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Background: Fingolimod, an oral sphingosine 1-phosphate receptor modulator, is approved by EMA for relapsing-remitting multiple sclerosis (RRMS). Objectives: To assess the effectiveness and safety of fingolimod in patients with RRMS in real-world clinical practice in Portugal. Methods: Retrospective, multicentre, non-interventional study, reporting 3 years follow-up of data collected from October 2015 to July 2016. Sociodemographic data and previous treatments at baseline and data regarding disease evolution, including number of relapses, annualised relapse rates (ARR) and Expanded Disability Status Scale (EDSS), were collected. Results: Two-hundred and seventy-five participants were enrolled in the REALMS study. Results showed that the main reason to switch to fingolimod was failure of previous treatment (56.7%) and only 3.6% were naïve patients. In the total population, there was a significant decrease in ARR of 64.6% in the first year of treatment, 79.7% in the second year and 82.3% in the third year, compared with baseline. More than 67.0% of patients had no relapses during the 3 years after switching to fingolimod. EDSS remained stable throughout the study. Conclusions: Therapy with fingolimod showed a sustained effectiveness and safety over the 3 years, particularly on patients switched from first-line drugs (BRACE). No new safety issues were reported. [ABSTRACT FROM AUTHOR]

The prevalence of multiple sclerosis (MS) in Portugal is still unknown. Recent studies conducted in southern European countries showed higher than expected rates of MS prevalence. In an attempt to evaluate the MS prevalence in Santarém—a district with 62621 inhabitants (1991 census) located in the centre of Portugal—we have conducted a population survey in this district for five years. The crude prevalence rate found was 46.3/100,000. This figure is not different from findings recently reported in studies conducted at similar latitudes in neighbour southern European countries. This was the first population survey conducted in Portugal, and it is the first accurate contribution to the knowledge of the MS prevalence in this country. [ABSTRACT FROM AUTHOR]

Background and purpose: Environmental factors are thought to be important in multiple sclerosis (MS) pathophysiology. We aimed to evaluate if there was an association between MS relapses and some climatic factors in a Portuguese population. Methods: Four year retrospective study analyzing 414 MS relapses in 249 consecutive relapsing–remitting patients. Non-parametric statistics were used to compare the distribution of relapses across months and seasons. Spearman’s coefficient was determined to evaluate the correlation between relapses frequency and maximum and minimum atmospheric temperatures, humidity and atmospheric pressure. Results: The mean number of relapses was not significantly different between months or seasons. No correlation was found between relapse frequency and any climatic factor. Conclusion: Our series is one of the largest addressing the influence of specific climatic factors on MS relapses. The number of clinical MS relapses seems to be unrelated to climatic factors. [ABSTRACT FROM AUTHOR]

The article "REALMS study: real-world effectiveness and safety of fingolimod in patients with relapsing-remitting multiple sclerosis in Portugal". [ABSTRACT FROM AUTHOR]

The escalating trend of inappropriate visits to Emergency Departments (ED) has led to significant concerns, including resource misallocation, compromised patient care, and an increased burden on healthcare workers. Portugal faces a notable challenge, reporting one of the highest per capita ED visit rates, with an annual average of approximately 6 million ED visits from 2013 to 2023. In response, the "Call First, Save Lives" pilot project was launched by the Portuguese NHS Executive Board, in 2023, at the Local Health Unit (LHU) of Póvoa de Varzim/Vila do Conde. This project leverages the SNS 24 telephone triage system to direct patients to the most appropriate care settings, alleviating pressure on ED, and optimizing healthcare resources. The project introduced several strategic enhancements, including optimizations of the SNS 24 system and inter-institutional initiatives to promote interoperability, hospital follow-ups for chronic conditions, and a "reverse referral" system directing non-urgent ED cases to Primary Care Services (PCS). In PCS, the project expanded acute care consultations and introduced complementary health services. The initiative also emphasized communication to improve health literacy and appropriate utilization of the NHS, supported by legal framework development. Since the beginning of the project, the number of calls received by SNS 24 showed an upward trend, both at the local, 27.6%, and national level, 44.5%, having already expanded to other LHU. Nonetheless, challenges such as the "reverse referral" process complexity, healthcare information systems integration, and procedural standardization need addressing, with future plans including satisfaction surveys and patient triage protocol refinements to improve service delivery and patient adherence., Competing Interests: FG-S, RM, FF and JA served on the Executive Board of the Portuguese National Health Service between 2022 and 2024. FA was the CEO of the Executive Board of the Portuguese National Health Service between 2022 and 2024. SC, FM, JS, MC, RV, RaG, IM-V and LP-G served as advisor to the Portuguese National Health Service Executive Board. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2025 Goiana-da-Silva, Costa, Malcata, Sá, Vasconcelos, Cabral, Guedes, Morais-Vilaça, Pinheiro-Guedes, Ferreira, Pereira, Gaspar-Pais, Neves, Monteiro, Pires, Paiva, Guimarães, Ashrafian, Moreira, Fonseca, Cardoso, Alves, Darzi and Araújo.)

