Cardiovascular risk assessment in Portugal's primary health care system: SCORE vs. SCORE2.

INTRODUCTION AND OBJECTIVES: The 2021 European Society of Cardiology guidelines on cardiovascular disease (CVD) prevention introduced the more accurate SCORE2 risk model as a replacement for the earlier SCORE, which is still used in primary care software in Portugal. Our objective is to determine whether the difference between risk assessment using SCORE and SCORE2, in the same patient population, is statistically significant. METHODS: A total of 1642 patients aged 40-65 without previous CVD, from the medical records of two Family Health Units, were included in this cross-sectional study. SCORE and SCORE2 were calculated using the variables gender, age, smoking status, lipid profile and systolic blood pressure. A statistical analysis was performed on the results. RESULTS: Using SCORE, 98% of the patients were in the low-moderate risk categories and 2% in the high or very high risk categories. When using SCORE2, the corresponding percentages were 55% and 45%, respectively. Reclassification with SCORE2 into higher categories was more often observed in younger (under 50 years of age) and male patients. With SCORE, 38.61% of patients were within the LDL-C target range; this figure fell to 20.28% with SCORE2. These differences are statistically significant (p<0.0001). CONCLUSION: Our findings show that a significant number of patients in this cohort who were classified through SCORE at lower risk levels were reclassified into higher risk categories with SCORE2. Similarly, the number of patients within the LDL-C target range for LDL-C was also lower using SCORE2.

Colonic Leiomyoma: A Case Report of an Uncommon Endoscopic Finding.

Leiomyomas are rare, benign tumors composed of smooth muscle cells. When found in the colon, they account for only about 3% of gastrointestinal leiomyomas. Typically asymptomatic, they are often incidentally discovered during endoscopic evaluations. This report describes the case of a 71-year-old female with abdominal pain and distension, whose colonoscopy revealed a 7 mm sessile polyp in the sigmoid colon. Histological analysis confirmed it to be a submucosal leiomyoma. Although endoscopic resection is a common therapeutic strategy, surgical treatment may be necessary for larger tumors or when malignancy is suspected. This case emphasizes the limitations of polyp classification through endoscopy alone and the important role histopathological analysis continues to play in this regard. Accurately diagnosing these lesions is crucial for appropriate treatment and surveillance, namely, in the primary healthcare context. Further research is needed to improve diagnostic capabilities and reduce the need for repeat colonoscopies, reducing patient burden.

Reflectance confocal microscopy for the diagnosis of skin infections and infestations.

Reflectance confocal microscopy (RCM) is a noninvasive real-time imaging technique that has been widely used for the diagnosis of skin cancer. More recently, it has been reported as a useful tool for the diagnosis and management of several inflammatory and infectious skin disorders. This article provides an overview of the current available applications of RCM use in cutaneous infections and infestations. PubMed was used to search the following terms in various combinations: reflectance confocal microscopy, skin, hair, nail, infection, parasitosis, mycosis, virus, bacteria. All papers were accordingly reviewed. In most cutaneous infections or infestations, the main alterations are found in the epidermis and upper dermis, where the accuracy of confocal microscopy is nearly similar to that of histopathology. The high resolution of this technique allows the visualization of most skin parasites, fungi, and a few bacteria. Although viruses cannot be identified because of their small size, viral cytopathic effects can be observed on keratinocytes. In addition, RCM can be used to monitor the response to treatment, thereby reducing unnecessary treatments.

Reflectance confocal microscopy for the noninvasive diagnosis of cutaneous juvenile xanthogranuloma.

Juvenile xanthogranuloma is the most common type of non-Langerhans cell histiocytosis. It appears primarily in infancy, where its differential diagnosis includes Spitz nevus, dermal nevus and molluscum contagiosum. We report the case of a 2-year-old boy with juvenile xanthogranuloma, as diagnosed using real-time, in vivo reflectance confocal microscopy.

Dermoscopic and reflectance confocal microscopic presentation of Hailey-Hailey disease: A case series.

BACKGROUND/PURPOSE: Hailey-Hailey disease is a rare inherited acantholytic skin disorder characterized by heterogeneous clinical presentation. Its differential diagnosis might be wide, including other genodermatoses, inflammatory, and infectious skin diseases. Although histopathology remains as diagnostic gold standard, noninvasive techniques such as dermoscopy and reflectance confocal microscopy may assist clinical examination. Herein, we aim to further characterize the dermoscopic and reflectance confocal microscopic presentation of Hailey-Hailey disease with histologic correlation. METHODS: Eight patients with Hailey-Hailey disease were consecutively recruited. All patients were examined using dermoscopy and reflectance confocal microscopy. RESULTS: In all cases, dermoscopy enabled the visualization of polymorphous vessels, including glomerular and linear-looped vessels, within a pink-whitish background. Reflectance confocal microscopy revealed wide suprabasilar partial acantholysis and clefting, crusts, dilated papillae with tortuous vessels, and inflammatory cells. Dyskeratosis, uplocated papillae, and adnexal sparing were also observed. CONCLUSION: Although definite diagnosis was obtained by histopathology in all cases, dermoscopy and reflectance confocal microscopy allowed the identification of common features (even in cases with dissimilar clinical presentation) that may support an early diagnosis of Hailey-Hailey disease, and its differentiation from other more frequent skin disorders.

CDK1 Prevents Unscheduled PLK4-STIL Complex Assembly in Centriole Biogenesis.

