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Introdução: Quando os consumidores excessivos crónicos de álcool, particularmente os indivíduos com o diagnóstico de perturbação de uso de álcool, suspendem abruptamente o consumo de bebidas alcoólicas, pode surgir um quadro clínico denominado síndrome de abstinência alcoólica. Nestes casos, é necessário muitas vezes instituir tratamento farmacológico para aliviar os sintomas e prevenir as complicações da abstinência. O tratamento farmacológico da síndrome de abstinência alcoólica é utilizado em unidades especializadas no tratamento de perturbação de uso de álcool, mas também pode ser necessário em serviços médico-cirúrgicos, quando esta síndrome se manifesta em doentes com perturbação de uso de álcool internados por patologias orgânicas.Métodos: Revisão de guidelines disponíveis na literatura sobre tratamento da síndrome de abstinência alcoólica com o objetivo de determinar qual o tratamento farmacológico recomendado.Resultados: Foram analisadas as quatro guidelines sobre tratamento farmacológico da síndrome de abstinência alcoólica (National Institute for Health and Care Excellence, American Society of Addiction Medicine, World Federation of Societies of Biological Psychiatry e American Psychiatric Association), em relação às suas recomendações e evidência da eficácia dos fármacos para tratamento da síndrome de abstinência alcoólica. Esta análise foi ainda complementada pela consulta das guidelines de Maudsley.Discussão: As guidelines analisadas recomendam, como tratamento de primeira linha, o uso de benzodiazepinas. A associação de anticonvulsivantes, agonistas adrenérgicos alfa-2, betabloqueantes e antipsicóticos com benzodiazepinas está recomendada para controlo sintomático em quadros de privação mais exuberantes. É recomendado administrar tiamina para profilaxia da encefalopatia de Wernicke-Korsakoff a todos os doentes. Caso existam desequilíbrios hidroelectrolíticos, estes deverão ser corrigidos.Conclusão: É fundamental manter um nível elevado de suspeita para o eventual aparecimento da síndrome de abstinência alcoólica em todos os contextos clínicos. Nesses casos, importa saber intervir precocemente.

Our results support the deleterious role of SLC1A4 variants and highlight the need of considering this entity, regardless of ethnicity, in pediatric patients presenting with unexplained neurodevelopmental delay and progressive microcephaly, associated or not with spastic tetraplegia or early onset epileptic encephalopathy.

Giardia duodenalis is a cosmopolitan enteric protozoan that affects a wide range of vertebrates, including humans and dogs. Genetic characterisation reveals eight different assemblages, with A and B having been found mainly in humans and several other animals, and thus considered potentially zoonotic, while C and D are adapted to infect dogs. This study aimed to determine the prevalence of G. duodenalis, their distribution into assemblages, and risk factors associated with their infection of dogs from the metropolitan area of Lisbon. Giardia duodenalis cysts were microscopically identified in 33.8% (27/80) of the faecal samples analysed. Multivariate logistic regression analysis revealed that dogs under 6 months of age and from both breeders and shelters, had a significantly higher risk of being infected with G. duodenalis. Based on phylogenetic analysis of the partial coding sequences for β-giardin, glutamate dehydrogenase, and triosephosphate isomerase, the parasites found in three dog isolates were typed as G. duodenalis assemblage C, 11 were typed as D, and four were typed as C or D, depending on the targeted genes. The risk to public health seems to be reduced, as no genotypes with zoonotic potential have been detected. Nevertheless, better health management towards a minimisation of the environmental faecal pollution, as well as an increase in the awareness of health professionals, dog owners, dog breeders and caregivers regarding the risks posed by this protozoan to the health of animals and humans, are recommended. GRAPHIC ABSTRACT: [Image: see text] ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s12639-020-01307-4) contains supplementary material, which is available to authorized users.