Vertical integration models aim for the integration of services from different levels of care (e.g., primary, and secondary care) with the objective of increasing coordination and continuity of care as well as improving efficiency, quality, and access outcomes. This paper provides a view of the Portuguese National Health Service (NHS) healthcare providers' vertical integration, operationalized by the Portuguese NHS Executive Board during 2023 and 2024. This paper also aims to contribute to the discussion regarding the opportunities and constraints posed by public healthcare organizations vertical integration reforms. The Portuguese NHS operationalized the development and generalization of Local Health Units management model throughout the country. The same institutions are now responsible for both the primary care and the hospital care provided by public services in each geographic area, in an integrated manner. This 2024 reform also changed the NHS organic and organizational structures, opening paths to streamline the continuum of care. However, it will be important to ensure adequate monitoring and support, with the participation of healthcare services as well as community structures and other stakeholders, to promote an effective integration of care., Competing Interests: FG-d-S and RM serve on the Management Board of the Portuguese National Health Service Executive Board. JuS, MC, RG, and RV serve as advisors to the Portuguese National Health Service Executive Board. AD is Chair of the Health Security initiative at Flagship Pioneering UK Ltd. FA is the Executive Director of the Portuguese National Health Service Executive Board. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Goiana-da-Silva, Sá, Cabral, Guedes, Vasconcelos, Sarmento, Morais Nunes, Moreira, Miraldo, Ashrafian, Darzi and Araújo.)

