Distribution of genetically characterized yeasts and its antifungals susceptibility in the hospital environment.

Candida spp. is one of the main pathogens associated with nosocomial infection in Brazil and worldwide. The aim of this study was to evaluate the distribution of Candida yeasts in the ICU and their susceptibility to the antifungal agents terbinafine and fluconazole. The samples were collected by swabbing nine surfaces in the ICU of a hospital located in Pelotas, RS. These isolates were genetically characterized by sequencing the internal transcript spacer (ITS) using the primers ITS1 and ITS4. The test against antifungals was performed by Microdilution in Broth (CLSI-M27-A4). 64 yeasts identified as Candida parapsilosis (45.31%; n = 29), Meyerozyma (Pichia) guilliermondii (28.12%; n = 18), Claviceps lusitaneae (25%; n = 16) and Candida tropicalis (1, 56%; n = 1) mostly at the counter used for handling medicines and food distribution (68.75%; n = 44). Susceptibility to antifungals varied between species. These results describe potentially pathogenic Candida species as contaminants in the ICU environment. The study environment is a potential source of exogenous infection for hospitalized patients.

Predicting participation of people with impaired vision in epidemiological studies.

BACKGROUND: The characteristics of the target group and the design of an epidemiologic study, in particular the recruiting methods, can influence participation. People with vision impairment have unique characteristics because those invited are often elderly and totally or partially dependent on help to complete daily activities such as travelling to study sites. Therefore, participation of people with impaired vision in studies is less predictable than predicting participation for the general population. METHODS: Participants were recruited in the context of a study of prevalence and costs of visual impairment in Portugal (PCVIP-study). Participants were recruited from 4 Portuguese public hospitals. Inclusion criteria were: acuity in the better eye from 0.5 decimal (0.30logMAR) or worse and/or visual field of less than 20 degrees. Recruitment involved sending invitation letters and follow-up phone calls. A multiple logistic regression model was used to assess determinants of participation. The J48 classifier, chi-square and Fisher's exact tests were applied to investigate the possible differences between subjects in our sample. RESULTS: Individual cases were divided into 3 groups: immediate, late and non-participants. A participation rate of 20% was obtained (15% immediate, 5% late). Factors positively associated with participation included years of education, annual hospital attendance, and intermediate visual acuity. Females and greater distance to the hospital were inversely associated with participation. CONCLUSION: In our study, a letter followed by a phone call was efficient to recruit a significant number of participants from a larger group of people with impaired vision. However, the improvement in participation observed after the phone call might not be cost-effective. People with low levels of education and women were more difficult to recruit. These findings need to be considered to avoid studies whose results are biased by gender or socio-economic inequalities of their participants. Young subjects and those at intermediate stages of vision impairment, or equivalent conditions, may need more persuasion than other profiles.

BK virus nephropathy complicated with meningoencephalitis after kidney transplantation.

BK disease is an opportunistic infection in organ transplant recipients and patients with other cellular immunodeficiencies. To the best of our knowledge, we report the second case of BK meningoencephalitis associated with nephropathy in a kidney transplant recipient. A 15-yr-old boy underwent a cadaveric kidney transplant without complications; however, 11 wk after the transplantation, he was admitted to the hospital for graft dysfunction and cytopenia, which were confirmed by BK nephropathy (plasma viral replication and histological evidence). Four days after his hospital admission, he developed a high-grade fever and headache. CSF analysis revealed pleocytosis with a positive PCR for BK virus. Reduction in immunosuppression and supportive care conducting cycles of immunoglobulin and cidofovir were successful in treating the patient. BK meningoencephalitis should be considered in kidney transplant recipients who present with signs and symptoms of meningoencephalitis.

Fatal Budd-Chiari syndrome associated with Hemodialysis Reliable Outflow (HeRO) graft.

Population aging and prolonged time on dialysis pose challenges to vascular access for nephrologists and vascular surgeons. HeRO grafts are an option used for patients with central venous obstruction and without the possibility of other vascular access on upper limbs. Some long-term complications, namely access thrombosis, infection, and limb ischemia, have already been reported. There are few data on thromboembolic complications associated with this device. We report the first case in the literature of Budd-Chiari Syndrome associated with the HeRO graft.

In vivo/in vitro studies of the effects of the type II arabinogalactan isolated from Maytenus ilicifolia Mart. ex Reissek on the gastrointestinal tract of rats.

