Nationwide Access to Endovascular Treatment for Acute Ischemic Stroke in Portugal.

INTRODUCTION: Since the publication of endovascular treatment trials and European Stroke Guidelines, Portugal has re-organized stroke healthcare. The nine centers performing endovascular treatment are not equally distributed within the country, which may lead to differential access to endovascular treatment. Our main aim was to perform a descriptive analysis of the main treatment metrics regarding endovascular treatment in mainland Portugal and its administrative districts. MATERIAL AND METHODS: A retrospective national multicentric cohort study was conducted, including all ischemic stroke patients treated with endovascular treatment in mainland Portugal over two years (July 2015 to June 2017). All endovascular treatment centers contributed to an anonymized database. Demographic, stroke-related and procedure-related variables were collected. Crude endovascular treatment rates were calculated per 100 000 inhabitants for mainland Portugal, and each district and endovascular treatment standardized ratios (indirect age-sex standardization) were also calculated. Patient time metrics were computed as the median time between stroke onset, first-door, and puncture. RESULTS: A total of 1625 endovascular treatment procedures were registered. The endovascular treatment rate was 8.27/100 000 inhabitants/year. We found regional heterogeneity in endovascular treatment rates (1.58 to 16.53/100 000/year), with higher rates in districts closer to endovascular treatment centers. When analyzed by district, the median time from stroke onset to puncture ranged from 212 to 432 minutes, reflecting regional heterogeneity. DISCUSSION: Overall endovascular treatment rates and procedural times in Portugal are comparable to other international registries. We found geographic heterogeneity, with lower endovascular treatment rates and longer onset-to-puncture time in southern and inner regions. CONCLUSION: The overall national rate of EVT in the first two years after the organization of EVT-capable centers is one of the highest among European countries, however, significant regional disparities were documented. Moreover, stroke-onset-to-first-door times and in-hospital procedural times in the EVT centers were comparable to those reported in the randomized controlled trials performed in high-volume tertiary hospitals.

Introdução: A aprovação do tratamento endovascular para o acidente vascular cerebral isquémico obrigou à reorganização dos cuidados de saúde em Portugal. Os nove centros que realizam tratamento endovascular não estão distribuídos equitativamente pelo território, o que poderá causar acesso diferencial a tratamento. O principal objetivo deste estudo é realizar uma análise descritiva da frequência e métricas temporais do tratamento endovascular em Portugal continental e seus distritos. Material e Métodos: Estudo de coorte nacional multicêntrico, incluindo todos os doentes com acidente vascular cerebral isquémico submetidos a tratamento endovascular em Portugal continental durante um período de dois anos (julho 2015 a junho 2017). Foram colhidos dados demográficos, relacionados com o acidente vascular cerebral e variáveis do procedimento. Taxas de tratamento endovascular brutas e ajustadas (ajuste indireto a idade e sexo) foram calculadas por 100 000 habitantes/ano para Portugal continental e cada distrito. Métricas de procedimento como tempo entre instalação, primeira porta e punção foram também analisadas. Resultados: Foram registados 1625 tratamentos endovasculares, indicando uma taxa bruta nacional de tratamento endovascular de 8,27/100 000 habitantes/ano. As taxas de tratamento endovascular entre distritos variaram entre 1,58 e 16,53/100 000/ano, com taxas mais elevadas nos distritos próximos a hospitais com tratamento endovascular. O tempo entre sintomas e punção femural entre distritos variou entre 212 e 432 minutos. Discussão: A análise nacional a taxas de tratamento endovascular e tempos de atuação é comparável a outros registos internacionais. Verificaram-se heterogeneidades geográficas, com taxas de tratamento endovascular menores e maior tempo para tratamento nos distritos do sul e interior. Conclusão: Portugal continental apresenta uma taxa nacional de tratamento endovascular elevada, apresentando, contudo, assimetrias regionais no acesso. As métricas temporais foram comparáveis com as observadas nos ensaios clínicos piloto.

Prevalence of SARS-CoV-2 Antibodies after First 6 Months of COVID-19 Pandemic, Portugal.

In September 2020, we tested 13,398 persons in Portugal for antibodies against severe acute respiratory syndrome coronavirus 2 by using a quota sample stratified by age and population density. We found a seroprevalence of 2.2%, 3-4 times larger than the official number of cases at the end of the first wave of the pandemic.

