Chronic treatment with hydroxychloroquine and SARS-CoV-2 infection.

Hydroxychloroquine sulfate (HCQ) is being scrutinized for repositioning in the treatment and prevention of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. This antimalarial drug is also chronically used to treat patients with autoimmune diseases. By analyzing the Portuguese anonymized data on private and public based medical prescriptions we have identified all cases chronically receiving HCQ for the management of diseases, such as systemic lupus erythematosus, rheumatoid arthritis, and other autoimmune diseases. Additionally, we have detected all laboratory confirmed cases of SARS-CoV-2 infection and all laboratory confirmed negative cases in the Portuguese population (mandatorily registered in a centrally managed database). Cross linking the two sets of data has allowed us to compare the proportion of HCQ chronic treatment (at least 2 grams per month) in laboratory confirmed cases of SARS-CoV-2 infection with laboratory confirmed negative cases. Out of 26 815 SARS-CoV-2 positive patients, 77 (0.29%) were chronically treated with HCQ, while 1215 (0.36%) out of 333 489 negative patients were receiving it chronically (P = .04). After adjustment for age, sex, and chronic treatment with corticosteroids and/or immunosuppressants, the odds ratio of SARS-CoV-2 infection for chronic treatment with HCQ has been 0.51 (0.37-0.70). Our data suggest that chronic treatment with HCQ confer protection against SARS-CoV-2 infection.

Translation, adaptation and validation of the Mini-Clinical Evaluation Exercise to the EU-Portuguese language / Traducción, adaptación y validación del Mini-Clinical Evaluation Exercise (Mini-CEX) al idioma portugués europeo

INTRODUCTION: The goal of this work is to validate tools to assess clinical competences of undergraduate medical students in the workplace. One of the most well-known scales is the Mini-Clinical Evaluation Exercise (Mini-CEX). This scale has been vastly studied, however, its validity is very variable amongst studies and it has never been validated to the EU-Portuguese language and context. Subjects and methods: The translation process of the Mini-CEX was conducted by 2 bilingual individuals and overseen by four physicians specialized in medical education. We performed methods of both qualitative (translation, assessment of the translation, back translation) and quantitative nature (internal consistency, construct and content validity analysis). The scale was applied to 3rd year medical students in a simulated assessment environment with a final sample size of 818 assessments. RESULTS: The results show that the Portuguese version of the Mini-CEX is a valid scale and fit its purpose for the assessment of clinical competencies. The Cronbach's alpha coefficient (0.927), confirmed the internal consistency of the scale. Additionally, the validity analysis also proved to be satisfactory, with confirmatory results for all domains of the analysis. CONCLUSIONS: This work intends to provide a scale, translated, adapted and validated to Portuguese that is focused on clinical competencies. Given the confirmatory results of the scale's validity, supporting its feasibility and applicability, we believe this tool is ready to be implemented as a complement to clinical skills assessment

INTRODUCCIÓN: El objetivo de este trabajo es validar herramientas para evaluar las competencias clínicas de los estudiantes de medicina de pregrado en el lugar de trabajo. Una de las escalas más conocidas es el Mini-Clinical Evaluation Exercise (Mini-CEX). Esta escala se ha estudiado ampliamente, pero su validez es muy variable entre los estudios y nunca se ha validado para el idioma y el contexto portugués europeo. Sujetos y métodos: El proceso de traducción del Mini-CEX fue realizado por dos personas bilingües y supervisado por cuatro médicos especializados en educación médica. Se llevaron a cabo métodos de naturaleza cualitativa (traducción, evaluación de la traducción, traducción inversa) y cuantitativa (consistencia interna, construcción y análisis de validez de contenido). La escala se aplicó a estudiantes de medicina de tercer año en un entorno de evaluación simulada, con un tamaño final de la muestra de 818 evaluaciones. RESULTADOS: Los resultados muestran que la versión portuguesa del Mini-CEX es una escala válida y se ajusta a su propósito para la evaluación de las competencias clínicas. El coeficiente alfa de Cronbach (0,927) confirmó la consistencia interna de la escala. Además, el análisis de validez también demostró ser satisfactorio, con resultados confirmatorios para todos los dominios del análisis. CONCLUSIONES: Este trabajo pretende proporcionar una escala, traducida, adaptada y validada al portugués, que se centre en las competencias clínicas. Dados los resultados confirmatorios de la validez de la escala, que respaldan su viabilidad y aplicabilidad, creemos que esta herramienta está lista para implementarse como complemento de la evaluación de habi-lidades clínicas

Intralobar pulmonary sequestration: diagnostic expertise.

An obese 22-year-old man with a history of recurrent respiratory infections presented to the emergency room with left pleuritic chest pain, productive cough with mucupurulent sputum and an axillary temperature of 37.7°C. Blood work showed elevated inflammatory parameters and chest X-ray was relevant for heterogeneous infiltration in the left base and opacity of the left costophrenic angle. An angio-CT scan revealed areas of bilateral consolidation with presence of an arterial branch originating from the aorta to the collected area of the left lower lobe, consistent with a respiratory infection grafted on a intralobar pulmonary sequestration of the left lung base. The infectious process was treated and the patient was planned for a lower left lobectomy.

Trazodone in the elderly: risk of extrapyramidal acute events.

Trazodone is a second-generation atypical antidepressant exercising selective inhibitory action on the transport of serotonin. It also has an antagonist effect, similar to nefazodone, on the 5HT1 and 5HT2 receptors, probably due to the therapeutic effects of such substances. It is very effective in the treatment of depression, in anxiety and insomnia. Its known side effects mainly occur with prolonged use of daily doses of 150-200 mg. The ability to enhance drowsiness may be associated with some risk in elderly patients. This clinical case illustrates an acute extrapyramidal event induced by a low dose of trazodone.