Health Status and COVID-19 Epidemiology in an Inland Region of Portugal: A Retrospective Study.

Multiple factors, from socioeconomic development to genetic background, can affect the regional impact of some diseases, and this has also been seen during the COVID-19 pandemic. The objective of this retrospective study was to characterize a population in the interior of Portugal regarding health status and COVID-19 epidemiology. Between October 2021 and January 2023, 1553 subjects residing in Beira Baixa, Portugal, were included. Using a self-report approach, demographic and clinical data were obtained. Blood group, blood pressure, peripheral oxygen saturation and anti-spike protein immunoglobulin concentration were also analyzed. Statistical analysis was performed using IBM SPSS Statistics. The average age of the participants was 48.95 (±14.43) years, with 64% being male and 36% being female. The most prevalent comorbidities were hypertension (19.2%), dyslipidemia (12.6%) and diabetes mellitus (6.6%). Half of the population was overweight, and more than half of the subjects had no history of tobacco consumption. Among the participants, 33% were infected with SARS-CoV-2: 70.1% had mild disease, 14.1% moderate disease and 1.4% severe disease. There was a very significant adherence to vaccination (97%). Previously infected or vaccinated people had higher anti-spike protein immunoglobulin values; this value depended on the vaccine administered (p < 0.001). Patients with autoimmune diseases and smokers had lower levels of anti-S IgG antibodies (p = 0.030 and p = 0.024, respectively). The severity of COVID-19 did not affect the concentration of anti-S IgG (p = 0.430). This study highlights the general health statuses and the impact of COVID-19 on a population in the Portuguese interior. Knowledge of the circulation and impact of the virus in this specific population can alert and assist in better interventions being conducted by health authorities.

Lung Cancer Screening: Low-Dose Thoracic Computed Tomography Performed in a High-Risk Portuguese Population.

INTRODUCTION: The Urgeiriça mines were once the main uranium producer in Portugal. The aim of this study was to estimate the benefit of low-dose chest computed tomography (LDCT) for lung cancer screening in former miners that were considered as being at high-risk. METHODS: A subgroup of former miners of the Uranium National Company exposed to uranium and with a smoking load greater than 20 pack-years, agreed to perform a LDCT. The Fleischner Society Guidelines were used to classify the nodules and establish follow-up. RESULTS: Initially, 265 former employees of the Uranium National Company were included. The mean time of employment was 15 (0 - 45) years. The non-smokers represented 50.9% and 30.2% were ever smokers; the remaining chose not to respond. One diagnosis of lung cancer was initially made. In the second phase, a subgroup of 66 former miner underwent a LDCT, 37 of whom presented pulmonary nodules. Most computed tomography (CT) scans revealed one single nodule (n = 13) and the mean size was 5 (1 - 16) mm. A suspicious 16 mm spiculated nodule was evaluated with PET/CT, and percutaneous and surgical biopsies, ultimately revealing a benign lesion. CONCLUSION: The data highlights the importance of lung cancer screening in high-risk populations. This was, to the best of our knowledge, the first study performed in Portugal and can act as a bridge towards a wider implementation in the country.

Investigating the rationale for COPD maintenance therapy prescription across Europe, findings from a multi-country study.

This study aims to understand healthcare professionals' thoughts and motivations about optimal management and treatment of patients with chronic obstructive pulmonary disease (COPD). We conducted a DELPHI survey through an online questionnaire distributed to 220 panellists from six European countries and a discrete choice experiment to describe the relationship between selected clinical criteria and the initial COPD treatment of choice. One hundred twenty-seven panellists (general practitioners [GPs] and pulmonologists) completed the survey. Despite the familiarity and use (89.8%) of the GOLD classification for initial treatment selection, a frequent use of LAMA/LABA/ICS was noted. In fact, panellists agreed that inhaled corticosteroids (ICS) are over-prescribed in the primary care setting. Our study showed that GPs felt less confident than pulmonologists with ICS withdrawal. This mismatch observed between best practice and behaviour indicates the need to increase awareness and efforts to improve the adherence to guidelines in clinical practice.

Pneumonitis Associated with Fluoropolymer Waterproofing Agents: Case Report.