Objectives: Cladribine is a selective and oral immunological reconstitution treatment, approved in Europe for very active multiple sclerosis (MS) with relapses. Aims were to assess the safety and effectiveness of cladribine in real-world setting, during treatment follow-up., Methods: This was a multicentric, longitudinal, observational study with retrospective and prospective data collection of clinical, laboratory, and imaging data. This interim analysis reports data from July 1, 2018 (study onset), to March 31, 2021., Results: A total of 182 patients were enrolled: 68.7% were female; mean age at onset was 30.1 ± 10.0 years, and mean age at first cycle of cladribine treatment was 41.1 ± 12.1; 88.5% were diagnosed with relapse-remitting MS and 11.5% with secondary progressive MS. Mean disease duration at cladribine start was 8.9 ± 7.7 years. Most patients (86.1%) were not naive, and median number of previous disease-modifying therapies was 2 (interquartile range, 1-3). At 12 months, we observed no significant Expanded Disability Status Scale score worsening ( P = 0.843, Mann-Whitney U test) and a significantly lower annualized relapse rate (0.9 at baseline to 0.2; 78% reduction). Cladribine treatment discontinuation was registered in 8% of patients, mainly (69.2%) due to disease activity persistence. Most frequent adverse reactions were lymphocytopenia (55%), infections (25.2%), and fatigue (10.7%). Serious adverse effects were reported in 3.3%. No patient has discontinued cladribine treatment because of adverse effects., Conclusion: Our study confirms the clinical efficacy and the safety profile of cladribine for treating MS patients with a long-term active disease in the real-world setting. Our data contribute to the body of knowledge of the clinical management of MS patients and the improvement of related clinical outcomes., Competing Interests: Conflicts of Interest and Source of Funding: This article was prepared with the medical writing support of W4Research, financially supported by Merck. Merck had no access to the data or any other role in study design, analysis, or decision to submit for publication. Mónica S., J. Sequeira, P.A., R.G., J.F., F.L., L.L., M.J.S., C.C., and J. de Sá have received honoraria from Merck and others for acting as speakers and for attending scientific meetings. J. Sequeira, P.A., R.G., J.F., F.L., L.L., M.J.S., V.S., C.C., and J. de Sá had also received fees for acting as a consultant and/or for participation in advisory boards from several companies, including Merck. The remaining authors did not receive any financial support and have no conflicts of interest to declare., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Introduction: Multiple sclerosis is a disease with a heterogeneous evolution. The early identification of secondary progressive multiple sclerosis is a clinical challenge, which would benefit from the definition of biomarkers and diagnostic tools applicable in the transition phase from relapsing-remitting multiple sclerosis to secondary progressive multiple sclerosis. We aimed to reach a Portuguese national consensus on the monitoring of patients with multiple sclerosis and on the more relevant clinical variables for the early identification of its progression., Material and Methods: A Delphi panel which included eleven Portuguese Neurologists participated in two rounds of questions between July and August of 2021. In the first round, 39 questions which belonged to the functional, cognitive, imaging, biomarkers and additional evaluations were included. Questions for which no consensus was obtained in the first round (less than 80% of agreement), were appraised by the panel during the second round., Results: The response rate was 100% in both rounds and consensus was reached for a total of 33 questions (84.6%). Consensus was reached for monitoring time, evaluation scales and clinical variables such as the degree of brain atrophy and mobility reduction, changes suggestive of secondary progressive multiple sclerosis. Additionally, digital devices were considered tools with potential to identify disease progression. Most questions for which no consensus was obtained referred to the cognitive assessment and the remaining referred to both functional and imaging domains., Conclusion: Consensus was obtained for the determination of the monitorization interval and for most of the clinical variables. Most questions that did not reach consensus were related with the confirmation of progression taking into account only one test/domain, reinforcing the multifactorial nature of multiple sclerosis.

Introduction: Several neuroimmunological disorders have distinct phenotypes according to the age of onset, as in multiple sclerosis or myasthenia gravis. It is also described that late onset NMOSD (LONMOSD) has a different phenotype., Objective: To describe the clinical/demographic characteristics of the LONMOSD and distinguish them from those with early onset (EONMOSD)., Methods: From a nationwide Portuguese NMOSD study we analyzed the clinical/demographic characteristics of the LONMOSD., Results: From the 180 Portuguese patients 45 had disease onset after 50 years old, 80% were female. 23 had anti-AQP4 antibodies (51.1%), 13 anti-MOG antibodies (28.9%) and 9 were double seronegative (20.0%). The most common presenting phenotypes in LONMOSD were transverse myelitis (53.3%) and optic neuritis (26.7%), without difference from EONMOSD (p = 0.074). The mean EDSS for LONMOSD was 6.0 (SD=2.8), after a mean follow-up time of 4.58 (SD=4.47) years, which was significantly greater than the mean EDSS of EONMOSD (3.25, SD=1.80)(p = 0.022). Anti-AQP4 antibodies positive LONMOSD patients had increased disability compared to anti-MOG antibodies positive LONMOSD (p = 0.022). The survival analysis showed a reduced time to use a cane for LONMOSD, irrespective of serostatus (p<0.001)., Conclusions: LONMOSD has increased disability and faster progression, despite no differences in the presenting clinical phenotype were seen in our cohort., (Copyright © 2022. Published by Elsevier B.V.)

