Characteristics of Oral Corticosteroid Users Among Persons with Asthma on GINA Step 3 Therapy and Above: A Cross-Sectional Study in Portuguese Community Pharmacies.

Purpose: Oral corticosteroids (OCS) are frequently used in asthma management but have an important risk-profile. The aim of the study is to characterize and compare the sociodemographic and clinical characteristics, treatment regimen and asthma control between OCS users and non-users among the population of asthma patients (≥18 years) at GINA step 3 and above treated with a fixed combination of an inhaled corticosteroid and a long-acting beta-agonist (ICS/LABA). Methods: Cross-sectional study in Portuguese community pharmacies. Data was collected via paper-based interview delivered at the pharmacy (sociodemographic characteristics and asthma treatment regimen, namely ICS/LABA and OCS utilization), followed by a telephonic interview collecting smoking history, comorbidities, body mass index (BMI), history of exacerbations and asthma-related healthcare resource utilization (HCRU) in the previous 12 months, as well as asthma control using the Control of Allergic Rhinitis and Asthma Test (CARAT®). Results: A total of 347 patients recruited in 98 pharmacies were included in the analysis. Of those, 328 had completed both questionnaires. A quarter of the individuals reported OCS use in the previous 12 months (OCS users), either as add-on therapy (6%) or exacerbation treatment (19%). Patients were mostly females (72%), with an average age of 59.5 years (SD=15.4). OCS users were significantly older and reported more frequently having conjunctivitis (25.9% vs 15.0%), osteoporosis (25.9% vs 13.4%), arthritis (14.6% vs 6.9%), and gastrointestinal disease (16.1% vs 8.1%). OCS users also reported greater urgent HCRU: unscheduled consultations (33.3% vs 9.3%) and emergency department (ED) visits (32.1% vs 12.1%). Both groups presented poor disease control (85.2% of OCS users vs 72.9% of non-OCS users). Conclusion: These results highlight the burden of OCS therapy to asthma patients and the need to improve asthma management, by adopting OCS sparing strategies in this subgroup of patients.

Nocardia spp. isolation in chronic lung diseases: Are there differences between patients with pulmonary nocardiosis and Nocardia colonization?

AIMS: Chronic lung diseases are a recognized risk factor for Nocardia spp. INFECTION: Nocardia spp. isolation does not inevitably imply disease, and thus colonization must be considered. Here, we aimed to analyse the differences between pulmonary nocardiosis (PN) and Nocardia spp. colonization in patients with chronic lung diseases. METHODS AND RESULTS: A retrospective study of patients with laboratory confirmation of isolation of Nocardia spp. in at least one respiratory sample was performed. Patients with PN and Nocardia spp. colonization were compared. There were 71 patients with Nocardia spp. identification, 64.8% were male, with a mean age of 67.7 ± 11.2 years. All patients had ≥1 pre-existing chronic lung disease, and 19.7% of patients were immunocompromised. PN and Nocardia spp. colonization were considered in 26.8% and 73.2% of patients, respectively. Symptoms and chest CT findings were significantly more frequent in patients with PN (p < 0.001). During follow-up time, 12 (16.9%) patients died, 6 in PN group. Immunosuppression, constitutional symptoms, haematological malignancy and PN diagnosis were associated with significantly shorter survival times, despite only immunosuppression (HR 3.399; 95% CI 1.052-10.989) and PN diagnosis (HR 3.568; 95% CI 1.078-11.910) remained associated with a higher death risk in multivariate analysis. CONCLUSIONS: PN was associated with clinical worsening, more chest CT findings and worse clinical outcomes. SIGNIFICANCE AND IMPACT OF STUDY: Nocardia spp. isolation in chronic lung disease patients is more common than expected and the differentiation between colonization and disease is crucial.

Infective Endocarditis: Still More Challenges Than Convictions. / Endocardite Infecciosa: Ainda mais Desafios que Certezas.

After fourteen decades of medical and technological evolution, infective endocarditis continues to challenge physicians in its daily diagnosis and management. Its increasing incidence, demographic shifts (affecting older patients), microbiology with higher rates of Staphylococcus infection, still frequent serious complications and substantial mortality make endocarditis a very complex disease. Despite this, innovations in the diagnosis, involving microbiology and imaging, and improvements in intensive care and cardiac surgical techniques, materials and timing can impact the prognosis of this disease. Ongoing challenges persist, including rethinking prophylaxis, improving the diagnosis criteria comprising blood culture-negative endocarditis and prosthetic valve endocarditis, timing of surgical intervention, and whether to perform surgery in the presence of ischemic stroke or in intravenous drug users. A combined strategy on infective endocarditis is crucial, involving advanced clinical decisions and protocols, a multidisciplinary approach, national healthcare organization and health policies to achieve better results for our patients.

