Estudo observacional de lesões oculares em gatos errantes na região de Lisboa : a propósito de 40 casos clínicos

Dissertação de Mestrado Integrado em Medicina VeterináriaOs gatos errantes (Felis silvestris catus) que habitam preferencialmente em meio urbano, estão mais expostos aos perigos da via pública e são mais propensos a terem comportamentos de risco que poderão levar ao aparecimento de lesões, nomeadamente a nível ocular. Este estudo observacional teve como objetivos contribuir para a caracterização do tipo de lesões oculares presentes em gatos errantes, possível relação com o seu modo de vida e suas implicações na visão do animal. Foram incluídos 40 animais provenientes de colónias de gatos errantes, examinados em três instalações de abrigo na zona de Lisboa e também gatos errantes presentes à consulta no Hospital Veterinário Arco do Cego (HVAC). Todos os gatos foram submetidos a um exame oftalmológico, tendo sido recolhida informação relacionada com variáveis como a idade, o género, o estado reprodutivo, o estado vacinal e o rastreio de FIV e FeLV. Da população em estudo, 55% (22/40) dos felídeos exibiam alterações oculares. A maioria das lesões oculares verificaram-se em machos (69%; 9/13), sendo que também se verificou uma maior prevalência de alterações em gatos inteiros (80%; 4/5). Relativamente às classes etárias afetadas, os adultos e seniores ( 3 anos) foram os que apresentaram uma maior percentagem de lesões oculares (67%; 12/18). Dos gatos errantes que exibiam lesões oculares, 54,5% dos animais (12/22) apresentavam conjuntivite, seguidos por 18% (4/22) com úlceras na córnea, 13,6% (3/22) exibiam melanose difusa da íris, 13,6% (3/22) perda do globo ocular, 9% (2/22) entrópion e, por último, foi observado apenas um caso de estrabismo (4,5%; 1/22). Do total de gatos com lesões oculares, 82% (18/22) estavam possivelmente associadas a trauma. A maior parte dos gatos que apresentavam sintomatologia ocular eram FIV positivos (67%; 6/9) e FeLV negativos (55%; 21/38). Os gatos errantes incluídos no estudo apresentaram uma elevada incidência de lesões oculares, estando a maior parte das vezes relacionadas com possíveis traumatismos. Neste estudo a conjuntivite foi a doença mais frequentemente diagnosticada. Tendo em mente a preocupação crescente atual com a problemática dos gatos errantes, pretende-se consciencializar os cuidadores de colónias e os responsáveis pelos abrigos e programas CED (Captura, Esterilização e Devolução) para a importância dum rastreio oftalmológico e para as lesões oculares mais frequentes neste contexto, bem como para as possíveis implicações para a visão e modo de vida destes animais.ABSTRACT - OBSERVATIONAL STUDY OF EYE INJURIES IN STRAY CATS IN THE LISBON REGION – FOLLOWING 40 CASES - Stray cats (Felis silvestris catus) that preferentially live in urban areas, are more exposed to the dangers of public roads and are more likely to present risky behaviours that may lead to injuries, particularly at ocular level. This observational study aimed to contribute to the characterization of the type of ocular injuries present in stray cats, to investigate the possibility of a possilbe relationship with their way of life and their implications in the animal's vision. In this study, 40 animals from colonies of stray cats examined in three shelters from the Lisbon region were included, as well as stray cats that presented to consultation at the Veterinary Hospital Arco do Cego. All cats underwent an ophthalmological examination and information related to variables such as age, gender, reproductive status, vaccination status and screening for FIV and FeLV, was collected. The majority of the animals (50%; 22/40) revealed ocular changes. Most ocular injuries occurred in males (69%; 9/13), and there was also a higher prevalence of alterations in intact cats (80%; 4/5). Regarding the affected age groups, adults and seniors ( 3 years old) presented the highest percentage of ophthalmic injuries (67%; 12/18). From the total of stray cats exhibiting ocular injuries, 54.5% (12/22) of the animals had conjunctivitis, followed by corneal ulcers in 18% (4/22) of the cats, diffuse iris melanosis in 13.6% (3/22), eyeball loss in 13.6% (3/22), entropion in 9% (2/22) and strabismus in 4.5% (1/22) of the cases. From the total of cats with ocular injuries, 82% (18/22) were possibly associated with trauma. Most of the cats that presented ocular symptoms were FIV positive (67%; 6/9) and FeLV negative (55%; 21/38). Stray cats included in this study presented a high incidence of ophtalmic injuries, possibly related to trauma. In this study, conjunctivitis was the most frequently diagnosed disease. Bearing in mind the current general public awareness with the stray cats’ problematic, we aim to raise awareness of colony caregivers and those responsible for shelters and TNR programs (Trap-Neuter-Return) for the importance of eye screening and for the most frequent ocular injuries in this context, as well as for the possible implications for the vision and way of living of these animals.N/

