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Introduction: Acute pharyngitis is a common diagnosis in primary care. Although viruses are the most common aetiology, antibiotic therapy is frequently prescribed. The inappropriate antibiotic prescription should be avoided to prevent antibiotic resistance. Many national and international guidelines recommend testing for group A streptococcus (GAS) before antibiotic treatment when clinical presentation suggests GAS infection. Aim: This study aims to describe the feasibility of the implementation of the rapid antigen detection test (RADT) in a primary care setting and its impact on antibiotic prescription. Secondary goals include the evaluation of possible associations between symptoms and RADT results. Methods: From October 2019 to March 2020, patients presenting with acute pharyngitis at USF do Parque were eligible. A questionnaire was applied to divide the individuals into four different groups (clearly viral, probably viral, diagnostic doubt, and probably bacterial), and to assess the previous intention to prescribe antibiotics. We applied 136 questionnaires and performed 133 RADT. Nursing staff classified the specimen collection process and result from interpretation according to its difficulty. The proportion of antibiotics avoided was estimated as the number of times physicians changed their intended antibiotic prescription following a negative RADT result. Results: Among the tests performed, 97.7% were easy to interpret. Without RADT, 45 patients were going to be prescribed an antibiotic. After the test result, 27 antibiotic prescriptions were avoided. Tonsil hypertrophy, palatal petechiae, and fever increased the odds of a positive RADT result. Cough was associated with a negative RADT result. Conclusions: This study showed that RADT is easy to implement and contributed to appropriate antibiotic prescription. Tonsil hypertrophy, palatal petechiae, and fever were significantly associated with a positive RADT result, and cough was associated with a negative RADT result. Primary care centers would benefit from having RADT available when there is a strong suspicion or doubt of bacterial pharyngitis.

A recessão gengival é uma condição frequente encontrada tanto pelo cirurgião-dentista quanto pelo paciente. É definido como o deslocamento apical da margem gengival além da junção cemento-esmalte. Provocando diferentes alterações no periodonto, entre as elas podem ser citadas hipersensibilidade dentinária e sensação de dente alongado. Tendo como objetivo relatar um caso clínico de recessão gengival classe III de Miller em uma paciente do sexo feminino, 45 anos, leucoderma, apresentando sensibilidade dentinária nos dentes anteroinferiores sendo proposto a técnica do enxerto gengival livre subepitelial. Considerado uma opção superior em comparação com a técnica do enxerto gengival livre clássico.

Heart failure and liver dysfunction can coexist owing to complex cardiohepatic interactions including the development of hypoxic hepatitis and congestive hepatopathy in patients with heart failure as well as 'cirrhotic cardiomyopathy' in advanced liver disease and following liver transplantation. The involvement of liver dysfunction in patients with heart failure reflects crucial systemic hemodynamic modifications occurring during the evolution of this syndrome. The arterial hypoperfusion and downstream hypoxia can lead to hypoxic hepatitis in acute heart failure patients whereas passive congestion is correlated with congestive hepatopathy occurring in patients with chronic heart failure. Nowadays, liquid biopsy strategies measuring liver function are well established in evaluating the prognosis of patients with heart failure. Large randomized clinical trials confirmed that gamma-glutamyltransferase, bilirubin, lactate deihydrogenase, and transaminases are useful prognostic biomarkers in patients with heart failure after transplantation. Deeper knowledge about the pathogenic mechanisms underlying cardiohepatic interactions would be useful to improve diagnosis, prognosis, and treatments of these comorbid patients. Epigenetic-sensitive modifications are heritable changes to gene expression without involving DNA sequence, comprising DNA methylation, histone modifications, and noncoding RNAs which seem to be relevant in the pathogenesis of heart failure and liver diseases when considered in a separate way. The goal of our review is to highlight the pertinence of detecting epigenetic modifications during the complex cardiohepatic interactions in clinical setting. Moreover, we propose a clinical research program which may be useful to identify epigenetic-sensitive biomarkers of cardiohepatic interactions and advance personalized therapy in these comorbid patients.