Após catorze décadas de evolução médica e tecnológica, a endocardite infeciosa continua a desafiar médicos no seu diagnóstico e manejo diário. O aumento da incidência, alterações demográficas (afetando pacientes mais idosos), microbiologia com taxas de infeção por Staphylococcus mais elevadas, com complicações graves ainda frequentes e uma mortalidade substancial tornam a endocardite uma doença muito complexa. Apesar de tudo, a inovação no seu diagnóstico, nomeadamente na área da microbiologia e imagem, e a melhoria nos cuidados intensivos e na cirurgia cardíaca (quanto às técnicas, materiais usados e momento de intervenção) podem ter um impacto no seu prognóstico. Os desafios persistem, incluindo repensar a profilaxia, melhorar os critérios de diagnóstico incluindo a endocardite com culturas negativas e endocardite de prótese valvar, o timing para a intervenção cirúrgica, e sua realização ou não na presença de acidente vascular cerebral isquêmico e em usuários de drogas intravenosas. Uma estratégia combinada na endocardite infeciosa é fundamental, incluindo decisões e protocolos clínicos avançados, um manejo multidisciplinar, organização e políticas de saúde que culminem em melhores resultados para os nossos pacientes.

Endocardite Infecciosa: Ainda mais Desafios que Certezas / Infective Endocarditis: Still More Challenges Than Convictions

Resumo Após catorze décadas de evolução médica e tecnológica, a endocardite infeciosa continua a desafiar médicos no seu diagnóstico e manejo diário. O aumento da incidência, alterações demográficas (afetando pacientes mais idosos), microbiologia com taxas de infeção por Staphylococcus mais elevadas, com complicações graves ainda frequentes e uma mortalidade substancial tornam a endocardite uma doença muito complexa. Apesar de tudo, a inovação no seu diagnóstico, nomeadamente na área da microbiologia e imagem, e a melhoria nos cuidados intensivos e na cirurgia cardíaca (quanto às técnicas, materiais usados e momento de intervenção) podem ter um impacto no seu prognóstico. Os desafios persistem, incluindo repensar a profilaxia, melhorar os critérios de diagnóstico incluindo a endocardite com culturas negativas e endocardite de prótese valvar, o timing para a intervenção cirúrgica, e sua realização ou não na presença de acidente vascular cerebral isquêmico e em usuários de drogas intravenosas. Uma estratégia combinada na endocardite infeciosa é fundamental, incluindo decisões e protocolos clínicos avançados, um manejo multidisciplinar, organização e políticas de saúde que culminem em melhores resultados para os nossos pacientes.

Abstract After fourteen decades of medical and technological evolution, infective endocarditis continues to challenge physicians in its daily diagnosis and management. Its increasing incidence, demographic shifts (affecting older patients), microbiology with higher rates of Staphylococcus infection, still frequent serious complications and substantial mortality make endocarditis a very complex disease. Despite this, innovations in the diagnosis, involving microbiology and imaging, and improvements in intensive care and cardiac surgical techniques, materials and timing can impact the prognosis of this disease. Ongoing challenges persist, including rethinking prophylaxis, improving the diagnosis criteria comprising blood culture-negative endocarditis and prosthetic valve endocarditis, timing of surgical intervention, and whether to perform surgery in the presence of ischemic stroke or in intravenous drug users. A combined strategy on infective endocarditis is crucial, involving advanced clinical decisions and protocols, a multidisciplinary approach, national healthcare organization and health policies to achieve better results for our patients.

In-hospital Outcomes of Infective Endocarditis from 1978 to 2015: Analysis Through Machine-Learning Techniques.