Type II arabinogalactan (AG) is a polysaccharide found in Maytenus ilicifolia (Celastraceae), a plant reputed as gastroprotective. Oral and intraperitoneal administration of the AG protected rats from gastric ulcers induced by ethanol. No alteration of mechanisms related to acid gastric secretion and gastrointestinal motility were observed. In vitro, the AG showed a potent scavenging activity against the radical of DPPH (2,2-diphenyl-1-picrylhydrazyl) with an IC50 value of 9.3 microM. However, the mechanism of the gastroprotective action remains to be identified.

Waiver of the psychotherapist-patient privilege: implications for child custody litigation.

The psychotherapist-patient privilege, rooted in both common and statutory law, is predicated upon the public policy goal of protecting the reasonable expectation of privacy of individuals seeking psychotherapy. The privilege is not absolute, however. State and federal courts are far from uniform in determining how and when the privilege should be waived, in whole or in part, through implication, inadvertence or the affirmative action of the parties. In the family law context, the law that has evolved around the exercise of this privilege is even more complex as the needs of children add another wrinkle to the goal of balancing the imperative of confidentiality with the need for useful information that may be provided.

The Learning Incubator: an innovative teaching and learning technology in nursing.

OBJECTIVE: To understand the meaning of the Learning Incubator as a teaching and learning technology in the nursing area. METHOD: Qualitative research, supported by grounded theory. Data was collected from March to November 2019, through interviews with guiding questions and hypotheses directed at two different groups. The analysis was done by comparative data analysis and included open, axial and integrated coding, as proposed by the method. The theoretical sample included 23 participants, which were nurses, technicians, and nursing students. RESULTS: The delimitation of the categories converged in the phenomenon (Re)signifying knowledge and practices in the Learning Incubator. Guided by the paradigmatic model, the categories were named according to the three following components: Condition: Recognizing that the being and the professional practice are inextricable; Action/interaction: Revisiting professional practices that are repetitive and mechanic; Consequence: Referring to the reflections and knowledge constructed in the Learning Incubator. CONCLUSION: The Learning Incubator, as seen by the study participants, is not limited to the Incubator meetings or the themes addressed in it. Beyond a welcoming physical space, the Incubator expands itself and becomes a tool that promotes self-reflection and self-assessment of professional behaviors and attitudes.

Amblyopia screening effectiveness at 3-4 years old: a cohort study.

OBJECTIVE: To study the effectiveness of amblyopia screening at ages 3-4. METHODS AND ANALYSIS: From a population with no previous screening, a cohort of 2300 children with 3-4 years old attending school (91% of children this age attend school in Portugal), were submitted to a complete ophthalmological evaluation. Amblyopia was diagnosed, treated and followed. Amblyopia prevalence, treatment effectiveness, absolute risk reduction (ARR), number needed to screen (NNS) and relative risk reduction (RRR) were estimated. RESULTS: Past/present history of amblyopia was higher than 3.1%-4.2%, depending on amblyopia definition normatives. Screening at age 3-4, had estimated ARR=2.09% (95% CI 1.50% to 2.68%) with a reduced risk of amblyopia in adulthood of 87% (RRR). NNS was 47.8 (95% CI 37.3 to 66.7). Treatment effectiveness of new diagnosis was 88% (83% if we include children already followed). 91% of new amblyopia diagnoses were refractive (of which 100% surpassed amblyopia Multi-Ethnic Pediatric Eye Disease Study criteria after treatment), while most strabismic amblyopias were already treated or undertreatment. Only 30% of children with refractive amblyopia risk factors that were not followed by an ophthalmologist, ended up having amblyopia at age 3-4. Eye patch was needed equally in new-diagnosis versus treated-earlier refractive amblyopia. CONCLUSIONS: Screening amblyopia in a whole-population setting at age 3-4 is highly effective. For each 48 children screened at age 3-4, one amblyopia is estimated to be prevented in the future (NNS). Screening earlier may lead to overdiagnosis and overtreatments: Treating all new diagnosis before age 3-4 would have a maximal difference in ARR of 0.3%, with the possible burden of as much as 70% children being unnecessary treated before age 3-4.Involving primary care, with policies for timely referral of suspicious/high-risk preverbal children, plus whole screening at age 3-4 seems a rational/effective way of controlling amblyopia.

Perinatal atrial flutter: different therapeutic outcomes in two case reports.

