Epidemiological and Clinical Aspects of Cutaneous and Mucosal Leishmaniases in Portugal: Retrospective Analysis of Cases Diagnosed in Public Hospitals and Reported in the Literature between 2010 and 2020.

Leishmania infantum, a zoonotic vector-born parasite, is endemic in the Mediterranean region, presenting mostly as visceral (VL), but also as cutaneous (CL) and mucosal leishmaniasis (ML). This study aimed to describe the epidemiological and clinical aspects of the CL and ML cases diagnosed in mainland Portugal between 2010 and 2020. Collaboration was requested from every hospital of the Portuguese National Health System. Cases were screened through a search of diagnostic discharge codes or positive laboratory results for Leishmania infection. Simultaneously, a comprehensive literature search was performed. Descriptive statistics and hypothesis testing were performed using IBM® SPSS® Statistics. A total of 43 CL and 7 ML cases were identified, with a predominance of autochthonous cases (86%). In CL, immunosuppressed individuals constituted a significant proportion of patients (48%), and in this group, disseminated CL (22%) and simultaneous VL (54%) were common. In autochthonous cases, lesions, mostly papules/nodules (62%), were frequently observed on the head (48%). The approach to treatment was very heterogeneous. ML cases were all autochthonous, were diagnosed primarily in older immunosuppressed individuals, and were generally treated with liposomal amphotericin B. The findings suggest a need for enhanced surveillance and reporting, clinical awareness, and diagnostic capacity of these forms of leishmaniasis to mitigate underdiagnosis and improve patient outcomes. A holistic One Health approach is advocated to address the multifaceted challenges posed by leishmaniases in Portugal and beyond.

Clinical and Epidemiological Features of Hospitalized and Ambulatory Patients with Human Monkeypox Infection: A Retrospective Observational Study in Portugal.

Monkeypox, a neglected and re-emergent zoonotic disease caused by monkeypox virus (MPXV) infection, has been endemic in Central and Western Africa for decades. More recently, an outbreak has spread to a global level, occurring in sites with no previous reported cases and being clustered among men who have sex with men, suggesting new modes of transmission. There is an urgent need for research for a better understanding of the genomic evolution and changing epidemiology of the Orthopoxvirus group. Our work aimed to characterize the clinical and epidemiological features of a cohort of patients with MPXV infection in a Portuguese hospital, admitted between 5 May and 26 July 2022. In this retrospective observational study, aggregate data of a case series on the presentation, clinical course, and outcomes of confirmed MPXV infections are reported. The study included 40 men and 1 woman, with a mean age of 37.2 years old; 92.7% identified as men who have sex with men, 90.2% had unprotected sex or sex with multiple or anonymous partners in the previous month, and 39.0% reported to have had sex with an MPXV-confirmed case; 59.5% had previously known human immunodeficiency virus (HIV) infection, all of whom were under antiretroviral therapy, and no patients had acquired immunodeficiency syndrome (AIDS) criteria. About a quarter of patients were observed only a week after symptom onset. All patients had skin or mucosal lesions and the anogenital region was the most frequent lesion site. There were no statistically significant clinical differences between HIV-positive and negative individuals. Four patients were admitted to the inpatient clinic, two of whom had proctitis with difficult-to-manage anal pain. There were no reported deaths. Our findings suggest the sexual route as a relevant mode of transmission of MPXV and confirm the mostly benign presentation of this disease.

A case of central nervous system infection by Candida famata in an immunosuppressed patient with HIV-1 infection.

Invasive fungal infections caused by Candida species are increasingly observed in immunosuppressed patients. Candida albicans is the more often identified species and neurocandidiasis is associated with high mortality rates. Diagnosis and treatment of these infections are frequently challenging. We report a case of central nervous system infection caused by Candida famata in an HIV-1 infected patient. To our best knowledge this is just the second published case of neural infection by this agent.

Venous Air Microembolism in Chest CT Angiography: Evidence of Normalization of Deviance Phenomenon.

