Iberia consensus on strategies to prevent and manage irritation by topical retinoids in facial and trunk acne. / Consenso Iberia sobre estrategias de prevención y manejo de la irritación por retinoides tópicos en acné localizado en cara y tronco.

OBJECTIVE: To assess the level of agreement on various prevention and management strategies for irritation caused by topical retinoids in facial and trunk acne in an attempt to alleviate it and minimize treatment discontinuations as much as possible. METHOD: After reviewing the scientific medical literatura currently available, 4 different areas of uncertainty in the management of irritation caused by topical retinoids in acne were identified. A questionnaire with 34 recommendations was created and evaluated by a group of 133 dermatologists (Delphi methodology). RESULTS: In 82.3% of the recommendations (28 out of 34), some level of agreement was reached (≥ 85% agreement in 22 recommendations and ≥ 70% agreement in 6). The results with the highest level of agreement focused on specific patient education strategies (explaining that irritation is an expected reaction at the beginning of treatment and tends to decrease over time), gradual and/or spaced application of topical retinoids (at night time to prevent and/or reduce skin irritation), and the importance of using adjuvant products, specific for acne-prone skin, hydration, photoprotection, and skin cleansing. These recommendations reflect a comprehensive approach to managing irritation associated with topical retinoids and promoting long-term adherence. CONCLUSIONS: Skin irritation caused by topical retinoids in facial and trunk acne is an expected, mild, and controllable reaction if proper prevention and management guidelines are followed, meaning that it should not be a reason for treatment discontinuation.

The usefulness of ecotoxicological tools to improve the assessment of water bodies in a climate change reality.

This study aimed to analyse the added value of using ecotoxicological tools to complement and improve the assessment of natural water bodies status, in situations of climate change, with a higher frequency of extreme events as floods or droughts. Four water bodies of streams in the Guadiana Basin (Álamos, Amieira, Lucefécit, Zebro) were studied in 2017 and 2018 and classified based on the Water Framework Directive (WFD) parameters: Biological Quality Element - Phytobenthos (diatoms), General chemical and physicochemical elements, Specific pollutants, and Priority Substances. Complementarily, bioassays (including lethal and sublethal parameters) were carried out with organisms of different trophic levels: (i) the bacteria Aliivibrio fischeri; (ii) the microalgae Pseudokirchneriella subcapitata; (iii) the crustaceans Daphnia magna, Thamnocephalus platyurus and Heterocypris incongruens. A classification system with 5 scores was developed, permitting to classify water bodies from non-toxic (EC50 > 100 %; growth and feeding rate > 80 %; blue) to highly toxic (EC50 < 10 %; growth and feeding rate < 10 %; red). The comparison between the classification based on the WFD parameters and on ecotoxicological endpoints showed similar results for 71 % of the samples, and significant positive Pearson correlations were detected between the diatom-based Specific Polluosensitivity Index (SPI) and EC50V.fisheri, the algae growth rate and Shannon diversity index. These results indicate that when the biological quality elements cannot be used (namely under drought or flooding conditions) the application of ecotoxicological bioassays may be a good alternative. Further, when ecotoxicological parameters were included, an increase of worse classifications (Bad and Poor) was observed, revealing an improvement in the sensitivity of the classification, mainly in presence of specific and priority substances. So, the ecotoxicological analysis appears to provide useful information regarding the potential presence of both known and unknown contaminants at concentrations that cause biological effects (even within the WFD limits), in agreement with several authors that have already suggested its use in biomonitoring.

Chronic obstructive pulmonary disease exacerbations' management in Portuguese hospitals - EvaluateCOPDpt, a multicentre, observational, prospective study.