BACKGROUND: Early identification of patients with infective endocarditis (IE) at higher risk for in-hospital mortality is essential to guide management and improve prognosis. METHODS: A retrospective analysis was conducted of a cohort of patients followed up from 1978 to 2015, classified according to the modified Duke criteria. Clinical parameters, echocardiographic data, and blood cultures were assessed. Techniques of machine learning, such as the classification tree, were used to explain the association between clinical characteristics and in-hospital mortality. Additionally, the log-linear model and graphical random forests (GRaFo) representation were used to assess the degree of dependence among in-hospital outcomes of IE. RESULTS: This study analyzed 653 patients: 449 (69.0%) with definite IE; 204 (31.0%) with possible IE; mean age, 41.3 ± 19.2 years; 420 (64%) men. Mode of IE acquisition: community-acquired (67.6%), nosocomial (17.0%), undetermined (15.4%). Complications occurred in 547 patients (83.7%), the most frequent being heart failure (47.0%), neurologic complications (30.7%), and dialysis-dependent renal failure (6.5%). In-hospital mortality was 36.0%. The classification tree analysis identified subgroups with higher in-hospital mortality: patients with community-acquired IE and peripheral stigmata on admission; and patients with nosocomial IE. The log-linear model showed that surgical treatment was related to higher in-hospital mortality in patients with neurologic complications. CONCLUSIONS: The use of a machine-learning model allowed identification of subgroups of patients at higher risk for in-hospital mortality. Peripheral stigmata, nosocomial IE, absence of vegetation, and surgery in the presence of neurologic complications are predictors of fatal outcomes in machine learning-based analysis.

CONTEXTE: Le dépistage précoce des patients atteints d'endocardite infectieuse (EI) présentant un risque élevé de mortalité à l'hôpital est essentiel pour orienter la prise en charge et améliorer le pronostic. MÉTHODOLOGIE: Une analyse rétrospective a été réalisée sur une cohorte de patients suivis de 1978 à 2015 et classés selon les critères de Duke modifiés. Les paramètres cliniques, les données des échocardiographies et les hémocultures ont été évalués. Des techniques d'apprentissage automatique, comme l'arbre de classification, ont été utilisées pour expliquer l'association entre les caractéristiques cliniques et la mortalité hospitalière. De plus, le modèle log-linéaire et la représentation graphique en forêts aléatoires ont été utilisés pour évaluer le degré de dépendance entre les résultats hospitaliers et l'EI. RÉSULTATS: Cette étude a permis d'analyser 653 patients : 449 (69,0 %) avec une EI avérée; 204 (31,0 %) avec une EI possible; âge moyen de 41,3 ± 19,2 ans; 420 (64 %) étaient des hommes. Mode d'acquisition de l'EI : communautaire (67,6 %), nosocomial (17,0 %), indéterminé (15,4 %). Des complications sont survenues chez 547 patients (83,7 %), les plus fréquentes étant l'insuffisance cardiaque (47,0 %), les complications neurologiques (30,7 %) et l'insuffisance rénale dépendante de la dialyse (6,5 %). La mortalité hospitalière était de 36,0 %. L'analyse de l'arbre de classification a permis d'identifier des sous-groupes présentant une mortalité hospitalière plus élevée : les patients présentant une EI communautaire et des stigmates périphériques à l'admission; et les patients présentant une EI nosocomiale. Le modèle log-linéaire a montré que le traitement chirurgical était lié à une mortalité hospitalière plus élevée chez les patients présentant des complications neurologiques. CONCLUSIONS: L'utilisation d'un modèle d'apprentissage automatique a permis d'identifier des sous-groupes de patients présentant un risque plus élevé de mortalité à l'hôpital. Les stigmates périphériques, l'EI nosocomiale, l'absence de végétation et la chirurgie en présence de complications neurologiques sont des prédicteurs d'issue fatale dans l'analyse basée sur l'apprentissage automatique.

Liquid biopsy: the value of different bodily fluids.

Liquid biopsies have gained an increasing interest in the last years among medical and scientific communities. Indeed, the value of liquid effusions, while less invasive and more accurate techniques, has been markedly highlighted. Peripheral blood comprises the most often analyzed sample, but recent evidences have pointed out the huge importance of other bodily fluids, including pleural and peritoneal fluids, urine, saliva and cerebrospinal fluid in the detection and monitoring of different tumor types. In face to these advances, this review aims to provide an overview of the value of tumor-associated mutations, detectable in different effusions, and how they can be used in clinical practice, namely in prognosis assessment and early disease and minimal disease recurrence detection, and in predicting the treatment response or acquired-resistance development.