Doctor Faustino Pérez Hernández: desarrollo con enfoque social en Cuba / Doctor Faustino Pérez Hernández: development with a social focus in Cuba

RESUMEN Fundamento: El tema del desarrollo ha evolucionado desde la perspectiva cuantitativa a la cualitativa con un enfoque integral; estos enfoques en Cuba han estado presentes en el pensamiento económico y político. Es insuficientemente conocido el ideario y obra de Faustino Pérez Hernández, quien en el cumplimiento de funciones políticas y administrativas abordó aspectos sobre el desarrollo con proyección integradora. Objetivo: Fundamentar que en el pensamiento y la obra del Dr. Faustino Pérez Hernández existe un enfoque social sobre el desarrollo en Cuba. Desarrollo: Se fundamenta ese pensamiento y obra en distintos momentos: cuando elige la carrera de Medicina y fungió como miembro de la Comisión Médica del Partido Ortodoxo, durante sus funciones como Comisionado General de la Administración Civil de los Territorios Liberados, siendo Ministro de Recuperación de Bienes Malversados; como Presidente del Instituto Nacional de Recursos Hidráulicos, como Primer Secretario del Partido Comunista de Cuba de la Región de Sancti Spíritus y desde su condición de Jefe del Plan Integral de la Ciénaga de Zapata. Conclusiones: En el pensamiento y la obra del Dr. Faustino Pérez Hernández existe un enfoque social sobre el desarrollo en Cuba con una proyección integral, que incluye la solución de los problemas relacionados con la salud del pueblo, constatable en su diverso accionar en el cumplimiento de importantes misiones, siguiendo un camino de ascendente maduración en dos planos o niveles: nacional y local.

ABSTRACT Background: The development issue has evolved from a quantitative perspective to a qualitative one with a comprehensive approach. In Cuba these approaches have been present in economic and political thought. The ideology and work of Faustino Pérez Hernández is insufficiently known, who in the fulfillment of political and administrative functions addressed aspects of development with an integrative projection. Objective: To establish that in the thought and work of Doctor Faustino Pérez Hernández there is a social focus on development in Cuba. Development: This thought and works are based on different moments: when he chose the career of Medicine and served as a member of the Medical Commission of the Orthodox Party, during his functions as General Commissioner of the Civil Administration of the Liberated Territories, being Minister of Recovery of Misappropriated Assets; as President of the National Institute of Hydraulic Resources, as First Secretary of the Communist Party of Cuba of the Sancti Spíritus Region and from his position as Head of the Integral Plan of the Zapata Swamp. Conclusions: In the thought and work of Doctor Faustino Pérez Hernández there is a social approach to development in Cuba with a comprehensive projection, which includes the solution of problems related to the health of the people, verifiable in his diverse actions in compliance with important missions, following a path of ascending maturation on two planes or levels: national and local.

Histological Outcomes and Predictive Value of Faecal Markers in Moderately to Severely Active Ulcerative Colitis Patients Receiving Infliximab.

BACKGROUND AND AIMS: Histological healing has emerged as a promising therapeutic goal in ulcerative colitis. This is especially important in the context of biological therapies. The objectives of the present study were to investigate the ability of infliximab to induce histological remission in ulcerative colitis [UC] patients and to explore the utility of faecal calprotectin and lactoferrin in predicting histological activity. METHODS: Multi-centre, single-cohort, open-label, 52-week trial including moderately to severely biological-naïve UC patients receiving intravenous infliximab [5mg/kg]. The primary outcome was the proportion of patients with histological remission [Geboes index ≤ 3.0] after 8 weeks of treatment, scored by two independent pathologists. RESULTS: Twenty patients were included. The rate of histological remission increased from 5% at baseline to 15% and 35% at Week 8 and Week 52, respectively. At Week 8, 40% of patients were in clinical remission [Mayo ≤ 2] and 45% achieved mucosal healing [Mayo endoscopy subscore 0-1]. At Week 52, 25% of patients had clinical, endoscopic and histological remission. Faecal calprotectin and lactoferrin showed the highest correlation with histological activity at Week 8 (area under the curve [AUC] 94%, p = 0.017; and 96%, p = 0.013, respectively) and both markers revealed an excellent positive predictive value for this outcome at this time point [100%, p = 0.017; and 94%, p = 0.013, respectively]. CONCLUSIONS: Infliximab was able to induce histological remission. There was a good agreement between histology and faecal biomarkers. Faecal calprotectin and lactoferrin were good predictors of histological remission. Our data support inclusion of histology as a treatment target complementary to endoscopy in clinical trials when evaluating therapeutic response in UC.