Atrial flutter is a rare but potentially lethal arrhythmia, characterized by a rapid regular atrial rate, accompanied by variable degrees of atrioventricular block. Two cases of neonatal atrial flutter are described. The first case was diagnosed in utero at 38 weeks of gestation and converted to sinus rhythm by electric shock on the eighth day of life. Case two, diagnosed at 11 days old, with a background of acute bronchiolitis and tachycardia associated with a cardiac tumor, was refractory to electrical cardioversion. Both cases proved difficult to convert to sinus rhythm, but there was clinical improvement and no recurrence. These two cases exemplify the variability of outcomes achieved with anti-arrhythmic agents and direct current cardioversion.

Access to original canal trajectory after deviation and perforation with guided endodontic assistance.

Procedural accidents are eventualities that may occur during endodontic treatment because of lack of attention to detail or even unforeseeable situations. Knowledge of the root canal anatomy and its variations is a prerequisite for successful endodontic treatment. This case report describes an endodontic treatment where there was an intercurrence, generating deviation and perforation, which was solved with the aid of guided endodontics. A 37 years old, ASA1, was referred to the clinic for localisation and treatment of a calcified canal of the second right upper premolar. The tomographic images revealed the presence of only one canal and deviation with apical perforation. With the help of CBCT and CAD/CAM, it was possible to perform the guided access technique even after deviation and root perforation. Once again, this technique proved to be safe and predictable, allowing for a favourable prognosis in the long term.

Exit site infections: systematic microbiologic and quality control are needed.

For the period January 2005 to June 2008, we reviewed the rates, causes, and outcomes of exit-site infection (ESI) among 137 consecutive patients [mean age: 51 +/- 16 years; 17 (12.4%) with diabetes; 76 (55%) on automated PD; time at risk: 240.41 dialysis years; mean follow-up: 20.4 +/- 13.8 months]. Treatment protocol included mini-laparotomy and Popovich-Moncrief placement method, with presurgical cefazolin prophylaxis and routine prescription of topical mupirocin for the exit site. Oral cotrimoxazole was the initial empirical ESI treatment. A total of 49 patients (36%) experienced 76 episodes of ESI, for a global incidence of 0.31 episodes per year at risk. Gram-positive organisms occurred in 56% of the cases, and gram-negative organisms in 27%. Staphylococcus aureus caused 15 ESIs (0.06 episodes/patient-year), and only 15% of gram-positive organisms were methicillin resistant. Methicillin-resistant S. aureus were all sensitive to cotrimoxazole. Pseudomonas species caused 11 ESIs (0.04 episodes/patient-year). Other Enterobacteriaceae occurred at a rate of 0.03 episodes/patient-year. Fungal ESLs occurred at a rate of 0.004 episodes/patient-year The ESI cure rate was 96%. In 3 patients, the catheter was removed, but only 2 patients (2.6%) experienced ESI-related peritonitis. Our unit's treatment policy and prophylactic use of exit-site mupirocin resulted in a low S. aureus ESI rate without an alarming incidence of gram-negative or Pseudomonas infections. Routine microbiologic and quality control is mandatory for strategies individualized to the dialysis center.

Quality of life and mental health in amblyopic children treated with and without occlusion therapy.

PURPOSE: To assess the long-term (≥1 year) psychosocial effects of occlusion therapy in children with refractive amblyopia and their caregivers. METHODS: Multiple self-reported questionnaires were used to investigate HRQoL, anxiety, depression, and stress in a cross-sectional study of children with refractive amblyopia and their caregivers. Children were divided into two subgroups: those treated with glasses only and those treated with both glasses and occlusion therapy who had stopped wearing a patch at least 1 year earlier. RESULTS: A total of 79 children were included: 32 in the refraction-only group and 47 in the glasses + occlusion group. Median age of subjects was 12 years (IQR = 3.0). Mean age of the 79 caregivers was 41.9 ± 5.0 years. No significant differences were found for any of the psychosocial outcomes analyzed between children treated with glasses and patching and those treated with glasses only. The differences remained insignificant between children according to age of first occlusion (<6 vs ≥6 years). The only significant (but not clinically relevant) difference observed for caregivers was a higher score in the depression dimension of the Hospital Anxiety and Depression Scale for caregivers of children treated with glasses only (P = 0.036; effect size = 0.23). CONCLUSIONS: In our study cohort, patching was not associated with long-term negative psychosocial outcomes in children with refractive amblyopia treated with occlusion therapy.

