    • Authors: Joana Santos, Irina Kislaya, Liliana Antunes, Ana João Santos, Ana Paula Rodrigues, Mariana Neto, Carlos Matias Dias
      Pages: 561 - 567
      Abstract: Introduction: Diabetes is a major public health problem and it is related to socioeconomic factors. The aim of this study is to describe socioeconomic inequalities in the distribution of diabetes in the population with 25 years or more, resident in Portugal in 2014.
      Material and Methods: Data from the Health National Survey 2014 was analysed, n = 16 786. We estimated the prevalence of diabetes in the population and stratified by socioeconomic variables namely educational level and income. The extent of socioeconomic inequalities was assessed using concentration index and the relative index of inequality.
      Results: Diabetes was found to be concentrated among the people with lower educational levels (concentration index = -0.26) and lower income quintiles (concentration index = -0.14). Relative index of inequality also showed a lower degree of inequality among the most educated (0,20; CI 95% = [0,12; 0,32]) and with higher income (0,59; CI 95% = [0,48; 0,74]).
      Discussion: Distribution of diabetes is associated with education and income. Previous studies have shown that although income might reflect lifestyle patterns, education reflects better social factors that are important for establishing healthier behaviours. Also, the National Health Service, of universal coverage and free of charge, might have contributed to reduce inequalities in the access to health by those with the lowest income.
      Conclusion: Supporting ‘Health in All Policies’ might reduce inequalities, namely by improving population educational level and actions that promote health literacy.
      PubDate: 2017-08-31
      Issue No: Vol. 30, No. 7-8 (2017)
  • Assessment of Urinary Incontinence in Pregnancy and Postpartum:
           Observational Study

    • Authors: Juliana Rocha, Pedro Brandão, Anabela Melo, Silvia Torres, Lurdes Mota, Fernanda Costa
      Pages: 568 - 572
      Abstract: Introduction: The urinary incontinence can affect up to 50% of women at some stage of their lives, particularly during pregnancy and postpartum. This study was designed in order to identify and assess the prevalence and risk factors for urinary incontinence during the third trimester of pregnancy and three months postpartum.
      Material and Methods: Observational and cross-sectional study. The population of the study was composed of 268 women who delivered and were admitted to the Centro Hospitalar Tâmega e Sousa in the years 2013 and 2014, and who agreed to participate in this study. Postpartum women were asked to fill out a questionnaire adapted from the International Consultation on Incontinence Questionnaire - Short Form, for urinary incontinence research in the third trimester of pregnancy. Three months after delivery, they were contacted by telephone and asked to answer the same questions about the urinary incontinence postpartum.
      Results: Of the 268 women interviewed, 31 were excluded from the study, taking into account the defined inclusion and exclusion criteria. In total (n = 237), 51.89% of women included in the study, reported the occurrence of urinary incontinence during pregnancy. The prevalence of urinary incontinence in pregnancy by parity (primiparous versus multiparous) was statistically significant (p = 0.006). At postpartum (n = 237), 28.69% of women with urinary incontinence had vaginal delivery and 5.91% of women underwent cesarean delivery (p = 0.001). In these group of women with postpartum urinary incontinence (n = 82), 31.69% have had urinary incontinence only in the postpartum and 68.31% of women have had symptoms during pregnancy (p < 0.001).
      Discussion: This study demonstrates the high prevalence of urinary incontinence in pregnancy and the respective decrease in postpartum.
      Conclusion: Multiparity and occurrence of urinary incontinence in pregnancy appear as potential risk factors in the emergence of the urinary incontinence.
      PubDate: 2017-08-31
      Issue No: Vol. 30, No. 7-8 (2017)
  • Choroidal Melanoma

    • Authors: Inês Coutinho, Tânia Teixeira, Paulo César Simões, João Casalta Lopes, Margarida Borrego, Júlia Fernandes, João Cabral, Isabel Prieto, Rui Proença
      Pages: 573 - 577
      Abstract: Choroidal melanoma is the most common primary intraocular malignant tumor in adults. None of the different treatments available offers advantages of survival, resorting more and more to conservative treatments such as brachytherapy, which has been available in Portugal since 2013. In this article we review the clinical characteristics, risk factors, diagnosis, complementary exams and therapeutic options in choroidal melanoma.
      PubDate: 2017-08-31
      Issue No: Vol. 30, No. 7-8 (2017)
  • Pneumonitis in Adult Onset Still’s Disease: Uncommon or Under

    • Authors: Silvia Fernandes, Margarida Almeida, José Alberto Pereira da Silva, José Carlos Romeu
      Pages: 578 - 581
      Abstract: The adult onset Still’s Disease is an uncommon entity characterized by multiple clinical manifestations. Pneumonitis, less often considered, deserves particular emphasis given the need for differential diagnosis and because it can progress to severe respiratory failure. With the aim to highlight the pulmonary parenchyma involvement in patients with adult onset Still’s Disease, we present a case report which progresses with pneumonitis.
      PubDate: 2017-08-31
      Issue No: Vol. 30, No. 7-8 (2017)
  • Family Phenotypic Heterogeneity Caused by Mitochondrial DNA Mutation

    • Authors: Daniela Alves, Maria Eufémia Calmeiro, Carmo Macário, Rosa Silva
      Pages: 581 - 585
      Abstract: Maternally inherited diabetes and deafness is a rare form of diabetes caused by a mitochondrial DNA mutation. The index case is a 55-year-old woman who was admitted with hypertrophic cardiomyopathy. She had a history of diabetes mellitus and hearing loss. The patient’s mother, two brothers and two sisters also had a history of diabetes and hearing loss. This pattern suggests a maternally inherited disorder. All siblings carried the A3243G mitochondrial DNA mutation. The identification of people with monogenic forms of diabetes mellitus is a diagnostic challenge. This condition should be considered whenever there is a history of diabetes associated with hearing loss and a relevant family history. Cardiopathy is also known to be an important feature of mitochondrial disease. In order to identify this aetiology, family screening, genetic counselling and screening of associated comorbidities are encouraged.
      PubDate: 2017-08-31
      Issue No: Vol. 30, No. 7-8 (2017)
  • Generalized Bullous Eruption During Treatment with Vancomycin

    • Authors: André Pinho, José Carlos Cardoso
      Pages: 586 - 586
      Abstract: N/A.
      PubDate: 2017-08-31
      Issue No: Vol. 30, No. 7-8 (2017)
  • Extensive Atypical HSV-2 Ulceration of the Finger

    • Authors: Nélia Cunha, Pedro Simões, Vasco Serrão
      Pages: 587 - 587
      Abstract: N/A.
      PubDate: 2017-08-31
      Issue No: Vol. 30, No. 7-8 (2017)
  • Letter to the Editor regarding the article: “Vitamin D and Prevention of
           Chronic Diseases” by António Vaz-Carneiro. Acta Med Port.

    • Authors: Vitorino Modesto dos Santos
      Pages: 588 - 588
      Abstract: N/A.
      PubDate: 2017-08-31
      Issue No: Vol. 30, No. 7-8 (2017)
School of Mathematical and Computer Sciences
Heriot-Watt University
Edinburgh, EH14 4AS, UK
Tel: +00 44 (0)131 4513762
Fax: +00 44 (0)131 4513327
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