Development of Nevirapine Resistance in Children Exposed to the Prevention of Mother-to-Child HIV-1 Transmission Programme in Maputo, Mozambique.

BACKGROUND: Single-dose nevirapine (sd-NVP) has been the main option for prevention of mother-to-child transmission (PMTCT) of HIV-1 in low-resource settings. However, sd-NVP can induce the selection of HIV-1 resistant mutations in mothers and infants. In Mozambique, there are limited data regarding the profile of NVP resistance associated mutations (RAM) in the context of PMTCT. OBJECTIVES: To assess the prevalence and the factors associated with NVP RAM among children born to HIV-1 infected mothers enrolled in the PMTCT programme adopted in Mozambique. METHODS: One hundred and fifty seven children aged 6 to 48 weeks were sequentially included (July 2011 to March 2012) at four centres in Maputo. Genotyping of RAM was performed in samples with HIV-1 RNA≥ 100 copies/µL (Viroseq). Sequencing was performed with ABI 3100 (Applied Biosystems). Logistic regression modelling was undertaken to identify the factors associated with NVP RAM. RESULTS: Seventy-nine children had their samples genotyped. Their median age was 7.0 (3-12) months and 92.4% received prophylaxis with sd-NVP at birth plus daily NVP. 35.4% of mothers received antiretrovirals (ARVs) for PMTCT. ARV RAM were detected in 43 (54.4%) of the children. 45.6% of these children had at least one NVP RAM. The most common mutations associated with NVP resistance were K103N (n = 16) and Y181C (n = 15). NVP RAM was significantly associated with mother exposure to PMTCT (crude odds ratio [OR] 30.3, 95% CI 4.93-186.34) and with mother's CD4 count < 350 cells/mm3 (crude OR 3.08, 95% CI 1.02-9.32). In the multivariable analysis the mother's exposure to PMTCT was the only variable significantly associated with NVP RAM (adjusted OR 48.65, 95% CI 9.33-253.66). CONCLUSIONS: We found a high prevalence of NVP RAM among children who were exposed to the drug regimen for PMTCT in Mozambique. The mothers' exposure to PMTCT significantly increased the risk of NVP RAM.

Patterns of adherence to and compliance with the Portuguese smoke-free law in the leisure-hospitality sector.

BACKGROUND: In 2008, the Portuguese smoke-free law came into effect including partial bans in the leisure-hospitality (LH) sector. The objective of the study is to assess the prevalence of smoking control policies (total ban, smoking permission and designated smoking areas) adopted by the LH sector in Portugal. The levels of noncompliance with each policy are investigated as well as the main factors associated with smoking permission and noncompliance with the law. METHODS: Cross-sectional study conducted between January 2010 and May 2011. A random sample of venues was selected from the Portuguese LH sector database, proportionally stratified according to type, size and geographical area. All venues were assessed in loco by an observer. The independent effects of venues' characteristics on smoking permission and the level of noncompliance with the law were explored using logistic regression. RESULTS: Overall, 1.412 venues were included. Total ban policy was adopted by 75.9% of venues, while 8.4% had designated smoking areas. Smoking ban was more prevalent in restaurants (85.9%). Only 29.7% of discos/bars/pubs opted for complete ban. Full or partial smoking permission was higher in discos/bar/pubs (OR = 7.37; 95%CI 4.87 to 11.17). Noncompliance with the law was higher in venues allowing smoking and lower in places with complete ban (33.6% and 7.6% respectively, p<0.001). Discos/bars/pubs with full smoking permission had the highest level of noncompliance (OR = 3.31; 95%CI 1.40 to 7.83). CONCLUSIONS: Our findings show a high adherence to smoking ban policy by the Portuguese LH sector. Nonetheless, one quarter of the venues is fully or partially permissive towards smoking, with the discos/bars/pubs considerably contributing to this situation. Venues with smoking permission policies were less compliant with the legislation. The implementation of a comprehensive smoke-free law, without any exceptions, is essential to effectively protect people from the second hand smoke.