Introduction: Patient registries allow better evaluations of therapeutic outcomes and support personalized health care in several conditions. This study aimed to implement a local registry in a multiple sclerosis center in Portugal, in order to carry out a critical analysis of its development stages, and to perform an initial analysis of the included patients., Material and Methods: The establishment of the registry was divided in two phases - development (creation of the online platform for data entry) and implementation (recruitment of patients and retrospective and prospective collection of available information). A demographic and clinical analysis of patients was performed., Results: Neurologists and study coordinators participated in the project, accounting for a total of 1050 hours of work in the implementation phase. Amongst the 498 multiple sclerosis patients included, 72.9% were female and relapsing-remitting multiple sclerosis was the most common subtype of the disease. The most frequently prescribed drugs at diagnosis were beta interferons. Missing data in electronic health records were detected concerning the progression of disability and diagnostic tests., Discussion: The difficulties encountered could be mitigated by defining minimum elements to be included in patient records and by implementing more minimalist registries. This could reduce the time spent by healthcare professionals in collecting information, thus optimizing costs, and allowing the focus to be placed on personalized healthcare by taking advantage of the registry and its associated tools., Conclusion: Despite the amount of data collected within the scope of this study, several difficulties affected the implementation and maintenance of the registry, which could be overcome by improving future strategies.

The purpose of this study is to characterize demographically and genetically the Portuguese population with retinoblastoma; to report the clinical stage at presentation and its impact on survival and ocular preservation rate and, finally, to assess the incidence of retinoblastoma in Portugal. Retrospective observational study including children consecutively diagnosed with retinoblastoma at the Portuguese National Referral Center of Intraocular Tumors, between October 2015 and October 2020. Twenty-eight children were diagnosed with retinoblastoma at our center, 15 hereditary from which 12 presented with bilateral retinoblastoma and 3 were unilateral. The overall mean age at diagnosis was 13.6 ± 11.1 months with hereditary retinoblastomas diagnosed slightly earlier at 9.6 ± 6.3 months. A familial history of retinoblastoma was found in only 4 (14.3%) of the cases. A pathogenic mutation in the RB1 gene was found in 13 (46.4%) of the children. The most frequent sign at referral was leukocoria in 71.4% of patients. Considering the ICRB classification of the tumors, 84.6% of non-hereditable hereditary retinoblastomas were referred to our center in advanced stages. In the group of hereditable retinoblastomas 86.7% presented with one of the eyes with advanced intraocular retinoblastoma. Fourteen children had one eye enucleated due to retinoblastoma. No deaths were registered during the study period. Considering the incidence analysis, we registered a year-of-birth controlled incidence analysis of 4.04 per 100.000 living births (IC 95% 1.59-6.49). This is the first characterization of the Portuguese Population diagnosed with Retinoblastoma in the National Reference Center., (© 2022. The Author(s).)

Introduction: Neuromyelitis optica spectrum disorder (NMOSD) is a rare disorder in which astrocyte damage and/or demyelination often cause severe neurological deficits., Objective: To identify Portuguese patients with NMOSD and assess their epidemiological/clinical characteristics., Methods: This was a nationwide multicenter study. Twenty-four Portuguese adult and 3 neuropediatric centers following NMOSD patients were included., Results: A total of 180 patients met the 2015 Wingerchuk NMOSD criteria, 77 were AQP4-antibody positive (Abs+), 67 MOG-Abs+, and 36 seronegative. Point prevalence on December 31, 2018 was 1.71/100,000 for NMOSD, 0.71/100,000 for AQP4-Abs+, 0.65/100,000 for MOG-Abs+, and 0.35/100,000 for seronegative NMOSD. A total of 44 new NMOSD cases were identified during the two-year study period (11 AQP4-Abs+, 27 MOG-Abs+, and 6 seronegative). The annual incidence rate in that period was 0.21/100,000 person-years for NMOSD, 0.05/100,000 for AQP4-Abs+, 0.13/100,000 for MOG-Abs+, and 0.03/100,000 for seronegative NMOSD. AQP4-Abs+ predominated in females and was associated with autoimmune disorders. Frequently presented with myelitis. Area postrema syndrome was exclusive of this subtype, and associated with higher morbidity/mortality than other forms of NMOSD. MOG-Ab+ more often presented with optic neuritis, required less immunosuppression, and had better outcome., Conclusion: Epidemiological/clinical NMOSD profiles in the Portuguese population are similar to other European countries., (Copyright © 2021. Published by Elsevier B.V.)

