Medical residency in Portugal: a cross-sectional study on the working conditions.

Objectives: The current European crisis in human resources in health has opened the debate about working conditions and fair wages. This is the case with Resident doctors, which have faced challenges throughout Europe. In Portugal, they account for about a third of the doctors in the Portuguese National Health Service. No studies to date objectively demonstrate the working conditions and responsibilities undertaken. This study aims to quantify the residents' workload and working conditions. Methods: Observational, retrospective cross-sectional study which involved a survey on the clinical and training activity of Portuguese residents, actively working in September 2020. The survey was distributed through e-mail to residents' representatives and directly to those affiliated with the Independent Union of Portuguese Doctors. The descriptive analysis assessed current workload, and logistic regression models analyzed associations with geographical location and residency seniority. Results: There were a total of 2,012 participants (19.6% of invited residents). Of the residents giving consultations, 85.3% do so with full autonomy. In the emergency department, 32.1% of the residents work 24 h shifts and 25.1% work shifts without a specialist doctor present. Regarding medical training, 40.8% invest over EUR 1,500 annually. Autonomy in consultations was associated with being a Family Medicine resident (OR 4.219, p < 0.001), being a senior resident (OR 5.143, p < 0.001), and working in the Center (OR 1.685, p = 0.009) and South regions (OR 2.172, p < 0.001). Seniority was also associated with investing over EUR 1,500 in training annually (OR 1.235, p = 0.021). Conclusion: Residents work far more than the contracted 40 h week, often on an unpaid basis. They present a high degree of autonomy in their practice, make a very significant personal and financial investment in medical training, with almost no time dedicated to studying during working hours. There is a need to provide better working conditions for health professionals, including residents, for the sake of the sustainability of health systems across Europe.

Clinical and Epidemiological Features of Hospitalized and Ambulatory Patients with Human Monkeypox Infection: A Retrospective Observational Study in Portugal.

Monkeypox, a neglected and re-emergent zoonotic disease caused by monkeypox virus (MPXV) infection, has been endemic in Central and Western Africa for decades. More recently, an outbreak has spread to a global level, occurring in sites with no previous reported cases and being clustered among men who have sex with men, suggesting new modes of transmission. There is an urgent need for research for a better understanding of the genomic evolution and changing epidemiology of the Orthopoxvirus group. Our work aimed to characterize the clinical and epidemiological features of a cohort of patients with MPXV infection in a Portuguese hospital, admitted between 5 May and 26 July 2022. In this retrospective observational study, aggregate data of a case series on the presentation, clinical course, and outcomes of confirmed MPXV infections are reported. The study included 40 men and 1 woman, with a mean age of 37.2 years old; 92.7% identified as men who have sex with men, 90.2% had unprotected sex or sex with multiple or anonymous partners in the previous month, and 39.0% reported to have had sex with an MPXV-confirmed case; 59.5% had previously known human immunodeficiency virus (HIV) infection, all of whom were under antiretroviral therapy, and no patients had acquired immunodeficiency syndrome (AIDS) criteria. About a quarter of patients were observed only a week after symptom onset. All patients had skin or mucosal lesions and the anogenital region was the most frequent lesion site. There were no statistically significant clinical differences between HIV-positive and negative individuals. Four patients were admitted to the inpatient clinic, two of whom had proctitis with difficult-to-manage anal pain. There were no reported deaths. Our findings suggest the sexual route as a relevant mode of transmission of MPXV and confirm the mostly benign presentation of this disease.

Acute disseminated encephalomyelitis, a rare post-malaria neurological complication: Case report and review of the literature.

There are four neurological complications that can occur after malaria treatment at a time when the patient is aparasitaemic: delayed cerebellar ataxia, acute inflammatory demyelinating polyneuropathy, post-malaria neurological syndrome and acute disseminated encephalomyelitis (ADEM). The authors describe a case of a 54-year-old male who presented with encephalopathy and generalized seizures forty-three days after complete recovery from acute malaria by Plasmodium falciparum. Diagnosis of post-malaria ADEM was made based on the acute onset of the neurological symptoms, characteristic findings in magnetic resonance imaging of the brain and prompt response to steroid therapy. ADEM is an autoimmune demyelinating disease of the central nervous system that usually arises after an infection or vaccination. Its occurrence after malaria infection is relatively rare, and to the best of our knowledge there are only thirteen cases described in the literature.

Epstein-Barr virus hemorrhagic meningoencephalitis: case report and review of the literature.

Neurologic complications related to Epstein-Barr virus (EBV) in immunocompetent adults are rare and most commonly self-limited. However, severe cases have been previously reported in the literature. We describe a case of meningoencephalitis with frontal bilateral hemorrhage in a non-immunocompromised adult following an EBV infection of the central nervous system confirmed by the presence of EBV-DNA in the cerebrospinal fluid. During the patient's hospital stay, there was a favorable clinical and radiologic evolution and the patient was discharged asymptomatic. To our knowledge, this is the fourth case of hemorrhagic meningoencephalitis related to EBV and the first one in an immunocompetent patient with a favorable outcome.

Aspectos de contaminação biológica em filtros de condicionadores de ar instalados em domicílios da cidade de Manaus - AM / Aspects of biological contamination in air conditioning filters installed in Manaus city houses (AM)

Este trabalho apresenta resultados da pesquisa de contaminação dos filtros de condicionadores de ar instalados no setor residencial da cidade de Manaus. A pesquisa foi realizada no âmbito do projeto CAEMA (Condicionadores de Ar, Energia e Meio Ambiente) que consistiu na troca de aparelhos de ar condicionado ineficientes por eficientes na zona urbana da cidade. Dos 500 condicionadores de ar retirados do sistema pelo projeto, foram selecionados 50 filtros (10 por cento) para a análise de contaminação biológica, tendo sido identificada uma enorme variedade de agentes prejudiciais à saúde humana, entre bactérias e fungos. A bactéria mais vezes identificada foi a Staphylococcus sp e o fungo mais freqüente foi o Penicillium sp. Também foi possível verificar, por meio de entrevistas telefônicas junto a 37 usuários desses equipamentos, a grande incidência de sintomas associados a problemas de insuficiente qualidade de ar nos ambientes residenciais. Circunstâncias que motivaram a oportunidade desta pesquisa também impossibilitaram a coleta das amostras por unidade de volume, com os condicionadores ainda em funcionamento. Esse fato não comprometeu os objetivos da pesquisa, de promover a reflexão sobre os cuidados com a correta limpeza dos condicionadores de ar residenciais.

This work presents the results of a research about the contamination caused by air conditioners filters that are installed in the residential area in Manaus. The research took place in the scope of CAEMA's project (Conditioning of Air, Energy and Environment), which one consisted in changing inefficient conditional air devices for efficient ones in the urban zone of the city. Amongst 500 air conditioners removed of the system by the project, 50 filters (10 percent) were selected for biological contamination analysis, having been identified an enormous variety of agents, like bacteria and fungus, that are harmful for human health. The most identified bacterium was the Staphylococcus sp and the fungus more frequent was the Penicillium sp. Also it was possible to verify, by telephonic interviews with 37 users of these equipments, the great incidence of symptoms associates to the insufficient air quality in residential environments. The circumstances that had motivated the chance of this research, had also disabled that the assemble could be made per volume unit, with the conditioners still working. This fact did not compromise the quality of the work, neither the objectives to promote one reflection about the cares with the correct cleanness of the residential air conditioners.