Satisfação e lealdade em função do perfil de cliente bancário (segmento empresa) na região do Algarve

O aumento da competitividade entre os Bancos, aliado a uma maior exigência por parte dos clientes, fruto da crescente globalização dos mercados e dos novos avanços tecnológicos, leva a que seja cada vez mais difícil agradar os clientes, sejam eles particulares ou empresas. As empresas são, cada vez mais, um segmento no qual os Bancos querem estar presentes, não apenas por se tratarem do pilar da economia, como por se afigurarem como um segmento rentável. Justifica-se, assim, realizar um estudo que permita compreender quais os fatores inerentes à satisfação e lealdade de clientes bancários, particularmente os clientes empresa. O presente estudo, de natureza exploratória, visa estudar o impacto da gestão da relação em clientes bancários do segmento empresa, através da análise da satisfação e da lealdade. A recolha de dados foi efetuada com um questionário aplicado a empresas da Região do Algarve, tendo posteriormente sido utilizado o programa Statistical Package for Social Sciences (SPSS), versão 25.0, no tratamento dos dados recolhidos, que possibilitou a realização de diversas análises estatísticas com vista a discutir objetivos específicos, definidos à priori, que permitiram ir de encontro ao objetivo geral do estudo. Através da aplicação dos métodos Nonlinear Canonical Correlation Analysis (OVERALS), clusters hierárquicos e CHi-squared Automatic Interaction Detection (CHAID), confirmou-se que uma gestão eficiente da imagem do banco, das expetativas dos clientes e da qualidade dos produtos e serviços prestados, a par de gestão focada nas componentes relacionais, são fatores-chave para satisfação e lealdade de clientes bancários empresas. Esta investigação assume particular relevância, na medida em que poderá representar um contributo à implementação e/ou aperfeiçoamento de estratégias de gestão que visem melhorar a imagem do banco e a relação comercial entre as empresas e o banco, permitindo aos bancos uma diferenciação competitiva que lhes permita permanecer e singrar no mercado competitivo em que atuam.The progressive increase in the competitiveness of the banks, allied with a greater demand from customers that results of the growing globalization of markets and new technological advances, makes satisfying customers, both individuals and companies, increasingly difficult. Companies a important target sector for banks, not only because they are the pillar of the economy, but also because they represent a profitable segment. Thus, is justified to study the factors that contribute to the satisfaction and loyalty of bank customers, especially businesses. The present study, exploratory in nature, aims to study the impact of the relationship management on bank enterprise clients, through the analysis of both satisfaction and loyalty factors. The data collection was performed with a questionnaire applied to companies from the Algarve Region, followed by several statistical analyses (using SPSS 25 package) that allowed permitted understanding and discussing specific objectives, defined a priori. Through the application of Canonical Correlation Analysis (OVERALS), hierarchical clusters and CHI-squared Automatic Interaction Detection (CHAID) methods, it was confirmed that the efficient management of the bank image, customer expectations and the quality of products and services provided, coupled with a bank management team focused on the relational components, are key factors for satisfaction and loyalty of bank business customers. This research has particular relevance because it can contribute to the implementation and/or improvement of management strategies aimed at improving the bank's image and the commercial relationship between the companies and the bank, allowing banks to gain competitive differentiation, that allows them to compete in their extremely competitive market