Patient's access to healthcare and treatment in rheumatoid arthritis: the views of stakeholders in Portugal.

BACKGROUND: The access to healthcare and treatment by rheumatoid arthritis (RA) patients, particularly to biologics, differs significantly among European countries.We aimed to explore the views and experiences of Portuguese healthcare stakeholders on key barriers which limit the access to treatment, and ultimately to biologics, by RA patients and to find potential solutions (leverage points) to overcome the identified barriers. METHODS: This was a qualitative research consisting of semi-structured face-to-face interviews with key stakeholders in RA framework. Thirty four individuals from eight groups of stakeholders were interviewed: rural and urban general practitioners (GPs), rheumatologists, hospital managers, hospital pharmacists, budget holders, representatives from the Portuguese Rheumatology Society and the RA Patient Association. Interviews were conducted between May and June 2011. Conventional content analysis with research triangulation was used. RESULTS: The key barriers identified were related to the accessibility to primary healthcare services, difficulties in RA diagnosis among GPs, inefficient referral to secondary healthcare and controlled process of biologics prescription in public hospitals. The leverage points identified included the improvement of epidemiological and clinical knowledge about RA in Portugal, a better understanding of the disease among patients and GPs, the clarification of biologics benefits among budget holders and a raised awareness of the current treatment guidelines. In order to further address the leverage points, the following key initiatives were proposed: optimization of RA national registry; dissemination of information on rheumatic symptoms in primary care facilities and among the general public; increase interaction between rheumatologists and GPs through clinical discussions of successfully treated patients or workshops; broader utilization of disease diagnosis and monitoring tools, such as DAS28, and implementation of hospital-based research to collect real-world data. CONCLUSIONS: Most of the key barriers limiting the access to treatment, including biologics, in RA in Portugal are upstream of rheumatology practice. Our findings suggest that future actions should be focused on the primary care level to improve referral to rheumatologists. In addition, the collection of real-world data seems essential to characterise the RA population, to improve disease management and to increase compliance with current treatment guidelines.

Effects of etanercept treatment on lipid profile in patients with moderate-to-severe chronic plaque psoriasis: a retrospective cohort study.

Treatment with tumor necrosis factor alpha (TNF-α) inhibitors may have favourable effects on the lipid profile. This is the first study to assess the impact of etanercept on the lipid profile in patients with moderate-to-severe plaque psoriasis. To investigate the effect of etanercept on the lipid profile after 24 weeks of treatment in patients with moderate-to-severe plaque psoriasis. We conducted a retrospective cohort study reviewing the medical records of 45 consecutive patients who were treated for psoriasis with etanercept between June 2006 and September 2009. Demographic and clinical data were collected. Levels of total cholesterol, LDL-C, HDL-C, triglycerides, fasting glucose and C-reactive protein were recorded at the start of etanercept and at week 24. Levels of total cholesterol, LDL-C and triglycerides increased after 24 weeks of treatment with etanercept, with mean differences of 7.1 mg/dL (p=0.505), 2.0 mg/dL (p=0.718) and 2.8 mg/dL (p=0.180), respectively. HDL-C decreased, with a mean difference of -1.4 mg/dL (p=0.995). None of these changes were statistically significant. We found no favourable changes on the lipid profile after 24 weeks of treatment with etanercept in responding patients with chronic plaque psoriasis.

[Nutritional repercussion in advanced heart failure and its value in prognostic assessment]. / Repercussão nutricional na insuficiência cardíaca avançada e seu valor na avaliação prognóstica.

OBJECTIVE: To analyze the nutritional repercussion in heart failure and its relations with left ventricular dysfunction and mortality. METHODS: A series of nutritional parameters in a group of 95 patients with advanced chronic heart failure, arising out of dilated cardiomyopathy and age < 65 years old, without concomitant diseases was studied. The duration of symptons, final diastolic diameter and left ventricular ejection fraction were verified. The nutritional assessment, included the ideal percentage of weight the triceps skin fold thickness, percentiles of circumference of muscular mass of the arm, the albumin serum levels and the lymphocytes global count. RESULTS: The nutritional situation was alterated in 45.3% to 94.7% of the patients in accordance to the assessment parameter used. There was neither correlation between the nutritional parameters and the length of symptoms, nor with the ventricular dysfunction level. That group of patients had a homogenous evolution, and 75.8% of them died in an average time of 21.86 weeks. The left ventricular diastolic diameter and ejection fraction did not allow for the prediction of survival. A diminished body mass identified a group with higher risk of death. The ideal percentage of the body mass was predictive of survival (p=0.0352), the patients with less than 80% of ideal weight had a higher relative risk of death of 1.99 (1.12-3.02) (p=0.0132). CONCLUSION: Malnutrition is frequent in patients with advanced heart failure and dilated cardiomyopathy. The reduced body mass was a better predictor of survival than the left ventricular ejection fraction in patients under advanced stage of myocardial compromising.

