Inpatient Multidisciplinary Rehabilitation in Adult Spinal Cord Injury Without Neuroimaging Abnormality (SCIWNA): A Case Report.

Spinal cord injury without radiographic abnormality is a condition primarily observed in the pediatric population. However, its occurrence in adults remains underreported. This case report aims to describe a rare instance of adult spinal cord injury without neuroimaging abnormality (SCIWNA) following a road accident in a 52-year-old woman, emphasizing the clinical nuances and management challenges associated with this condition. The patient presented with tetraplegia (American Spinal Injury Association Impairment Scale D) with a neurological injury level at C4, exhibiting subtle improvements during inpatient care. Comprehensive examinations revealed conflicting clinical and imaging findings, leading to the diagnosis of SCIWNA. A tailored rehabilitation program involving a multidisciplinary team resulted in notable improvements in neuromotor function, gait, and activities of daily living. The mechanisms behind SCIWNA in adults remain debated, possibly involving pre-existing spinal pathologies exacerbated by trauma. Neurological deficits can range from minor sensory issues to severe tetraplegia with unpredictable times of onset. Diagnostic challenges persist due to normal imaging results despite clinical symptoms. Treatment guidelines lack consensus, encompassing conservative approaches, steroid administration, and surgical interventions in select cases. This rare case of SCIWNA underscores the diagnostic complexity when clinical spinal cord injury contrasts with normal neuroimaging. This report highlights the significance of clinical assessment and the evolving landscape in diagnosing SCIWNA in adults. In addition, the absence of a standardized management protocol emphasizes the need for individualized strategies tailored to patient-specific needs, warranting further research and consensus-building among healthcare professionals.

Predicting and explaining absenteeism risk in hospital patients before and during COVID-19.

In order to address one of the most challenging problems in hospital management - patients' absenteeism without prior notice - this study analyses the risk factors associated with this event. To this end, through real data from a hospital located in the North of Portugal, a prediction model previously validated in the literature is used to infer absenteeism risk factors, and an explainable model is proposed, based on a modified CART algorithm. The latter intends to generate a human-interpretable explanation for patient absenteeism, and its implementation is described in detail. Furthermore, given the significant impact, the COVID-19 pandemic had on hospital management, a comparison between patients' profiles upon absenteeism before and during the COVID-19 pandemic situation is performed. Results obtained differ between hospital specialities and time periods meaning that patient profiles on absenteeism change during pandemic periods and within specialities.

A multiple criteria approach for building a pandemic impact assessment composite indicator: The case of COVID-19 in Portugal.

The COVID-19 pandemic has caused major damage and disruption to social, economic, and health systems (among others). In addition, it has posed unprecedented challenges to public health and policy/decision-makers who have been responsible for designing and implementing measures to mitigate its strong negative impact. The Portuguese health authorities have used decision analysis techniques to assess the impact of the pandemic and implemented measures for counties, regions, or across the entire country. These decision tools have been subject to some criticism and many stakeholders requested novel approaches. In particular, those which considered the dynamic changes in the pandemic's behaviour due to new virus variants and vaccines. A multidisciplinary team formed by researchers from the COVID-19 Committee of Instituto Superior Técnico at the University of Lisbon (CCIST analyst team) and physicians from the Crisis Office of the Portuguese Medical Association (GCOM expert team) collaborated to create a new tool to help politicians and decision-makers to fight the pandemic. This paper presents the main steps that led to the building of a pandemic impact assessment composite indicator applied to the specific case of COVID-19 in Portugal. A multiple criteria approach based on an additive multi-attribute value theory aggregation model was used to build the pandemic assessment composite indicator. The parameters of the additive model were devised based on an interactive socio-technical and co-constructive process between the CCIST and GCOM team members. The deck of cards method was the adopted technical tool to assist in the assessment the value functions as well as in the assessment of the criteria weights. The final tool was presented at a press conference and had a powerful impact on the Portuguese media and on the main health decision-making stakeholders in the country. In this paper, a completed mathematical and graphical description of this tool is presented.

SARS-CoV-2 Antibody Prevalence in the Portuguese Municipality of Vila Nova de Gaia after the First Wave of the Pandemic.

