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Purpose: To identify potential predictors of prolonged length of hospital stay in patients submitted to lung resection surgery. Materials and methods: This is a cohort study, carried out in 105 patients with lung cancer, submitted to posterolateral thoracotomy pulmonary resection. Data collection included preoperative assessment of demographic, clinical, pulmonary function, respiratory muscle function, physical fitness, and behavioral habits. After surgery, length of hospital stay was documented, and the sample was divided into two groups according to the length of hospital stay (LOS): the normal hospital stay group (NLOS) until 8 days, and the prolonged hospital stay group (PLOS) with more than 8 days of hospital stay. Multiple linear regressions were performed between length of hospital stay and the studied variables, for the total sample and, specifically, for the PLOS group. Results: The multiple linear regression for the total sample, the most explanatory power variables were TLC, MIP, PEF, and BMI. When considering only the PLOS, the variables that mostly explained were the MIP%, MEP and TLC%. Conclusion: Besides the classic outcomes used to calculate surgical risk, the body mass index, respiratory muscle strength, peak expiratory flow, and total lung capacity are predictors of the variation on length of hospital stay in patients submitted to lung resection. IMPLICATIONS FOR REHABILITATION: The addition of the respiratory muscles function in the preoperative assessment, might contribute to predict prolonged hospital stay in patients submitted to lung resection surgery. Respiratory muscle strength might be included in a prehabilitation program for patients selected to lung resection surgery. The preoperative respiratory muscle strength increment might contribute to reduce economic cost related to prolonged hospital stay after pulmonary resection surgery. [ABSTRACT FROM AUTHOR]

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To characterize moderate to severe psoriasis (PsO) adult patients treated with secukinumab, estimate drug persistence and assess any reasons for treatment discontinuation. Non‐interventional, retrospective, longitudinal record‐based study including patients diagnosed with PsO who started secukinumab between January 2018 and January 2020. Baseline characteristics were analyzed by descriptive statistics; drug persistence and predictive factors were assessed through Kaplan–Meier curves and univariate and multivariate analysis, respectively. A total of 302 patients were included in the study: mean age was 48.4 years, 41.7% were female, median time since diagnosis was 12.9 years. 51.3% of patients were bio‐naïve while 48.7% had previously been treated with biologics. PsO in difficult‐to‐treat locations (DTL) was present in 82.1% of patients, with scalp PsO in about half of patients. At 5‐years follow‐up, 84 patients discontinued secukinumab, 45 of which due to loss of efficacy. At week 104, overall treatment persistence was 71.7%. A higher probability of drug persistence was identified among those patients who initiated secukinumab ≥5 years after diagnosis, were bio‐naïve or treated with only one previous biologic, had no PsO on DTL, and had diabetes mellitus. The predictive factors for discontinuation identified in our study were the start of secukinumab <5 years after diagnosis (p = 0.001), the bio‐experimented status with ≥2 biologics (p = 0.007), and the presence of PsO on DTL (p = 0.014). A time since diagnosis of ≥5 years, naïve status or previous use of only one biologic are predictors for secukinumab persistence, whereas the presence of PsO on DTL predicts drug discontinuation. [ABSTRACT FROM AUTHOR]

The present study focused on the methodology for identification of the wastewater stream that presents the highest phenolic impact at a large oil refinery. As a case-study, the oil refinery, Petrogal S.A., in Sines, Portugal, was selected. Firstly, stripped sour water from the cracking complex was identified as the most relevant wastewater stream concerning phenolic emission. Secondly, multivariate data analysis was used, through projection to latent structures (PLS) regression, to find existing correlations between process parameters and phenols content in stripped sour water. The models developed allowed the prediction of phenols concentration with predictive errors down to 20.16 mg/L (corresponding to 8.2% average error), depending on the complexity of the correlation used, and R2 values as high as 0.85. Models were based in input parameters related to fluid catalytic crackers (FCC) feedstock quality, crudemix and steam injected in the catalyst stripper. The studied data analysis approach showed to be useful as a tool to predict the phenolic content in stripped sour water. Such prediction would help improve the wastewater management system, especially the units responsible for phenol degradation. The methodology shown in this work can be used in other refineries containing catalytic cracking complexes, providing a tool which allows the online prediction of phenols in stripped sour water and the identification of the most relevant process parameters. An optimised system at any refinery leads to an improvement in the wastewater quality and costs associated with pollutant discharge; thus, the development of monitoring online tools, as proposed in this work, is essential. [ABSTRACT FROM AUTHOR]

