Guidelines for the Diagnosis and Treatment of Uncomplicated (NonLymphogranuloma Venereum) Chlamydia trachomatis Infection in Portugal

Chlamydia trachomatis infection is the most prevalent sexually transmitted bacterial infection in the world. Being associated with a large number of asymptomatic carriers, the diagnosis is frequently challenging and requires appropriate laboratory testing. In Portugal, the incidence of the disease has been consistently increasing in recent years, meaning that special awareness is required for case identification, contact tracing and application of appropriate treatments. These recommendations result from the adaptation of the international consensuses on the diagnosis and treatment of Chlamydia trachomatis infection to the Portuguese healthcare setting, with the aim of standardizing the clinical and laboratory approach to symptomatic and nonsymptomatic carriers of the disease.info:eu-repo/semantics/publishedVersio

OPTImized Coronary Interventions EXplaIn the BEst CliNical OutcomEs (OPTI-XIENCE) Study. Rationale and Study Design

Introduction: Clinical events may occur after percutaneous coronary intervention (PCI), particularly in complex lesions and complex patients. The optimization of PCI result, using pressure guidewire and intracoronary imaging techniques, may reduce the risk of these events. The hypothesis of the present study is that the clinical outcome of patients with indication of PCI and coronary stent implantation that are at high risk of events can be improved with an unrestricted use of intracoronary tools that allow PCI optimization. Methods and analysis: Observational prospective multicenter international study, with a follow-up of 12 months, including 1064 patients treated with a cobalt‑chromium everolimus-eluting stent. Inclusion criteria include any of the following: Lesion length > 28 mm; Reference vessel diameter 4.25 mm; Chronic total occlusion; Bifurcation with side branch ≥2.0 mm;Ostial lesion; Left main lesion; In-stent restenosis; >2 lesions stented in the same vessel; Treatment of >2 vessels; Acute myocardial infarction; Renal insufficiency; Left ventricular ejection fraction <30 %; Staged procedure. The control group will be comprised by a similar number of matched patients included in the "extended risk" cohort of the XIENCE V USA study. The primary endpoint will be the 1-year rate of target lesion failure (TLF) (composite of ischemia-driven TLR, myocardial infarction (MI) related to the target vessel, or cardiac death related to the target vessel). Secondary endpoints will include overall mortality, cardiovascular mortality, acute myocardial infarction, TVR, TLR, target vessel failure, and definitive or probable stent thrombosis at 1 year. Implications: The ongoing OPTI-XIENCE study will contribute to the growing evidence supporting the use of intra-coronary imaging techniques for stent optimization in patients with complex coronary lesions.info:eu-repo/semantics/publishedVersio