Pneumonitis associated with fluoropolymer waterproofing agents, an entity with few reported cases, can result from occupational exposure. This condition has a rapid onset after exposure, usually resolves with supportive treatment but there could be chronic sequelae. The authors report the case of a 48-year-old male patient admitted to hospital with acute onset of dyspnea and chest pain after using an aerosolized fluoropolymer-containing waterproofing product. He presented tachypnea, leukocytosis, elevated C reactive protein, elevated serum lactate dehydrogenase and hypoxemic respiratory failure. Chest computed tomography revealed bilateral ground-glass opacities with peribronchovascular distribution. The patient was treated with oxygen and corticosteroid therapy, with clinical improvement. This chemical pneumonitis represents a diagnostic challenge since it implies a history of exposure to toxic agents and the pathophysiological mechanisms and safe exposure limits are still unknown.

A pneumonite associada a impermeabilizantes com fluoropolímeros é uma entidade com poucos casos relatados e que pode resultar duma exposição ocupacional. Esta condição tem um início rápido após a exposição, que geralmente se resolve com tratamento de suporte, podendo resultar em sequelas crónicas. Os autores relatam o caso de um homem de 48 anos admitido no hospital com quadro agudo de dispneia e dor torácica após uso de impermeabilizante que continha fluoropolímeros em aerossol. Apresentava taquipneia, leucocitose, proteína C reativa elevada, níveis séricos de lactato desidrogenase elevados e insuficiência respiratória hipoxémica. A tomografia computadorizada do tórax revelou opacidades em vidro despolido bilaterais com distribuição peribroncovascular. O doente foi tratado com oxigenoterapia e corticoterapia com melhoria clínica. Esta pneumonite química representa um diagnóstico desafiante já que implica uma história de exposição a tóxicos, sendo que a fisiopatologia e os limites de segurança de exposição ainda são desconhecidos.

Optimistic Youth: Young Adults Predicted a Faster Decrease in Risk during COVID-19 Emergency State in Portugal.

Perception of risk is known to change throughout the lifespan. Previous studies showed that younger adults are more prone to risk behaviours than older adults. Do these age-related differences influence risk perception during a pandemic crisis? Here, we investigated how age influenced predicted risk during the COVID-19 emergency state in Portugal. We show that time-projected estimations (e.g., appraisals based on 'now' vs. 'in two weeks' time', or 'in four weeks' time') of both risk behaviour and importance of transmission prevention decrease over time. Importantly, projected risk decreased more steeply for younger than older adults. Our findings suggest that younger adults have a different perception of epidemic-related risk than older adults. This seems to support the view that public health policy making during epidemics should differentially target younger adults.

A perceção do risco muda ao longo da vida. Estudos anteriores mostraram que os jovens adultos são mais propensos a comportamentos de risco do que os adultos mais velhos. Será que estas diferenças relacionadas com a idade influenciam a perceção de risco durante uma crise pandémica? Aqui, investigámos como a idade influenciou o risco previsto durante o estado de emergência da COVID-19 em Portugal. Demonstramos que as estimativas de tempo projetadas (e.g., avaliações baseadas em agora vs. "daqui a duas semanas", ou "daqui a quatro semanas") tanto do comportamento de risco como da importância da prevenção da transmissão diminuem ao longo do tempo. É importante notar que o risco projetado diminuiu mais acentuadamente para os jovens adultos do que para os adultos mais velhos. Os nossos resultados sugerem que os jovens adultos têm uma perceção do risco relacionado com epidemias diferente do que os adultos mais velhos e parecem corroborar a perspetiva de que a elaboração de políticas de saúde pública durante epidemias deve visar de forma diferente os jovens adultos.

Treatable Traits in COPD - A Proposed Approach.

The well-recognized individual heterogeneity within COPD patients has led to a growing interest in greater personalization in the approach of these patients. Thus, the treatable traits strategy has been proposed as a further step towards precision medicine in the management of chronic airway disease, both in stable phase and acute exacerbations. The aim of this paper is to perform a critical review on the treatable traits strategy and propose a guide to approach COPD patients in the light of this new concept. An innovative stepwise approach is proposed - a multidisciplinary model based on two distinct phases, with the potential to be implemented in both primary care and hospital settings. The first phase is the initial and focused assessment of a selected subset of treatable traits, which should be addressed in all COPD patients in both settings (primary care and hospital). As some patients may present with advanced disease at diagnosis or may progress despite this initial treatment requiring a more specialized assessment, they should progress to a second phase, in which a broader approach is recommended. Beyond stable COPD, we explore how the treatable traits strategy may be applied to reduce the risk of future exacerbations and improve the management of COPD exacerbations. Since many treatable traits have already been related to exacerbation risk, the strategy proposed here represents an opportunity to be proactive. Although it still lacks prospective validation, we believe this is the way forward for the future of the COPD approach.

