Hepatitis A in Portugal: epidemiological overview of incidence in the last decade

Hepatitis A is an acute liver disease with fecal-oral transmission caused by a hepatotrophic picornavírus - Hepatitis A Virus (HAV). Food contamination with HAV can occur at any time: cultivation, harvesting, processing, handling, and even after cooking. Food and water contamination takes place more frequently in developing countries where the disease is common but can also occur in developed countries. Although uncommon, foodborne outbreaks have also occurred due to people consuming contaminated fresh and frozen imported food products. Therefore, monitoring the disease is an essential tool for the early implementation of preventive measures, applying the One Health approach to both the human and environmental dimensions to mitigate the impact that an outbreak may have on the population. Aim of the study: To characterize the evolution of the incidence of Hepatitis A cases in Portugal between the years 2012 and 2022.info:eu-repo/semantics/publishedVersio

Hepatitis A in Portugal – epidemiological overview of incidence in the last decade

Background. Hepatitis A is an acute liver disease with faecal-oral transmission caused by a hepatotrophic picornavírus - Hepatitis A Virus (HAV). Food contamination with HAV can occur at any time: cultivation, harvesting, processing, handling and even after cooking.1,2 Food and water contamination happens more frequently in developing countries where the disease is common but can also happen in developed countries. Although uncommon, foodborne outbreaks have occurred due to people consuming contaminated fresh and frozen imported food products. Therefore, monitoring the disease is an essential tool for the early implementation of preventive measures, applying the One Health approach to both the human and environmental dimensions to mitigate the impact that an outbreak may have on the population.3 Methods. Retrospective observational study, which analyses the incidence of reported cases of Hepatitis A in Portugal between 2012 and 2022. Data presented were collected from the Directorate-General for Health (DGS) and the European Center for Disease Prevention and Control (ECDC). Descriptive statistics were performed using Microsoft Excel® software. Results. Portugal had 806 cases of Hepatitis A between 2012 and 2022, the majority of which were male (n=597, 74.1%), aged between 25 and 44 years (n=397; 49.3%). Between 2012 and 2016, there was a gradual increase in incidence, from 0.1 in 2012 to 0.5 per 100 000 population in 2016. In 2017, there was a peak in incidence (4.7 per 100 000 population), corresponding to an outbreak of Hepatitis A that year. After 2017, the incidence gradually decreased. However, it never reached values lower than those of 2012, even during the years of the COVID-19 pandemic. During the study period, the incidence in men and women was similar, except between 2016 and 2019, where the incidence in men was higher. In terms of age, the incidence of Hepatitis A by age group showed high heterogeneity over the years, without a predominance. Conclusions. In Portugal, the incidence, except for 2017, was relatively low. However, most diagnoses occur in adults when the disease can present greater severity, with consequences in terms of morbidity and mortality. The decrease in incidence is a good indicator of improved hygiene and sanitary conditions, but it increases the possibility of outbreaks since the population tends to see its natural immunity against the disease reduced. It is essential to monitor the incidence of the disease in the population of Portugal to develop timely public health strategies to control potential outbreaks of Hepatitis A. Strategies to be implemented must take into account not only the human dimension in terms of prevention with vaccination, diagnosis and treatment of the disease but also measures in the environmental dimension, since transmission of the disease occurs via the faecal-oral route, it is essential to implement legislation and measures that promote food and water safety and alert the population to risk behaviours. References. 1Hofmeister MG, Foster MA, Teshale EH. Epidemiology and Transmission of Hepatitis A Virus and Hepatitis E Virus Infections in the United States. 2019. 2Castaneda D, Gonzalez AJ, Alomari M, et al. From hepatitis A to E: A critical review of viral hepatitis. World J Gastroenterol 2021; 27: 1691–1715. 3Jefferies M, Rauff B, Rashid H, et al. Update on global epidemiology of viral hepatitis and preventive strategies. Australia World J Clin Cases 2018; 6:589–599.N/

Hospitalizações por Hepatite A em Portugal – Análise da tendência entre 2013-2022