Caracterização (farmaco) epidemiológica da diabetes tipo 2 em Portugal

Tese de doutoramento, Farmácia (Farmacoepidemiologia), Universidade de Lisboa, Faculdade de Farmácia, 2012A prevalência de diabetes tipo 2 diagnosticada em Portugal é de 6.6%, tendo-se vindo a registar um aumento da despesa em saúde com a pessoa com diabetes. Sendo a gestão da diabetes, complexa e multifactorial, urge melhorar o conhecimento da situação nacional no que concerne à abordagem da pessoa com diabetes, com vista a minimizar recursos e maximizar resultados. Este trabalho teve por objectivo caracterizar a dimensão (farmaco) epidemiológica da diabetes tipo 2, em Portugal, através de: I. Caracterização do consumo de antidiabéticos na última década, por análise de base de dados de consumo nacional e de estudos de utilização de medicamentos (2003/04 (n=1090) e 2008/09 (n=806)). Destaca-se a diminuição de consumo de sulfonilureias (SUs) e aumento de biguanidas, em linha com as guidelines. Mais de metade dos doentes estavam tratados com politerapia de ADOs. II. Caracterização da percepção da prestação de cuidados de saúde, ao diabético tipo 2 (2003/04 vs. 2008/09), avaliando-se: variáveis clínicas, educação para controlo da doença, auto-vigilância, posse do ‘Guia da Pessoa com Diabetes’, avaliação da realização de exame aos olhos, exame aos pés e vacinação antigripal. Verificou-se que mais de 2/3 dos doentes faziam auto-vigilância, cerca de 1/3 não tinham efectuado exame aos olhos no ano anterior e aproximadamente 70% não tinha feito exame aos pés. Só cerca de 50% receberam vacina antigripal. III. Diferentes abordagens metodológicas para estimar a prevalência de DM2, diagnosticada e não disgnosticada. (1) Estimativa indirecta da prevalência de diabetes tipo 2, com base no consumo de ADOs (2000 a 2009), corrigindo para politerapia e não adesão à terapêutica. Em 2009, a prevalência estimou-se entre 5.06-7.05%, o que sugere que esta técnica pode vir a ser usada como estratégia de monitorização da prevalência. (2) Identificação de escalas para detecção de pessoas com diabetes tipo 2 não diagnosticada. A estratégia de busca recuperou 136 resumos que conduziram à inclusão de dez artigos na revisão sistemática de literatura efectuada.The prevalence of type 2 Diabetes in Portugal is 6.6% and we are witnessing a rise of health expenditures with diabetic patients. Diabetic patients’ management is complex and multifaceted. It is urgent to increase our knowledge about the current situation of care delivery to the the diabetic patient in Portugal, in order to minimize costs and obtain maximal beneficts in health outcomes. Utilizing different methods and distinct methodological approaches, our goal was to improve the knowledge of the (pharmaco)epidemiology of type 2 diabetes in Portugal. This report is divided into three main chapters as follows: I. The analysis of the consumption of hypoglycemic agents over the last decade, by means of drug consumption data base analysis and field drug use studies. The main findings were a decrease in the consumption of sulphonylureas alongside a rise of biguanides, in accordance with guidelines. More than half of the patients were treated with 2 or more oral hypoglycaemic agents (OHAs). II. The self-reported provision of health care to patients with type 2 diabetes including information concerning: disease-related variables, education for disease control, selfmonitoring of blood glucose, having the “Guide for the Person with Diabetes”, assessment of diabetic retinopathy examination, foot examination, and flu vaccination. It has been found that 68.3% patients performed SMBG. Circa 50% respondents reported having had flu vaccination. One third reported not having had an eye examination and 70% did not have a feet examination. III. We performed an indirect estimate of type 2 diabetes based on OHAs consumption correcting for the proportion of polytherapy and non-adherence, obtaining a value similar to the one reported in the literature, which suggests that this approach could be used to monitor diabetes prevalence. We also performed a systematic review of the literature to collect risk scores to identify patients with undiagnosed type 2 diabetes. The search strategy retrieved 136 abstracts which led to the inclusion of ten articles

Limitations and perceived delays for diagnosis and staging of lung cancer in Portugal: A nationwide survey analysis

