Corrigendum to "Biomedical and health informatics teaching in Portugal: Current status" [Heliyon 9(3) (March 2023) e14163].

[This corrects the article DOI: 10.1016/j.heliyon.2023.e14163.].

Biomedical and health informatics teaching in Portugal: Current status.

Background: The domain of Biomedical and Health Informatics (BMHI) lies in the intersection of multiple disciplines, making it difficult to define and, consequently, characterise the workforce, training needs and requirements in this domain. Nevertheless, to the best of our knowledge, there isn't any aggregated information about the higher education programmes in BMHI currently being delivered in Portugal, and which knowledge, skills, and competencies these programmes aim to develop. Aim: Our aim is to map BMHI teaching in Portugal. More specifically, our objective is to identify and characterise the: a.) programmes delivering relevant BMHI teaching; b.) geographical distribution and chronological evolution of such programmes; and c.) credit distribution and weight. Methods: We conducted a descriptive, cross-sectional study to systematically identify all programmes currently delivering any core BMHI modules in Portugal. Our population included all graduate-level programmes being delivered in the 2021/2022 academic year in any Portuguese higher education institution. Results: We identified 23 programmes delivering relevant teaching in BMHI in Portugal. Of these, eight (35%) were classified as dedicated educational programmes in BMHI, mostly delivered in polytechnic institutes at a master's level (5; 63%) and located preferentially in the northern part of the country (7). Currently, there are four programmes with potential for accreditation but still requiring some workload increase in certain areas in order to be eligible.

A New Perspective on Supporting Vulnerable Road Users' Safety, Security and Comfort through Personalized Route Planning.

Due to an increase in population, urban centers are currently seeing an increase in traffic, resulting in negative consequences such as pollution and congestion. Efforts have been made to promote a modal shift towards the use of more sustainable means of transport, such as walking and cycling, but several deterrents influence the citizens' perceptions of safety, security and comfort, discouraging their choice of active modes of transport. This study focuses on the importance of providing meaningful information to vulnerable road users (VRUs) to support their perceptions and objectives while moving within urban spaces through a novel concept of route planning. A broad survey of the needs and concerns of VRUs through interviews, focus groups and questionnaires, applied to the Portuguese population of the Metropolitan Area of Porto, led to the development of a new concept of route planners that show personalized routes according to the individual perceptions of each user. This concept is materialized in a route planner prototype that has been extensively tested by potential users. Subjective evaluation and feedback showed the usefulness of the concept and added value to a familiar product, leading to a satisfying experience for participants. This study shows that there is an opportunity to improve these tools to provide a higher degree of power and customization to users on route planning, which includes addressing mobility restrictions and personal perceptions of safety, security and comfort. The ultimate goal of this new approach is to persuade citizens to switch to more sustainable means of transport.

The CirCor DigiScope Dataset: From Murmur Detection to Murmur Classification.

Cardiac auscultation is one of the most cost-effective techniques used to detect and identify many heart conditions. Computer-assisted decision systems based on auscultation can support physicians in their decisions. Unfortunately, the application of such systems in clinical trials is still minimal since most of them only aim to detect the presence of extra or abnormal waves in the phonocardiogram signal, i.e., only a binary ground truth variable (normal vs abnormal) is provided. This is mainly due to the lack of large publicly available datasets, where a more detailed description of such abnormal waves (e.g., cardiac murmurs) exists. To pave the way to more effective research on healthcare recommendation systems based on auscultation, our team has prepared the currently largest pediatric heart sound dataset. A total of 5282 recordings have been collected from the four main auscultation locations of 1568 patients, in the process, 215780 heart sounds have been manually annotated. Furthermore, and for the first time, each cardiac murmur has been manually annotated by an expert annotator according to its timing, shape, pitch, grading, and quality. In addition, the auscultation locations where the murmur is present were identified as well as the auscultation location where the murmur is detected more intensively. Such detailed description for a relatively large number of heart sounds may pave the way for new machine learning algorithms with a real-world application for the detection and analysis of murmur waves for diagnostic purposes.

Clinical and economic impact of remote monitoring on the follow-up of patients with implantable electronic cardiovascular devices: an observational study.