Introdução: A Hepatite A é uma doença infeciosa provocada pelo vírus da Hepatite A (VHA). A principal via de transmissão é fecal-oral, embora a transmissão sexual tenha vindo a desempenhar um papel mais preponderante na disseminação deste agente. Existe uma associação entre a incidência de Hepatite A com o acesso à água potável e indicadores socioeconómicos. Regiões globais de alta renda têm um reduzido número de novos casos de doença, no entanto a maioria dos diagnósticos é realizado em adultos, faixa etária em que a doença tende a apresentar maior gravidade, com consequências na morbilidade e mortalidade. A infeção por VHA pode ser assintomática, subclínica ou provocar insuficiência hepática aguda. O diagnóstico precoce da infeção é essencial, a hidratação adequada e controlo dos sintomas integram o processo terapêutico. É fundamental a prestação de cuidados intensivos, multidisciplinares para o reconhecimento de fatores de mau prognóstico, como complicações hepáticas ou extra-hepáticas. Objetivo: Caraterizar a tendência de hospitalizações por Hepatite A ocorridas em Portugal entre 2013 e 2022. Material e métodos: Estudo observacional retrospetivo, que analisou a tendência de hospitalizações por hepatite A identificadas na Base de Dados de Morbilidade Hospitalar (BDMH/ACSS), utilizando os códigos 070.0 e 070.1 (ICD-09) e B15 e B15.9 (ICD-10), entre 2013 e 2022. Estatística descritiva foi realizada através SPSS® ver.25 e a tendência das hospitalizações foi estimada através do Joinpoint Regression Program 5.0.2. Resultados: Entre 2013 e 2022, ocorreram 546 hospitalizações por Hepatite A com uma mediana de duração de 5 dias (0-133 dias). A maioria das hospitalizações corresponderam a indivíduos do sexo masculino (n=391; 71,6%), com idades entre 25 e 44 anos (n=231; 42.3%). Apenas 5.5% das hospitalizações envolverem crianças com idade 65 anos foram as únicas a apresentar uma tendência crescente estatisticamente significativa (+39.2, p=0.01; +46.8, p=0.004). Discussão e Conclusão: Em Portugal, o número de novos casos de doença reportados é baixo. A diminuição dos casos, apesar de ser um bom indicador da melhoria das condições higieno-sanitárias, aumenta a possibilidade da ocorrência de surtos pois a população tenderá a ver reduzida a sua imunidade natural contra a doença. A maioria dos diagnósticos ocorre em indivíduos de idade adulta, traduzindo-se no aumento da gravidade da doença e consequentemente no aumento das hospitalizações. Nas regiões urbanas, Lisboa e Porto, a disseminação da infeção foi associada maioritariamente a transmissão sexual. A monitorização da doença é fundamental para a implementação precoce de medidas de prevenção, de forma a mitigar danos que um surto possa ter na população e auxiliar no desenvolvimento de estratégias de saúde pública no controlo da Hepatite A.info:eu-repo/semantics/publishedVersio

Optical coherence tomography angiography in herpetic leucoma

Herpes simplex virus (HSV) keratitis remains a leading infectious cause of blindness worldwide. Although all forms of HSV keratitis are commonly recurrent, the risk is greatest in stromal keratitis, which is the most likely to result in corneal scarring, thinning, and neovascularization. Recent studies showed the ability of Optical Coherence Tomography Angiography (OCTA) to detect and study vascular abnormalities in the anterior segment, including abnormal corneal vessels. This study intends to investigate the potential of OCTA device to image and describe quantitatively the vascularization in eyes diagnosed with herpetic leucoma and to discuss and review the usefulness of this technique in this pathology. A Cross-sectional study was made, including 17 eyes of 15 patients with leucoma secondary to herpetic keratitis. All eyes underwent anterior segment Slit-Lamp photography (SLP), and OCTA with en-face, b-scans and c-scans imaging. The vessel density (VD) was analyzed in the inferior, nasal and temporal corneal margin in all patients, and in the central area, in eyes with central corneal neovascularization (CoNV). The measurements were calculated after binarization with ImageJ software, using OCTA scans with 6 × 6 mm in a depth of 800 μm. Patients included had a mean age 53.267 ± 21.542 (years ± SD). The mean total vessel area was 50.907% ± 3.435%. VD was higher in the nasal quadrant (51.156% ± 4.276%) but there were no significant differences between the three analyzed areas (p = 0.940). OCTA was able to identify abnormal vessels when SLP apparently showed no abnormal vessels; OCTA was able to distinguish between larger and smaller vessels even in central cornea; OCTA scans allowed the investigation of several corneal planes and the relation of them with clinical findings. OCTA can be useful in both qualitative and quantitative follow-up of patients and may become a non-invasive alternative to objectively monitor treatment response in eyes with corneal vascularization due to herpetic infection.info:eu-repo/semantics/publishedVersio