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Objetivos: Pretendemos conhecer os fatores associados à não realização e as recomendações do médico de medicina geral e familiar (MGF) e do pediatra acerca destas vacinas. Tipo de estudo: observacional, transversal, descritivo. Local: USF da zona norte do País (Braga - USF de Ruães). População: Crianças com idades compreendidas entre os 2 e os 4 anos de idade; pediatras e MGF de Braga. Métodos: Consulta do processo clínico eletrónico da criança juntamente com um questionário realizado por via telefónica, respondido pelos pais ou encarregados de educação, no período de agosto de 2014 a janeiro de 2015. Para avaliação das recomendações dos médicos MGF e pediatra foi aplicado um questionário eletrónico, de resposta online, a médicos de pediatria e MGF. Os dados foram analisados com recurso ao programa Statistical Package for the Social Sciences (SPSS®, Chicago, IL, USA), versão 17.0 para Microsoft Windows®. Resultados: Amostra de 180 crianças, dos 2-4 anos de idade. A taxa de cobertura vacinal contra Streptococcus pneumoniae 13-valente foi de 81,7%. Não se encontrou relação estatisticamente significativa entre o desemprego e a não realização das vacinas extra-PNV. Verificamos uma maior vacinação contra Neisseria meningitidis do serogrupo B e contra o vírus da hepatite A (VHA) na ausência de insuficiência económica (p value de Fisher=0,008 e p=0,046, respetivamente). Verificou-se uma associação entre a realização da vacina contra o rotavírus e frequência de infantário (p=0,029). Observou-se também uma associação estatisticamente significativa entre as crianças cuja escolaridade do pai ou da mãe era licenciatura/bacharelato e a realização das vacinas contra o rotavírus e anti-VHA. O elemento informador das vacinas extra-PNV foi o médico de família em 46%. A realização de todas as vacinas extra-PNV (exceto gripe sazonal) foi superior nas crianças que eram ou tinham sido seguidas por pediatra. Quanto ao questionário aplicado aos médicos obtivemos uma amostra total de 30 MGF e 30 pediatras. Revelou que a vacina mais aconselhada em ambos os grupos foi a contra Streptococcus pneumoniae. A ordem de importância atribuída às vacinas extra-PNV foi a mesma entre os dois grupos de profissionais. A principal razão para nem sempre aconselharem a vacina contra Streptococcus pneumoniae foi o preço. Conclusões: Para a maioria destas vacinas, desemprego e insuficiência económica não são fundamentais na decisão de não vacinar, o que salienta o esforço por parte dos pais em garantir a vacinação. É urgente a tomada de medidas que permitam um acesso mais justo às diferentes opções vacinais. Aims: We aim to know the factors associated with compliance with recommendations for vaccination of children outside the national vaccination plan among patients of general practitioners (GP) and pediatricians. Type of Study: Cross-sectional study. Local: Ruães Family Health Unit (Cávado I Group of Health Centres). Population: Children aged 2-4 years old and pediatricians and GP from Braga. Methods: Electronic health records of children were studied. A questionnaire was administered by telephone interview of parents or guardians from August 2014 to January 2015. We used an electronic questionnaire with online response by GP and pediatricians to evaluate GP and pediatricians' compliance with recommendations. Data were analyzed using the Statistical Package for Social Sciences (SPSS, Chicago, IL, USA), version 17.0 for Microsoft Windows®. Results: We selected a sample of 180 children, aged of 2-4 years old. Vaccination coverage against Streptococcus pneumoniae was 81.7%. There was no statistically significant association between unemployment of the parent or guardian and non-compliance vaccines outside the plan. We found higher rates of vaccination against Neisseria meningitidis serogroup B and against hepatitis A virus (HAV) in the absence of economic difficulties (p value of Fisher=0.008 and p=0.046, respectively). Association between rotavirus vaccination and kindergarten attendance was statistically significant (p=0.029). There was also a statistically significant association between university-level education of the father or mother and rotavirus and hepatitis A vaccination. Vaccines outside the national plan were recommended by the family doctor in 46% of cases. Vaccination with vaccines outside the national plan was higher in children who were or had been followed by pediatrician (except flu vaccine). The sample of 30 GP and 30 pediatricians revealed that the most commonly recommended vaccine was that against Streptococcus pneumoniae. The order of importance attributed to vaccines was the same in both groups of professionals. The main reason for not recommending the Streptococcus pneumoniae vaccine was its price. Discussion and conclusions: For most vaccines, unemployment and economic difficulties are not decisive factors in the decision not to vaccinate. This emphasizes the parents' role in vaccination. Measures are required to ensure a fair access to different vaccine options.