Development of shoulder pain with job-related repetitive load: mechanisms of tendon pathology and anxiety.

BACKGROUND: The paucity of longitudinal clinical studies limits our understanding of the development of shoulder pain with repetitive shoulder tasks, and its association with underlying mind and body mechanisms. Tendon thickening characterizes painful shoulder supraspinatus tendinopathy, and the perception of pain can be affected by the presence of psychological factors such as anxiety and depression. This study determined the incidence of shoulder pain in novice individuals exposed to repetitive shoulder tasks, and the associated change in outcomes of supraspinatus tendon morphology and measures of anxiety and depression. METHODS: We recruited dental hygiene (DH) students (n = 45, novice and exposed to shoulder repetitive tasks) and occupational therapy (OT) students (n = 52, novice, but not exposed to shoulder repetitive tasks), following them over their first year of training. We measured shoulder pain, supraspinatus morphology via ultrasonography, and psychosocial distress via the Hospital Anxiety and Depression Scale. We compared the incidence of shoulder pain (defined as a change of visual analog scale for pain score greater than the minimal clinically important difference) between DH and OT students using Fisher exact test. We used mixed effects models to longitudinally compare the change in outcomes between 3 groups: DH students who develop and did not develop shoulder pain, and OT students. RESULTS: The incidence of shoulder pain is higher in DH students (relative risk = 4.0, 95% confidence interval [CI] 1.4, 11.4). After 1 year, DH students with pain had the greatest thickening of the supraspinatus (0.7 mm, 95% CI 0.4, 0.9). The change in supraspinatus thickness of DH students with pain was greater than both DH students with no pain (0.4 mm, 95% CI 0.1, 0.8) and OT students (0.9 mm, 95% CI 0.5, 1.2). Anxiety score increased 3.8 points (95% CI 1.6, 5.1) in DH students with pain, and 43% of DH students with pain had abnormal anxiety score at 1 year (relative risk = 2.9, 95% CI 1.0, 8.6). CONCLUSION: Our results provide support for the theoretical model of repetitive load as a mechanism of tendinopathy. The supraspinatus tendon thickens in the presence of repetitive tasks, and it thickens the most in those who develop shoulder pain. Concurrently, anxiety develops with shoulder pain, indicating a potential maladaptive central mechanism that may impact the perception of pain.

Liquid Biopsy for Disease Monitoring in Non-Small Cell Lung Cancer: The Link between Biology and the Clinic.

INTRODUCTION: Cell-free DNA (cfDNA) analysis offers a non-invasive method to identify sensitising and resistance mutations in advanced Non-Small Cell Lung Cancer (NSCLC) patients. Next-generation sequencing (NGS) of circulating free DNA (cfDNA) is a valuable tool for mutations detection and disease's clonal monitoring. MATERIAL AND METHODS: An amplicon-based targeted gene NGS panel was used to analyse 101 plasma samples of advanced non-small cell lung cancer (NSCLC) patients with known oncogenic mutations, mostly EGFR mutations, serially collected at different clinically relevant time points of the disease. RESULTS: The variant allelic frequency (VAF) monitoring in consecutive plasma samples demonstrated different molecular response and progression patterns. The decrease in or the clearance of the mutant alleles was associated with response and the increase in or the emergence of novel alterations with progression. At the best response, the median VAF was 0% (0.0% to 3.62%), lower than that at baseline, with a median of 0.53% (0.0% to 9.9%) (p = 0.004). At progression, the VAF was significantly higher (median 4.67; range: 0.0-36.9%) than that observed at the best response (p = 0.001) and baseline (p = 0.006). These variations anticipated radiographic changes in most cases, with a median time of 0.86 months. Overall, the VAF evolution of different oncogenic mutations predicts clinical outcomes. CONCLUSION: The targeted NGS of circulating tumour DNA (ctDNA) has clinical utility to monitor treatment response in patients with advanced lung adenocarcinoma.

Gender Based Analysis of a Population Series of Patients Hospitalized with Infective Endocarditis in Portugal - How do Women and Men Compare?