Redesenhar e requalificar o lugar informal - o Bairro na cidade : o bairro do Barruncho, Odivelas.

Dissertação para obtenção do grau de Mestre em Arquitetura, apresentada na Universidade de Lisboa - Faculdade de Arquitetura

Ensaio de hipóteses: perspectivas clássica e bayesiana

Mestrado em Matemática Aplicada à Economia e à Gestãoinfo:eu-repo/semantics/publishedVersio

Multi-level conceptual modeling:Theory, language and application

In many important subject domains, there are central real-world phenomena that span across multiple classification levels. In these subject domains, besides having the traditional type-level domain regularities (classes) that classify multiple concrete instances, we also have higher-order type-level regularities (metaclasses) that classify multiple instances that are themselves types. Multi-Level Modeling aims to address this technical challenge. Despite the advances in this area in the last decade, a number of requirements arising from representation needs in subject domains have not yet been addressed in current modeling approaches. In this paper, we address this issue by proposing an expressive multi-level conceptual modeling language (dubbed ML2). We follow a principled language engineering approach in the design of ML2, constructing its abstract syntax as to reflect a fully axiomatized theory for multi-level modeling (termed MLT*). We show that ML2 enables the expression of a number of multi-level modeling scenarios that cannot be currently expressed in the existing multi-level modeling languages. A textual syntax for ML2 is provided with an implementation in Xtext. We discuss how the formal theory influences the language in two aspects: (i) by providing rigorous justification for the language's syntactic rules, which follow MLT* theorems and (ii) by forming the basis for model simulation and verification. We show that the language can reveal problems in multi-level taxonomic structures, using Wikidata fragments to demonstrate the language's practical relevance.</p

Data-driven prescription patterns in patients under maintenance treatment for respiratory diseases from the Portuguese prescription database

We aimed to identify prescription patterns in respiratory patients using an unsupervised (data-driven) method, in a random sample of patients aged >14 years (n=8799), retrieved from the Portuguese Electronic Medical Prescription database. Respiratory patients were defined if >2 packs of maintenance treatment for respiratory diseases were prescribed in 2016. We analysed all the prescriptions (n=39810) for respiratory diseases and exacerbations by medication type. Two-step clustering was based on the presence of ICS, LABA, LTRA, LAMA, LABA, SABA, SAMA and on the speciality of prescriber.info:eu-repo/semantics/publishedVersio

Evidence of large-scale conceptual disarray in multi-level taxonomies in Wikidata

The distinction between types and individuals is key to most conceptual modeling techniques and knowledge representation languages. Despite that, there are a number of situations in which modelers navigate this distinction inadequately, leading to problematic models. We show evidence of a large number of representation mistakes associated with the failure to employ this distinction in the Wikidata knowledge graph, which can be identified with the incorrect use of instantiation, which is a relation between an instance and a type, and specialization (or subtyping), which is a relation between two types. The prevalence of the problems in Wikidata’s taxonomies suggests that methodological and computational tools are required to mitigate the issues identified, which occur in many settings when individuals, types, and their metatypes are included in the domain of interest. We conduct a conceptual analysis of entities involved in recurrent erroneous cases identified in this empirical data, and present a tool that supports users in identifying some of these mistakes