INTRODUCTION: Assessment of SARS-CoV-2 seroprevalence may detect the real spread of the virus because antibody data can provide a long-lasting measure of infection. Existing serological studies in Portugal have tested new serology methods, albeit with small sample sizes and a lack the focus on geographical regions with a high rate of infection cases. The aim of this study was to estimate the serological prevalence of SARS-CoV-2 in Vila Nova de Gaia, the most populous municipality in the north of Portugal and one of those most affected during the first pandemic wave. MATERIAL AND METHODS: A cross-sectional observational study was conducted between June 23rd and July 17th, 2020. Included in the cohort were 18- to 74-year-old men and women living in the municipality of Vila Nova de Gaia, who were sampled through a nonprobabilistic quota-based approach. Cases with a previous RT-PCR diagnosis of COVID-19 were excluded. Sociodemographic and clinical information was collected using a self-administered, written questionnaire. Blood samples were collected for serological laboratory analysis to detect and quantify SARS-CoV-2 anti-IgG antibodies. RESULTS: We tested 2754 participants. Our results show a SARS-CoV-2 seroprevalence of 3.03% (95% confidence interval: 2.37% - 3.87%). Being a smoker (odds ratio: 0.382, 95% confidence interval: 0.147 - 0.99) and having symptoms of COVID-19 (odds ratio: 2.480, 95% confidence interval: 1.360 - 4.522) were consistently associated with lower and higher odds of SARS-CoV-2 antibody presence, respectively, regardless of the analytic design. Moreover, without adjusting for any variables, having had contact with an infected person within the household was associated with increased odds of a positive test (odds ratio: 9.684, 95% confidence interval: 4.06 - 23.101); after adjusting, having self-reported chronic diseases (odds ratio: 0.448, 95% confidence interval: 0.213 - 0.941) was associated with decreased odds. CONCLUSION: This was the first study to estimate the serological prevalence of SARS-CoV-2 in one of the most populous municipalities in Portugal, representing the first step in the development of an epidemiological surveillance system in Portugal, which can help to improve the diagnosis of COVID-19.

Persistence of IgG COVID-19 antibodies: A longitudinal analysis.

Background and aim: The kinetics of antibody production in response to coronavirus disease 2019 (COVID-19) infection is not well-defined yet. This study aimed to evaluate the antibody responses to SARS-CoV-2 and its dynamics during 9-months in a cohort of patients infected during the first phase of the pandemic. As a secondary aim, it was intended to evaluate the factors associated with different concentrations of IgG antibodies. Methods: A prospective cohort study was conducted from June 2020 to January 2021. This study recruited a convenience sample of adult individuals who where recently diagnosed with COVID-19 and were living in mainland Portugal. A total of 1,695 blood samples were collected from 585 recovered COVID-19 patients up to 9 months after SARS-CoV-2 acute infection. A blood sample was collected at baseline and three, 6 and 9 months after SARS-CoV-2 acute infection to assess the concentration of IgG antibody against SARS-CoV-2. Results: The positivity rate of IgG reached 77.7% in the first 3 months after symptom onset. The IgG persists at all subsequent follow-up time-points, which was 87.7 and 89.2% in the 6th and 9th months after symptom onset, respectively. Three distinct kinetics of antibody response were found within the 9 months after infection. Kinetic 1 (K1) was characterized by a constant low IgG antibody concentration kinetic (group size: 65.2%); kinetic 2 (K2), composed by constant moderate IgG kinetic (group size: 27.5%) and kinetic 3 (K3) characterized by higher IgG kinetic (group size: 7.3%). People with ≥56 years old (OR: 3.33; CI 95%: [1.64; 6.67]; p-value: 0.001) and symptomatic COVID-19 (OR: 2.08; CI 95%: [1.08; 4.00]; p-value: 0.031) had higher odds of a "Moderate IgG kinetic." No significant association were found regarding the "Higher IgG kinetic." Conclusion: Our results demonstrate a lasting anti-spike (anti-S) IgG antibody response at least 9 months after infection in the majority of patients with COVID-19. Younger participants with asymptomatic disease have lower IgG antibody positivity and possibly more susceptible to reinfection. This information contributes to expanding knowledge of SARS-CoV-2 immune response and has direct implications in the adoption of preventive strategies and public health policies.

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.

Selection of cowpea cultivars for high temperature tolerance: physiological, biochemical and yield aspects.