Publisher Copyright: © 2021 The Author(s). Erratum: Correction to: Discontinuation of chronic benzodiazepine use in primary care: a nonrandomized intervention (Family Practice. 2022;39(2):241-248). Family Practice. 2022.39(3):563. (WOS: 000788675100001), (PMID:35485949), (Scopus ID: 85131225556). Background: Chronic benzodiazepine use is a challenge in primary care practice. Protocols to support safe discontinuation are still needed, especially in countries with high utilization rates. Objectives: To evaluate the feasibility, effectiveness, and safety of a benzodiazepine discontinuation protocol in primary care setting. Methods: Nonrandomized, single-arm interventional study, at primary care units. Family physicians (FPs) recruited patients (18-85 years-old) with benzodiazepine dependence and chronic daily use ≥3 months. Patients with daily dosages ≥30 mg diazepam-equivalent, taking zolpidem, with a history of other substance abuse or major psychiatric disease were excluded. After the switch to diazepam, the dosage was gradually tapered according to a standardized protocol. Primary endpoint was the percentage of patients who stopped benzodiazepine at the intervention last visit. Dosage reduction, withdrawal symptoms, patients' and FPs' satisfaction with the protocol were evaluated. Results: From 66 enrolled patients (74% female; 66.7% aged >64 years; median time of benzodiazepine use was 120 months), 2 withdrew due to medical reasons and 3 presented protocol deviations. Overall, 59.4% of participants successfully stopped benzodiazepine (60.7% when excluding protocol deviations). Men had higher probability of success (relative risk = 0.51, P = 0.001). A total of 31 patients reported at least 1 withdrawal symptom, most frequently insomnia and anxiety. Most of participating FP considered the clinical protocol useful and feasible in daily practice. Among patients completing the protocol, 77% were satisfied. For the patients who reduced dosage, 85% kept without benzodiazepines after 12 months. Conclusion: The discontinuation protocol with standardized dosage reduction was feasible at primary care and showed long-term effectiveness. publishersversion publishersversion published

Current management of patients undergoing allogeneic hematopoietic stem cell transplantation (allo-HSCT) lacks immunosuppressant drugs able to block the host immune response toward the graft antigens. Novel treatments may include epigenetic compounds (epidrugs) some of which have been yet approved by the Food and Drugs Administration for the treatment of specific blood malignancies. The most investigated in clinical trials for allo-HSCT are DNA demethylating agents (DNMTi), such as azacitidine (Vidaza) and decitabine (Dacogen) as well as histone deacetylases inhibitors (HDACi), such as vorinostat (Zolinza) and panobinostat (Farydak). Indeed, azacitidine monotherapy before allo-HSCT may reduce the conventional chemotherapy-related complications, whereas it may reduce relapse risk and death after allo-HSCT. Besides, a decitabine-containing conditioning regimen could protect against graft versus host disease (GVHD) and respiratory infections after allo-HSCT. Regarding HDACi, the addition of vorinostat and panobinostat to the conditioning regimen after allo-HSCT seems to reduce the incidence of acute GVHD. Furthermore, panobinostat alone or in combination with low-dose decitabine may reduce the relapse rate in high-risk patients with acute myeloid leukemia patients after allo-HSCT. We discuss the phase 1 and 2 clinical trials evaluating the possible beneficial effects of repurposing specific epidrugs which may guide personalized therapy in the setting of allo-HSCT.