Low serum levels of prohepcidin, but not hepcidin-25, are related to anemia in familial amyloidosis TTR V30M.

Familial amyloidosis TTR V30M (FAP-I) usually presents as a sensorimotor and autonomic neuropathy. Anemia was first described in this disease more than 20 years ago and classified as an anemia of chronic disease. However, so far no studies have addressed the role of inflammatory proteins in this disease. The anemia affects 24.8% of symptomatic FAP-I Portuguese patients, and is associated with low serum erythropoietin levels, independently of the presence of clinical nephropathy. In this study we evaluate the role of systemic inflammation on the erythropoietin production and anemia genesis in FAP-I. Data from 24 FAP-I patients (50% with anemia) and 33 healthy controls were analysed. Laboratory data included hemoglobin, hematocrit, ferritin, transferrin saturation, soluble transferrin receptors (sTR), prohepcidin, hepcidin-25, C-reactive protein (CRP), interleukin-6 and erythropoietin levels. In general, FAP-I patients presented significantly lower hemoglobin, hematocrit and observed/expected erythropoietin levels. Mean sTR was lower in FAP-I patients than in controls (2.36+/-1.3 vs 2.96+/-0.8 mg/l, P=0.055) correlating with hemoglobin and hematocrit. As expected, sTR were positively correlated with erythropoietin both in controls and in FAP-I patients. No significant differences on CRP, interleukin-6, transferrin saturation, ferritin and hepcidin-25 were found between anemic and non-anemic FAP-I patients and between non-anemic FAP-I patients and healthy controls. In all groups, a positive correlation was observed between hepcidin-25 and ferritin. Surprisingly, significantly lower prohepcidin levels were found in FAP-I patients, with or without anemia, not correlated with serum hepcidin-25 levels. In general, the decreased observed/expected EPO levels in FAP-I correlated with the prohepcidin levels, therefore raising the possibility that a common defect in these two hormones may be somehow involved in the genesis of the disease.

Anti-inflammatory and analgesic properties in a rodent model of a (1-->3),(1-->6)-linked beta-glucan isolated from Pleurotus pulmonarius.

A glucan was extracted with hot water from the basidiomycete Pleurotus pulmonarius and shown to have a (1-->3)-linked beta-D-glucopyranosyl main-chain substituted at O-6 of every third unit by single beta-D-glucopyranosyl non-reducing end units. This was shown by mono- and bidimensional nuclear magnetic resonance (NMR) spectroscopy, methylation analysis, and a controlled Smith degradation. The glucan was tested for its effects on the acetic acid-induced writhing reaction in mice, a typical model for quantifying inflammatory pain. It caused a marked and dose-dependent anti-inflammatory response, demonstrated by the inhibition of leukocyte migration to injured tissues (82 +/- 6%) with an ID50 of 1.19 (0.74-1.92) mg/kg. Furthermore, animals previously treated with the glucan (3 mg/kg i.p.), showed a reduction of 85 +/- 5% of writhes, after receiving the acetic acid injection. Furthermore, in the formalin test, the glucan (3-30 mg/kg, i.p.) also caused significant inhibition of both the early (neurogenic pain) and the late phases (inflammatory pain) of formalin-induced licking. However, it was more potent and effective in relation to the late phase of the formalin test, with mean ID(50) values for the neurogenic and the inflammatory phases of > 30 and 12.9 (6.7-24.6) mg/kg and the inhibitions observed were 43 +/- 5% and 96 +/- 4%, respectively. These data showed that the glucan had potent anti-inflammatory and analgesic (antinociceptive) activities, possibly by the inhibition of pro-inflammatory cytokines.

Gastroprotective activity of the chloroform extract of the roots from Arctium lappa L.

Arctium lappa L. is used in folk medicine as a diuretic, depurative and digestive stimulant and in dermatological conditions. The objective of this study was to evaluate the effect and the possible mechanisms involved in the gastroprotective effects of a chloroform extract (CE) of the roots from A. lappa and its fractions. Oral pretreatment with CE (10, 30 and 100 mg kg(-1)) significantly reduced gastric lesions induced by ethanol by 61%, 70% and 76%, respectively. Oral administration of CE (100 mg kg(-1) per day for 7 days) reduced the chronic gastric ulceration induced by acetic acid by 52%. Intraduodenal CE (100, 300 and 600 mg kg(-1)) reduced the total acidity of gastric secretion by 22%, 22% and 33%, respectively, while i.p. administration (10, 30 and 100 mg kg(-1)) inhibited total acidity by 50%, 60% and 67%, respectively. In-vitro, CE inhibited H+, K+ -ATPase activity with an EC50 of 53 microgmL(-1) and fraction A (30 and 100 microgmL(-1)) reduced this by 48% and 89%, respectively. CE had no effect on gastrointestinal motility. CE (250 microgmL(-1)) and fraction B (100 and 250 microgmL(-1)) had free-radical scavenging ability, inhibiting 2,2-diphenyl-1-picrylhydrazyl (DPPH) radical activity by 50%, 20% and 55%, respectively. Collectively, the results show that the CE protects animals from gastric lesions by reducing gastric acid secretion via inhibition of gastric H+, K+ -ATPase.