The aim of this study was to test the effectiveness of a stepwise intervention with an increasing level of complexity and cost to increase adherence to organized cervical cancer screening. This was a randomized (1: 1) controlled trial, conducted among 13 Portuguese primary health care units. Participants (n = 1220) were women aged 25-49 years, eligible for cervical cancer screening, with a mobile phone number available. The tested intervention was a 3-step invitation to screening, based on automated text messages/phone calls (step 1), manual phone calls (step 2) and face-to-face interviews (step 3), applied sequentially to non-adherent women after each step. Participants in the control group were invited through a written letter (standard of care). The primary outcome was the proportion of women screened, which was assessed after step 1 (45 days after the initial invitation), steps 1 + 2 (90 days after the initial invitation) and steps 1 + 2 + 3 (150 days after the initial invitation). Adherence to cervical cancer screening was significantly higher among women assigned to the intervention than those in the control group for step 1 (39.9% vs. 25.7%, p 0.001), steps 1 + 2 (48.6% vs. 30.7%, p 0.001) and steps 1 + 2 + 3 (51.2% vs. 34.0%, p 0.001). In conclusion, adherence to cervical cancer screening was higher by 17% among women invited through the 3-step intervention, compared to those receiving the standard invitation letter. The former strategy has the potential to be broadly implemented due to the low requirements of technology and training. Clinical Trial Registration: NCT03122275.

The aim of this study was to test the effectiveness of invitation to cervical cancer screening through a very low-cost strategy based on automated and customized text messages, phone calls and reminders. A randomized (1:1) controlled trial was conducted among 13 Portuguese primary care units, recruiting women aged 25 to 49 years, eligible for cervical cancer screening, with an available mobile phone number. In the intervention group, participants were invited for cervical cancer screening through automated/customized text messages and phone calls, followed by text message reminders. Participants in the control group were invited through a written letter (standard of care). The primary outcome was the proportion of women adherent to screening up to 45 days after invitation and the secondary outcome was defined as the adherence proportion after invitation based only on text messages and reminders. A total of 1220 women were randomized, 605 to intervention and 615 to control group. The adherence to cervical cancer was significantly higher among women assigned to intervention (39.0% vs. 25.7%, p 0.001); this corresponds to a difference of 13.3% (95% CI 8.1 to 18.5). The difference in adherence between an invitation strategy based only on text messages and reminders and the standard of care was -0.4%, 95% CI -5.3 to 4.5. In conclusion, an invitation to cervical cancer screening using automated text messages/phone calls and reminders increases the adherence to cervical cancer screening. Such a low-cost and operator-independent strategy of invitation may contribute to the sustainability of organized screening programs.NCT03122275.

Background: Osteoarthritis is a widespread chronic disease seen as a continuum of clinical occurrences within several phases, which go from synovial inflammation and microscopic changes of bone and cartilage to painful destructive changes of all the joint structures. Being the most common joint disease, it is the leading cause of disability in working individuals above 50 years of age. In some cases, conventional treatments produce just a mild and brief pain reduction and have considerable side-effects. Contemporary Traditional Chinese Medicine (TCM) is a model of systems biology based on a logically accessible theoretical background. It integrates several therapeutic approaches, among them acupuncture, which has shown effective results in the treatment of knee and hip osteoarthritis, minimizing pain, improving functionality and consequently leading to a better quality of life. Methods: The present case study included two patients with clinical signs of osteoarthritis and diagnosis of medial pain, as defined by the Heidelberg Model of TCM. Over 6 weeks, those patients were treated with acupuncture, with a frequency of one session a week. The sessions lasted for thirty minutes and were based on the needling of 4 local acupoints. Before and after each session, pain and mobility assessments were performed. Results: The results were positive, with significant reduction of pain and increased knee joint flexion amplitude and mobility. Conclusion: Acupuncture was effective as an alternative or complementary treatment of knee osteoarthritis, with high levels of improvement within a modest intervention period.