Background: Multiple sclerosis (MS) is a chronic immune-mediated disease of the central nervous system. Prodromal symptoms and higher healthcare use have been suggested in patients who later develop MS., Objectives: Assess the healthcare utilization pattern of relapsing-remitting MS (RRMS) patients in the five years prior to MS diagnosis., Methods: Retrospective, multicentric study. Demographic and clinical data, drug prescriptions and diagnostic tests were collected from electronic health records five-years previous to MS diagnosis and compared with national data., Results: Included 168 patients, 112 (66.7%) female, median age 34±11 years. The mean number of healthcare use per patient per year was 3.14±2,69, most of them in primary healthcare (47%). Most frequent symptoms were musculoskeletal (22%), gastrointestinal (17%), sensitive (14%) and sensory organs (14%). Median number of diagnostic tests per patient was 6 (IQR 7), and drug prescriptions per patient was 6 (IQR 9). Most frequently prescribed drugs were analgesic/anti-inflammatories, antibiotics and anxiolytics and there was a high request rate of MRIs., Conclusion: RRMS patients had a high frequency of healthcare utilization when compared to national data. This supports the current evidence showing a prodromal phase in MS., (Copyright © 2021. Published by Elsevier B.V.)

Background: A significant proportion of pediatric-onset multiple sclerosis (POMS) patients do not respond to first-line disease-modifying therapies. Clinical trials showed that natalizumab is effective and safe in adults, but there are limited clinical trial data for children. Natalizumab is currently prescribed off-label for POMS. We aimed to characterize the effectiveness, safety and tolerability of natalizumab in all POMS cases treated in Portugal (from 2007 to 2018)., Methods: Data from clinical records were retrospectively collected for all POMS cases treated with natalizumab in Portugal., Results: Twenty-one patients were included, 14 (67%) of which were female. The median age at POMS diagnosis was 13 years old. The median duration of treatment with natalizumab was 2 years and 3 months. Median Expanded Disability Status Scale score decreased from 1.5 to 1.0 after 24 months. The Annualized Relapse Rate decreased from 1.31 events/patient/year before treatment with natalizumab to 0 after 12 months of treatment and to 0.04 after 24 months. No gadolinium-enhancing lesions or new or enlarged T2 hyperintense lesions were observed in 8/8 patients (100%) after 12 months, and 4/5 (80%) after 24 months. There was one possible serious adverse event, which did not require dose adjustment. Five patients discontinued treatment due to positive anti-JCV (JC virus) antibody JC serostatus., Conclusion: Natalizumab may be an effective and safe disease-modifying therapy for POMS. Our results are in line with data published for the adult population, as well as with similar observational studies in pediatric populations in other regions., Competing Interests: Declaration of Competing Interest Filipe Palavra: Participates as investigator in clinical trials and observational studies sponsored by Biogen, Novartis, Merck, Roche, Sanofi-Genzyme and Teva. Received clinical research funding from Biogen and Merck. Received personal compensation for participating on advisory boards from Novartis, Biogen, Teva, Sanofi-Genzyme, Merck, Bayer and Roche and for participating as a speaker at meetings and teaching courses sponsored by Biogen, Novartis, Merck, Teva and Sanofi-Genzyme. Sónia Figueiroa: Participates as investigator in clinical trials and observational studies sponsored by Biogen. Received clinical research funding from Biogen. Received personal compensation for participating on advisory boards from Merck. Ana Sofia Correia: Participates as investigator in clinical trials and observational studies sponsored by Biogen, Novartis and Sanofi-Genzyme. Received an educational sponsorship from Merck Serono. Received personal compensation for participating on advisory boards from Novartis, Biogen, Sanofi-Genzyme, Merck and Roche and for participating as a speaker at meetings and teaching courses sponsored by Biogen, Novartis and Merck. Fernando Tapadinhas: Has no conflicts of interest to disclose. João Cerqueira: Participates as investigator in clinical trials and observational studies sponsored by Biogen, Novartis, Merck, Roche, Celgene and J&J. Received research funding from Biogen. Received personal compensation for participating on advisory boards