Background: Drug survival analysis of biologic agents in psoriasis is of extreme importance, as it allows not only the evaluation of objective clinical outcomes (such as effectiveness and safety) but also of factors that are associated with patients' adherence to treatment. The aim of this study was to evaluate and compare the drug survival of the most recent biologic agents approved for the treatment of moderate-to-severe psoriasis—ustekinumab, secukinumab, ixekizumab, brodalumab, guselkumab, and risankizumab—and to identify clinical predictors that can influence the drug survival of these drugs. Methods: This retrospective multicentric cohort study from 16 dermatology centers in Portugal, Spain, Italy, Switzerland, Czech Republic, Canada, and the United States included patients that started IL-12/23, IL-17 (IL-17A and IL-17R) and IL-23 inhibitors for the treatment of psoriasis between January 1, 2012 and December 31, 2019. Survival analysis was performed using a Kaplan-Meier estimator, to obtain descriptive survival curves, and proportional hazard Cox regression models. Results: A total of 3312 treatment courses (total patients: 3145) were included in the study; 1118 (33.8%) with an IL-12/23 inhibitor (ustekinumab), 1678 (50.7%) with an IL-17 inhibitor [911 (27.5%) on secukinumab, 651 (19.7%) on ixekizumab, 116 (3.5%) on brodalumab], and 516 (15.5%) with an IL-23 inhibitor [398 (12.0%) on guselkumab, 118 (3.5%) on risankizumab]. At 18 months, the cumulative probability of survival was 96.4% for risankizumab, 91.1% for guselkumab, 86.3% for brodalumab, 86.1% for ustekinumab, 82.0% for ixekizumab, and 79.9% for secukinumab. Using ustekinumab as reference, drug survival of guselkumab was higher (HR 0.609; 95% CI 0.418–0.887) and that of secukinumab was lower (HR 1.490; 95% CI 1.257–1.766). In the final multivariable model, secukinumab, female sex, higher BMI, and prior exposure to biologic agents significantly increased the risk of drug discontinuation, whereas risankizumab was protective. Conclusion: In this multinational cohort with 8439 patient-years of follow-up, the cumulative probability of drug survival for all drugs was >79% at 18 months. Prescribed biologic, female sex, higher BMI, and previous exposure to biologic agents were predictors of drug discontinuation. Drug survival of guselkumab and risankizumab was higher than that of ustekinumab, and secukinumab was lower. [ABSTRACT FROM AUTHOR]

Background Portugal has the highest prevalence rate of HIV infection in Western Europe. The proportion of patients with a late diagnosis, carried out in full-blown AIDS stage, remains high. Skin and mucous membrane manifestations are not rare in these patients. Objective A demographic, clinical, and laboratorial characterization of patients with de novo HIV infection diagnosis made in the Department of Dermatology and Venereology of a central hospital in Lisbon, Portugal. Methods Retrospective review of medical records of adult patients newly diagnosed with HIV infection (reactive immunoassay for antibodies to HIV-1/HIV-2 or HIV p24 antigen) in the Dermatology and Venereology Department of a Portuguese central hospital in the period between January 2005 and December 2013. Results During the study period, 97 new cases were diagnosed, 70 men and 27 women. The median age at diagnosis was 36 years. Of the total, 50 cases were diagnosed with a concomitant sexually transmitted infection (STI), more frequently syphilis and ano-genital HPV infection. The remaining 47 patients were diagnosed with other dermatological conditions such as prurigo nodularis, psoriasis, and Kaposi's sarcoma. The duration of complaints that lead to medical attention ranged from <1 week to 8 years, being significantly lower in patients diagnosed with a concomitant STI ( p < 0.01). Basal viral load was also lower in this group of patients ( p < 0.05). Of all the new diagnosed cases, 80% of patients are currently retained in care. Conclusion This study grants a descriptive overview of de novo HIV infection diagnoses performed by dermatovenereologists in a central hospital in Lisbon, Portugal. As in the past, the importance of Dermato-Venereology for HIV infection diagnosis remains present in daily clinical practice. [ABSTRACT FROM AUTHOR]