Abstract Background: The impact of gender on the outcome of patients hospitalized with infective endocarditis (IE) is not fully understood. Objective: To verify the association between gender and the clinical profile of patients hospitalized with IE, treatment strategies, and clinical outcomes. Methods: This is a retrospective nationwide study of patients hospitalized with IE, based on hospital admissions between 2010 and 2018 in Portugal. Descriptive statistics were used to present variables. An inferential analysis was performed using multiple logistic regression. A 95% confidence interval and a 5% significance level were considered. Results: In total, 3266 (43.1%) women and 4308 (56.9%) men were hospitalized with IE. The women were older (76 vs 69 years old, p<0.001), more frequently presented arterial hypertension (39.8% vs 35.4%, p<0.001) and atrial fibrillation (29.5% vs 21.2%, p<0.001), and had less cardiovascular comorbidities. Acute heart failure was more common in women (32.9 vs 26.9%, p<0.001) and acute renal failure (13.6% vs 11.7%, p<0.001) and sepsis (12.1% vs 9.1%, p<0.001), in men. Women were less likely to undergo cardiac surgery (OR 0.48 - 95%CI 0.40-0.57, p<0.001) and had a higher postoperative mortality (OR 1.84, 95% CI 1.19-2.84, p=0.006). In-hospital mortality rates were comparable between genders (20.3% vs 19.6%, p=0.45). Conclusions: Women were less likely to undergo cardiac surgery when hospitalized with IE, and the female gender was a predictor factor for postoperative mortality. Overall, in-hospital mortality was not influenced by gender. Further research is necessary to fully clarify the impact of gender on IE management and outcomes.

Comparative analysis of the bronchoalveolar microbiome in Portuguese patients with different chronic lung disorders.

The lung is inhabited by a diverse microbiome that originates from the oropharynx by a mechanism of micro-aspiration. Its bacterial biomass is usually low; however, this condition shifts in lung cancer (LC), chronic obstructive pulmonary disease (COPD) and interstitial lung disease (ILD). These chronic lung disorders (CLD) may coexist in the same patient as comorbidities and share common risk factors, among which the microbiome is included. We characterized the microbiome of 106 bronchoalveolar lavages. Samples were initially subdivided into cancer and non-cancer and high-throughput sequenced for the 16S rRNA gene. Additionally, we used a cohort of 25 CLD patients where crossed comorbidities were excluded. Firmicutes, Proteobacteria and Bacteroidetes were the most prevalent phyla independently of the analyzed group. Streptococcus and Prevotella were associated with LC and Haemophilus was enhanced in COPD versus ILD. Although no significant discrepancies in microbial diversity were observed between cancer and non-cancer samples, statistical tests suggested a gradient across CLD where COPD and ILD displayed the highest and lowest alpha diversities, respectively. Moreover, COPD and ILD were separated in two clusters by the unweighted UniFrac distance (P value = 0.0068). Our results support the association of Streptoccocus and Prevotella with LC and of Haemophilus with COPD, and advocate for specific CLD signatures.

The Role of Liquid Biopsy in Early Diagnosis of Lung Cancer.

Liquid biopsy is an emerging technology with a potential role in the screening and early detection of lung cancer. Several liquid biopsy-derived biomarkers have been identified and are currently under ongoing investigation. In this article, we review the available data on the use of circulating biomarkers for the early detection of lung cancer, focusing on the circulating tumor cells, circulating cell-free DNA, circulating micro-RNAs, tumor-derived exosomes, and tumor-educated platelets, providing an overview of future potential applicability in the clinical practice. While several biomarkers have shown exciting results, diagnostic performance and clinical applicability is still limited. The combination of different biomarkers, as well as their combination with other diagnostic tools show great promise, although further research is still required to define and validate the role of liquid biopsies in clinical practice.

Resistance Profile of Osimertinib in Pre-treated Patients With EGFR T790M-Mutated Non-small Cell Lung Cancer.

Background: Osimertinib efficacy in pre-treated patients with epidermal growth factor receptor (EGFR) T790M-mutated non-small cell lung cancer (NSCLC) has been demonstrated in clinical trials, but real-world data, particularly regarding resistance profile, remains limited. This study aims to analyze the resistance mechanisms acquired after treatment with Osimertinib. Methods: Clinical outcomes and molecular results from re-biopsies at the time of osimertinib progression of EGFR T790M-mutated NSCLC patient were analyzed. Results: Twenty-one patients with stage IV adenocarcinoma were included [median 69 years; 57.1% female; 85.7% never-smokers; 23.8% ECOG performance status (PS) ≥2]. Median PFS and OS were 13.4 (95% CI: 8.0-18.9) and 26.4 (95% IC: 8.9-43.8) months, respectively. At the time of analysis, 10 patients had tumor progression (47.6%). T790M loss occurred in 50%, being associated with earlier progression (median PFS 8.1 vs. 21.4 months, p = 0.011). Diverse molecular alterations were identified, including C797S mutation (n = 1), PIK3CA mutation (n = 2), MET amplification (n = 1), CTNNB1 mutation (n = 1), and DCTN1-ALK fusion (n = 1). Histological transformation into small cell carcinoma occurred in one patient. Conclusions: This real-world life study highlights the relevance of re-biopsy at the time of disease progression, contributing to understand resistance mechanisms and to guide treatment strategies.