Traditional follow-up of patients with cardiovascular devices is still an activity that, in addition to serving an increasing population, requires a considerable amount of time and specialized human and technical resources. Our aim was to evaluate the applicability of the CareLink(®) (Medtronic, Minneapolis, MN) remote monitoring system as a complementary option to the follow-up of patients with implanted devices, between in-office visits. Evaluated outcomes included both clinical (event detection and time to diagnosis) and nonclinical (patient's satisfaction and economic costs) aspects. An observational, longitudinal, prospective study was conducted with patients from a Portuguese central hospital sampled by convenience during 1 week (43 patients). Data were collected in four moments: two in-office visits and two remote evaluations, reproducing 1 year of clinical follow-up. Data sources included health records, implant reports, initial demographic data collection, follow-up printouts, and a questionnaire. After selection criteria were verified, 15 patients (11 men [73%]) were included, 63.4±10.8 years old, representing 14.0±6.3 implant months. Clinically, 15 events were detected (9 by remote monitoring and 6 by patient-initiated activation), of which only 9 were symptomatic. We verified that remote monitoring could detect both symptomatic and asymptomatic events, whereas patient-initiated activation only detected symptomatic ones (p=0.028). Moreover, the mean diagnosis anticipation in patients with events was approximately 58 days (p<0.001). In nonclinical terms, we observed high or very high satisfaction (67% and 33%, respectively) with using remote monitoring technology, but still 8 patients (53%) stated they preferred in-office visits. Finally, the introduction of remote monitoring technology has the ability to reduce total follow-up costs for patients by 25%. We conclude that the use of this system constitutes a viable complementary option to the follow-up of patients with implantable devices, between in-office visits.

A review on remote monitoring technology applied to implantable electronic cardiovascular devices.

Implantable electronic cardiovascular devices (IECD) include a broad spectrum of devices that have the ability to maintain rhythm, provide cardiac resynchronization therapy, and/or prevent sudden cardiac death. The incidence of bradyarrhythmias and other cardiac problems led to a broader use of IECD, which turned traditional follow-up into an extremely heavy burden for healthcare systems to support. Our aim was to assess the impact of remote monitoring on the follow-up of patients with IECD. We performed a review through PubMed using a specific query. The paper selection process included a three-step approach in which title, abstract, and cross-references were analyzed. Studies were then selected using previously defined inclusion criteria and analyzed according to the country of origin of the study, year, and journal of publication; type of study; and main issues covered. Twenty articles were included in this review. Eighty percent of the selected papers addressed clinical issues, from which 94% referred clinical events identification, clinical stability, time savings, or physician satisfaction as advantages, whereas 38% referred disadvantages that included both legal and technical issues. Forty-five percent of the papers referred patient issues, from which 89% presented advantages, focusing on patient acceptance/satisfaction, and patient time-savings. The main downsides were technical issues but patient privacy was also addressed. All the papers dealing with economic issues (20%) referred both advantages and disadvantages equally. Remote monitoring is presently a safe technology, widely accepted by patients and physicians, for its convenience, reassurance, and diagnostic potential. This review summarizes the principles of remote IECD monitoring presenting the current state-of-the-art. Patient safety and device interaction, applicability of current technology, and limitations of remote IECD monitoring are also addressed. The use of remote monitor should consider the selection of patients, the type of disease, and centers' availability to receive, interpret and respond to device alerts. Before remote IECD monitoring can be routinely used, technical, procedure, and ethical/legal issues should be addressed.

A nutriçäo enteral na insuficiência respiratória / Enteral feeding in respiratory failure

Dez pacientes com insuficiência respiratória foram submetidos à hiperalimentación enteral a fim de cerificar-se o seu valor quando instituída precocemente. A dieta apresentava 38 a 42% de hidratos de carbono, 38 a 42% de lipídios e 20% de protídios. Foi administrada por sonda nasoentérica tipo DobbHoff por infusäo contínua por 24 horas. Os pacientes foram submetidos à avaliaçäo nutricional no primeiro e entre o sétimo e décimo dias de nutriçäo. Encontrou-se reduçäo da PaCO2, o pH arterial apresentou comportamento estável a partir do terceiro dia de nutriçäo. A contagem média de linfócitos variou de 889,8 + ou - por mm3 no primeiro dia, para 2.447,6 + ou - 1.292 por mm3 na segunda medida (W=53, significante). A albumina sérica apresentou média de 3,12 + ou - 0,7gna primeira e 2,65 + ou - 0,67gna segunda dosagem (W = 20, p > 0,05); quanto à espessura da pele tricipital encontrou-se 5,8 + ou - 3,0 e 5,0 + ou - 2,8mm (W = 67, p > 0,05); para circunferência muscular do braço encontrou-se 22,66 + ou - 1,2cm e 22,1 + ou - 1,9cm (W=69, p > 0,05). A nutriçäo enteral nos portadores de insuficiência respiratória é, segura, bem tolerada, apresenta poucos efeitos colaterais e colabora para impedir a desnutriçäo. Novos estudos deveräo ser realizados para comparar outras fórmulas de nutriçäo enteral e seu comportamento quanto ao pH arterial e PaCO2, inclusive durante a retirada da ventilaçäo mecânic

Meiloma multiplo: encefalopatia hipercalcêmica, pancreatite aguda e insuficiência renal aguda / Multiple myeloma: hypercalcemic encephalopathy, acute renal failure