INTRODUCTION AND OBJECTIVES: In order to improve the quality of chronic obstructive pulmonary disease (COPD) patients' care, better knowledge of clinical practice and the factors associated with patient outcomes are needed. This study aimed to evaluate the relation between clinical practice and the outcomes of patients admitted for COPD exacerbations in Portuguese hospitals. MATERIALS AND METHODS: Observational, multicentre, prospective study with a 60-days follow-up period, in 11 hospitals, including patients aged ≥ 30 years, admitted to hospital for at least 24 hours due to an acute exacerbation of COPD. Demographic and clinical data were collected, including sex, age, smoking habits, hospitalisations, pulmonary function, comorbidities, COPD symptoms, and treatment. Sixty days after discharge, COPD exacerbations management, outcome measures, and readmission data were evaluated through a structured phone follow-up interview. RESULTS: 196 patients were included (85.7% male, mean age 71.2 years), the majority admitted through the emergency service. Ex-smokers and current smokers accounted for 51% and 36%, respectively. On admission, 72.4% were on LAMA, 54.6% on LABA, and 45.5% were on LABA/LAMA. Inhaled corticosteroids (ICS) were used in 37.3% and systemic steroids (SCS) in 10.3%. 35.7 % had had at least one exacerbation, with hospitalisation, in the previous year. There was no spirometry data for 23.2%. On hospitalisation, 98.5% of patients were treated with oxygen and 38.3% with non-invasive ventilation. Additionally, 93.4% used SCS and 60.2% ICS. Antibiotics were administered to 85.2%. 95.4% of patients were discharged; 9 died, 5 of whom had a COPD-related death. The median length of stay was 12 days for discharged patients and 33 days for patients who died. At discharge, 79.1% were prescribed with LAMA, 63.6% SCS, 61.5% LABA and 55.6% LAMA+LABA. 26,2% were prescribed with ICS+LABA+LAMA. At follow-up, 44.4% had a scheduled medical appointment within the 60 days after being discharged, and 28.3% were later readmitted due to exacerbation, of whom 52.8% were hospitalised. CONCLUSIONS: The severity of COPD, particularly in exacerbations, is directly related to impaired lung function and quality of life, mortality, and significant health system costs. Knowledge about COPD exacerbations' management in acute hospital admissions in Portugal may help stimulate a national discussion and review of existing data to engage clinicians, policymakers, managers, and patients, raising awareness and promoting action on COPD.

Occurrence and risk assessment of pesticides in a Mediterranean Basin with strong agricultural pressure (Guadiana Basin: Southern of Portugal).

The study aimed to assess the occurrence and the environmental risk of a group of 51 selected pesticides in the Guadiana Basin (a biodiversity hotspot, in the Mediterranean). The most abundant pesticides were bentazone and 2,4-D, while terbuthylazine together with terbutryn constituted the most ubiquitous pesticides. Eighteen out of the 38 pesticides detected are no longer approved in Europe, and 5 of them are included in the list of priority substances. The risk assessment showed that azinphos ethyl, diflufenican, irganol, imidacloprid, and oxadiazon occurred occasionally, but always in concentrations above their respective ecotoxicological threshold value. Contrary, bentazone, terbuthylazine, and terbutryn presented a high risk in most of the sampled locations and periods. The site-specific risk assessment showed a spatial and temporal pattern, with a higher risk occurring mainly in intermittent streams, in the drought period. The presence of pesticides banned from the EU market since 2009 showed the importance of improving the monitoring process, to identify the main sources of pollution and the fate of these emerging compounds. The results showed the need of implementing actions to improve the sustainable use of pesticides in agricultural areas, working with farmers and management entities to reduce the contamination of aquatic ecosystems. Transboundary water governance is also required to solve potential transboundary contamination problems.

Understanding the relationship between patient language and outcomes in internet-enabled cognitive behavioural therapy: A deep learning approach to automatic coding of session transcripts.