For commercial oyster aquaculture, triploidy has significant advantages. To produce triploids, the principal technology uses diploid × tetraploid crosses. The development of tetraploid brood stock for this purpose has been successful, but as more is understood about tetraploids, it seems clear that chromosome instability is a principal feature in oysters. This paper is a continuation of work to investigate chromosome instability in polyploid Crassostrea virginica. We established families between tetraploids—apparently stable (non-mosaic) and unstable (mosaic)—and normal reference diploids, creating triploid groups, as well as tetraploids between mosaic and non-mosaic tetraploids. Chromosome loss was about the same for triploid juveniles produced from either mosaic or non-mosaic tetraploids or from either male or female tetraploids. However, there was a statistically significant difference in chromosome loss in tetraploid juveniles produced from mosaic versus non-mosaic parents, with mosaics producing more unstable progeny. These results confirm that chromosome instability, as manifested in mosaic tetraploids, is of little concern for producing triploids, but it is clearly problematic for tetraploid breeding. Concordance between the results from cytogenetics and flow cytometry was also tested for the first time in oysters, by assessing the ploidy of individuals using both techniques. Results between the two were non-concordant.

Prostate cancer is affecting a higher proportion of male population. Health Related Quality of Life assessment can guide the development of an interdisciplinary and patient-centered care intervention. This study is aimed to assess Health Related Quality of Life in prostate cancer patients. Relationships between socio-demographic, clinical characteristics and patient-reported outcomes have been considered. Consecutive outpatients with prostate cancer, admitted at the Urology Clinic of the Instituto Portugues de Oncologia do Porto, were studied (n = 300). Health Related Quality of Life was assessed as part of the routine practice. The European Organisation for Research and Treatment of Cancer general questionnaire, QLQ-C30, and its specific module for prostate cancer patients, QLQ-PR25, were used. Evolution along time (elapsed since diagnosis, and up to 5 years) was considered in order to search for a prognosis prediction in prostate cancer patients. This study confirms the feasibility of a systematic Health Related Quality of Life assessment. Global Health Related Quality of Life was found to be higher 6 months after diagnosis, decreasing then until the second year after diagnosis and improving thereafter. A peak with better scores was identified at the fifth year after diagnosis. Social and physical dimensions revealed a similar pattern. Clinical significance was found 6 months and 5 years after diagnosis. The prospective analysis of Health Related Quality of Life changes is able to explore the patients’ outcomes in order to find patterns and relationships for prognosis prediction along the disease course. Such approach might promote patient confidence and thus a better cancer experience.

Folie à deux is a relatively rare mental disorder first described in France in 1877 by Lasègue and Falret. However, folie à deux is still a matter of study and debate today as it remains a challenge for psychiatrists. The aim of our work is to report a clinical case of folie à deux, subtype A of Gralnick, between an inducer daughter and an induced mother who lived quite socially isolated and had a strong and close relationship. In the clinical case presented, folie à deux was easily diagnosed but its treatment proved to be a higher challenge. The main diagnosis of the inducer patient was also quite interesting. Many years after it was first described, folie à deux is still an interesting and challenging disorder to psychiatrists, especially concerning its pathophysiology and treatment.

Resumo Evidencias recentes sugerem que a periodontite e um potencial factor de risco para as doencas induzidas por aterosclerose, nomeadamente o acidente vascular cerebral (AVC). Assim sendo, este trabalho tem como objectivo determinar a existencia de uma associacao entre a periodontite, a segunda maior patologia dentaria e o AVC, a primeira causa de morte em Portugal. Os possiveis mecanismos fisiopatologicos que estao na base desta possivel associacao sao a accao directa dos microorganismos, a predisposicao genetica, o mimetismo molecular e a hiperlipidemia. Contudo, mais estudos sao necessarios de forma a identificar a verdadeira natureza desta possivel associacao.