Centrioles are essential for the assembly of both centrosomes and cilia. Centriole biogenesis occurs once and only once per cell cycle and is temporally coordinated with cell-cycle progression, ensuring the formation of the right number of centrioles at the right time. The formation of new daughter centrioles is guided by a pre-existing, mother centriole. The proximity between mother and daughter centrioles was proposed to restrict new centriole formation until they separate beyond a critical distance. Paradoxically, mother and daughter centrioles overcome this distance in early mitosis, at a time when triggers for centriole biogenesis Polo-like kinase 4 (PLK4) and its substrate STIL are abundant. Here we show that in mitosis, the mitotic kinase CDK1-CyclinB binds STIL and prevents formation of the PLK4-STIL complex and STIL phosphorylation by PLK4, thus inhibiting untimely onset of centriole biogenesis. After CDK1-CyclinB inactivation upon mitotic exit, PLK4 can bind and phosphorylate STIL in G1, allowing pro-centriole assembly in the subsequent S phase. Our work shows that complementary mechanisms, such as mother-daughter centriole proximity and CDK1-CyclinB interaction with centriolar components, ensure that centriole biogenesis occurs once and only once per cell cycle, raising parallels to the cell-cycle regulation of DNA replication and centromere formation.

Diabetes mellitus: gestão de uma doença crónica num agrupamento de centros de saúde da Região Norte / Diabetes mellitus: management of a chronic disease in a cluster of health centers in the Northern Region

Durante a última década, muitos países tem vindo a reorientar os seus sistemas de saúde no sentido a incluir, progressivamente, a gestão integrada das doenças crónicas, onde a Diabetes Mellitus (DM) também está inserida. O modelo de gestão de doença crónica (MGDC) tem, frequentemente, constituído o referencial teórico de suporte à ação nesse sentido, sendo o Assessment of Chronic Illness Care (ACIC) o instrumento mais usado na mensuração do seu nível de concretização. Assim, o presente estudo pretendeu: proceder à tradução e validação do ACIC 3.5; caraterizar as diferenças entre as unidades de cuidados de saúde personalizados (UCSP) e as unidades de saúde familiar (USF) relativamente à gestão dos cuidados prestados aos doentes diabéticos; comparar os custos diretos (tratamento em ambulatório) entre as duas tipologias de unidades de saúde e estudar a relação entre os ganhos em saúde inerentes aos valores de hemoglobina glicosilada (HbA1c) e as tipologias das unidades de saúde. Este é um estudo transversal e de natureza exploratório descritivo-comparativo. O ACIC foi aplicado 175 médicos e enfermeiros de um ACES da Região Norte. Para a determinação dos custos e os valores da HbA1c foi consultado o Sistema de Informação da ARS e envolveu registos de 17985 doentes com DM que frequentaram a consulta no período 01/01/2012 a 31/12/2012. Definiu-se o nível de significância de 5%. Em termos de resultados, constata-se que o ACIC versão 3.5 obteve um alfa de Cronbach de 0,958, indicando uma elevada fiabilidade e um coeficiente de Kaiser-Meyer-Olkin de 0.918, demonstrando que os nossos dados apresentam uma excelente adequabilidade à análise fatorial. Não se registaram diferenças estatísticas significativas entre os scores médios do ACIC alcançados nas USF e nas UCSP, ou seja, ambas as tipologias de Unidades garantem apenas um apoio básico às pessoas com DM. No que diz respeito aos custos diretos dos tratamentos em ambulatório, registaram-se diferenças significativas apresentando as UCSP um custo superior às USF. Também nos resultados da HbA1c ≥8%, registaram-se diferenças significativas entre as duas tipologias em análise. Em síntese, as USF evidenciam, no presente estudo, melhores resultados em termos de custos e ganhos em saúde inerentes a pessoas diabéticas, apresentando uma menor percentagem de pessoas com diabetes com a HbA1c ≥8%. Em termos de modelo de gestão de doença crónica aplicados à pessoa diabética e família, as duas tipologias de unidades situam-se ao mesmo nível, deixando antever um longo percurso a fazer, neste domínio.

During the last decade, many countries have been refocusing their healthcare systems in order to progressively include integrated management of chronic illness, in which Diabetes Mellitus (DM) is also included. The chronic care model (CCM) has often been the theoretical support when acting in this regard, and the Assessment of Chronic Illness Care (ACIC) instrument is the most commonly used when assessing levels of achievement. Thus, this study aimed to: undertake the translation and validation of the ACIC 3.5; characterize the differences between the personalized healthcare unities (UCSP) and family health unities (USF) regarding the management of care provided to the diabetic patient; compare direct costs (outpatient treatment) between the two types of healthcare unities and study the relationship between healthcare gains related to the glycated hemoglobin (HbA1c) and the types of healthcare unities. This is a cross-sectional study of exploratory and descriptive-comparative. The ACIC was applied to 175 doctors and nurses in a ACES of the Northern Region. To determine the costs and gains in HbA1c, the ARS Information System´s records were consulted involving 17985 patients with DM who had an appointment during the period between 01/01/2012 and 31/12/2012. The level of significance was defined of 5 %. In terms of results it appears that the ACIC version 3.5 achieved a Cronbach's alpha of 0.958, indicating a high reliability and a coefficient of Kaiser - Meyer - Olkin measure of 0.918, demonstrating that our data showed an excellent suitability for factor analysis. No significant statistically differences were registered between the average scores in the ACIC achieved in the USF and the UCSP, i.e., in both types of unities only basic support was insured to the diabetic patient. With regard to the direct costs of outpatient treatment, there were significant differences with the UCSP presenting higher costs than the USF. With results of HbA1c ≥ 8%, there were significant differences between the two types of unities in question. In summary, the USF shows in this study the best results in terms of costs and healthcare gains inherent to people with diabetes with a lower percentage of diabetics with HbA1c ≥ 8%. In terms of the chronic care model applied to the diabetic patient and family, the two types of unities were situated at the same level, remaining a long road to travel in this area.