Objective: Understanding patient responses to psychotherapy is important in developing effective interventions. However, coding patient language is a resource-intensive exercise and difficult to perform at scale. Our aim was to develop a deep learning model to automatically identify patient utterances during text-based internet-enabled Cognitive Behavioural Therapy and to determine the association between utterances and clinical outcomes. Method: Using 340 manually annotated transcripts we trained a deep learning model to categorize patient utterances into one or more of five categories. The model was used to automatically code patient utterances from our entire data set of transcripts (∼34,000 patients), and logistic regression analyses used to determine the association between both reliable improvement and engagement, and patient responses. Results: Our model reached human-level agreement on three of the five patient categories. Regression analyses revealed that increased counter change-talk (movement away from change) was associated with lower odds of both reliable improvement and engagement, while increased change-talk (movement towards change or self-exploration) was associated with increased odds of improvement and engagement. Conclusions: Deep learning provides an effective means of automatically coding patient utterances at scale. This approach enables the development of a data-driven understanding of the relationship between therapist and patient during therapy.

Risks of floating microplastic in the global ocean.

Despite the ubiquitous and persistent presence of microplastic (MP) in marine ecosystems, knowledge of its potential harmful ecological effects is low. In this work, we assessed the risk of floating MP (1 µm-5 mm) to marine ecosystems by comparing ambient concentrations in the global ocean with available ecotoxicity data. The integration of twenty-three species-specific effect threshold concentration data in a species sensitivity distribution yielded a median unacceptable level of 1.21 ∗ 105 MP m-³ (95% CI: 7.99 ∗ 103-1.49 ∗ 106 MP m-³). We found that in 2010 for 0.17% of the surface layer (0-5 m) of the global ocean a threatening risk would occur. By 2050 and 2100, this fraction increases to 0.52% and 1.62%, respectively, according to the worst-case predicted future plastic discharge into the ocean. Our results reveal a spatial and multidecadal variability of MP-related risk at the global ocean surface. For example, we have identified the Mediterranean Sea and the Yellow Sea as hotspots of marine microplastic risks already now and even more pronounced in future decades.

Erratum to "Gastroenteropancreatic Neuroendocrine Neoplasia Characterization in Portugal: Results from the NETs Study Group of the Portuguese Society of Endocrinology, Diabetes and Metabolism".

[This corrects the article DOI: 10.1155/2019/4518742.].

Gastroenteropancreatic Neuroendocrine Neoplasia Characterization in Portugal: Results from the NETs Study Group of the Portuguese Society of Endocrinology, Diabetes and Metabolism.

BACKGROUND: The incidence of gastroenteropancreatic neuroendocrine neoplasms (GEP-NENs) has been increasing in the last five decades, but there is no large-scale data regarding these tumours in Portugal. We conducted a cross-sectional, multicentric study in main Portuguese centers to evaluate the clinical, pathological, and therapeutic profile of GEP-NENs. METHODS: From November, 2012, to July, 2014, data from 293 patients diagnosed with GEP-NENs from 15 centers in Portugal was collected and registered in an online electronic platform. RESULTS: Median age at diagnosis was 56.5 (range: 15-87) years with a preponderance of females (54.6%). The most frequent primary sites were the pancreas (31.1%), jejunum-ileum (24.2%), stomach (13.7%), and rectum (8.5%). Data regarding hormonal status was not available in most patients (82.3%). Stratified by the tumour grade (WHO 2010 classification), we observed 64.0% of NET G1, 24.7% of NET G2, and 11.3% of NEC. Poorly differentiated tumours occurred mainly in older patients (p = 0.017), were larger (p < 0.001), and presented more vascular (p = 0.004) and lymphatic (p = 0.001) invasion. At the time of diagnosis, 44.4% of GEP-NENs presented metastatic disease. Surgery (79.6%) and somatostatin analogues (30.7%) were the most frequently used therapies of GEP-NENs with reported grading. CONCLUSION: In general, Portuguese patients with GEP-NENs presented similar characteristics to other populations described in the literature. This cross-sectional study represents the first step to establish a national database of GEP-NENs that may aid in understanding the clinical and epidemiological features of these tumours in Portugal.

Giant fibrous hamartoma of infancy: pitfall of CD34 positive dermal mesenchymal tumor.