OBJETIVO: Avaliar o impacto da umidificação aquecida introduzida no início da terapia com pressão positiva automática em vias aéreas (APAP, do inglês automatic positive airway pressure) na adesão e efeitos secundários. MÉTODOS: Foram randomizados 39 doentes com síndroma de apneia obstrutiva do sono sem terapia prévia em dois grupos de tratamento com APAP: com umidificação aquecida (grupo APAPcom; e sem umidificação (grupo APAPsem). Os doentes foram avaliados 7 e 30 dias após a colocação de APAP. Os parâmetros analisados foram a adesão ao tratamento (número médio de horas/noite), efeitos secundários (secura nasal ou da boca, obstrução nasal e rinorreia), sonolência diurna (escore da escala de sonolência de Epworth) e o conforto subjectivo (escala visual analógica). Foram ainda avaliados o índice de apneia-hipopneia (IAH) residual, pressões e fugas médias registados nos ventiladores. RESULTADOS: Os dois grupos de doentes estudados eram semelhantes no que respeita à média etária (APAPcom: 57,4 ± 9,2; APAPsem: 56,5 ± 10,7 anos), IAH (APAPcom: 28,1 ± 14,0; APAPsem: 28,8 ± 20,5 eventos/hora de sono), Epworth basal (APAPcom: 11,2 ± 5,8; APAPsem: 11,9 ± 6,3) e sintomas nasais iniciais. A adesão foi semelhante nos dois grupos (APAPcom: 5,3 ± 2,4; APAPsem: 5,2 ± 2,3 horas/noite). Não se verificaram diferenças nos outros parâmetros avaliados. CONCLUSÕES: A introdução inicial da umidificação aquecida na terapia com APAP não demonstrou vantagem no que diz respeito à adesão e efeitos secundários.

Resumo: Objectivo: Foi objectivo deste estudo determinar a sensibilidade e a especificidade da oximetria nocturna (ON) como método de screening diagnóstico para a síndroma de apneia-hipopneia obstrutiva do sono (SAHOS), utilizando como método de referência a polissonografia (PSG).Metodologia: Foram incluídos 63 doentes com sus-peita clínica de SAHOS e exclusão de doença respiratória, sendo submetidos a uma PSG completa, incluin-do ON. Posteriormente, foram determinados: a sensibilidade, a especificidade e os valores preditivos positivo (VPP) e negativo (VPN) da ON.Resultados: A SAHOS foi diagnosticada em 47 doentes com uma média etária de 54 anos. Verificaram-se diferenças significativas na avaliação da percentagem do tempo total de sono (TTS) com dessaturação de O2 abaixo de 90% entre doentes com SAHOS (25,4 29,7%) e sem SAHOS (1±1,5%), p

Aim: The aim of our study was to evaluate the sensitivity and specificity of Nocturnal Oximetry (NO) as a diagnostic screening tool for obstructive sleep apnoea hypopnoea syndrome (OSAHS), compared with polysomnography (PSG) as the gold standard. Methodology: 63 patients with clinical suspicion of OSAHS and exclusion of respiratory disease underwent PSG and NO. We then determined NO sensitivity, specificity, positive (PPV) and negative predictive values (NPV). Results: OSAHS was diagnosed in 47 patients with a mean age of 54 years. In the evaluation of the percentage of Total Sleep Time (TST) with oxygen desaturation below 90%, we found significant differences between patients with OSAHS (25.4 ± 29.7%) and without OSAHS (1 ± 1.5%), p

Pheochromocytoma and paraganglioma are rare neuroendocrine tumours in paediatric ages. We report a case of a 14-year-old girl referred to our oncology centre due to an abdominal mass. She had an 11-month history of paroxysmal episodes of headache, nausea, dizziness, palpitations and visual disturbances. Imaging studies showed a left paravertebral mass measuring 5.8 × 4.6 × 3.5 cm. Metaiodobenzylguanidine scintigraphy revealed an abnormal hyperfixation on the left upper quadrant. Chromogranin A was elevated, as well as normetanephrine. The patient was submitted to surgery during which a connection between this mass and the adrenal gland was found. A diagnosis of pheochromocytoma was performed.

Introduction: Acute transverse myelitis (ATM) refers to a frequently idiopathic, segmental spinal cord inflammation. It is a rare condition, in particular in children, and not previously reported in a family retinitis pigmentosa (RP) clinical setting. Case Report: An 11-year-old previously healthy girl, with a family history of RP, presented with a subacute flaccid paraparesis, with bilateral, up to the fourth dorsal level, mixed sensory hypoesthesia and autonomic dysfunction. Brain and spinal cord magnetic resonance imaging (MRI) showed an extensive, T2-hyperintense, non-contrast enhancing lesion from the second to fifth dorsal levels. Cerebrospinal fluid (CSF) and lab studies were normal, as the ophthalmologic observation. Treated with high-dose corticosteroids and intensive physical therapy, a significant recovery could be seen. Conclusion: Early pharmacological and physical treatment is fundamental and may indeed change the prognosis of this disease ATM. The family history of RP, although probably incidental, brings nevertheless the issue of a possible etiological contribution, or pathologic common pathways.