Effects of Acute Sleep Deprivation Resulting from Night Shift Work on Young Doctors.

INTRODUCTION: To evaluate sleep deprivation and its effects on young physicians in relation to concentration capacity and psychomotor performance. MATERIAL AND METHODS: Eighteen physicians aged 26 - 33 years were divided into 2 groups: non-sleep deprived group (with no night work) and sleep deprived group (minimum 12 hour of night work/week). We applied Pittsburgh Sleep Quality Index to screen the presence of sleep pathology and Epworth Sleepiness Scale to evaluate subjective daytime sleepiness; we used actigraphy and sleep diary to assess sleep hygiene and standard sleep-wake cycles. To demonstrate the effects of sleep deprivation, we applied Toulouse-Piéron's test (concentration test) and a battery of three reaction time tasks after the night duty. RESULTS: Sleep deprived group had higher daytime sleepiness on Epworth Sleepiness Scale (p < 0.05) and during week sleep deprivation was higher (p < 0.010). The mean duration of sleep during the period of night duty was 184.2 minutes to sleep deprived group and 397.7 minutes to non-sleep deprived group (p < 0.001). In the Toulouse-Piéron's test, the sleep deprived group had more omissions (p < 0.05) with a poorer result in concentration (p < 0.05). Psychomotor tests that evaluated response to simple stimuli revealed longer response latency (p < 0.05) and more errors (p < 0.05) in Sleep deprived group; in reaction to instruction test the sleep deprived group showed worse perfection index (p < 0.05); in the fine movements test there was no statistically significant difference between the groups. DISCUSSION: Acute sleep deprivation resulting from nocturnal work in medical professions is associated with a reduction in attention and concentration and delayed response to stimuli. This may compromise patient care as well as the physician's health and quality of life. CONCLUSION: It is essential to study the effects of acute sleep deprivation on the cognitive abilities and performance of health professionals.

Introdução: Avaliar a privação do sono e seus efeitos sobre os jovens médicos relativamente à capacidade de concentração e desempenho psicomotor. Material e Métodos: Dezoito médicos, com idades entre 26 - 33 anos, divididos em dois grupos: grupo sem privação de sono (sem trabalho nocturno) e grupo com privação de sono (no mínimo 12 horas de trabalho nocturno / semana). Aplicámos o Índice de Qualidade de Sono de Pittsburgh para rastrear a presença de patologia do sono e a Escala de Sonolência Epworth para avaliar subjectivamente a sonolência diurna; usamos actigrafia e o diário de sono para avaliar a higiene do sono e os ciclos de sono-vigília. Para demonstrar os efeitos da privação do sono, foi aplicado o teste de Toulouse-Piéron (teste de concentração) e uma bateria de trêstestes de tempo de reação após o período de trabalho nocturno. Resultados: O grupo com privação de sono apresentou maior sonolência diurna na Escala de Sonolência Epworth (p < 0,05) e durante a semana a privação de sono foi maior (p < 0,010). A duração média do sono durante o período de trabalho nocturno foi de 184,2 minutos para o grupo com privação de sono e 397,7 minutos para grupo sem privação de sono (p < 0,001). No teste Toulouse-Piéron o grupo com privação de sono apresentou maior número de omissões (p < 0,05) com um pior resultado no índice de concentração (p < 0,05). Os testes psicomotores que avaliaram a resposta a estímulos simples revelaram maior latência na resposta (p < 0,05) e mais erros (p < 0,05) no grupo com privação de sono; no teste de reacção a instrução o e grupo com privação de sono apresentou pior índice de perfeição (p < 0,05); no teste de movimentos finos não houve diferença estatisticamente significativa entre os grupos. Discussão: A privação de sono aguda resultante do trabalho nocturno em profissões médicas está associada a uma diminuição da atenção e concentração e no atraso de resposta a estímulos. Isto pode comprometer o atendimento ao paciente, bem como a saúde e a qualidade de vida do próprio médico. Conclusão: Ã essencial estudar os efeitos da privação aguda de sono sobre a capacidade cognitiva e de desempenho dos profissionais de saúde.

Simultaneous interstitial pneumonitis and cardiomyopathy induced by venlafaxine.