The lack of a precise stratification algorithm for predicting patients at high risk of graft rejection challenges the current solid organ transplantation (SOT) clinical setting. In fact, the established biomarkers for transplantation outcomes are unable to accurately predict the onset time and severity of graft rejection (acute or chronic) as well as the individual response to immunosuppressive drugs. Thus, identifying novel molecular pathways underlying early immunological responses which can damage transplant integrity is needed to reach precision medicine and personalized therapy of SOT. Direct epigenetic-sensitive mechanisms, mainly DNA methylation and histone modifications, may play a relevant role for immune activation and long-term effects (e.g., activation of fibrotic processes) which may be translated in new non-invasive biomarkers and drug targets. In particular, the measure of DNA methylation by using the blood-based ?epigenetic clock? system may be an added value to the donor eligibility criteria providing an estimation of the heart biological age as well as a predictive biomarkers. Besides, monitoring of DNA methylation changes may aid to predict acute vs chronic graft damage in kidney transplantation (KT) patients. For example, hypermethylation of genes belonging to the Notch and Wnt pathways showed a higher predictive value for chronic injury occurring at 12 months post-KT with respect to established clinical parameters. Detecting higher circulating cell-free DNA (cfDNA) fragments carrying hepatocyte-specific unmethylated loci in the inter-alpha-trypsin inhibitor heavy chain 4 (ITIH4), insulin like growth factor 2 receptor (IGF2R), and vitronectin (VTN) genes may be useful to predict acute graft injury after liver transplantation (LT) in serum samples. Furthermore, hypomethylation in the forkhead box P3 (FOXP3) gene may serve as a marker of infiltrating natural Treg percentage in the graft providing the ability to predict acute rejection events after heart transplantation (HTx). We aim to update on the possible clinical relevance of DNA methylation changes regulating immune-related pathways underlying acute or chronic graft rejection in KT, LT, and HTx which might be useful to prevent, monitor, and treat solid organ rejection at personalized level. ? 2021 Elsevier Inc. All rights reserved.

Objective Smoking, unhealthy diet and obesity, sedentary behavior and inability to maintain adequate exercise have significant consequences for several chronic disorders. Blood centers can play a public health role in obesity surveillance and interventions. The purpose study was to evaluate the health status of the blood donors by monitoring the nutritional habits and lifestyle. Methods A descriptive cross-sectional face-to-face questionnaire was developed. It included a 41 item dietary assessment, reporting semi-quantitative food frequency, dietary behavior and questions on self-rated health status. Donors were regular repeat blood donors, eligible to donate. Results Of the 2468 blood donors enrolled between July 2017 and January 2018, 1390 were repeat donors. Only 205 agreed to respond to the questionnaire. Data showed that donors followed mainly a Mediterranean diet and had more awareness to lifestyle, women more than men, in comparison with general population. The prevalence of overweight was found 50.7% in men and 16.9% in women. Conclusions Overweight and obesity are common among regular blood donors and it is more frequent in men than women. The female blood donors seem to be characterized by better knowledge on the relationship between lifestyle and health, and by a better "putting into practice" of the information possessed.

In recent years, the seroprevalence of anti-hepatitis E virus immunoglobulins (HEV) has increased in European countries with significant variability among the different geographical areas. HEV infection is spread in a wide range of animal species of which domestic pigs and wild boar represent the main reservoirs of genotype 3 and 4 (the genotypes present also in Europe). European citizens are incidental hosts, mainly infected by direct contact or consumption of foods derived from undercooked or insufficient hygiene handling infected pork products or wild boar meat. Epidemiologically, the HEV incidence is low in humans but serological data show a high proportion of subclinical infection caused by genotypes 3 or 4. In the general population, asymptomatic infection represents a high potential risk in particular subjects such as blood component recipients or occupationally exposed workers. This review offers a landscape of the current epidemiological status of HEV infection (genotypes 1, 2, 3, 4, 7) both in European asymptomatic subjects, patients with chronic diseases, and domestic pig impact on humans. We also underline advantages/disadvantages of high sensitivity and specificity tests using for detecting viral RNA or anti-HEV antibodies.

INTRODUCTION: Blood transfusion is a lifesaving procedure for patients affected by hematological diseases or hemorrhage risk. AIM: This retrospective study was aimed to evaluate clinical safety of pediatric transfusions by comparing the frequency of adverse events caused by apheretic blood components vs whole blood. METHODS: From 2011 to 2015, 214 patients (blood malignancy patients, n = 144 and thalassemic patients, n = 70) received 12 531 units of blood components. The adverse acute reactions occurred during patient hospitalization were reported to the Hemovigilance system and assessed by fitting a logistic mixed-effect model. RESULTS: A total of 33 (0.3%) adverse acute events occurred. Odds ratio (OR) of adverse events from apheresis vs whole blood transfusion adjusted by patient classification was not statistically significant (OR [95% CI], 0.75 [0.23-2.47]). CONCLUSION: Our findings showed no significant differences in the prevalence of adverse acute events between blood component collected by apheresis vs whole blood in our study center.