High temperature stress can hinder the development of cowpea resulting in several damages including vegetative and reproductive phases of the crop. In this context, the objective of this study was to select cowpea cultivars tolerant to high temperature stress using various parameters related to physiological, biochemical, and yield aspects. For this, the cultivars Carijó, Itaim, Pujante, Rouxinol, and Tapahium were used, maintained in two temperature regimes: 20-26-33 °C and 24.8-30.8-37.8 °C. The experiment was carried out in growth chambers, in a 5 × 2 factorial arrangement (cultivars × temperature regimes). Responses differentiated among the cultivars Carijó, Itaim, Pujante, Rouxinol, and Tapahium with the increase of 4.8 °C in air temperature. The high temperature promoted a greater quantity of aborted flowers, leading to a reduction in the yield of the cultivars Carijó, Pujante, Rouxinol, and Tapahium. The photosynthesis, stomatal conductance, leaf transpiration and enzymatic activities were significantly influenced by high temperature. From the combination of the responses of biometric, physiological and productive variables, the cultivar Itaim can be considered as tolerant to an increase of 4.8 °C in air temperature.

Randomized Trial of Nocturnal Oxygen in Chronic Obstructive Pulmonary Disease.

BACKGROUND: Long-term oxygen therapy improves survival in patients with chronic obstructive pulmonary disease (COPD) and chronic severe daytime hypoxemia. However, the efficacy of oxygen therapy for the management of isolated nocturnal hypoxemia is uncertain. METHODS: We designed this double-blind, placebo-controlled, randomized trial to determine, in patients with COPD who have nocturnal arterial oxygen desaturation without qualifying for long-term oxygen therapy, whether nocturnal oxygen provided for a period of 3 to 4 years would decrease mortality or the worsening of disease such that patients meet current specifications for long-term oxygen therapy. Patients with an oxygen saturation of less than 90% for at least 30% of the recording time on nocturnal oximetry were assigned, in a 1:1 ratio, to receive either nocturnal oxygen or ambient air from a sham concentrator (placebo). The primary outcome was a composite of death from any cause or a requirement for long-term oxygen therapy as defined by the Nocturnal Oxygen Therapy Trial (NOTT) criteria in the intention-to-treat population. RESULTS: Recruitment was stopped prematurely because of recruitment and retention difficulties after 243 patients, of a projected 600, had undergone randomization at 28 centers. At 3 years of follow-up, 39.0% of the patients assigned to nocturnal oxygen (48 of 123) and 42.0% of those assigned to placebo (50 of 119) met the NOTT-defined criteria for long-term oxygen therapy or had died (difference, -3.0 percentage points; 95% confidence interval, -15.1 to 9.1). CONCLUSIONS: Our underpowered trial provides no indication that nocturnal oxygen has a positive or negative effect on survival or progression to long-term oxygen therapy in patients with COPD. (Funded by the Canadian Institutes of Health Research; INOX ClinicalTrials.gov number, NCT01044628.).

Safety and effectiveness of laparoscopic peritoneal lavage in Hinchey III diverticulitis / Segurança e eficácia da lavagem peritoneal laparoscópica na diverticulite Hinchey III

Abstract Introduction: The management of Hinchey III diverticulitis has been subject to investigation over the years. Hartmann's procedure is widely referred as the standard treatment. However, this option is associated with relevant morbidity and mortality which motivated the arise of alternative interventions such as the laparoscopic peritoneal lavage. Aim: The aim of this review is to synthesize the evidence on the safety and effectiveness of laparoscopic peritoneal lavage in the management of diverticulitis with generalized purulent peritonitis in comparison to resection procedures. Materials and methods: The bibliographic research was conducted using the electronic database Medline from Pubmed. Of the 358 articles identified, our criterious selection resulted in a total of 27 articles for review. Results: Overall, laparoscopic lavage revealed low mortality rates with no remarkable differences between procedures. The non-randomized studies tended to show lower recurrence and morbidity rates comparatively to the latest RCTs, in the lavage groups, however, no significant differences have been found. Discussion and conclusion: In this review, laparoscopic peritoneal lavage proved to be safe and comparatively effective, although not superior to resection, reaching mixed results. We believe it can be applied as a damage control operation to treat or as a bridge to elective resection. Still, more studies are needed to determine indications and factors for the success of laparoscopic lavage.

