Respiratory viral infections before the COVID-19 in Portugal: A single center study.

Objectives: We aimed to describe the respiratory viruses (RV) found in respiratory samples from patients admitted to Hospital de São Bernardo, Setúbal, Portugal, between October 2019 and March 2020, and to correlate these with clinical features. Design: This retrospective study explored 948 fresh frozen naso/oropharyngeal swabs, tested by reverse transcription-polymerase chain reaction. Results: Rhinovirus/enterovirus, influenza, and respiratory syncytial virus (hRSV) were the most prevalent RV. Half of the patients fulfilled the acute respiratory infection (ARI) and/or influenza-like illness (ILI) criteria, with increasing age significantly reducing the risk of ARI and/or ILI. Hospital admission was more frequently observed in symptomatic patients, but the length of stay and mortality were significantly lower. Most (96.5 %) patients had a main respiratory diagnosis. In adults, the most prevalent was pneumonia, which particularly affected older patients, while in children, the most common was bronchiolitis. The number of hospital admissions was high. Sudden onset, shortness of breath, older age, and hRSV detection significantly increased the risk of hospital admission overall. In bronchiolitis, female gender significantly increased the risk of hospital admission, while older age significantly reduced this risk. Twenty patients died within the first month of sampling, and all were older adults. Older age and male gender significantly increased the risk of death. Conclusions: Respiratory viral infections can have a significant clinical impact, particularly in young infants with bronchiolitis and older adults with pneumonia. This study provides the first snapshot of the respiratory viral infections just before the outbreak of SARS-CoV-2 in Portugal, providing relevant clinical insights.

Diagnostic Images of Pulmonary Alveolar Microlithiasis: A Rare, Autosomal Recessive Disorder.

Pulmonary alveolar microlithiasis (PAM) is a genetic lung disorder that is characterized by the accumulation of calcium phosphate deposits in the alveolar spaces of the lung. PAM is discovered incidentally on radiographs performed for other purposes, and the typical disease course is characterized by slowly progressive respiratory failure over decades. Treatment remains supportive. A 62-year-old woman presented in the emergency department with dyspnoea and fatigue. On physical examination she had crackles on pulmonary auscultation and digital clubbing. A CT scan of the chest showed multiple high-density areas throughout the lung parenchyma, suggesting the presence of alveolar microlithiasis. This CT finding is the typical radiological presentation of PAM, while the hallmark presentation is clinical-radiological dissociation. LEARNING POINTS: Pulmonary alveolar microlithiasis (PAM) is a rare genetic lung disorder resulting in accumulation of calcium phosphate deposits in the alveoli.The typical radiological presentation of PAM is the classic 'sandstorm' appearance in the lung.The key to diagnosis of this disease is clinical-radiological dissociation.

Apical fibrobullous lung disease in ankylosing spondylitis: case report and literature review.

Ankylosing spondylitis (AS) is associated with several unique pulmonary manifestations such as apical fibrobullous disease (AFBD), which is a rare extra-spinal complication, predominantly occurring in advanced disease. Infectious complications and differential diagnosis of cavitated lung lesions may be challenging, particularly in patients already submitted to immunosuppression. In this report, we present a low body-mass-index 47-year-old male patient, ex-smoker, with AS and severe joint involvement, medicated in the past with anti-TNF-α therapy, who was diagnosed with AFBD and developed pulmonary tuberculosis and later chronic cavitary pulmonary aspergillosis. The patient died due to lung cavity major bleeding.

Portuguese in vitro antibiotic susceptibilities favor current nontuberculous mycobacteria treatment guidelines.