Background Patients with end-stage liver disease (ESLD) have a compromised nutritional status because of the liver crucial role in regulating metabolic homeostasis and energy balance. Data sources A systematic review of literature based on extensive relevant articles published from 2001 to 2017 in English in PubMed database was performed by searching keywords such as liver disease, non-alcoholic liver disease, alcoholic liver disease, malnutrition, epigenetics, gut microbiota, and probiotics. Results Liver transplantation would be one eligible therapy for ESLD patients, even if, the clinical outcome is negatively influenced by malnutrition and/or infections. The malnutrition is a condition of nutrient imbalance with a high incidence in ESLD patients. An accurate evaluation of nutritional status could be fundamental for reducing complications and prolonging the survival of ESLD patients including those undergoing liver transplantation. In addition, the interaction among nutrients, diet and genes via epigenetics has emerged as a potential target to reduce the morbidity and mortality in ESLD patients. The malnutrition induces changes in gut microbiota causing dysbiosis with a probable translocation of bacteria and/or pathogen-derived factors from the intestine to the liver. Gut microbiota contribute to the progression of chronic liver diseases as well as hepatocellular carcinoma. The administration of probiotics modulating gut microbiota could improve all chronic liver diseases. Conclusions This review provides an update on malnutrition status linked to epigenetics and the potential benefit of some probiotics on the management of ESLD patients. In support of this view and to reveal the constant and growing interest in this field, some clinical trials are reported.

Intravenous immunoglobulin (IVIG) products are known to have beneficial immunomodulatory effects on several inflammatory and autoimmune disorders. These effects could be attributed to a different inhibitory action on complement factors, but other mechanisms could be implicated, e.g., immunocomplexes development and/or anti-idiotypic antibodies. Positive results on the reduction of anti-Human Leukocyte Antigens (HLA) antibodies in highly sensitized patients have also been found. The present study focuses on the effect of IVIG on the reduction of Panel Reactive Antibody level and crossmatch positivity in sensitized patients awaiting kidney transplantation.The study was performed adapting an in vitro assay on sensitized patients' sera in waiting list for kidney transplantation. Sera of twelve highly sensitized patients were evaluated for the cytotoxicity inhibition after 10% IVIG treatment.A reduction of anti- HLA antibody levels was observed in 75% (9/12) of treated patients in vitro, while 25% (3/12) resulted unresponsiveness. Particularly, our data showed a significantly higher Panel Reactive Antibody reduction for T lymphocytes (p0.010) than B lymphocytes (p0.032).In this study, we have used an in vitro assay to investigate susceptibility to desensitization with IVIG treatment of sensitized patient sera. These findings reveal that the variable effect of IVIG on reducing Panel Reactive Antibody in our immunized patients could be attributed to a different inhibitory action on complement, likely due to the type and the titre of anti-HLA antibodies.

Automated chemiluminescent immunoassays (CLIAs) are useful for the detection of hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus 1/2 antigen/antibodies (HIV 1/2 Ag/Ab) in blood donor screening. Eight hundred and forty serum samples were tested for hepatitis B surface antigen (HBsAg), HCV antibodies (anti-HCV), and HIV1/2 Ag/Ab in parallel using 2 different CLIAs (Abbott Architect i2000SR and Roche Cobas e411). The concordance between the 2 systems was high (Cohen's kappa 0.97 for HBsAg, 0.77 for anti-HCV, 0.92 for HIV1/2 Ag/Ab) and the specificity and the positive predictive value were comparable. Among the 12 discrepant results, 11 were false-positive and 1 (reactive by Architect) was true-positive for anti-HCV. Positivity for HBV DNA, HCV RNA, and HIV RNA was recorded in 90.9%, 38.9%, and 100% of true-positive samples, respectively. This study represents the first stringent comparison between Architect i2000SR and Cobas e411 in blood donors. We observed a good correlation and high agreement among HBV, HCV, and HIV with the 2 automated systems.