Background: The percentage of Portuguese psoriasis patients with psoriatic arthritis is unknown but musculoskeletal complaints related to PsA affect up to a third of patients. Dermatologists can identify early PsA as skin symptoms often precede joint symptoms in 80% of patients. Efficient and easy to perform screening tools are needed to help dermatologists effectively discriminate between Pso and PsA patients. The present study aims to evaluate the prevalence of PsA in Pso patients followed in Portuguese dermatology clinics. Additionally, it aims to evaluate the EARP-PT performance (validity, sensitivity, specificity) and the best cut-off point to allow an early identification of PsA potential patients., Methods: A multicentre national, cross-sectional, observational study with two independent assessments (dermatologist and rheumatologist), was performed. A PsA case was defined by a combination of expert opinion and classification criteria for psoriatic arthritis (CASPAR). The EARP-PT questionnaire screening performance was evaluated., Results: Pso patients (n=172) were included with a mean age of 53.8+/-14.5 years, 53.5% were male with a mean time of diagnosis of 17.4+/-14.9 years. The prevalence of PsA in patients with Pso in our sample was 8.70% (95% CI: 4.8-14.2). The EARP-PT questionnaire displayed good internal consistency (Cronbach's α=0.81) and, using a validated initial cut-off point of 3, demonstrated a sensitivity of 71.4% and specificity of 40.1%., Conclusion: The estimated prevalence of PsA in a population of Pso patients followed in Portuguese dermatology clinics, is 8.7%. The EARP-PT questionnaire appears to be a useful tool for dermatologists in the early detection of PsA.

Introduction: Psoriasis is a common, chronic, and inflammatory skin disorder with a high personal, social and economic burden and important implications for healthcare systems. The aim of this study was to provide an epidemiological characterization of individuals with psoriasis in Portugal., Material and Methods: A large observational, cross-sectional, nationwide, population-based survey study developed by the Portuguese Psoriasis Group of the Portuguese Society of Dermatology and Venereology (GPP-SPDV). A structured questionnaire was designed and applied by experienced interviewers to a random, representative sample of Portuguese individuals with psoriasis and/or psoriatic arthritis. Patients were considered to have psoriasis if they replied positively to one of the following questions: "Does any physician have ever diagnosed you with psoriasis?" or "Do you have a skin disorder characterized by scaling, reddish skin lesions located in the elbows/knees/scalp?"., Results: A total of 6381 individuals were interviewed, of which 283 met the criteria for psoriasis, corresponding to a prevalence rate of 4.4% (95% CI 3.95 - 4.98). Out of the participants that met psoriasis criteria, 24% had suggestive signs/symptoms but did not have a clinical diagnosis established and were not being monitored by a physician. Although more than 70% of participants had active disease (scaling, erythema, or pruritus) and one third had joint symptoms, only 12% were on systemic treatment. Fifty percent of participants with psoriasis (n = 139) had relevant comorbidities (most frequently depression/anxiety and cardiometabolic diseases). Sixteen percent of participants with psoriasis (n = 46) reported that psoriasis interfered with their daily activities (median impact of 5 in a 0 - 10 scale) and 12% mentioned the disease had an impact in their sexual life (median impact of 5 in a 0 - 10 scale)., Conclusion: The results of this study suggest that the prevalence rate of psoriasis is likely to be high in Portugal, and several gaps exist at different levels of healthcare delivery to these patients, from diagnosis to treatment. This study provides important data for the future planning of interventions targeting the improvement of psoriasis care in Portugal.

Psoriatic disease (Psoriasis and Psoriatic Arthritis, PsD) is a condition that affects the skin, the musculoskeletal system, and beyond, impairing patients' quality of life. A multidisciplinary approach of combined dermatology-rheumatology clinics is recommended and valuable to respond to PsD diagnosis, management, and treatment challenges. In Portugal, five Hospitals have implemented a multidisciplinary clinic for PsD assessment. This report aims to describe how these multidisciplinary clinics were developed, their characteristics, and the main obstacles to their implementation. Although the different hospitals adopted distinct functional models, a consensus respecting the minimal core set assessment for PsD in Multidisciplinary Dermatology/Rheumatology Clinics should comprise all disease manifestations and, if possible, quality of life. The main objective of these clinics is to achieve remission/minimal disease activity. Limitations to these multidisciplinary approaches are discussed, namely financial, time management, and human resources obstacles that can be a handicap in their implementation, despite the benefits of PsD integrated care.