Fibrous hamartoma of infancy (FHI) is a rare benign soft tissue tumor with a triphasic organoid histologic appearance. The authors present a case of a 21-month-old healthy girl with a slowly growing flesh-colored subcutaneous plaque 12cm in size on the lower back, with overlying hypertrichosis. A punch biopsy revealed a proliferation of spindle cells infiltrating the dermis and hypodermis organized in a dense storiform pattern with a strong diffuse positivity for CD34. The diagnosis of congenital dermatofibrosarcoma protuberans (DFSP) was considered and an excision was performed. Histopathologic analysis showed an extensive poorly demarcated mass infiltrating the dermis and hypodermis, composed of different components: a monomorphous fibroblastic/myofibroblastic component, a mature adipose component, and an immature mesenchymal basophilic component. The clinical aspects with the histologic and immunohistochemical features led to the diagnosis of giant fibrous hamartoma of infancy. In our case the strong diffuse CD34 positivity was a diagnostic pitfall leading to an incorrect hypothesis of congenital DFSP. The characteristic triphasic histology of FHI was missed owing to the small size of the punch biopsy. This article highlights the importance of being aware of the CD34+ dermal mesenchymal tumor differential diagnosis and the necessity of appropriate size biopsies to avoid sampling error.

Cutaneous complication of perinatal hypoxia.

Subcutaneous fat necrosis of the newborn is an uncommon, transient, and self-healing panniculitis, mostly affecting term newborns with perinatal complications. The authors present a case of a female full-term neonate, born from an uncomplicated pregnancy, admitted into the neonatology unit 5 hours after delivery because of refractory multifocal seizures in the context of hypoxic-ischemic encephalopathy. Nine days after birth, indurated and erythematous nodules and plaques were noted on the left arm and back. Skin biopsy was compatible with subcutaneous fat necrosis of the newborn. Laboratory evaluation including serum calcium showed normal values. No treatment was initiated. This entity generally follows an uncomplicated course. However, there are important complications for which the patient must be regularly monitored, including thrombocytopenia, hypoglycemia, hypertriglyceridemia, and most importantly, hypercalcemia. Patients should have serial serum calcium determinations for up to 6 months after the appearance of the skin lesions. The early diagnosis and prompt treatment of hypercalcemia are essential to prevent severe complications.

Emergence of Thelazia callipaeda Infection in Dogs and Cats from East-Central Portugal.

The eyeworm Thelazia callipaeda (Spirurida, Thelaziidae) infects domestic animals, wildlife and human beings, and is considered an emerging pathogen in Europe. This study aimed at investigating the prevalence and risk factors of T. callipaeda infection in dogs and cats from east-central Portugal, a region where the parasite was previously detected in two red foxes (Vulpes vulpes). Thelazia callipaeda was found in 22 (3.8%) of 586 dogs and in four (23.5%) of 17 cats. A total of 178 adult worms (71.9% of females and 28.1% of males) were collected from the conjunctiva of the infected dogs. The number of worms collected per dog ranged from 1 to 35 (average ± standard deviation: 8.08 ± 9.49), with four dogs (18.2%) harbouring only a single parasite. Worms were gathered from dogs throughout all months of the year. A total of 17 adult worms (64.7% of females and 35.3% of males) were obtained from cats. The number of worms per cat ranged from 1 to 14 (4.3 ± 6.5), with three cats (75.0%) having a single parasite. Eyeworm infection was statistically more prevalent in pastoral and farm dogs, in those dogs with contact with other animals and in dogs with ocular manifestations. T. callipaeda is endemic in the east-central part of Portugal, reportedly infecting domestic (dogs and cats) and wild carnivores (red foxes) and evidencing a southerly dissemination. Future investigations should be focused on determining the local distribution and density of the insect vector (Phortica variegata) in this geographical area. This emergent zoonosis should be included by veterinarians, physicians and ophthalmologists in the differential diagnosis of ocular manifestations in their patients, particularly in areas where T. callipaeda is endemic.