Objectives: To assess the impact of the increase in user fees on the demand for primary health care in the Parque Family Health Unit, to compare consultation rates in the Parque FHU between January 1and May 31, 2011, and the same period in 2012, and to identify factors associated with patient demand for care in this unit. Design: Retrospective longitudinal, observational and analytical. Setting: Parque Family Health Unit, North Lisbon Health Centres Group (ACES Lisboa Norte) Population: Patients of the Parque Family Health Unit. Methods: A convenience sample of patients was selected from the health records of the Family Health Unit. The Student’s t-test, Anova, Pearson correlation and Spearman correlation were used with statistical significance set at the 5% level. Results:We analyzed the records of 338 patients. The majority were female (n = 241; 71,3%), with a mean age of 57 years (standard deviation = 18,92). There was an increase in the consultation rate from 2011 to 2012. The mean number of visits was 0.87 (IC95% 0.623-1.129, p < 0.01). Older patients, patients with more illnesses, and those taking daily medication had higher visiting rates (p < 0.05). There were fewer visits made by patients with a higher monthly income (p < 0.05). A positive correlation between the number of illnesses and the number of medical visits was observed in patients exempt from user fees. Conclusions: In 2012 the number of visits to the Health Unit increased. Advanced age, a larger number of illnesses and daily medication use were associated with a greater number of visits. Higher economic status was associated with lower visiting rates in both study periods. The increase in user fees did not have a negative impact on patient demand for primary health care in the Parque Family Health Unit., Objectivos: Averiguar o impacte do aumento das taxas moderadoras na procura dos cuidados de saúde primários na USF do Parque. Comparar as afluências às consultas na USF do Parque nos períodos homólogos de 1 de Janeiro a 31 de Maio dos anos 2011 e 2012. Identificar outros factores relevantes na afluência dos utentes às consultas da USF. Tipo de Estudo: Longitudinal retrospectivo, Observacional e Analítico. Local: USF do Parque, ACES Lisboa Norte. População: Utentes utilizadores da USF do Parque. Métodos:Amostragem por conveniência. Colheita de dados realizada através de questionário e consulta dos registos informáticos da USF. Análise dos resultados através do programa SPSS Statistics versão 19, com nível de significância estatística de 5%, com recurso aos testes t de Student, Anova, correlação de Pearson e correlação de Spearman. Resultados: Foram analisados 338 doentes com predomínio do sexo feminino (n = 241; 71,3%), com uma média de idades de 57 anos (DP = 18,92). Registou-se um aumento do número de consultas de 2011 para 2012 de 0,87 consultas por utente (IC95%: 0,623-1,129) (p < 0,01). Utentes mais idosos, com mais patologias e medicação diária apresentam maior afluência às consultas (p < 0,05). Houve menos consultas em utentes cujo rendimento mensal do agregado é elevado (p < 0,05). Verificou-se ainda uma correlação positiva superior entre o número total de patologias e consultas na população isenta, em 2012 (p < 0,05). Conclusões: O número de consultas em 2012 foi superior a 2011. A idade avançada, a multipatologia e a medicação diária justificam um maior número de consultas de seguimento. Um maior rendimento económico contribuiu para uma menor afluência em ambos os períodos. O aumento das taxas moderadoras não apresentou um impacte negativo no recurso às consultas da USF do Parque.

Clinical guidelines have the potential to increase health gains, but also to cause harm. In this opinion article we state some misgivings about the application of the Portuguese National Health Directorate's guideline type 2 diabetes therapy: metformin in primary care. We seek to highlight guideline wording that may allow for multiple interpretations (alternatives to monotherapy with metformin, hierarchy of drugs to be associated with metformin, and metformin contraindications). Furthermore, we argue that it seems that choosing a glycemic target of 6.5% in a normative document to be applied in the general population may have unforeseen consequences. publishersversion published

A prescrição de um ou mais agentes farmacológicos constitui a forma de terminar a maior parte das consultas médicas. O modo como os medicamentos são utilizados tem consequências óbvias para a saúde dos indivíduos e das populações e para a utilização eficiente dos recursos de saúde disponíveis. Este assunto interessa aos decisores políticos, aos profissionais de saúde, aos doentes e ao público em geral.