Inhibition of H+/K+ ATPase in the gastroprotective effect of Baccharis illinita DC.

Baccharis illinita DC (Compositae) is used in folk medicine to treat gastric disturbances. Preliminary studies with other extracts of B. Illinita showed gastric protection against ethanol-, indometacin- and stress-induced ulcers and the inhibition of gastric secretion. Based on these data, the aim of this study was to verify the pathways involved in the inhibition of gastric secretion. The chloroform extract (CE) of flowers from B. illinita (3, 10, 30 and 100 mg kg(-1) i.p.) tested on rats with pylorus ligature reduced the volume and the total acidity of gastric content by approximately 50% (ED50 = 69 mg kg(-1)). Treatment with CE (100 mg kg(-1) i.p.) reduced the gastric total acidity stimulated by histamine, bethanechol and pentagastrin to 42%, 27% and 57% of that in the stimulated control group, respectively. The CE (10, 30 and 100 microM) inhibited H+/K+ ATPase activity in-vitro, with an IC50 of 37 microM. The isolated flavonoid luteolin (1, 3, 10 and 30 microM) also inhibited H+/K+ ATPase activity by 50%, at a dose of 30 microM. Our results suggest that the reduction in gastric secretion occurs through inhibition of H+/K+ ATPase, which is the final step in acid secretion and therefore one of the most important steps.

Antiulcerogenic activity of bark extract of Tabebuia avellanedae, Lorentz ex Griseb.

Tabebuia avellanedae is commonly used for the treatment of peptic ulcers. We carried out this study with the ethanolic extract of bark from Tabebuia avellanedae (EET) (30-1000 mg/kg) to determine its gastroprotective activity and to clarify the pathways involved in this effect. Acute gastric ulceration in rats was produced by oral administration of ethanol and ibuprofen. After ethanol administration, the gastric wall mucus was examined. Chronic gastric ulceration was produced by injection of acetic acid in rat gastric subserosa. Anti-secretory studies were undertaken using Shay rat pylorus ligature technique and measurement of enzymatic activity of H+, K+-ATPase in vitro. Administration of EET p.o. or i.p. significantly inhibited gastric mucosa damage induced by ethanol and ibuprofen. The anti-ulcer effect was further confirmed by enhanced gastric mucus production. In pylorus ligature rats, EET significantly reduced the basal gastric acid secretion and total acidity; moreover, it inhibited the increase in total acidity induced by histamine. In addition, EET reduced the activity of H+, K+, ATPase. The results obtained in the present pharmacological assay indicate that this plant has a protective action against gastric lesions, involving the maintenance of protective factors, such as mucus and prostaglandin, besides the reduction of gastric total acidity.

Suction-induced retinopathy: optical coherence tomography correlations.

We report a clinical case of a teenager whose eyes were exposed to highly negative suction pressures for brief seconds. The patient presented with a bilateral cystoid macular oedema associated with a thickening of outer nuclear layer evidenced by optical coherence tomography. The patient's constellation of findings is most easily explained by the abrupt expansion and traction of a cohesive vitreous base onto the retinal layers.