A 2-year-old girl was referred to our paediatric pulmonary consultation due to recurrent pneumonia and residual pneumatocele. The child was born at 32 weeks of gestation by emergency caesarean delivery due to a maternal cause. No evidence of congenital malformation was found on prenatal ultrasounds. From 9 months of age, the child had had three bouts of pneumonia, all in the same location (right lung base). Thoracic radiography showed …

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Aims: To assess nutritional risk of alcoholic patients admitted for alcohol detoxification. Methods: Screening of nutritional risk of alcoholic patients using the Malnutrition Universal Screening Tool. Results: Fifty-three percentage patients at presentation were rated as being at medium or high risk of malnutrition. Conclusion: Malnutrition should be actively considered and screened for in alcoholic patients admitted for alcohol detoxification due to its high prevalence and benefits obtained from treatment.

Little information exists regarding the effect of several obesity markers on blood pressure (BP) levels in youth.Transverse study including 2494 boys and 2589 girls.Height, weight and waist were measured according to the international criteria and body fat (BF) by bioimpedance. BP was measured by an automated device. Hypertension was defined using sex-specific, age-specific and height-specific observation-points.Body mass index (BMI) and waist were positively related with systolic blood pressure (SBP) and diastolic blood pressure (DBP) and heart rate in both sexes, whereas the relationships with BF were less consistent. Stepwise linear regression analysis showed that BMI was positively related with SBP and DBP in both sexes, whereas BF was negatively related with SBP in both sexes and with heart rate in boys only; finally, waist was positively related with SBP in boys and heart rate in girls. Age and heart rate-adjusted values of SBP and DBP increased with BMI: for SBP, 117+/-1, 123+/-1 and 124+/-1 mmHg in normal, overweight and obese boys, respectively; corresponding values for girls were 111+/-1, 114+/-1 and 116+/-2 mmHg (mean+/-SE, P0.001). Overweight and obese boys had an odds ratio for being hypertensive of 2.26 (95% confidence interval: 1.79-2.86) and 3.36 (2.32-4.87), respectively; corresponding values for girls were 1.58 (confidence interval 1.25-1.99) and 2.31 (1.53-3.50).BMI, not BF or waist, is consistently and independently related to BP levels in children; overweight and obesity considerably increase the risk of hypertension.

Background: Drug resistance in Plasmodium falciparum has posed an obstacle to effective treatment and challenges many malaria control programmes in endemic areas. In Angola, until 2003, chloroquine (CQ) was used as first-line therapy for uncomplicated malaria. It was replaced initially by amodiaquine and, in 2006, by artemisinin-based combination therapy (ACT) with artemether-lumefantrine (AL, Coartem®). Efficacy study of ACT, conducted in Angola between 2004 and 2005, showed a baseline efficacy of ≈99 %. Methods: 103 malaria patients were enrolled according to WHO proceedings. Patients were followed up with clinical and parasitological evaluations for 28 days, parasite density and identification was evaluated by microscopy, the pfmsp2 were genotyped by nested-PCR, to distinguish parasite recrudescence from new infections; the polymorphisms at codons 86 and 1246 of pfmdr1 gene, and 769 of pfatp6 gene were assessed by PCR-RFLP and sequencing for pfk13-propeller genotype. Results: The cure rate was 91.3 %. The obtained results showed that from 103 patients, 12.6 % (n = 13) still had parasitaemia 1 day after the treatment was finished. On day 0, of the 94 evaluated samples, wild-type alleles were identified in 73.4 % (n = 69) for pfmdr1 N86Y position and only one sample carried the mutant allele (Y) for pfmdr1 1246; 14 % of these samples showed increased pfmdr1 copy number; 100 % (n = 21) had wild-type allele of k13 gene in all the studied positions. Discussion: These results showed changes in parasite profile susceptibility to AL in comparison to the baseline data from 2002 to 2004 and on the genotyping characteristics; the clinical outcome after treatment with AL did not link a particular genotype with treatment failure; observed changes do not provide sufficient evidence for a treatment policy change, but they suggest that a carefully monitoring is needed in this area. publishersversion published