Background: We aimed to identify the perception of physicians on the limitations and delays for diagnosing, staging and treatment of lung cancer in Portugal. Methods: Portuguese physicians were invited to participate an electronic survey (Feb-Apr-2020). Descriptive statistical analyses were performed, with categorical variables reported as absolute and relative frequencies, and continuous variables with non-normal distribution as median and interquartile range (IQR). The association between categorical variables was assessed through Pearson's chi-square test. Mann-Whitney test was used to compare categorical and continuous variables (Stata v.15.0). Results: Sixty-one physicians participated in the study (45 pulmonologists, 16 oncologists), with n = 26 exclusively assisting lung cancer patients. Most experts work in public hospitals (90.16%) in Lisbon (36.07%). During the last semester of 2019, responders performed a median of 85 (IQR 55-140) diagnoses of lung cancer. Factors preventing faster referral to the specialty included poor articulation between services (60.0%) and patients low economic/cultural level (44.26%). Obtaining National Drugs Authority authorization was one of the main reasons (75.41%) for delaying the begin of treatment. The cumulative lag-time from patients' admission until treatment ranged from 42-61 days. Experts believe that the time to diagnosis could be optimized in around 11.05 days [IQR 9.61-12.50]. Most physicians (88.52%) started treatment before biomarkers results motivated by performance status deterioration (65.57%) or high tumor burden (52.46%). Clinicians exclusively assisting lung cancer cases reported fewer delays for obtaining authorization for biomarkers analysis (p = 0.023). Higher waiting times for surgery (p = 0.001), radiotherapy (p = 0.004), immunotherapy (p = 0.003) were reported by professionals from public hospitals. Conclusions: Physicians believe that is possible to reduce delays in all stages of lung cancer diagnosis with further efforts from multidisciplinary teams and hospital administration.his work was supported by AstraZeneca. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscripinfo:eu-repo/semantics/publishedVersio

The initial journey of patients with metastatic pancreatic cancer (PaCTO project): a nationwide survey among Portuguese specialist physicians

