Trends of case-fatality rate by acute coronary syndrome in Portugal : impact of a fast track to the coronary unit

© The Author(s) 2019. Creative Commons Non Commercial CC BY-NC: This article is distributed under the terms of the Creative Commons AttributionNonCommercial 4.0 License (http://www.creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).Introduction: Efforts were made to improve management of coronary disease as the fast-track system to the Coronary Unit. We aim to analyse case-fatality rates by acute coronary syndrome in Portugal from 2000 to 2016, mainly the impact of the fast-track system and the proportion of patients that activate the fast-track system. Methods: We analysed monthly acute coronary syndrome case-fatality before and after the implementation of the fasttrack system in 2007. Impact of the system was assessed through regression models for interrupted time-series. We calculated annual proportion of fast-track system admissions. Results: After 2007 case-fatality by acute coronary syndrome decreased (b¼1.27, p-value < 0.01). The estimates obtained for ST Elevation Myocardial Infarction suggest a reduction of nearly 86 monthly deaths prevented after 2007. The highest percentage of patients admitted through the fast-track system was 35%. Conclusions: Our results suggest fast-track system may have contributed to a decline in acute coronary syndrome case-fatality. However, more than half of patients were not admitted through the system. This should encourage health authorities to make efforts to ensure compliance.info:eu-repo/semantics/publishedVersio

APOE genotypes and dyslipidemias in a sample of the Portuguese population

The objective of this work was to study the distribution of apolipoprotein E (APOE) genotypes in a sample of the Portuguese population, and its association with the dyslipidemias observed. Study participants were healthy users of local Public Health Laboratories in six regions of mainland Portugal (Porto, Vila Real, Viseu, Lisboa, Portalegre and Faro). A total of 779 men and 1153 women aged 15-74 years agreed to participate. Fasting lipid levels and APOE genotypes were determined centrally at the National Institute of Health in Lisboa. The frequency distribution of APOE alleles was: epsilon2=5.3%, epsilon3=84.9% and epsilon4=9.8%. Dyslipidemias were present in 66.6% of men and 60.7% of women. Comparison of APOE genotypes and relative allele frequencies showed that in dyslipidemic compared to normolipidemic subjects, the epsilon4 allele was more frequent in both sexes, although in a more pronounced way in men than in women due to higher frequencies of epsilon3/epsilon4 and epsilon4/epsilon4 genotypes. The known association of the epsilon4 allele with high cholesterol levels, the association of the epsilon2 allele with low cholesterol levels, and the association of the epsilon2 allele with high levels of triglycerides and low levels of high-density lipoprotein-cholesterol were confirmed in this study

Familial haemophagocytic lymphohistiocytosis: two case reports

Haemophagocytic lymphohistiocytosis (HLH) is a life threatening inflammatory syndrome, which presents a highly stimulated but ineffective immune response with severe hypercytokinaemia. HLH, primary or secondary, is characterised by prolonged fever and hepatosplenomegaly associated with pancytopenia, hypertriglyceridaemia and hypofibrinogenaemia. However, the hallmark of HLH is impaired or absent function of natural killer cells and cytotoxic T lymphocytes. HLH presents major diagnostic difficulties, since it may have an incomplete and/or late onset and with many conditions leading to the same clinical picture. When untreated, it is fatal in all primary cases and in a high percentage of acquired cases. Awareness of the clinical picture and diagnostic criteria is thus important to start life saving treatment. We describe two cases of primary HLH, with significant differences in their clinical presentation and evolution