Purpose This article provides evidence that detection of venous air microbubbles (VAMB) in chest computed tomography angiography (CTA) can be an indicator for "normalization of deviance" phenomenon in CT. Method and Materials Institutional review board-approved retrospective study, with waiver for informed consent. Contrast-enhanced chest CT performed during 6 months were reviewed for presence of VAMB in venous segments visible in chest CT (subclavian, brachiocephalic vein, superior vena cava) and cardiac chambers. VAMB volumes were quantified through a semiautomatic method (MIAlite plugin for OsiriX), using a region of interest (ROI) covering the bubble. With basal results, protocols for correct injection technique were reinforced, and VAMB were estimated again at 1 and 3 months. Six months later, questionnaires were sent to the CT technologists to inquire about their perception of VAMB. Descriptive measures with central distribution and dispersion were performed; statistical significance was considered at p < 0.05. Results A total of 602 chest CTA were analyzed, 332 were women (55.14%), with a median age of 58 (interquartile range [IQR] 44-72) years. Among those, 16.11% (100 cases) presented VAMB. Most were emergency department patients (51.6%), male (50.3%), with a median age of 54 (IQR 26) years. There was no difference on detection of VAMB regarding sex ( p = 0.19), age ( p = 0.46), or referral diagnosis ( p = 0.35). Mean air bubbles volume was 0.2 mL (range 0.01-3.4 mL). After intervention, the number of exams with VAMB dropped to 3.29 % (3/91) ( p < 0.001). On the 6-month query, 50% of the technicians still considered that VMAB is inevitable, and 60% thought that the occurrence is not associated to risk, and therefore, not actionable. Conclusion VAMB are a frequent finding in chest CTA, and being independent from patient-related variables, it is likely due to technical issues such as intravenous access manipulation during the exam. Reduction after reinforcement of proper performance, and certification of a low concern from CT technicians for any risk associated, provides evidence that there is normalization of deviance in this everyday procedure.

[Iatrogeny in paediatrics: reconsider attitudes]. / Iatrogenia em pediatria: repensar atitudes.

Iatrogeny is a pathologic condition caused in a patient in the different stages of a medical act. In the United States, it is the fourth cause of death but in Portugal, data are not yet available. Though different from medical error, it is still a taboo subject for health care providers. The authors report a case of relational, diagnostic and therapeutic iatrogeny with serious consequences for the patient. Doctors have a fundamental role in reducing morbidity and mortality due to iatrogenic causes; they have the duty to question and reconsider diagnosis and treatments, keeping an alert attitude and self-criticism in order to identify potential iatrogenic interventions or to correct it as soon as possible.

[New vaccines]. / Novas vacinas.

INTRODUCTION: Vaccines prevent more cases of diseases than any other medical treatment. However, information on new vaccines introduced in the market and not included in the National Vaccination Program (NVP) is often sparse, and their knowledge limited. OBJECTIVES: Evaluate general and specific knowledge of healthy children's parents on three vaccines not included in the NVP: pneumococcal (PCV7), varicella (Var) and rotavirus (RV). METHODS AND MATERIAL: Transversal descriptive study, in the format of a questionnaire applied randomly to parents of children that attended three Primary Care Centers of Portugal (Lisbon, Porto and Queluz), between March and April 2007. We analyzed sociodemographic parameters, level of knowledge (the existence and type of preventable disease by the three vaccines), its realization or intention of realization, and the availability of acquiring them by parents. Statistic analysis used Qui-Squares and T-Student tests (CI>95%), with p<0,05 considered statistically significant. RESULTS: We interviewed 187 children's parents with a median age of 13 months. Most (82%) had incomplete schooling and a mean monthly income of 1256€. In 83% of the interviews, the parents knew at least one of the vaccines: pneumococcal (72%), varicella (42%) and rotavirus (1,3%), and applying the same order, the type of disease each vaccine prevented: 118/135 (87%), 83/84 (99%) and 21/24 (87,5%). In 80% of cases, health care professionals provided the information to parents: pediatrician (67) and primary care doctor (49). Most (96%) parents considered the PCV7 the most important vaccine. Of the children evaluated, 93% had the NVS actualized, additionally, 39% had the pneumococcal vaccine, 0,5% varicella and 3% rotavirus vaccine. Knowledge about the varicella and rotavirus was associated with a higher academic level of the parents (40 vs 46,p = 0,018; 8 vs 16,p = 0,026) and the acquisition of the pneumococcal and rotavirus vaccine with a higher income (1506€ vs 1144€; p = 0,04) and (2283€ vs 1162€; p = 0,04). CONCLUSION: With exception of the PCV7 the remaining vaccines are still insufficiently known. It is up to health care professionals to disclose information and encourage families for vaccination.