from Novartis, Biogen, Teva, Sanofi-Genzyme, Merck, Bayer and Roche and for participating as a speaker at meetings and teaching courses sponsored by Roche, Biogen, Novartis, Merck, Teva and Sanofi-Genzyme. Rui Pedro Guerreiro: Participates as investigator in clinical trials and observational studies sponsored by Biogen, Novartis, Merck and Sanofi-Genzyme. Received personal compensation for participating on advisory boards from Novartis, Biogen, Sanofi-Genzyme, Merck and Bayer and for participating as a speaker at meetings and teaching courses sponsored by Biogen, Novartis and Merck. João de Sá: Participates as a speaker at meetings and teaching courses sponsored by Biogen, Sanofi-Genzyme, Novartis, Merck and Roche. Maria José Sá: Participates as investigator in clinical trials and observational studies sponsored by Biogen, Novartis, Merck, Roche, Sanofi-Genzyme and Teva. Received personal compensation for participating on advisory boards from Bayer, Biogen, Novartis, Teva, Sanofi-Genzyme, Merck and Roche and for participating as a speaker at meetings and teaching courses. Sofia Almeida: Employee of and hold stock and/or stock options in Biogen. Patrícia Mota: Employee of and hold stock and/or stock options in Biogen. Lívia Sousa: Participates as investigator in clinical trials and observational studies sponsored by Biogen, Novartis, Merck, Roche, Sanofi-Genzyme and Teva. Received personal compensation for participating on advisory boards from Bayer, Biogen, Novartis, Teva, Sanofi-Genzyme, Merck and Roche and for participating as a speaker at meetings and teaching courses., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Introduction: Radiologically isolated syndrome (RIS) refers to the incidental discovery of white matter lesions suggestive of MS, on brain MRI, in asymptomatic patients. Recent studies suggest similar features of cognitive impairment between RIS and MS patients. Also, lower levels of health-related quality of life (QOL) and fatigue are reported in such patients., Aims: characterize and compare the cognitive profile of a multicentric Portuguese cohort of RIS patients with a control group., Methods: multicentric comparative study of a cohort of adult patients with RIS, and age and gender-matched controls followed in the headache outpatient clinic with prior MRI not fulfilling criteria for RIS diagnosis. We conducted interviews with participants, collected clinical data and applied the BICAMS battery and self-reported questionnaires (HADS, MFIS, MSQOL-54)., Results: we evaluated 31 patients with RIS (median age 46 years, IQR [(Dusankova et al., 2012-52], 72% women) and 19 control individuals (median age 32 years, IQR [(O'Jile et al., 2005-48], 71% women). Prevalence of cognitive impairment did not differ between groups (16% of the RIS and 10% of the controls, p=0.579). We found no differences between groups on the BICAMS tests, although the results of the California Verbal Learning Test (CVLT-II) score presented a trend to significance, with a lower value on the RIS group (53.9 vs. 59.3, p=0.066). There were no significant differences regarding fatigue, QOL, anxiety/depression scores., Conclusion: this is the first study on a Portuguese cohort of RIS patients assessing cognitive profile with BICAMS. A non-neglectable part of our cohort presented cognitive impairment. Our findings add to previous studies in suggesting that a more pronounced impairment of verbal memory and learning, evaluated by CVLT-II, may be present in RIS patients compared to controls. BICAMS should be assessed on future studies with larger cohorts., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Multiple sclerosis typically affects young women of reproductive age. Therefore, all healthcare professionals involved in the follow-up of multiple sclerosis patients must be prepared to discuss pregnancy and breastfeeding issues and provide the best possible counselling. However, there are still many doubts and heterogeneous clinical approaches partly due to the lack of consensus and guidelines. Concerning the handling of disease modifying therapies during pregnancy and postpartum, existing uncertainties have been complicated by the increase in the number of treatments available in recent years. This article aims to present the state-of-the-art and provide guidance based on the best level of available evidence and expert opinion regarding the management of multiple sclerosis patients at different stages: pregnancy planning, pregnancy, partum, and the postpartum period.