A Bacia do Algarve: estratigrafia, paleogeografia e tectónica

A “Bacia do Algarve” corresponde, segundo a literatura científica tradicional, aos terrenos mesocenozóicos que orlam o Sul de Portugal, desde o Cabo de São Vicente ao rio Guadiana (~140km), penetrando irregularmente para o interior entre 3 km a 25 km, sobre terrenos de idade carbónica da Zona Sul Portuguesa. O hiato, de aproximadamente 70 milhões de anos, materializado pela discordância angular entre as rochas sedimentares de tipo flysch do Carbónico, metamorfizadas e deformadas durante a orogenia varisca, e as rochas sedimentares continentais do Triásico inferior provável, separa dois ciclos de Wilson. Os sedimentos carbónicos metamorfizados resultam do empilhamento orogénico de um possível prisma de acrecção associado à orogenia varisca e ao fecho de um oceano paleozóico e formação da Pangeia, enquanto que os sedimentos continentais triásicos resultam do fim do colapso e do arrasamento do orógeno varisco e início do estiramento continental que viriam a culminar com a separação das placas litosféricas África, Eurásia e América.Os sedimentos mais recentes do Mesozóico e os mais antigos bem datados do Cenozóico encontram-se separados por um outro hiato que ultrapassa ligeiramente os 70 milhões de anos na área emersa. Este hiato resulta duma alteração tectónica radical no contexto onde nessa época geológica se inseria a Bacia do Algarve. Esta mudança, que ocorreu no fim do Cenomaniano, resultou da rotação do vector de deslocamento da trajectória de África em relação à Eurásia, de aproximadamente NW-SE para SW-NE (segundo as coordenadas actuais, e.g. Dewey et al, 1989), poria termo ao regime distensivo e de bacia de tipo rifte na Bacia do Algarve, com o fim do regime transtensivo entre a região noroeste da placa África e sudoeste da placa Eurásia e início da colisão

Análise temporal de correlação dos atributos carbono e nitrogênio em quatro profundidades no solo do Semiárido.

Objetivou-se avaliar os impactos dos sistemas de cultivos de milho e pastagem, correlacionando-os entre as variáveis de carbono e nitrogênio nos anos de 2012 e 2016, em quatro profundidades diferentes

Hypertension prevalence in Portugal: results from the first Portuguese Health Examination Survey 2015

O estudo teve como objetivo estimar a distribuição da prevalência de hipertensão, seu conhecimento (awareness), tratamento e controlo na população portuguesa em 2015. Realizou-se um inquérito nacional com uma amostra representativa de 4911 indivíduos, com idade compreendida entre 25 e 74 anos e residentes em Portugal há mais de 12 meses. O inquérito foi realizado por profissionais de saúde com treino específico nos procedimentos do estudo e compreendeu a realização de uma entrevista, exame físico e colheita de sangue. A medição da tensão arterial (no braço direito, três medições, com um minuto de intervalo) e as definições adotadas foram efetuadas de acordo com os procedimentos do European Health Examination Survey. A prevalência de hipertensão arterial, seu conhecimento, tratamento e controlo foi estratificada por sexo, grupo etário e região de saúde. Estimou-se uma prevalência de hipertensão arterial de 36,0% (IC95%:34,3-37,7), tendo sido observados valores mais elevados no sexo masculino [39,6%; (IC95%:36,5- 42,8)] e no grupo etários dos 65 aos 74 anos [71,3%; (IC95%:65,7-76,4)]. Entre os indivíduos hipertensos, 69,8% (IC95%: 64,8-74,3) referiu ter conhecimento da sua condição de saúde, 69,4% (IC95%:65,2-73,3) estava sob tratamento e destes, 71,3% (IC95%:67,6-74,7) tinha valores normais de tensão arterial. Quando comparados com estudos anteriores realizados em Portugal, (PAP, 2003; PHYSA, 2011-2012), estes resultados sugerem uma redução na prevalência de hipertensão arterial e um melhor controlo dos valores tensionais dos indivíduos com hipertensão arterial. No entanto, foram encontradas diferenças na prevalência da hipertensão arterial entre grupos específicos da população.The aim of this study was to estimate the distribution of prevalence, awareness, treatment and control of hyper tension in the Portuguese population in 2015. A National survey using a representative sample of 4911 individuals, living in Portugal for more than 12 months and aged between 25 and 74 years old, was implemented. Trained nurses per formed a health inter view and a physical examination, which comprised blood pressure measurement (right arm, 3 measurements, 1- minute intervals). Parameters’ estimates were defined according to the European Health Examination Survey procedures. Prevalence of hyper tension, awareness, treatment and control were stratified by sex, age group and health region. The overall hyper tension prevalence was 36.0% (IC95%:34.3-37.7). Highest values were observed in males [39.6%; (IC95%:36.5-42.8)] and in individuals aged between 65 and 74 years old [71.3%; (IC95%:65.7-76.4)]. Among the hyper tensive individuals, 69.8% (IC95%:64.8-74.3) were aware of their condition, 69.4% (IC95%:65.2-73.3) were under treatment and of these, 71.3% (IC95%:67.6-74.7) were controlled. Results suggest a reduction in hyper tension prevalence and a more effective control, when comparing to similar previous studies per formed in Portugal (PAP, 2003; PHYSA, 2011-2012). However, important differences in hyper tension prevalence were found between specific population groups.info:eu-repo/semantics/publishedVersio