Apresentam-se os resultados de um estudo destinado a caracterizar e avaliar a adequação da prescrição de antibióticos para infecções respiratórias por parte dos médicos de Medicina Geral e Familiar (MF). Para o efeito, foi inquirida, entre os meses de Dezembro de 2001 e Janeiro de 2002, uma amostra aleatória de MF, estratificada por etapas sucessivas, quanto ao tipo de antibiótico prescrito em infecções do foro respiratório. Participaram no estudo, enviando pelo menos uma ficha adequadamente preenchida, 247 médicos de Clínica Geral e da carreira de Medicina Geral e Familiar. Foi avaliado um total de 2.200 prescrições, correspondendo a 2.257 indicações. A idade média dos doentes foi de 31,87. As indicações para a prescrição de antibióticos com 100 ou mais inquéritos válidos foram, por ordem decrescente de frequência, a amigdalite (663, 29,38%), bronquite (430, 19,05%), otite (315, 13,96%), sinusite (232, 10,28%), faringite (228, 10,10%), rinite/rinofaringite (212, 9,39%), e a pneumonia (116, 5,14%). Os grupos ATC3 de antimicrobianos mais prescritos foram, por ordem decrescente de frequência, os betalactâmicos/ penicilinas (50,55%), os macrólidos (23,09%), as cefalosporinas (14,77%), as quinolonas (8,32%), as tetraciclinas (2,45%) e as sulfonamidas/trimetoprim (0,59%). No referente ao nível ATC5, o antimicrobiano mais prescrito foi a associação amoxicilina/ácido clavulânico (35,36%), a qual foi, também, o antibiótico mais prescrito em cada uma das situações clínicas referidas. No que respeita ao perfil dos fármacos escolhidos para cada indicação, foram evidenciadas situações de clara inadequação, salientando-se a larga e não justificada utilização da associação amoxicilina/ácido clavulânico no tratamento da amigdalite/faringite. Os antibióticos foram frequentemente prescritos em situações clínicas nas quais não estão formalmente indicados e as recomendações do FEM quanto a fármacos de primeira linha apenas foram observadas para a pneumonia. Os autores concluem pela possibilidade de obter benefícios clínicos e económicos significativos melhorando a prática clínica corrente nesta área específica através de intervenções apropriadas., The authors present the results from a prospective study aimed at the characterization and evaluation of the adequateness of the prescription of antimicrobials for systemic use in respiratory infections in primary care. For the purposes of the study, ten similar questionnaires concerning the type of antibiotic which was prescribed for respiratory tract infections were submitted to a sample of general practitioners (GP), randomized by successive staging, at the national level, between December 2001 and January 2002. Two hundred forty seven GP have participated in the study by sending back, at least, one adequately filled questionnaire. A total of 2200 prescriptions were evaluated, corresponding to 2257 therapeutic indications. Mean patient’s age was 31.87 years. The indications leading to antibiotic prescription in those with 100 or more validated questionnaires were tonsillitis (663, 29.38%), bronchitis (430, 19.05%), otitis (315, 13.96%), sinusitis (232, 10.28%), pharyngitis (228, 10.10%), rhinitis/rhinopharyngitis (212, 9.39%) and pneumonia (116, 5.14%). The most frequently prescribed antimicrobials at the ATC3 level were betalactam/penicillins (50.55%), macrolides (23.09%), cephalosporins (14.77%), quinolones (8.32%), tetracyclines (2.45% and sulphonamides/trimethoprim (0.59%). At the ATC5 level, the most frequently prescribed antimicrobial was amoxycillin/clavulanic acid (35.36%), which was also the most frequently prescribed antibiotic for each individual indication. As far as the choice for the antibiotic for each indication is concerned, some inadequacies were detected, namely regarding the large and unjustified use of amoxycillin/clavulanic acid for the treatment of tonsillitis. Also, antimicrobials were frequently prescribed for situations for which they are not currently formally indicated, and the recommendations of the European Drug Formulary regarding first-line treatment for the concerned indications were not observed, with the exception of pneumonia. The authors conclude that significant clinical and economic benefit may be obtained by improving current clinical practice through appropriate interventions.