Ganhos da Interdisciplinaridade em Saúde. Estudo de Caso

Introdução: A Insuficiência Cardíaca (IC) é causada por uma anomalia cardíaca, com sinais típicos, recomendando-se uma abordagem interdisciplinar (McDonagh et al., 2021). Um adequado planeamento de alta tem impacto na eficiência e satisfação do doente (Escoval et al., 2010). Objetivos: Evidenciar os ganhos da interdisciplinaridade nos cuidados à pessoa com IC. Material e métodos: Clinicamente, destaca-se miocardiopatia dilatada com IC, NYHA III-IV. Antecedentes: IC com 6 internamentos/ano, insuficiência respiratória global (sob Oxigenioterapia longa duração 1L/m). Na admissão, exame objetivo: dispneia e dificuldade em articular frases, perfil hipertenso, taquicardico, SpO297% sob 3L/m. À auscultação: tons arrítmicos, taquicardíacos, Murmúrios Vesiculares diminuídos nas bases, fervores bibasais. Membros inferiores com edema. Radiografia tórax com aumento do Índice Cardiotorácico e estase nos campos inferiores. Apresentava: 76,8Kg, cansaço a mínimos esforços, dependência elevada nas Atividades Vida diária (AVD), dificuldade na terapêutica. Identificaram-se diagnósticos enfermagem: Dispneia Presente, Posicionar-se/Vestuário dependente grau elevado, Alimentar-se/Higiene/Sanitário/Movimento muscular dependente grau moderado, Gestão do Regime terapêutico comprometida. O doente vive com esposa. Tem 2 filhas, sem disponibilidade para apoio presencial. Reconhecem-se indicadores de risco social: Problema social (Escala Gijón=15), Dependência funcional, desconhecimento dos recursos da comunidade/direitos, iliteracia em saúde e incapacidade familiar de apoio. Admitiu-se o doente no “Plano Integrado de Alta Hospitalar”, informando-se a Unidade de Saúde sobre o internamento. Cumpriu levosimendan. e furosemida. Fez-se desmame de O2 até ao basal. Procedeu-se ao treino de estratégias de conservação de energia, posições de descanso e AVD. Realizou-se exercício aeróbio e desmitificou-se crenças sobre terapêutica. Orientou-se para direitos sociais. Agendou-se conferência familiar. Resultados: Verificou-se que o incumprimento desencadeou a descompensação (dosagens prescritas e administradas diferentes), devido a inadequação da comunicação e por falta de apoio para detetar erros na administração. Definiu-se como plano com a pessoa e família: apoio domiciliário (AVD e medicação) e envolvimento familiar. Enviou-se informação à equipa da Unidade de Saúde que, pós-alta, constatou adesão ao regime terapêutico. O doente foi reavaliado em consulta: maior autonomia e tolerância ao esforço, com consequente ganho em saude e eficácia organizacional. Conclusões: A abordagem interdisciplinar ao doente com IC é impreterível para se evitarem hospitalizações (McDonagh et al., 2021). A aplicação de uma alta integrada em doentes de alto risco clínico/social melhora o planeamento dos cuidados, assegurando a sua continuidade e segurança de cuidados.info:eu-repo/semantics/publishedVersio

Biochemical and Anthropometric Outcomes in Paediatric Patients with Heterozygous Familial Hypercholesterolemia after COVID-19 Pandemic Lockdowns: An Exploratory Analysis

The COVID-19 pandemic lockdowns affected the lifestyles of children and adolescents, leading to an increase in childhood obesity. Paediatric patients with familial hypercholesterolemia (FH) may be more susceptible to lockdown effects due to their increased cardiovascular risk. However, data are lacking. We investigated the effect of lockdowns on the metabolic profile of paediatric patients with FH. Blood lipids and anthropometry measured in September 2021-April 2022 were retrospectively compared with pre-pandemic values. Thirty participants were included (1-16 years; 57% female). From baseline to post-pandemic, median [P25, P75] blood LDL-C concentration was 125 [112, 150] mg/dL vs. 125 [100, 147] mg/dL (p = 0.894); HDL-C was 58 [52, 65] mg/dL vs. 56 [51, 61] mg/dL (p = 0.107); triglycerides were 64 [44, 86] mg/dL vs. 59 [42, 86] mg/dL (p = 0.178). The BMI z-score did not change significantly (0.19 [-0.58, 0.89] vs. 0.30 [-0.48, 1.10], p = 0.524). The lack of deterioration in metabolic profiles during lockdowns is positive, as some deterioration was expected. We speculate that patients and caregivers were successfully educated about healthy lifestyle and dietary habits. Our results should be interpreted with caution since the study sample was small and heterogeneous. Multicentre research is needed to better understand the impact of lockdowns on this population.info:eu-repo/semantics/publishedVersio

Estratégias para a Promoção da Investigação nos Cuidados de Saúde Primários em Portugal: Um Estudo Qualitativo

Introduction: There are several barriers discouraging clinicians from undertaking research, including insufficient funding, lack of time, organizational issues and lack of support. The strengthening of research capacity is perceived from three levels: characteristics of the researcher, the environment, and organizational issues. To date, Portugal is lacking studies on this subject. The aim of this study was to identify the best practices to promote research in Portuguese Primary Health Care. Methods: We conducted a qualitative study using semi-structured interviews with family doctors with broadly recognized research work and other stakeholders. We selected a sample by convenience and snowball sampling. From a total of 14 doctors invited by email, 12 responded positively, and we subsequently included two other stakeholders. We conducted the interviews in digital or face-to-face formats. Two team members handled the coding of interviews independently. We kept all recordings and transcripts confidential, only accessible to researchers. Results: We identified 16 strategies: 1) increasing institutional support; 2) creating support structures; 3) redefining the residency program; 4) investing in research training; 5) redefining curriculum evaluation; 6) establishing dedicated time for research; 7) increasing funding; 8) improving access to research data; 9) being a research driver; 10) establishing a research culture; 11) working in collaboration; 12) creating formally organized research groups; 13) creating autonomous research centers; 14) improving the definition of the research subjects and study designs; 15) reviewing procedures for ethics' committees; and 16) reviewing the current selection of articles for publication. Conclusion: Overall, a greater proportion of interviewees identified the following as the most relevant strategies for research promotion: institutional support, including technical and scientific support from public institutions, private entities and academic centers; the reorganization of working hours with protected time for research; increased funding directed towards research and breaking isolation in research, promoting teamwork with clinicians within the same area or from different professional backgrounds.info:eu-repo/semantics/publishedVersio