Infective Endocarditis as the Cause of Death: A Populationbased Study in Portugal, from 2002 to 2018.

INTRODUCTION: Infective endocarditis presents a high rate of morbidity and mortality. Population-based studies addressing mortality caused by infective endocarditis in Portugal are scarce. We aimed to study deaths caused by Infective endocarditis, as well as corresponding demographics and temporal trends. MATERIAL AND METHODS: Retrospective cohort study of all patients whose main cause of death was Infective endocarditis in Portugal from 2002 to 2018. The data was obtained from the national death certificate information system. RESULTS: In Portugal, 3634 people died from infective endocarditis throughout the 17-year study period - infective endocarditis specific mortality rate of 2.1 per 100 000 habitants. Of all deceased, 89% were at least 60 years old, and most were women (55%). Overall, 72% died in a healthcare institution. An annual 9% increase in the incidence death rate from Infective endocarditis was observed, with a significant upward trend during the colder months. DISCUSSION: In Portugal, mortality by infective endocarditis increased, mainly affecting older patients and women, and which can partially be explained by factors such as ageing of the population. The management of older patients with infective endocarditis is challenging as they present a higher number of comorbidities, more valvular heart disease and valve implants, invasive medical procedures and are less likely to undergo cardiac surgery. CONCLUSION: In addition to data on the evolution of demographics in Portugal, it is crucial to study the incidence of infective endocarditis over time to help explain these findings. The identification of factors that can be used to better model national health policies to improve clinical outcomes of infective endocarditis in Portugal is also required.

Introdução: A endocardite infeciosa apresenta uma taxa substancial de morbilidade e mortalidade. Estudos populacionais que abordam a mortalidade por endocardite infeciosa em Portugal são escassos. O nosso objetivo foi estudar as mortes causadas por endocardite infeciosa e os dados demográficos e tendências temporais correspondentes. Material e Métodos: Estudo de coorte retrospetivo de todos os doentes cuja causa de óbito foi endocardite infeciosa em Portugal entre 2002 e 2018. Os dados foram obtidos no sistema nacional de informação de certificados de óbito. Resultados: Em Portugal, 3634 pessoas morreram de endocardite infeciosa ao longo de um período de 17 anos - taxa de mortalidade específica da endocardite infeciosa de 2,1 por 100 000 habitantes. De todos os falecidos, 89% tinham pelo menos 60 anos, a maior parte dos quais do género feminino (55%) e morreram por endocardite infeciosa. Globalmente, 72% morreram numa instituição de saúde. Foi demonstrado um aumento anual de 9% na taxa de mortalidade por endocardite infeciosa, com uma tendência ascendente significativa nos meses mais frios. Discussão: Em Portugal, a mortalidade por endocardite infeciosa aumentou, afetando principalmente doentes mais idosos e mulheres, o que pode ser parcialmente explicado pelo envelhecimento da população. O manejo de doentes idosos com endocardite infeciosa é exigente, pois apresentam maior número de comorbidades, mais valvulopatia e próteses valvulares, procedimentos médicos invasivos e menor probabilidade de serem submetidos a cirurgia cardíaca. Conclusão: Para além dos dados sobre a evolução demográfica de Portugal, é indispensável rever a incidência da endocardite infeciosa e a sua tendência, de forma a melhor interpretar estes resultados. É fundamental identificar indicadores que possam ser usados para melhor modelar as políticas nacionais de saúde, de forma a melhorar os resultados clínicos na endocardite infeciosa no nosso país.

Insight into the epidemiology of infective endocarditis in Portugal: a contemporary nationwide study from 2010 to 2018.