Resumo Introdução: O tratamento da diverticulite por Hinchey III tem sido objeto de investigação ao longo dos anos. A operação tipo Hartmann é amplamente referida como o tratamento padrão. No entanto, esta opção está associada à morbilidade e mortalidade relevante, o que motivou o surgimento de intervenções alternativas, como a lavagem peritoneal laparoscópica. Objetivo: O objetivo desta revisão é sintetizar a evidência sobre a segurança e a eficácia da lavagem peritoneal laparoscópica no tratamento da diverticulite com peritonite generalizada purulenta em comparação com os procedimentos de ressecção. Materiais e métodos: A pesquisa bibliográfica foi realizada na base de dados eletrónica Medline da Pubmed. Dos 358 artigos identificados, a nossa seleção criteriosa resultou num total de 27 artigos para revisão. Resultados: No geral, a lavagem laparoscópica revelou baixas taxas de mortalidade sem diferenças significativas entre os procedimentos. Os estudos não randomizados tenderam a mostrar menores taxas de recorrência e morbilidade comparativamente aos últimos ensaios clínicos randomizados, nos grupos submetidos à lavagem, no entanto, nenhuma diferença significativa foi encontrada. Discussão e conclusão: Nesta revisão, a lavagem peritoneal laparoscópica mostrou-se segura e comparativamente eficaz, embora não superior à ressecção, não alcançando resultados constantes. Nós acreditamos que pode ser aplicada como um procedimento de controlo de danos para tratamento ou como ponte para cirurgia eletiva. Ainda assim, são necessários mais estudos para determinar indicações e fatores para o sucesso da lavagem laparoscópica.

Combined Pulmonary Fibrosis and Emphysema Versus Idiopathic Pulmonary Fibrosis Versus Emphysema: A Clinical Perspective / Comparación con perspectiva clínica de la combinación de fibrosis pulmonar y enfisema, la fibrosis pulmonar idiopática y el enfisema

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[Medical Student Secrecy, its Link to the Duty of Confidentiality and the Right to Access and Reuse Health Information]. / O Segredo do Estudante de Medicina, a Sua Vinculação ao Dever de Sigilo e o Direito em Aceder e Reutilizar Informação de Saúde.

The authors address the legal void that exists regarding medical student access to clinical records and health information that local healthcare organizations hold under legal and institutional custody. They develop a legal thesis that configures the creation of medical student professional secrecy and its connection with the duty of confidentiality as assumptions that underlie the medical student's right to access and reuse health information. Medical students have the legitimacy to access health information and clinical records, as they bear an unequivocal informational, legitimate, constitutionally protected and sufficiently relevant need. They conclude that the legislature must work together with universities and hospital institutions to legally establish the concept of Medical Student Professional Secrecy, its link to the duty of confidentiality and the right of the medical student to access and reuse health information. Furthermore, it must do so in a specific legal act and in the precise terms of the text approved unanimously by the Council of Portuguese Medical Schools, by the National Council of Medical Ethics and Deontology, by the National Council of the Portuguese Medical Association and by its President.

Os autores abordam o vazio legal que existe, no acesso, por parte de estudantes de medicina, aos registos clínicos, à informação de saúde, na posse e à guarda legal e institucional das unidades de saúde. Por outro lado, desenvolvem uma tese jurídica que configura a criação do segredo do estudante de medicina e a sua vinculação ao dever de sigilo, como pressupostos que fundamentam o direito do estudante de medicina em aceder e reutilizar informação de saúde. O estudante de medicina tem legitimidade para aceder a informação de saúde, a registos clínicos, já que é inequívoco ser portador de uma necessidade informacional, legítima, constitucionalmente protegida e suficientemente relevante. Concluem, que o poder legislativo se associe às instituições, universitárias e hospitalares, instituindo, por diploma legal, o Segredo do Estudante de Medicina, a sua vinculação ao dever de sigilo e o direito do estudante de medicina em aceder e reutilizar informação de saúde. E deve fazê-lo, em diploma específico, nos precisos termos do texto aprovado, por unanimidade, pelo Conselho das Escolas Médicas Portuguesas, pelo Conselho Nacional de Ética e Deontologia Médicas, pelo Conselho Nacional da Ordem dos Médicos e pelo Bastonário da referida Ordem.

[The Medical Carreer and the Key Factors Driving the Exodus of Doctors from the National Health Service in Portugal]. / A Carreira Médica e os Fatores Determinantes da Saída do Serviço Nacional de Saúde.