A hipercalcemia é observada em pacientes com câncer múltiplo encontra-se entre as enfermidades que podem apresentar este distúrbio metabólico. Os autores relatam o caso de um homem de 61 anos, branco, portador de mieloma múltiplo que foi admitido no serviço de emergência com alteraçäo da consciência. Apresentava hematócrito de 25%, uréia de 75mg%, creatinina de 3,3mg%, proteínas totais de 11,0g% com 7,6% de globulinas; cálcio plasmático de 18,0mg%. O mielograma foi comaptível com mieloma múltiplo. O R-X mostrava lesöes líticas na coluna vertebral, bacia e fêmur direito. A amilasemia foi de 1.595U%. O cálcio pode estar elevado no mieloma devido a invasäo óssea pélos plasmócitos e pelo aumento da atividade osteoclástica causada por fatores de aaçäo local produzidas pelas células do mieloma. O aumento da concentraçäo do cálcio na secreçäo e tecidos pancreáticos podem ativar o tripsinogênio, assim como iniciar a proteólise no pâncreas, causando pancreatite aguda

Alteraçöes pleuropulmonares no lupus entematoso sistêmico / Pleuropulmonary involvement in systemic lupus erythematosus

Quatorze pacientes portadores de lúpus eritematoso sistêmico (LES) foram investigados quanto à presença de manifestaçöes pleuropulmonares, encontradas em nove. Pleuris foi achado mais freqüente (44,4%); pneumonite lúpica, infecçäo bacteriana, doença intersticial crônica, congestäo pulmonar e disfunçäo diagragmática foram também encontrados. Três pacientes foram submetidos a provas de funçäo pulmonar, sendo em todos encontrada capacidade vital inferior a 70% do predito. FAN positivo foi a alteraçäo sérica mais encontrada (88,8%). Anemia e nefrite foram tambem encontradas com freqüência. Em seis pacientes com doença pulmonar e renal, a depuraçäo da creatinina foi a prova de maior sensibilidade para a deteccäo de lesäo renal (média de 67,75 ñ 28,03ml/min). Todos estes resultados säo confrontados com estudos clínicos de outros autores

Porfiria aguda intermitente: relato de um caso / Acute intermittent porphyria: report of a case

É relatado um caso de porfiria aguda intermitente. Descrevem-se os seus aspectos clínico-laboratoriais, ressaltando-se as medidas terapêuticas atuais que säo utilizadas. Infelizmente, na maioria dos casos, o prognóstico é reservado

Tireoidite aguda supurada / Acute suppurative thyroiditis

A tireoidite aguda supurada é, atualmente, pouco vista. Por isso é relatado um caso desta natureza. A terapêutica foi cirúrgica. O estudo bacteriológico incriminou o Streptococcus pneumoniae. A antibioticoterapia contribuiu para o tratamento específico

Duas neoplasias malignas torácicas, simultâneas e diferentes / 2 thoracic malignant neoplasms, simultaneous and different

Relata-se o caso de um paciente que apresentou, simultaneamente, condrossarcoma pouco diferenciado de costela e carcinoma epidermóide bem diferenciado do pulmäo. Säo revistos vários casos de tumores múltiplos assinalados na literatura e enfatizados os dados mais importantes da imunologia tumoral. Aconselha-se vigilância cuidadosa dos pacientes operados de neoplasias, principalmente do tubo digestivo, após cinco anos de sobrevida, ante a possibilidade de sobrevir nova neoplasia primária

Tireoidite aguda supurada / Acute suppurative thyroiditis

A tireoidite aguda supurada é, atualmente, pouco vista. Por isso, é relatado um caso dessa natureza. A terapêutica foi cirúrgica. O estudo bacteriológico incriminou o Streptococcus pneumoniae. A antibioticoterapia contribuiu para a cura do paciente

Principais manifestaçöes adversas dos medicamentos / Main adverse manifestation of drugs

É feita revisäo sucinta das manifestaçöes clínicas adversas mais comuns produzidas por medicamentos. Entre estas, no entanto, incluíram os autores algumas menos freqüentes, com intuito de chamar a atençäo dos clínicos para o importante problema que estudaram

Síndrome de Cassidy-Scholte-Thorson-Björck-Waldestrom ou, simplesmente, síndrome carcinóide: relato de um caso / Cassidy-Scholte-Thorson-Björck-Wasdetrom syndrome: carcinoide syndrome; a case report

Os autores apresentam um caso de síndrome carcinóide com manifestaçöes clínicas típicas, exceto quanto ao broncoespasmo. Exibem a documentaçäo feita por biópsia hepática. Utilizaram o cipro-heptomicina, cuja eficácia foi discreta. Frisam que a literatura médica brasileira é escassa quanto a síndrome carcinóide