BACKGROUND: Nationwide hospital admissions data series have contributed to a reliable assessment of the changing epidemiology of infective endocarditis, even though conclusions are not uniform. We sought to use a recent populational series to describe the temporal trends on the incidence of infective endocarditis, its clinical characteristics and outcome results, in Portugal. METHODS: A nationwide retrospective temporal trend study on the incidence and clinical characterization of patients hospitalized with infective endocarditis, between 2010 and 2018. RESULTS: 7574 patients were hospitalized with infective endocarditis from 2010 to 2018 in Portuguese public hospitals. The average length of hospitalization was 29.3 ± 28.7 days, predominantly men (56.9%), and 47.1% had between 60 and 79 years old. The most frequent infectious agents involved were Staphylococcus (16.4%) and Streptococcus (13.6%). During hospitalization, 12.4% of patients underwent heart valve surgery and 20% of the total cohort died. After a 1-year post-discharge follow-up, 13.2% of the total initial cohort had had heart valve surgery and 21.2% in total died. The annual incidence of infective endocarditis was 8.31 per 100,000 habitants, being higher in men (9.96 per 100,000 in males versus 6.82 in females, p < 0.001) and increased with age, peaking at patients 80 years old or older (40.62 per 100,000). In-hospital mortality rate significantly increased during the analyzed period, the strongest independent predictors being ischemic or hemorrhagic stroke, sepsis, and acute renal failure. Younger age and cardiac surgery had a protective effect towards a fatal outcome. CONCLUSIONS: In Portugal, between 2010 and 2018, the incidence of infective endocarditis presented a general growth trend with a deceleration in the most recent years. Also, a significant rate of in-hospital complications, a mildly lower than expected stable surgical rate and a still high and growing mortality rate were noted.

Analysis of the spine posture, mobility and strength in healthy individuals with and without scapular dyskinesis / Análise da postura, mobilidade e força da coluna vertebral em indivíduos saudáveis com e sem discinese escapular

Spine posture, mobility and strength can be associated with changes in scapular movement and shoulder pain. However, these aspects have not been assessed in healthy individuals with scapular dyskinesis without shoulder and/or back pain. Objective: To analyze spine posture, mobility and strength in healthy individuals with and without scapular dyskinesis. Method: Cross-sectional study, fifty-two college-aged individuals were divided into two groups, according to scapular dyskinesis testing: a group without scapular dyskinesis (n= 19; age= 22.95±2.86 years; BMI= 22.97±3.12 kg/m²; 10 males) and another with scapular dyskinesis (n= 33; age= 22.06±2.73 years; BMI= 22.14±3.22 kg/m²; 10 males). Posture of the head and shoulders was analyzed from photographs by a postural assessment software (PAS/SAPO). Thoracic kyphosis and range of motion of the cervical and thoracolumbar spine were measured by a digital inclinometer, and the strength of the cervical and thoracolumbar spine muscles by a hand-held dynamometer. Intergroup comparison for all the variables was conducted using analysis of variance (one-way ANOVA), considering p≤0.05 as significant. Results: No intergroup difference was found for spine posture (p= 0.18-0.99), mobility (p= 0.23-0.96) and strength (p= 0.42-0.99). Conclusion: Spine posture, mobility and strength do not differ between healthy individuals with and without scapular dyskinesis. The outcomes suggest that scapular dyskinesis may be related to interpersonal variations. Future prospective studies be conducted in order to verify if these variables can change and influence the development of shoulder pain.

A postura, mobilidade e força da coluna podem estar associadas com mudanças no movimento da escápula e dor no ombro. Objetivo: Analisar a postura da coluna vertebral, mobilidade e força em indivíduos saudáveis com e sem discinese escapular. Método: Estudo transversal com cinquenta e dois indivíduos em idade universitária foram divididos em dois grupos, de acordo com o teste de discinese escapular: um grupo sem discinese escapular (n= 19; idade= 22,95±2,86 anos; IMC= 22,97±3,12 kg/m²; 10 masculino) e outro com discinese escapular (n= 33; idade= 22,06±2,73 anos; IMC= 22,14±3,22 kg/m²; 10 masculino). A postura da cabeça e dos ombros foi analisada a partir de fotografias por um software de avaliação postural (PAS/SAPO). A cifose torácica e a amplitude de movimento da coluna cervical e torácica foram medidas por um inclinômetro digital, e a força dos músculos cervical e torác lombar por um dinamômetro portátil. A comparação intergrupo para todas as variáveis foi realizada utilizando-se a análise de variância (ANOVA unidirecional), considerando p≤0,05 como significativa. Resultados: Não foi encontrada diferença entre grupos postura (p= 0,18-0,99), mobilidade (p= 0,23-0,96) e força da coluna (p= 0,42-0,99). Conclusão: Postura, mobilidade e força da coluna vertebral não diferem entre indivíduos saudáveis com e sem discinese escapular. Os resultados sugerem que a discinese escapular pode estar relacionada a variações interpessoais. Estudos prospectivos futuros devem ser conduzidos afim de verificar se essas variáveis podem modificar e influenciar o desenvolvimento da dor no ombro.