This work was supported by AstraZeneca. The funders had no role in study design, data collection, and analysis nor in the preparation of the manuscript.ABSTRACT - Introduction: We aimed to characterize the initial healthcare journey of metastatic pancreatic ductal adenocarcinoma (mPDAC) patients in Portugal, including healthcare provision and factors affecting therapeutic decisions, namely BRCA mutation testing. Methods: This is a descriptive cross-sectional, web-based survey using a convenience sampling approach. Portuguese oncologists and pathologists who routinely work with mPDAC patients from different geographical regions and settings were invited to participate in the study via email (December 2020). Descriptive statistical analyses were performed, with categorical variables reported as absolute and relative frequencies, and continuous variables with non-normal distribution as median and interquartile range (IQR) (Stata v.15.0). Results: Seventy physicians participated in the study (43 oncologists, 27 pathologists). According to the responses, a median of 28 patients per center (IQR 12–70) was diagnosed with PDAC in the previous year; 22 of them were referred (IQR 8–70) to mPDAC. The pointed median time from patients’ first hospital admission until disease diagnosis/staging is between 2 and 4 weeks. Endoscopic ultrasound with fine-needle biopsy is available in most hospitals (86%). Around 50% of physicians request BRCA testing; the assessment of additional biomarkers besides BRCA is requested by 40% of professionals. Half of them stated that BRCA testing should be requested earlier–upon histological diagnosis, especially because the median time for results is of 4.0 weeks (IQR 4–8). PARP inhibitors such as olaparib, when available, would be the therapy of choice for most oncologists (71%) if no disease progression occurs after 4 months. Treatment selection is usually grounded on clinical criteria (e.g., performance status, liver function). Around 45% of patients use FOLFIRINOX/mFOLFIRINOX as the first-line therapy. Gemcitabine + nab-paclitaxel is used by 35% of patients as the second-line therapy. Conclusions: Physicians in Portugal support the increasing role of patient-tailored treatments in mPDAC, whose selection should be grounded on tumoral subtyping and molecular profiling. Further efforts to develop multidisciplinary teams, standardize clinical practice, and optimize the implementation of new target therapies are needed.RESUMO - Introdução: Este estudo teve como objetivo caracterizar o percurso inicial dos doentes com adenocarcinoma ductal pancreático metastático (ACDPm) em Portugal, incluindo a prestação de cuidados de saúde e determinação de fatores que afetam as decisões terapêuticas, nomeadamente o teste de mutações BRCA.Métodos: Trata-se de um estudo descritivo transversal (web-based) usando uma abordagem de amostragem por conveniência. Médicos oncologistas e anatomopatologistas portugueses dedicados ao ACDPm e de diferentes regiões geográficas e instituições foram convidados a participar do estudo por email (Dez-2020). Foram realizadas análises estatísticas descritivas, com variáveis categóricas relatadas como frequências absolutas e relativas, e variáveis contínuas com distribuição não-normal como mediana e intervalo interquartil (IIQ) (Stata v.15.0).Resultados: Setenta médicos participaram do estudo (43 oncologistas, 27 patologistas). De acordo com as respostas, uma mediana de 28 doentes por centro (IIQ 12–70) foi diagnosticada com ACDP no ano anterior; 22 deles (IIQ 8–70) referentes a ACDPm. O tempo médio desde a primeira admissão hospitalar dos doentes até o diagnóstico/estadiamento da doença foi entre 2–4 semanas. A ultrassonografia endoscópica com biópsia por agulha fina é realizada pela maioria dos hospitais (86%). Aproximadamente 50% dos médicos referem solicitar o teste BRCA; a avaliação de biomarcadores adicionais além do BRCA é solicitada por 40% dos profissionais. Metade dos médicos assume que o teste BRCA deveria ser solicitado mais precocemente – durante o diagnóstico histológico, principalmente porque o tempo médio para obtenção do resultado é de 4,0 semanas (IIQ 4–8). Os inibidores PARP, como o olaparibe, quando disponíveis, seriam a terapia de escolha para a maioria dos oncologistas (71%) caso não haja progressão da doença após quatro meses. A seleção dos tratamentos é usualmente baseada em critérios clínicos (por exemplo, performance status, função hepática). Em cerca de 45% dos doentes é utilizado FOLFIRINOX/mFOLFIRINOX como terapia de primeira linha. Um esquema com Gemcitabina + nab-paclitaxel é usado em 35% dos doentes como terapia de segunda linha.Conclusões: Os médicos em Portugal apoiam o papel crescente do tratamento individualizado no ACDPm, cuja seleção deve ser baseada na subtipagem tumoral e no perfil molecular. São necessários mais esforços para capacitar as equipas multidisciplinares, desenvolver práticas clínicas padronizadas e otimizar a implementação de novas terapias-alvo.info:eu-repo/semantics/publishedVersio

a nationwide Portuguese consensus

Introduction and objectives: We aimed to build a national consensus to optimize the use of oral corticosteroids (OCS) in severe asthma in Portugal. Material and methods: A modified 3-round Delphi including 65 statements (topics on chronic systemic corticotherapy, therapeutic schemes, asthma safety and monitoring) was performed via online platform (October-November 2019). A five-point Likert-type scale was used (1-‘strongly disagree’; 5-‘strongly agree’). Consensus threshold was established as a percentage of agreement among participants ≥90% in the 1st round and ≥85% in the 2nd and 3rd rounds. The level of consensus achieved by the panel was discussed with the participants (face-to-face meeting). Results: Forty-eight expert physicians in severe asthma (specialists in allergology and pulmonology) participated in the study. Almost half of the statements (28/65; 43.1%) obtained positive consensus by the end of round one. By the end of the exercise, 12 (18.5%) statements did not achieve consensus. Overall, 87% of physicians agree that further actions for OCS cumulative risk assessment in acute asthma exacerbations are needed. The vast majority (91.7%) demonstrated a favorable perception for using biological agents whenever patients are eligible. Most participants (95.8%) are more willing to accept some degree of lung function deterioration compared to other outcomes (worsening of symptoms, quality of life) when reducing OCS dose. Monitoring patients’ comorbidities was rated as imperative by all experts. Conclusions: : These results can guide an update on asthma management in Portugal and should be supplemented by studies on therapy access, patients’ adherence, and costs.publishersversionpublishe