INTRODUCTION: This article addresses the organization and management of medical careers in Portugal within the framework of the National Health Service. It focuses, in particular, on some indicators of motivation and professional satisfaction. MATERIAL AND METHODS: This article is part of a broader research project on the organization of medical careers in Portugal. It draws on the results of a survey carried out to active medical doctors, residents and those that have already abandoned the National Health Service. The sample was drawn from the database of physicians enrolled in the Northern Section of the Medical Association. RESULTS: A total of 3253 physicians were surveyed. Physician satisfaction levels vary according to age, type of connection to the National Health Service and are associated with expectations regarding the professional future. DISCUSSION: Despite the close connection with the National Health Service, younger doctors showed higher levels of professional dissatisfaction and uncertainty regarding their professional future. Although with varying degrees of discontent depending on the groups considered, the dissatisfaction of the professionals interviewed is with the physical conditions of the workplace and with the opportunities for career advancement. At the level of interpersonal relations and training, satisfaction is high. The anticipation of retirement and the transfer to the private sector are options that professionals consider as a strategy to respond to professional dissatisfaction. CONCLUSION: The study shows that the current functioning of the National Health Service does not diminish the interest in the practice of medicine, but rather motivates the search for more attractive and rewarding working conditions.

Introdução: Este artigo aborda a temática da organização e gestão da carreira médica em Portugal no quadro do Serviço Nacional de Saúde. Foca, em particular, alguns indicadores de motivação e satisfação profissional.Material e Métodos: Este artigo resulta de um projeto de investigação mais alargado sobre a organização da carreira médica em Portugal. Foram aplicados inquéritos a médicos especialistas ativos, a realizar o internato de especialidade médica e que já abandonaram o Serviço Nacional de Saúde. A base de sondagem compreende os médicos inscritos na Secção Norte da Ordem dos Médicos.Resultados: Foram inquiridos 3253 médicos. Os níveis de satisfação dos médicos variam em função da idade, do tipo de ligação ao SNS e associados às expectativas em relação ao futuro profissional.Discussão: Apesar da estreita ligação com o Serviço Nacional de Saúde, os médicos mais jovens evidenciaram maiores níveis de insatisfação profissional e incerteza em relação ao seu futuro profissional. Ainda que com graus de descontentamento variáveis em função dos grupos considerados, a insatisfação dos profissionais inquiridos é com as condições materiais de exercício da profissão e com as oportunidades de progressão. No plano das relações interpessoais e da formação, a satisfação é elevada. A antecipação da reforma e a transferência para o setor privado são opções que os profissionais equacionam como estratégia para responder à insatisfação profissional.Conclusão: O estudo demonstra que as configurações atuais de funcionamento do Serviço Nacional de Saúde não diminuem o interesse pelo exercício da medicina, mas sim motivam a procura de condições mais aliciantes e compensatórias no exercício da mesma.

Assessment of Respiratory Muscle Weakness in Subjects With Neuromuscular Disease.

INTRODUCTION: Neuromuscular diseases (NMD) are a group of rare heterogeneous disorders that may be accompanied by respiratory muscle weakness. The simplest measurements of respiratory muscle strength are maximum inspiratory pressure (PImax) and maximum expiratory pressure (PEmax) of the mouth. Inspiratory muscle weakness can also be evaluated by the sniff test (sniff nasal inspiratory pressure method). This study tested the agreements in PImax and PEmax (measured by using a plethysmograph and portable equipment) as well as the correlations of PImax and PEmax by using the sniff nasal inspiratory pressure method, lung function, and arterial blood gas parameters in subjects with NMD. METHODS: This prospective, noninterventional study measured respiratory parameters in all the subjects with NMD who underwent measurement of maximum respiratory pressures. RESULTS: A total of 55 subjects with NMD were included. There were no statistically significant differences in PImax and PEmax measured by using a plethysmograph and portable equipment. Moreover, PImax showed a good correlation with the sniff nasal inspiratory pressure method. CONCLUSIONS: Measurements of PImax and PEmax by using portable equipment were equivalent to those performed by using the accepted standard, plethysmography, in the subjects with NMD. Noninvasive evaluation of the sniff test with the portable equipment correlates with PImax, which makes this approach a good method for measuring the maximum strength of inspiratory muscles in patients with NMD.