An Unusual Case of Overlapping Immunoglobulin G4-Related Disease and Systemic Lupus Erythematosus.

Immunoglobulin G4-related disease (IgG4-RD) and systemic lupus erythematosus (SLE) are multisystemic autoimmune disorders that can present with renal manifestations. Overlapping cases of these diseases are extremely rare and present both diagnostic and therapeutic challenges. We report the case of a 70-year-old male with a history of autoimmune pancreatitis, who was admitted with fatigue, weight loss, and worsening kidney function. Laboratory tests revealed anemia with a positive Coombs test, leucopenia, elevated IgG4, hypocomplementemia, and positive results for ANA, anti-double-stranded DNA (dsDNA), anti-nucleosome, anti-RP11 antibodies, and rheumatoid factor. A spot urine sample showed subnephrotic proteinuria without hematuria. The patient met the criteria for both SLE and possible IgG4-RD, but the cause of the worsening renal function remained unclear, prompting a kidney biopsy. The biopsy revealed a lymphoplasmacytic infiltrate, storiform fibrosis, and IgG4-positive staining, consistent with IgG4-related tubulointerstitial nephritis, but without evidence of lupus nephritis. The patient was treated with prednisolone, resulting in improvement of both his symptoms and kidney function. However, significant leukopenia, anemia, and elevated anti-dsDNA titers persisted, which were presumed to be secondary to the overlapping SLE. Hydroxychloroquine and azathioprine were added to the treatment regimen, leading to improvement in cytopenias at the three-month follow-up. This case underscores the importance of kidney biopsy in suspected overlapping autoimmune diseases for identifying kidney involvement and guiding treatment, although evidence regarding optimal therapy remains limited

Adenocarcinoma do pulmão: importância diagnóstica da ecocardiografia

info:eu-repo/semantics/publishedVersio

Endocarditis with Osler Nodes and Janeway Lesions

info:eu-repo/semantics/publishedVersio

Perceção da Cardiologia, Preferências Profissionais e Impacto na Escolha de Carreira Entre Cardiologistas Portugueses: Resultados do Questionário da Task Force Mulheres na Cardiologia da Sociedade Portuguesa de Cardiologia

Introduction and objectives: Cardiology has not been seen as an attractive specialty, and women have avoided it for many years. Some surveys have been performed in other countries, but in Portugal, the situation is largely unknown. Methods: An online survey on perceptions of cardiology and professional preferences was sent to 1371 members of the Portuguese Society of Cardiology, of whom 18.2% completed the survey. Results: We included 219 cardiologists or cardiology trainees, of whom 50.2% were female, with decreasing proportions from younger to older age groups, in which males still predominate. Women are less often married and more frequently childless, particularly those working in an invasive subspecialty, where they represent only 16% of all respondents working in these areas. Men's perception is that women do not choose these areas due to family reasons, radiation concerns and difficult working conditions, but from the female perspective, male dominance, lack of female role models and restricted access are the main barriers. Women consider it is difficult for them to obtain a leadership role, but men do not think the same (75.5% vs. 27.5%). Conclusion: In Portugal, females predominate in younger age groups, suggesting a paradigm change. Women are less frequently married and more frequently childless, particularly women working in invasive subspecialties. Women consider that it is more difficult for them to obtain a leadership role. Moreover, the barriers reported by women are substantially different from men regarding the reasons for not choosing an invasive subspecialty.info:eu-repo/semantics/publishedVersio