Venlafaxine is a serotonin-norepinephrine reuptake inhibitor used as an antidepressant. Interindividual variability and herb-drug interactions can lead to drug-induced toxicity. We report the case of a 35-year-old female patient diagnosed with synchronous pneumonitis and acute cardiomyopathy attributed to venlafaxine. The patient sought medical attention due to dyspnea and dry cough that started three months after initiating treatment with venlafaxine for depression. The patient was concomitantly taking Centella asiatica and Fucus vesiculosus as phytotherapeutic agents. Chest CT angiography and chest X-ray revealed parenchymal lung disease (diffuse micronodules and focal ground-glass opacities) and simultaneous dilated cardiomyopathy. Ecocardiography revealed a left ventricular ejection fraction (LVEF) of 21%. A thorough investigation was carried out, including BAL, imaging studies, autoimmune testing, right heart catheterization, and myocardial biopsy. After excluding other etiologies and applying the Naranjo Adverse Drug Reaction Probability Scale, a diagnosis of synchronous pneumonitis/cardiomyopathy associated with venlafaxine was assumed. The herbal supplements taken by the patient have a known potential to inhibit cytochrome P450 enzyme complex, which is responsible for the metabolization of venlafaxine. After venlafaxine discontinuation, there was rapid improvement, with regression of the radiological abnormalities and normalization of the LVEF. This was an important case of drug-induced cardiopulmonary toxicity. The circumstantial intake of inhibitors of the CYP2D6 isoenzyme and the presence of a CYP2D6 slow metabolism phenotype might have resulted in the toxic accumulation of venlafaxine and the subsequent clinical manifestations. Here, we also discuss why macrophage-dominant phospholipidosis was the most likely mechanism of toxicity in this case.

Simultaneous interstitial pneumonitis and cardiomyopathy induced by venlafaxine / Pneumonite intersticial e miocardiopatia simultâneas induzidas por venlafaxina

Venlafaxine is a serotonin-norepinephrine reuptake inhibitor used as an antidepressant. Interindividual variability and herb-drug interactions can lead to drug-induced toxicity. We report the case of a 35-year-old female patient diagnosed with synchronous pneumonitis and acute cardiomyopathy attributed to venlafaxine. The patient sought medical attention due to dyspnea and dry cough that started three months after initiating treatment with venlafaxine for depression. The patient was concomitantly taking Centella asiatica and Fucus vesiculosus as phytotherapeutic agents. Chest CT angiography and chest X-ray revealed parenchymal lung disease (diffuse micronodules and focal ground-glass opacities) and simultaneous dilated cardiomyopathy. Ecocardiography revealed a left ventricular ejection fraction (LVEF) of 21%. A thorough investigation was carried out, including BAL, imaging studies, autoimmune testing, right heart catheterization, and myocardial biopsy. After excluding other etiologies and applying the Naranjo Adverse Drug Reaction Probability Scale, a diagnosis of synchronous pneumonitis/cardiomyopathy associated with venlafaxine was assumed. The herbal supplements taken by the patient have a known potential to inhibit cytochrome P450 enzyme complex, which is responsible for the metabolization of venlafaxine. After venlafaxine discontinuation, there was rapid improvement, with regression of the radiological abnormalities and normalization of the LVEF. This was an important case of drug-induced cardiopulmonary toxicity. The circumstantial intake of inhibitors of the CYP2D6 isoenzyme and the presence of a CYP2D6 slow metabolism phenotype might have resulted in the toxic accumulation of venlafaxine and the subsequent clinical manifestations. Here, we also discuss why macrophage-dominant phospholipidosis was the most likely mechanism of toxicity in this case.

A venlafaxina é um inibidor de recaptação de serotonina e noradrenalina utilizado como antidepressivo. A variabilidade individual ou interações entre fitoterápicos e fármacos podem causar toxicidade induzida por drogas. Relatamos o caso de uma paciente de 35 anos diagnosticada com pneumonite intersticial e miocardiopatia dilatada atribuídas à venlafaxina. A paciente procurou atendimento médico devido a dispneia e tosse seca, que começaram três meses após iniciar tratamento com venlafaxina para depressão. Concomitantemente tomava suplementos fitoterápicos contendo Centella asiatica e Fucus vesiculosus. A radiografia e a CT de tórax revelaram doença pulmonar parenquimatosa (micronódulos difusos e opacidades em vidro fosco) e, simultaneamente, foi diagnosticada uma miocardiopatia por ecocardiograma, que revelou uma fração de ejeção ventricular esquerda (FEVE) de 21%. Uma investigação ampla foi realizada, incluindo LBA, estudos de imagem, detecção de doenças autoimunes, cateterismo cardíaco direito e biópsia miocárdica. Após a exclusão de outras etiologias e a aplicação da Escala de Probabilidade de Reações Adversas a Medicamentos de Naranjo, foi assumido o diagnóstico de pneumonite/miocardiopatia síncronas associadas à venlafaxina. Já foi demonstrado que os suplementos fitoterápicos utilizados pela paciente podem inibir a isoenzima do complexo enzimático citocromo P450, responsável pelo metabolismo da venlafaxina. Após a descontinuação da venlafaxina, verificou-se uma rápida melhora clínica com regressão das alterações radiológicas e normalização da FEVE. Este é um importante caso de toxicidade cardiopulmonar induzida por droga. A administração circunstancial de inibidores da isoenzima CYP2D6 e a presença de um fenótipo de metabolização lenta de CYP2D6 podem ter resultado na acumulação tóxica da venlafaxina e na manifestação clínica subsequente. Aqui, é discutida a hipótese de a fosfolipidose macrofágica ser o mecanismo de toxicidade.