Correction: The meaning of lymphadenopathies during adjuvant durvalumab after chemoradiotherapy for lung cancer: thinking beyond disease progression

This article has been corrected at the request of the authors to include Virginia Sousa as the fourth author as she was erroneously omitted during the submission process. The authors deeply regret that this error was not identified and addressed prior to publication.info:eu-repo/semantics/publishedVersio

COMPRIME - COnhecer Mais PaRa Intervir MElhor: Preliminary Mapping of Municipal Level Determinants of COVID-19 Transmission in Portugal at Different Moments of the 1st Epidemic Wave

The role of demographic and socio-economic determinants of COVID-19 transmission is still unclear and is expected to vary in different contexts and epidemic periods. Exploring such determinants may generate a hypothesis about transmission and aid the definition of prevention strategies. Objectives: To identify municipality-level demographic and socio-economic determinants of COVID-19 in Portugal. Methods: We assessed determinants of COVID-19 daily cases at 4 moments of the first COVID-19 epidemic wave in Portugal, related with lockdown and post-lockdown measures. We selected 60 potential determinants from 5 dimensions: population and settlement, disease, economy, social context, and mobility. We conducted a multiple linear regression (MLR) stepwise analysis (p < 0.05) and an artificial neural network (ANN) analysis with the variables to identify predictors of the number of daily cases. Results: For MLR, some of the identified variables were: resident population and population density, exports, overnight stays in touristic facilities, the location quotient of employment in accommodation, catering and similar activities, education, restaurants and lodging, some industries and building construction, the share of the population working outside the municipality, the net migration rate, income, and renting. In ANN, some of the identified variables were: population density and resident population, urbanization, students in higher education, income, exports, social housing buildings, production services employment, and the share of the population working outside the municipality of residence. Conclusions: Several factors were identified as possible determinants of COVID- 19 transmission at the municipality level. Despite limitations to the study, we believe that this information should be considered to promote communication and prevention approaches. Further research should be conducted.info:eu-repo/semantics/publishedVersio

Comparison with adult-onset rheumatic diseases

Objective To compare physical disability, mental health, fatigue and health-related quality of life (HRQoL) across juvenile idiopathic arthritis (JIA) categories in adulthood and between JIA and adult-onset rheumatic diseases. Methods Cross-sectional analysis nested in a cohort of adult patients with JIA registered in the Rheumatic Diseases Portuguese Register (Reuma.pt). Physical disability (Health Assessment Questionnaire - Disability Index), mental health symptoms (Hospital Anxiety and Depression Scale), fatigue (Functional Assessment of Chronic Illness Therapy - Fatigue Scale (FACIT-F)) and HRQoL (EuroQol-5D (EQ5D) and Short Form (SF-36)) were compared across JIA categories. Patients with polyarticular JIA and enthesis-related arthritis (ERA) JIA were compared respectively to patients with rheumatoid arthritis (RA) and spondyloarthritis (SpA), matched for gender and age, adjusted for disease duration and activity. Results 585 adult patients with JIA were included. Comparison across JIA categories showed that persistent oligoarthritis and patients with ERA reported a higher score in EQ5D and SF-36 physical component when compared with other JIA categories. Polyarticular JIA reported less disability and fatigue than patients with RA (median Health Assessment Questionnaire of 0.25 vs 0.63; p<0.001 and median FACIT-F score 42 vs 40; p=0.041). Polyarticular JIA had also better scores on EQ5D and all domains of SF-36, than patients with RA. Patients with ERA reported less depression and anxiety symptoms (0% vs 14.8%; p=0.003% and 9% vs 21.3%; p=0.002) and less fatigue symptoms (45 vs 41; p=0.01) than patients with SpA. Conclusion Persistent oligoarticular JIA and ERA are the JIA categories in adulthood with better HRQoL. Overall, adult polyarticular and patients with ERA JIA have lower functional impairment and better quality-of-life than patients with RA and SpA.publishersversionpublishe

Relatório de Primavera 2022

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