Ciclo de Supervisão de Peter Nicklin num Cenário de Ensino Clínico de Enfermagem / Peter nicklin's supervision cycle in a nursing clinical practice scenario

Objetivo: Relatar cenário de supervisão clínica de estudante de enfermagem no primeiro ensino clínico, com base no ciclo de supervisão de Nicklin. Métodos: Relato de Experiência no ensino com análise crítica de um cenário de supervisão clínica de estudante de enfermagem, em contexto do primeiro ensino clínico, num serviço de medicina, com a duração de 10 semanas, com base no ciclo de supervisão de Nicklin. Resultados: Analisaram-se as práticas e foram identificados problemas de natureza cognitiva, técnica, comunicacional, comportamental, relacional, de gestão das emoções e de autocontrole. O plano de intervenção de supervisão baseou-se na mobilização estratégias supervisivas que permitissem concretizar objetivos no sentido da aquisição de competências nos domínios em que foram identificados problemas. A implementação do plano decorre a partir da avaliação intercalar, nas últimas cinco semanas de ensino clínico. Conclusão: Concluiu-se que o ciclo de supervisão clínica de Nicklin, cuja estrutura encontra paralelismos na metodologia científica do processo de enfermagem, possibilita a análise do processo de desenvolvimento de estudantes em ensino clínico, com base no método científico, o que permite uma supervisão estruturada e baseada na identificação e resolução dos problemas. (AU)

Objective: To report a clinical supervision scenario of a nursing student in the first clinical training based on Nicklin's supervision cycle. Methods: Teaching Experience Report with a critical analysis of a nursing student clinical supervision scenario, in the context of the first clinical training, in a medical ward, lasting 10 weeks, based on Nicklin's supervision cycle. Results: Practices were analysed and problems of a cognitive, technical, communicational, behavioural, relational, emotional management and self-control nature were identified. The supervisory intervention plan was based on the mobilization of supervisory strategies that would make possible to achieve objectives in the sense of acquiring skills in the areas in which problems were identified. The implementation of the plan takes place from the mid-term evaluation, in the last five weeks of clinical training. Conclusion: We concluded that Nicklin's clinical supervision cycle, whose structure finds parallels in the scientific methodology of the nursing process, allows the analysis of the students' development process in clinical training, based on the scientific method, which allows a supervision structured and based on the identification and resolution of problems. (AU)

Objetivo: Informar el escenario de supervisión clínica de un estudiante de enfermería en la primera educación clínica, basado en el ciclo de supervisión de Nicklin. Métodos: Informe de experiencia docente con un análisis crítico del escenario de supervisión clínica de un estudiante de enfermería, en el contexto de la primera enseñanza clínica, en un servicio médico, con una duración de 10 semanas, basado en el ciclo de supervisión de Nicklin. Resultados: Se analizaron las prácticas y se identificaron problemas de naturaleza cognitiva, técnica, comunicacional, conductual, relacional, emocional y de autocontrol. El plan de intervención de supervisión se basó en la movilización de estrategias de supervisión que permitirían alcanzar objetivos en el sentido de adquirir habilidades en las áreas en las que se identificaron problemas. La implementación del plan se lleva a cabo desde la evaluación intermedia, en las últimas cinco semanas de enseñanza clínica. Conclusión: Se concluyó que el ciclo de supervisión clínica de Nicklin, cuya estructura encuentra paralelos en la metodología científica del proceso de enfermería, permite el análisis del proceso de desarrollo del estudiante en la enseñanza clínica, basado en el método científico, que permite la supervisión estructurado y basado en la identificación y resolución de problemas. (AU)