Compilation of parameterized seismogenic sources in Iberia for the SHARE European-scale seismic source model.

Abstract: SHARE (Seismic Hazard Harmonization in Europe) is an EC-funded project (FP7) that aims to evaluate European seismic hazards using an integrated, standardized approach. In the context of SHARE, we are compiling a fully-parameterized active fault database for Iberia and the nearby offshore region. The principal goal of this initiative is for fault sources in the Iberian region to be represented in SHARE and incorporated into the source model that will be used to produce seismic hazard maps at the European scale. The SHARE project relies heavily on input from many regional experts throughout the Euro-Mediterranean region. At the SHARE regional meeting for Iberia, the 2010 Working Group on Iberian Seismogenic Sources (WGISS) was established; these researchers are contributing to this large effort by providing their data to the Iberian regional integrators in a standardized format. The development of the SHARE Iberian active fault database is occurring in parallel with IBERFAULT, another ongoing effort to compile a database of active faults in the Iberian region. The SHARE Iberian active fault database synthesizes a wide range of geological and geophysical observations on active seismogenic sources, and incorporates existing compilations (e.g., Cabral, 1995; Silva et al., 2008), original data contributed directly from researchers, data compiled from the literature, parameters estimated using empirical and analytical relationships, and, where necessary, parameters derived using expert judgment. The Iberian seismogenic source model derived for SHARE will be the first regional-scale source model for Iberia that includes fault data and follows an internationally standardized approach (Basili et al., 2008; 2009). This model can be used in both seismic hazard and risk analyses and will be appropriate for use in Iberian- and European-scale assessments

Surveillance of multiple congenital anomalies; searching for new associations

\ua9 2023, The Author(s).Many human teratogens are associated with a spectrum of congenital anomalies rather than a single defect, and therefore the identification of congenital anomalies occurring together more frequently than expected may improve the detection of teratogens. Thirty-two EUROCAT congenital anomaly registries covering 6,599,765 births provided 123,566 cases with one or more major congenital anomalies (excluding chromosomal and genetic syndromes) for the birth years 2008–2016. The EUROCAT multiple congenital anomaly algorithm identified 8804 cases with two or more major congenital anomalies in different organ systems, that were not recognized as part of a syndrome or sequence. For each pair of anomalies, the odds of a case having both anomalies relative to having only one anomaly was calculated and the p value was estimated using a two-sided Fisher’s exact test. The Benjamini–Hochberg procedure adjusted p values to control the false discovery rate and pairs of anomalies with adjusted p values &lt; 0.05 were identified. A total of 1386 combinations of two anomalies were analyzed. Out of the 31 statistically significant positive associations identified, 20 were found to be known associations or sequences already described in the literature and 11 were considered “potential new associations” by the EUROCAT Coding and Classification Committee. After a review of the literature and a detailed examination of the individual cases with the anomaly pairs, six pairs remained classified as new associations. In summary, systematically searching for congenital anomalies occurring together more frequently than expected using the EUROCAT database is worthwhile and has identified six new associations that merit further investigation