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O actual sistema de saúde apresenta limitações e constrangimentos vários, dos quais se destacam, uma reduzida acessibilidade, a duplicação de cuidados, a ausência de comunicação entre cuidados primários e cuidados hospitalares e a ausência de garantia de continuidade e globalidade de cuidados. Apesar das insuficiências do sistema, bem reconhecidas por todos, diversos factores de natureza institucional, cultural, política e económica constituem barreiras ao processo de mudança, fazendo com que hospitais e centros de saúde continuem, desde há muito, de costas voltadas. No presente artigo, preconiza-se uma abordagem faseada do problema com vista ao estabelecimento de relações e colaboração entre cuidados primários e cuidados secundários, no sentido de criar um sistema de saúde verdadeiramente centrado nos interesses dos cidadãos e não das instituições envolvidas., Limitations and constraints of various natures have been identified to the heath system including low accessibility, duplication of care, absence of communication between primary and secondary care, and lack of continuous and global care. In spite of the well known limitations of the system, institutional, cultural, political and economical factors represent significant barriers to the changing process, creating a gap between hospitals and health centers. In this paper, the author suggests a stepping process aiming to establish communication and cooperation between primary and secondary care as a way to create a patient-centered health system

To determine the number and type of HIV tests requested in general practice (GP) and in hospital outpatient clinics, to identify principle risk behaviors, to determine the percentage of HIV positive tests and to identify possible factors associated with the request of HIV tests. METHODS: Cross-sectional, analytical and observational study, involving 80 GPs and 45 hospital specialists in the region of Lisbon. All requests for HIV tests were analysed during a 12 month period. RESULTS: 936 HIV tests were requested, with a mean of 12.47 in GP and 0.69 in the hospital. Risk behaviors observed were mainly heterosexual contacts and intravenous drug abuse (IVDA). The motives of the requests mainly were pregnancy, risk behaviors in GP and the presence of symptoms suggesting HIV infection in the hospital. The initiative of the request came from doctors in 70% of the cases. The percentage of HIV positive tests (ELISA + Western blot) was 4.2% in GP and 32% in the hospital. According to risk behaviors, the percentage of seropositivity was 33% in homo/bisexuals, 13% in IVDA, 7% in heterosexuals with risk behaviors and 0.2% in individuals with unidentified risk behaviors. CONCLUSIONS: The patterns of request of HIV tests differ in hospital and in GP. In a significant percentage of cases, no informed consent was obtained prior to HIV testing, both in hospital and GP. This study may serve as an indicator of the need for information and education programs concerning HIV testing directed to health professionals and the general population., Objectivos: Determinar o numero e o tipo de testes serológicos para o VIH solicitados em consultas de clinica geral e em consultas hospitalares, identificar os principais comportamentos de risco, determinar a percentagem de seropositividade para o VIR e identificar possíveis factores associados ao pedido dos testes. Métodos: Estudo de observação, transversal e analítico, com a participação de 80 clínicos gerais e 45 especialistas hospitalares. Foram analisados todos os pedi dos de testes serológicos para o VIR feitos durante 1 ano. Resultados: Foram pedidos 936 testes para o VIR, sendo a media por medico de 12,47 na clinica geral e 0,69 no hospital. Os comporta mentos de risco mais vezes observados foram os contactos heterossexuais de risco e a toxicodependência. Os principais motivos de pedido foram a gravidez e a existência de comportamentos de risco na clinica geral e a suspeita de infecção VIH no hospital. A iniciativa do pedido partiu do medico em mais de 70% dos casos. Numa percentagem significativa de casos os testes foram pedidos numa fase em que poderia não ter ocorrido ainda a seropositivação. A percentagem de seropositivos para o VIR (ELISA Westernblot) foi de 4,2% nas consultas de clinica geral e 32% no hospital. A percentagem de seropositividade foi de 33% nos homo/bissexuais, 13% nos toxico dependentes, 7% nos heterossexuais com comportamento sexual de risco e 0,2% nos indivíduos sem factores de risco. Conclusões: Os padrões de pedido dos testes serológicos para o VIR são significativamente diferentes a nível da clinica geral e do hospital. Parecem verificar-se algumas atitudes menos adequadas por parte dos médicos, nomeadamente a ausência de consentimento esclarecido dos doentes antes da realização dos testes, numa percentagem significativa de casos. Estudos deste tipo podem constituir indicadores importantes da percepção do risco de infecção pelo VIR por parte da população em geral e dos próprios profissionais de saúde, permitindo avaliar da necessidade de determinados programas de intervenção, nomeadamente campanhas de informação e formação.

