Increasing HIV early diagnosis by implementing an automated screening strategy in emergency departments.

INTRODUCTION: Late HIV diagnosis is associated with increased morbidity, mortality and risk of onward transmission. Increasing HIV early diagnosis is still a priority. In this observational study with historical control, we determined the impact of an opportunistic HIV screening strategy in the reduction of late diagnosis and missed opportunities for earlier diagnosis. METHODS: The screening programme was implemented in the emergency department (ED) of the Hospital de Cascais between September 2018 and September 2021. Eligible patients were aged 18-64 years, with no known HIV diagnosis or antibody testing performed in the previous year, and who required blood work for any reason. Out of the 252 153 emergency visits to the ED, we identified 43 153 (17.1%) patients eligible for HIV testing. Among the total population eligible for the screening, 38 357 (88.9%) patients were ultimately tested for HIV. Impact of the ED screening was determined by analysing late diagnosis in the ED and missed opportunities at different healthcare settings 3 years before and 3 years after the start of the ED screening. RESULTS: After 3 years of automated HIV ED testing, we found 69 newly diagnosed HIV cases (54% male, 39% Portuguese nationals, mean age 40.5 years). When comparing the characteristics of HIV diagnoses made in the ED, we observed a significant reduction in the number of people with late HIV diagnosis before and after implementation of the screening programme (78.4% vs. 39.1%, respectively; p = 0.0291). The mean number of missed opportunities for diagnosis also fell (2.6 vs. 1.5 annual encounters with the healthcare system per patient, p = 0.0997). CONCLUSIONS: People living with HIV in Cascais and their providers miss several opportunities for earlier diagnosis. Opportunistic screening strategies in settings previously deemed to be unconventional, such as EDs, are feasible and effective in mitigating missed opportunities for timely HIV diagnosis.

Cognitive impairment in liver transplanted patients with transthyretin-related hereditary amyloid polyneuropathy.

INTRODUCTION AND AIM: Hereditary transthyretin-related amyloidosis (ATTR-FAP) is characterized by a progressive neuropathy, cardiomyopathy, nephropathy and ocular disease. More than 90% of amyloidogenic transthyretin is produced by the liver; however, this protein is also synthesized in the choroid plexus. Although some patients have transitory neurologic events, the impact on cognition is still unknown. The aim was to study the cognitive performance of ATTR-FAP V30M patients with long disease course. METHODS: A prospective observational study of a consecutive sample of patients with 10 or more years of disease duration was conducted. All patients underwent an extensive neuropsychological evaluation. RESULTS: Sixteen patients were included, with a mean age of 53 years and mean duration of disease of 18 years. All had been submitted to liver transplantation. The functional status was not incapacitating in the majority, with 75% needing at most a stick to walk and 38% still actively working. The neuropsychological evaluation disclosed episodic memory impairments in 31% and executive dysfunction in 25% of patients. CONCLUSIONS: These novel findings suggest that cognitive dysfunction can be a delayed manifestation of hereditary transthyretin-related amyloidosis. The putative relation of cognitive dysfunction with transthyretin-amyloid deposition can provide another model to study the amyloid hypothesis of cognitive impairment.

O cotidiano da vida de hipertensos: mudanças, restriçöes e reaçöes / Hypertension's daily living: changes, restrictions and reactions

Objetivou-se descrever o cotidiano da vida de hipertensos após o conhecimento do diagnóstico da hipertensäo arterial (HA); e, identificar possíveis mudanças na dinâmica da vida de hipertensos após o início do tratamento da HA...