Distanciamento social na covid-19: análise dos casos de violência sexual em um municipio de triplice fronteira durante a pandemia / Social distancing in covid-19: analysis of sexual violence in a municipality of triplice border during the pandemic / Distancia social en covid-19: análisis de casos de violencia sexual en un municipio triplical transfronterizo durante pandemia

Durante a pandemia da COVID-19, o distanciamento social e a quarentena tiveram um impacto significativo no aumento do número de casos de violência sexual. Embora essas medidas tenham sido essenciais para conter a propagação do vírus, elas também criaram um ambiente propício para o aumento da violência doméstica e sexual. Este estudo teve como objetivo identificar o perfil dos casos de violência sexual notificados no município de Foz do Iguaçu durante o período da pandemia da Covid-19 (2020 a 2022). Trata-se de uma pesquisa transversal, descritiva e exploratória de caráter quantitativo, realizado com as fichas de notificação compulsória dos casos de violência sexual, da vigilância epidemiológica do município de Foz do Iguaçu-PR, durante os anos de 2020 a 2022. Identificou-se predomínio de violência sexual no sexo feminino, com idade entre 1 a 15 anos. O primeiro trimestre de 2020 e 2021 tiveram maiores números de registros. Os agressores em sua maioria foram conhecidos, padrastos e o pai. A maioria dos casos ocorreram na própria residência. O distanciamento social e a quarentena criaram condições propícias para o aumento desses casos, colocando as vítimas em situações de maior vulnerabilidade e limitando seu acesso a recursos de apoio.

During the COVID-19 pandemic, social distancing and quarantine have had a significant impact on the increase in the number of cases of sexual violence. While these measures have been essential to contain the spread of the virus, they have also created an environment conducive to increased domestic and sexual violence. This study aimed to identify the profile of cases of sexual violence reported in the municipality of Foz do Iguaçu during the COVID-19 pandemic period (2020 to 2022). This is a cross- sectional, descriptive and exploratory survey of a quantitative nature, carried out with the compulsory notification sheets of cases of sexual violence, the epidemiological surveillance of the municipality of Foz do Iguaçu-PR, during the years 2020 to 2022. A predominance of sexual violence was identified in the female sex, aged between 1 and 15 years. The first quarter of 2020 and 2021 had higher numbers of registrations. The aggressors were mostly known, stepfathers and father. Most of the cases occurred at home. Social distancing and quarantine have created favorable conditions for the increase in such cases, placing victims in situations of greater vulnerability and limiting their access to support resources.

Durante la pandemia COVID-19, el distanciamiento social y la cuarentena tuvieron un impacto significativo en el aumento del número de casos de violencia sexual. Aunque estas medidas eran esenciales para contener la propagación del virus, también creaban un entorno favorable para el aumento de la violencia doméstica y sexual. El objetivo de este estudio fue identificar el perfil de violencia sexual reportada en el municipio de Foz do Iguaçu durante el periodo de pandemia Covid-19 (2020-2022). Se trata de un estudio transversal, descriptivo y exploratorio de carácter cuantitativo, realizado con las fichas obligatorias de notificación de violencia sexual, la vigilancia epidemiológica del municipio de Foz do Iguaçu-PR durante los años 2020-22. El predominio de la violencia sexual se identificó en el sexo femenino, de edades comprendidas entre 1 y 15 años. El primer trimestre de 2020 y 2021 tuvo un mayor número de registros. Los agresores en su mayoría eran conocidos, padrastro y padre. La mayoría de los casos ocurrieron en casa. El distanciamiento social y la cuarentena han creado las condiciones para aumentar esos casos, situando a las víctimas en situaciones de mayor vulnerabilidad y limitando su acceso a los recursos de apoyo.

Cystic Fibrosis Newborn Screening in Portugal: PAP Value in Populations with Stringent Rules for Genetic Studies.

Newborn screening (NBS) for cystic fibrosis (CF) has been shown to be advantageous for children with CF, and has thus been included in most NBS programs using various algorithms. With this study, we intend to establish the most appropriate algorithm for CF-NBS in the Portuguese population, to determine the incidence, and to contribute to elucidating the genetic epidemiology of CF in Portugal. This was a nationwide three-year pilot study including 255,000 newborns (NB) that were also screened for congenital hypothyroidism (CH) and 24 other metabolic disorders included in the Portuguese screening program. Most samples were collected in local health centers spread all over the country, between the 3rd and 6th days of life. The algorithm tested includes immunoreactive trypsinogen (IRT) determination, pancreatitis associated protein (PAP) as a second tier, and genetic study for cases referred to specialized clinical centers. Thirty-four CF cases were confirmed positive, thus indicating an incidence of 1:7500 NB. The p.F508del mutation was found in 79% of the alleles. According to the results presented here, CF-NBS is recommended to be included in the Portuguese NBS panel with a small adjustment regarding the PAP cut-off, which we expect to contribute to the improvement of the CF-NBS performance. According to our results, this algorithm is a valuable alternative for CF-NBS in populations with stringent rules for genetic studies.