SETTING: Nontuberculous mycobacteria (NTM) are increasingly recognized as causative agents of opportunistic infections in humans for which effective treatment is challenging. There is, however, very little information on the prevalence of NTM drug resistance in Portugal. OBJECTIVE AND DESIGN: Our aim was to analyze the drug susceptibility testing (DST) performed in NTM at the Portuguese National Health Institute Dr. Ricardo Jorge from February 2003 to February 2016. A total of 262 DST were included in the analysis. RESULTS: Most (94%) M. avium intracellulare complex isolates showed in vitro susceptibility to clarithromycin. All M. kansasii isolates were susceptible to rifampicin and ethambutol and 97.1% were susceptible to isoniazid. The majority of rapidly-growing mycobacteria (RGM) demonstrated in vitro susceptibility to amikacin, clarithromycin and cefoxitin. However, in RGM there was a marked increase on the relative risk of having sulfamethoxazole resistance in isolates resistant to ciprofloxacin compared to susceptible isolates. CONCLUSION: Tested NTM in Portugal revealed in vitro susceptibility to most of the antimicrobials currently recommended for treatment. However, our results also suggest that sulfamethoxazole should be avoided in treatment of RGM resistant to ciprofloxacin (or vice versa). Further trials that correlate the in vitro DST results with the clinical outcome are needed in order to reach conclusions on efficient antimicrobial therapy.

Insulation Cork Boards-Environmental Life Cycle Assessment of an Organic Construction Material.

Envelope insulation is a relevant technical solution to cut energy consumption and reduce environmental impacts in buildings. Insulation Cork Boards (ICB) are a natural thermal insulation material whose production promotes the recycling of agricultural waste. The aim of this paper is to determine and evaluate the environmental impacts of the production, use, and end-of-life processing of ICB. A "cradle-to-cradle" environmental Life Cycle Assessment (LCA) was performed according to International LCA standards and the European standards on the environmental evaluation of buildings. These results were based on site-specific data and resulted from a consistent methodology, fully described in the paper for each life cycle stage: Cork oak tree growth, ICB production, and end-of-life processing-modeling of the carbon flows (i.e., uptakes and emissions), including sensitivity analysis of this procedure; at the production stage-the modeling of energy processes and a sensitivity analysis of the allocation procedures; during building operation-the expected service life of ICB; an analysis concerning the need to consider the thermal diffusivity of ICB in the comparison of the performance of insulation materials. This paper presents the up-to-date "cradle-to-cradle" environmental performance of ICB for the environmental categories and life-cycle stages defined in European standards.

Educação Para a Saúde como estratégia para a promoção do Envelhecimento saudável / Health Education as a strategy to promote healthy aging

As alterações demográficas dos últimos anos têm vindo a operar mudanças significativas na nossa sociedade, sendo relevante o aumento da população mais velha. Este fato traz novos desafios, a que a enfermagem não pode ficar indiferente. Manter os nossos idosos saudáveis, ativos e participativos nas suas comunidades deverá ser a prioridade. Um bom estado de saúde é fundamental para que as pessoas mais velhas possam continuar a ser ativas e autónomas. A promoção de estilos de vida saudáveis visa levar as pessoas à adoção de comportamentos de saúde, prevenindo doenças e melhorando a gestão de outras já existentes. A promoção de um envelhecimento saudável deverá ser um dos objetivos das estruturas existentes numa comunidade, sejam estas de saúde, politicas, sociais e da sociedade civil, sendo essencial a atuação conjunta. No decorrer do estágio académico, com o propósito de desenvolver competências específicas na área da enfermagem comunitária, a mestranda recorre a parcerias com varias instituições da comunidade com o objetivo de implementar o projeto de educação para a saúde visando a promoção do envelhecimento saudável. Esta foi a problemática estruturante da prática clínica, emergindo a questão: a educação para a saúde na pessoa com idade superior a 50 anos promove o envelhecimento saudável? Foram realizadas várias intervenções junto do grupo alvo definido, tendo como objetivo a promoção de estilos de vida saudáveis, com vista à capacitação destas pessoas. Estas intervenções foram suportadas em fundamentação científica através de revisão bibliográfica realizada ao longo do estágio. A mestranda realizou também revisão sistemática de literatura nas bases de dados científicas e encontrou evidências de que a educação para a saúde para a adoção de comportamentos saudáveis é essencial para um envelhecimento saudável, ativo e participativo