Wildland smoke exposure values and exhaled breath indicators in firefighters.

Smoke from forest fires contains significant amounts of gaseous and particulate pollutants. Firefighters exposed to wildland fire smoke can suffer from several acute and chronic adverse health effects. Consequently, exposure data are of vital importance for the establishment of cause/effect relationships between exposure to smoke and firefighter health effects. The aims of this study were to (1) characterize the relationship between wildland smoke exposure and medical parameters and (2) identify health effects pertinent to wildland forest fire smoke exposure. In this study, firefighter exposure levels of carbon monoxide (CO), nitrogen dioxide (NO2), and volatile organic compounds (VOC) were measured in wildfires during three fire seasons in Portugal. Personal monitoring devices were used to measure exposure. Firefighters were also tested for exhaled nitric oxide (eNO) and CO before and after their firefighting activities. Data indicated that exposure levels during firefighting activities were beyond limits recommended by the Occupational Exposure Standard (OES) values. Medical tests conducted on the firefighters also indicated a considerable effect on measured medical parameters, with a significant increase in CO and decrease in NO in exhaled air of majority of the firefighters.

Monitoring of firefighters exposure to smoke during fire experiments in Portugal.

Forest fires represent a serious threat to public security in Europe due to the large burned area. Moreover, smoke pollution due to forest fire events is an important public health issue for the communities directly affected, and particularly for the personnel involved in firefighting operations. Aiming to contribute to the scientific knowledge concerning firefighters exposure to forest fires smoke, data of individual exposure to carbon monoxide, nitrogen dioxide, volatile organic compounds, and particulate matter were obtained during experimental field fires for a group of 10 firefighters equipped with portable "in continuum" measuring devices. Measured values are very high exceeding the Occupational Exposure Standard limits, in particular for peak limit thresholds. These are the first measurements and analysis of firefighter's individual exposure to toxic gases and particles in fire smoke experiments in Europe. However, they already indicate that urgent measures to avoid these levels of exposure are needed.

Silicosis - brief review and experience of a pulmonology ward.

Silicosis is a diffuse interstitial fibronodular lung disease, caused by the inhalation of crystalline silica. We undertook a brief review of the topic, focusing on the most important aspects and performed a retrospective analysis of 84 patients admitted to the Pulmonology Ward of the Coimbra University Hospital over a 10-year period whose main or secondary diagnosis was silicosis. We also present the most relevant clinical features and the conclusions drawn from this review. The authors assess patients' occupational history, changes in respiratory function study, the imaging findings and the associated complications.

Bronchoalveolar lavage in occupational lung diseases.

Occupational lung diseases (OLDs) are related to the exposure and inhalation of organic, inorganic, and synthetic particles, fumes, gases, or infectious agents. From the long list of OLDs this article focuses the discussion on bronchoalveolar lavage (BAL) in parenchymal immunoinflammatory conditions, such as hypersensitivity pneumonitis (HP) and pneumoconiosis. Several antigens may cause HP, including products of plant or animal origin, aerosolized microorganisms, and organic chemicals. BAL is used not only to assess the pathogenesis of these diseases but also to identify the typical pattern of intense lymphocytic alveolitis, usually with a CD4:CD8 ratio below normal and frequently with the presence of mast cells, plasma cells, and foamy macrophages. Pneumoconioses are chronic interstitial lung diseases caused by the inhalation of mineral and metallic inorganic particles/dusts in an occupational setting, showing a decreasing prevalence in recent years. BAL is a useful tool not only to express the complex pathogenic mechanisms of these entities but also in excluding other diagnoses and causes of alveolitis, and to document specific exposures, such as the identification of asbestos bodies (ABs) in asbestosis or the proliferative response of BAL lymphocytes to beryllium in chronic beryllium disease (CBD).