Decrease in Stigma Towards Mental Illness in Portuguese Medical Students After a Psychiatry Course.

INTRODUCTION: Stigma towards mental illness is considered a key obstacle to the provision of medical care to psychiatric patients. This is not only present in the general population but also among healthcare professionals. Therefore, medical students could be a target population for stigma prevention measures. The aim of this study is to assess the evolution of the attitudes of medical students from the Faculty of Medicine of the University of Coimbra towards psychiatric patients, before and after attending Psychology and Psychiatric courses. MATERIAL AND METHODS: Students from the third and fourth years of the integrated Master's degree in Medicine in the Faculty of Medicine of the University of Coimbra were asked to complete four questionnaires. The surveys were distributed before and after the attendance of the courses. RESULTS: There was a statistically significant decrease of the stigma scores (p = 0.025) between the two measurements (38.16 initially, 36.72 on the second moment). The baseline level of stigma was found to be negatively associated with empathy (rP = -0.477) and with the type of personality, with higher levels of openness to new experiences being associated with lower levels of initial stigma (rP = -0.357). DISCUSSION: Overall, the students' attitudes towards patients with mental illness were positive, with a decrease of the stigma value from the first to the second semester. This corroborates the hypothesis that education and contact with people with a mental condition could shape positive changes in attitudes and discrimination against those patients. CONCLUSION: Our results emphasise the importance of implementing programs inside medical schools in order to reduce stigma among future doctors.

Introdução: O estigma face às doenças mentais é considerado como um dos principais obstáculos à prestação de cuidados médicos a doentes psiquiátricos. Esta problemática não está presente apenas na população geral, mas também entre os profissionais de saúde. Assim, os estudantes de medicina podem ser uma população alvo para a introdução de medidas de prevenção de estigma. O objetivo deste estudo é avaliar a evolução das atitudes dos estudantes de Medicina da Faculdade de Medicina da Universidade de Coimbra (FMUC) face aos doentes psiquiátricos, antes e depois de frequentar as cadeiras de Psicologia e Psiquiatria. Material e Métodos: Foram distribuídos quatro questionários aos alunos do terceiro e quarto anos do Mestrado Integrado em Medicina da FMUC antes e depois de frequentarem as unidades curriculares. Resultados: Foi observada uma diminuição estatisticamente significativa dos valores de estigma (p = 0,025) entre as duas medições (38,16 no primeiro momento, 37,72 no segundo). Foram ainda encontradas correlações inversas, quer entre o valor do estigma inicial e a empatia (rP = -0,477), como em relação ao tipo de personalidade, com maiores níveis de abertura à experiência originando níveis mais baixos de estigma (rP = -0,357). Discussão: Em geral, as atitudes dos estudantes de Medicina relativamente aos doentes psiquiátricos foram positivas, com uma diminuição significativa do valor do estigma do primeiro para o segundo semestre. Estes resultados corroboram a hipótese de que a educação e o contacto com pessoas com uma patologia mental poderão modificar positivamente as atitudes e discriminação contra as mesmas. Conclusão: Este estudo salienta a importância da implementação de programas nas Faculdades de Medicina com o intuito de reduzir o estigma entre futuros Médicos.

Complications of Biliary Drainage in Patients with Malignant Biliary Obstruction.

PURPOSE: Biliary tract obstruction in cancer patients is usually associated with a poor prognosis. The obstruction may cause distressing symptoms, such as pruritus. As this situation occurs mostly in advanced cancer, the primary objective of the treatment is in many cases symptom control and not prolonging life. However, some patients can be candidates for chemotherapy. To see the outcomes of stenting insertion in patients of our oncology center. METHODS: A retrospective study of patients who have undergone this procedure between 1 October 2011 and 31 December 2018 was carried out. RESULTS: Insertion of a biliary stent was performed in 171 patients. The most common diagnoses were gastric and colorectal cancers, each with 42 (24%), followed by pancreatic (34 (20%)) and biliary tract cancer (25 (14%)). Most stents (155 (91%)) were placed percutaneously. Complications were seen in 91 (53%) patients and the most common was cholangitis in 48 (53%) patients, and the median survival was 75.5 days (3-1246). A total of 168 (98%) patients were referred to palliative care. In a multivariable analysis, the ECOG performance status was associated with survival, with the ECOG 0, 1, and 2 associated with better survival and peritoneal metastases associated with lower survival. CONCLUSIONS: For many patients with advanced cancers, it may not be clear if the benefits of palliative biliary stents outweigh the risks. Therefore, the problem should be discussed with the patients and their families, making clear the goals of care and the potential benefits and risks that can be expected.

Botulism disguised as parotitis.

Botulism is an acute toxin-mediated neuroparalytic syndrome caused by some Clostridium species. It typically presents itself as an acute symmetric descending paralysis of cranial and peripheral nerves, which can potentially evolve to respiratory failure and death. We report a case of botulism diagnosed in a patient presenting with a parotitis probably due to xerostomia, even though he had already sought medical assistance for blurred vision and dysphagia. The neurological symptoms resolved without administration of antitoxin and botulism diagnosis was confirmed with identification of both toxins B and F in patient's serum. We aim to illustrate the need for a high clinical suspicion for the diagnosis of botulism and to report an atypical case of botulism with the production of toxins B and F, the latter being of rare occurrence.