Repercussão nutricional na insuficiência cardíaca avancada e seu valor na avaliacão prognóstica / Nutritional repercussion in advanced heart failure and its value in prognostic assessment

OBJETIVO: Analisar a repercussão nutricional na insuficiência cardíaca e suas relacões com a disfuncão ventricular esquerda e a mortalidade. MÉTODOS: Estudou-se uma série de parâmetros nutricionais num grupo de 95 pacientes com insuficiência cardíaca crônica avancada decorrente de cardiomiopatia dilatada e idade < 65 anos, sem evidências de doencas concomitantes. Foram verificados a duracão dos sintomas, o diâmetro diastólico final e a fracão de ejecão do ventrículo esquerdo. A avaliacão nutricional incluiu a percentagem ideal do peso, a espessura da prega tricipital, os percentis da circunferência da massa muscular do braco, os níveis séricos de albumina e a contagem global dos linfócitos. RESULTADOS: A situacão nutricional esteve alterada em 45,3 por cento a 94,7 por cento dos pacientes conforme o parâmetro da avaliacão empregado. Não houve correlacão entre os parâmetros nutricionais e a duracão dos sintomas, nem com o grau de disfuncão ventricular. Este grupo de pacientes teve uma evolucão homogênea e 75,8 por cento dos pacientes faleceram num tempo médio de 21,86 semanas. O diâmetro diastólico e a fracão de ejecão do ventrículo esquerdo não permitiram predizer a sobrevida. Uma massa corpórea diminuída identificou um grupo com maior risco de morte. A percentagem ideal do peso corpóreo foi preditiva da sobrevida (p=0,0352), os pacientes com menos de 80 por cento do peso ideal tiveram um risco relativo maior de morte de 1,99 (1,12-3,02) (p=0,0132). CONCLUSAO: A desnutricão é freqüente nos pacientes com insuficiência cardíaca avancada e cardiomiopatia dilatada. A massa corpórea reduzida foi melhor preditor de sobrevida do que a fracão de ejecão do ventrículo esquerdo, nos pacientes em fase avancada de comprometimento miocárdico.

Enfermedad por citomegalovirus (CMV): estudio morfológico de 24 casos de autopsia / Cytomegalovirus disease: pathological findings in 24 autopsies

Con el aumento de la sobrevida de pacientes inmunodeprimidos la enfermedad por CMV ha cobrado cada vez más importancia. Su diagnóstico se basa frecuentemente en estudios morfológicos. Los objetivos de esta revisión de autopsias fueron: a) delimitar los patrones morfológicos de la enfermedad por CMV; b) determinar el posible rol del CMV como causa de muerte y c) conocer la relación entre la condición de base del paciente y la extensión de la enfermedad. Se reunieron 24 casos. En 13 se encontraron inclusiones virales en más de un órgano. El pulmón fue el órgano más afectado (19 casos), seguido del hígado (7), suprarrenal y colon (5) y riñón, bazo e intestino delgado (4). En 20 casos (83 por ciento) se encontró una condición basal inmunodepresiva; neoplasia maligna (6 casos), sindrome de inmunodeficiencia (5), tratamiento inmunusupresor por patología no tumoral (4) y otros (5). El 54 por ciento de las autopsias presentó otras infecciones asociadas; micótica (8 casos), bacteriana (5), viral (2) y parasitaria (1). En 9 casos se consideró el CMV causa posible de muerte y en 5 fue la única causa posible encontrada. Los grupos con neoplasias y sindrome de inmunodeficiencia presentaron una enfermedad por CMV más extensa y el patrón pulmonar más frecuentemente encontrado como causa de muerte fue daño alveolar difuso y bronconeumonia extensa