Background: Capture-recapture methods (CRMs) are well established in epidemiologic surveillance and considered useful for the task of correcting for case-finding limitations in multiple sclerosis (MS) prevalence surveys. To date, however, CRMs have been exclusively applied to crude prevalence figures. This study therefore sought to explore an age-specific application of this method to an urban Portuguese population of 229,342., Methods: We used a CRM to correct for the age-specific prevalence of MS obtained from two data sources, i.e. general practitioners in three primary-care districts and a neurology unit at the referral hospital. The corrected figures were adjusted for age using the European standard population as reference., Results: When applied to 95 MS patients, the CRM impact was highest at ages 50-59 years, with a 110% increase in cases where the corrected prevalence was highest, i.e. 181.8 (95% CI 75.7-287.9) per 100,000, and lowest, nil, at ages ≥70 years, with an unchanged corrected prevalence of 13.8. The crude prevalence of 41.4 per 100,000 increased by 36% to 56.20 per 100,000 when it was CRM- and age-adjusted. Source independence was poor., Conclusions: CRMs can be differentially applied to MS counts. Valid comparisons may require simultaneous adjustment for age and other variables, such as diagnostic delay and diagnostic criteria. CRM applications to crude figures and dependent sources should be approached with caution., (Copyright © 2012 S. Karger AG, Basel.)

Objective: To evaluate the satisfaction level of multiple sclerosis (MS) patients treated with interferon beta-1b (IFNbeta-1b, Betaferon*) using a newly developed application system compared to their currently used application system., Methods: A survey was conducted in Portugal in patients treated with IFNbeta-1b for relapsing-remitting MS with the Betaject or Betaject Lite autoinjector. Nurses demonstrated the new application system and supervised the first injection. Patients rated their overall satisfaction retrospectively with their current application system and prospectively after the first, the seventh and the 15th injection with the newly developed application system. Additionally, the ease of use was evaluated for both application systems using a questionnaire consisting of 13 questions. Responses were compiled and descriptive analyses performed., Results: A total of 249 patients evaluated the current and the new system after the first, 235 after the seventh and 174 after the 15th injection. The satisfaction level was high with the current system (70.3%, 'satisfied' or 'very satisfied'). However, compared with the current system, more patients were either 'satisfied' or 'very satisfied' (98%) with the new system after first injection. Only a minority of patients rated 'somewhat satisfied': 2.0% after the first, 8.6% after the seventh, and 4.4% after the 15th injection. Increased overall satisfaction level ('satisfied' or 'very satisfied') with the newly developed system was maintained over time (98% - first, 90.5% - seventh, 93.8% - 15th injection). The thinner, pre-attached 30-gauge needle and the visual signalling of injection completion were among the changes considered as strong improvements to the new system by up to 80.3% of patients., Limitation: Retrospective analysis of current system., Conclusions: This survey documented patient satisfaction with different application systems of IFNbeta-1b. The increased satisfaction with the new application system indicates an improvement to the currently used injection system, which may contribute to further advancement in adherence and consequently higher clinical efficacy of treatment.