Copyright © 1991 Wiley-Liss, Inc., A Wiley Company, In the course of a study of lymphocyte responses to microbial antigens in HIV-infected patients, we detected a previously unrecognized phenomenon of inhibition of lymphocyte baseline proliferation, induced by the presence of tetanus toxoid and Escherichia coli in the cultures. The effects of tetanus toxoid and Escherichia coli on lymphocyte proliferation in vitro were assessed by comparing the 3H-thymidine uptake by lymphocytes cultured without stimulant with the uptake of lymphocytes cultured in the presence of the antigens. Twenty-six patients with HIV infection (20 asymptomatic/persistent generalized lymphadenopathy, 2 AIDS-related complex, 4 AIDS) were investigated and the controls were 33 healthy individuals without evidence of HIV infection. Eight out of 22 asymptomatic/PGL and ARC patients progressed to full-blown AIDS in the mean follow-up of 26 months. The inhibition of proliferation was considered to be significant when the uptake of 3H-thymidine was reduced by 20% in the presence of the antigens. Using these criteria, 50% of the patients studied with tetanus toxoid and 36% of those studied with E. coli had evidence of the inhibitory phenomenon. Seven of the eight patients who developed AIDS during the observation period had the inhibitory phenomenon. In the group of patients without the inhibitory signs only one evolved to AIDS during the follow-up. The possibility of this phenomenon being related to an induction of suppressor cell activity by the antigens is discussed.

Copyright © 1989 by The Journal of Rheumatology Publishing Co. Ltd., Agranulocytosis and liver injury is described in a patient with Reiter's syndrome of 3 years duration who received pyrazinobutazone for 6 weeks before the development of the clinical picture reported. Other causes of agranulocytosis and hepatic damage were excluded and a lymphocyte transformation test to the drug revealed significant lymphocyte proliferation in response to the drug. This suggests a hypersensitivity reaction as the mechanism for this previously unrecognized association of adverse effects to pyrazinobutazone.

Copyright © 2020 IOS Press All rights reserved., Plant sterols have been reported to decrease plasma concentrations of cholesterol without any side effects. To evaluate the effects on plasma cholesterol concentrations and the hemorheological parameters, we performed a study with hypercholesterolemic patients (n=19) treated with phytosterol-enriched milk (2 g/day). Hypercholesterolemic patients (n=15) of matched age drinking equal type of milk but without phytosterols were used as control group. Concentrations of total cholesterol, HDL-C, LDL-C and hemorheological parameters were measured in the beginning, after 15 and 30 days of milk intake. After 15 days of beverage intake, hypercholesterolemic subjects treated with phytosterol-enriched milk showed a significant decrease in plasma concentrations of total cholesterol and LDL-C by 9.62% (p, This study was supported by grant from Lactogal S.A. of Portugal.

Copyright © Journal of Hepatology 1994, The diagnosis of drug-induced hepatitis is usually based on clinical criteria, with emphasis on both the temporal relationship between drug intake and liver injury and the exclusion of alternative causes. In vitro tests of lymphocyte sensitization to drugs are considered to have a low sensitivity. We investigated the possibility of detecting lymphocyte reactivity to drugs in drug-induced hepatitis by analyzing the lymphocyte proliferative responses to ex-vivo drug or metabolite antigens to improve the sensitivity of the in vitro test. Lymphocyte proliferative responses to five different concentrations of the drug and to ex-vivo drug antigens (serum collected from normal subjects after the ingestion of the drugs) were analyzed in 25 patients with a clinical diagnosis of drug-induced hepatitis, 27 healthy subjects and 10 individuals with a recent exposure to the same drugs without development of adverse drug reactions. In seven of the 25 patients, lymphocyte reactivity to drugs was detected (28%). The use of sera collected from healthy volunteers after drug intake (ex-vivo drug antigens) and the addition of a prostaglandin inhibitor to the cultures allowed the detection of lymphocyte sensitization in seven additional cases, increasing the detection ability from 28% to 56%. We suggest that the use of ex-vivo drug antigens may represent a significant contribution to the identification of the drug involved in cases of drug-induced hepatitis.