Introduction: Foreign body aspiration (FBA) is frequent in children but uncommon in adults it's and often remains hidden for long periods of time. A high index of suspicion is essential for the correct diagnosis of this condition. Early extraction of FB avoids sequelae and complications., Methods: Retrospective study of FBA cases in adults that occurred in a 20 year period (1985-2005). The authors reviewed of the clinical records of all patients admitted with the diagnosis of foreign body in the airway in that time period., Results: In that period of time 77 FB were extracted. Male:female ratio was 68:32%, mean age was 51.4 years and mean delay between FB aspiration and removal 401 days (min: 3 h, max: 21 years). Most common clinical presentations: acute asphyxia in 28%, persistent cough 22%. Nature of FB: bone fragments 33%, vegetable matter 31%. The majority of FBs (61%) was lodged in the right bronchial tree; 26% were radiopaque. Rigid bronchoscopy was performed in 75 cases and fiberoptic bronchoscopy in only two. Two patients needed two bronchoscopies for FB removal. There were no complications, need for surgery or relevant sequelae., Conclusions: FBA may happen at any age. In adults the clinical presentation is variable and the FBA episode is often missed, delaying the diagnosis. Rigid bronchoscopy proved to be an efficient and safe procedure. FBA must be a diagnostic hypothesis when studying an adult with long standing respiratory complaints.

After a brief review of computer assisted ECG interpretation techniques, a microcomputer-based system for off-line ECG (Frank) analysis and interpretation developed at the University of Porto is presented. The program is menu-structured and includes report correction and editing facilities. Clinical data can be stored along with the ECG in the individual patient file. More than 500 characteristics are extracted from the ECG signal by the measurement section of the program. The diagnostic section uses Boolean-tree logic. The diagnostic threshold values and interpretation statements are kept in an independent file and can be changed at any moment by the user. Taking the cardiologist using the same logic and criteria as reference standard, an evaluation of the diagnostic efficiency of the system was performed in 509 reports from pediatric and adult patients: 7% of the reports needed corrections and 113 (3.7%) out of 3070 diagnostic statements produced had to be changed. Output options include the clinical data, more or less extensive listings of the wave measurements, X, Y and Z and polar plots and the 12-lead (derived) ECG, besides the interpretation report itself.

Objective: to characterize and to assess in terms of severity the surgical and trauma patients admitted to a medical intensive care unit (ICU)., Design: retrospective study base on clinical records and the ICU computerized database., Setting: the medical ICU of a tertiary hospital., Results: of the 2468 patients admitted to the ICU in 1989, 289 (11.7%) were surgical or trauma ones. The more frequent reasons for admission were: the need for mechanical ventilation, metabolic problems, and depression of consciousness. Of these 289 patients, 48.1% required mechanical ventilation, 14.9 hemodialysis; 4.8% had a pulmonary artery catheter inserted. Mean APACHE II, TISS and MOF scores were high (20.09 +/- 9.29, 24.17 +/- 11.45 and 5.4 +/- 3.59); they were determined in 79.2, 88.2 and 43.9% of patients respectively. Both APACHE and TISS scores were correlated with mortality. When compared with medical patients, surgical/trauma ones although younger (52.9 +/- 20.7 years versus 55.9 +/- 20.2, p = 0.00152), had a longer mean stay in the ICU (7.63 +/- 12.7 days v. 3.64 +/- 7.61, p = 0.0001), and a higher mortality (also in the ICU) (28.7 v. 16.7, p = 0.0005., Comments: these are seriously ill patients, who are frequently referred to the ICU in late stages of clinical evolution. We propose they should be closely followed, from the earliest possible stage, by medical-surgical teams, in order to benefit from a multidisciplinary approach.

A computer program for ECG analysis and interpretation developed at the University of Porto, Portugal is presented. The program runs on a microcomputer and employs the three-lead Frank VCG. The signals are sampled at 250 Hz with 8-bit precision during 5.5 s. Details on signal conditioning and wave recognition and measurement techniques are given. The diagnostic part of the program uses decision-tree logic. The decision rules are mainly derived from the Washington Code. The diagnostic accuracy of four classes (normal, left and right ventricular hypertrophies and myocardial infarction), evaluated in a sample of 1,075 pediatric and adult patients and classified by ECG-independent means was 76%. The program is currently being evaluated on the CSE database.