Controlo de Infe����o em Portugal: Evolu����o e Atualidade

A ��rea da infe����o em Portugal tem a sua pr��pria hist��ria, com algum atraso relativamente a outros pa��ses europeus. Teve maior proje����o entre 1988-1998 com o ���Projeto de Controlo de Infe����o���. Em 1996, surgiu o primeiro enquadramento normativo para as Comiss��es de Controlo de Infe����o (CCI), normas, e cursos para profissionais das CCI. Entre 1998-2002, iniciou-se a atividade de vigil��ncia epidemiol��gica em rede nacional / europeia. Em 2007, a Dire����o-Geral da Sa��de reformulou o Programa Nacional de Controlo de Infe����o (PNCI) e criou os grupos coordenadores regionais (gest��o descentralizada). Surgiu a forma����o p��s-graduada, a par do incremento da investiga����o. Com a ��rea da seguran��a do doente, tornou-se evidente um maior envolvimento dos ��rg��os de gest��o e dos profissionais de sa��de e maior informa����o da popula����o atrav��s dos meios de comunica����o social. Em 2013, os Programas de Controlo da Infe����o e das Resist��ncias aos Antimicrobianos juntaram-se num ��nico Programa (Programa de Preven����o e Controlo de Infe����o e Resist��ncias aos Antimicrobianos - PPCIRA ��� Programa priorit��rio). E o futuro?

Pr��cticas de Prescripci��n de Nutrici��n Parenteral Neonatal en Portugal

Introducci��n: La utilizaci��n de normas de orientaci��n para la nutrici��n parenteral neonatal mejora la eficiencia y la seguridad de su prescripci��n. Objetivo: Evaluar la pr��ctica de prescripci��n de nutrici��n parenteral neonatal en Portugal y el cumplimiento del Consenso Nacional (2008). M��todos: Encuesta de respuesta m��ltiple sobre la prescripci��n de nutrici��n parenteral (NP) enviada a los coordinadores de las 50 unidades de cuidados especiales neonatales portuguesas, tanto p��blicas como privadas, siendo 25 de n��vel ii y 25 de nivel iii. Resultados: Se prescribe NP en 32 unidades neonatales, habiendo 23 (71,9%) respondido la encuesta. De estas, 19 (82,6%) afirman tener como referencia el Consenso Nacional y las restantes siguen protocolos internos; 17 (73,9%) afirman preferir la prescripci��n mediante soporte inform��tico. En reci��n nacidos pret��rmino, la mayor��a reporta una administraci��n cautelosa de l��quidos en la primera semana posnatal; inicio de amino��cidos desde el primer d��a posnatal con 1,5-3 g/kg/d��a y aumento hasta 3-4 g/kg/d��a; inicio de l��pidos en los 3 d��as posnatales com 1 g/kg/d��a y aumento hasta 3 g/kg/d��a; administraci��n de 40-70 mg/kg/d��a de calcio y f��sforo, con un ratio calcio:f��sforo de 1,7:1 (mg:mg), y estimaci��n de la osmolaridad de las soluciones y control semanal de la trigliceridemia, uremia, fosforemia y funci��n hep��tica. Conclusiones: Por la elevada tasa de respuesta la muestra probablemente es representativa de la pr��ctica de prescripci��n de nutrici��n parenteral neonatal en Portugal. La mayor��a de las unidades tienen como referencia el Consenso Nacional, lo que contribuye a unos mejores cuidados de los reci��n nacidos.

A Case of Kawasaki Disease in Portugal

This case report is believed to be the first case of Kawasaki disease in Portugal. An otherwise healthy 20 years old female was carefully examined and diagnosis of mucocutaneous lyrnphnode syndrome estab lished, based on: typical clinical picture, exclusion of other mimicking situations and middle term evolution of this patient. The A. A. wish to emphasize their diagnosis complied on C. D. C. criteria for Kawasaki disease. A short up dated briefing on this peculiar entity and geographycal pathology are included in this article.

Pr��cticas de Preparaci��n de Nutrici��n Parenteral Neonatal en Portugal; Comparaci��n con las Recomendaciones Espa��olas

Evaluar la pr��ctica de preparaci��n de nutrici��n parenteral (NP) neonatal en Portugal y su concordancia con las recomendaciones del Consenso Espa��ol sobre Preparaci��n de Mezclas Nutrientes Parenterales 2008. M��todos: Cuestionario electr��nico sobre elementos relativos a la preparaci��n de la NP, enviado entre junio y octubre 2009 a los farmac��uticos o enfermeros responsables de la preparaci��n de la NP neonatal en los 50 hospitales (p��blicos y privados) de Portugal con unidades de cuidados especiales neonatales. Resultados: Se preparaba NP neonatal en 30 hospitales,de los que 22 (73,3%) respondieron la encuesta. En el 77% de los hospitales, la NP neonatal se preparaba en los servicios farmac��uticos y en la propia unidad neonatal en el resto. En la mayor��a de hospitales se preparaba apenas en los d��as laborables, y la en la mitad de los casos la prescripci��n llegaba a los responsables en soporte digital. Los responsables identificaron diversos problemas asociados a la interpretaci��n de la prescripci��n (14-41% de las NP). La pr��ctica de la mayor��a de los hospitales portugueses estaba en concordancia con el Consenso Espa��ol en documentaci��n, instalaciones y equipamientos, recursos humanos y etiquetado. En cuanto a las soluciones, la mayor��a estaba en concordancia con los plazos l��mite de utilizaci��n, fotoprotecci��n, utilizaci��n de filtros terminales, control f��sico-qu��mico por inspecci��n visual y control microbiol��gico. Conclusiones: Los resultados del presente estudio proporcionan un buen panorama de la pr��ctica de preparaci��n de la NP neonatal en Portugal. La comparaci��n con el Consenso Espa��ol permiti�� identificar los puntos d��biles y de mejora.

Juvenile Systemic Lupus Erythematosus in Portugal: Clinical and Immunological Patterns of Disease Expression in a Cohort of 56 Patients

Objective: To define the pattern of disease expression and to gain better understanding in patients with juvenile onset systemic lupus erythematosus (SLE) in Portugal. Methods: The features of unselected patients with systemic lupus erythematosus who had disease onset before the age of 18 years were retrospectively analysed in three Portuguese centres with Pediatric Rheumatology Clinic over a 24-year period (1987-2011). Demographic, clinical and laboratory manifestations, therapy and outcome were assessed. Results: A cohort of 56 patients with a mean age at disease onset of 12.6��4.04 years (mean��1SD) (range, 1.0-17.0 years) and a mean period of follow-up of 5.5��5.4 years. Forty six (82.1%) patients were female. The most common disease manifestations were musculoskeletal (87.5%), mucocutaneous (80.3%) and haematological abnormalities (75%). Lupus nephritis was diagnosed in 46.4% of patients and consisted of glomerular ne - phritis in all cases. Neuropsychiatric manifestations occurred in 21.4% but severe central nervous system complications were uncommon, as brain infarcts and organic brain syndrome in 4 (7.1%) patients. Antinuclear antibodies and anti-double stranded DNA were positive in most patients in (98.2% and 71.4% respectively), as well as low C3 and/or C4 were observed frequently (85.7%). Generally, most patients had a good response to therapy as demonstrated by a significant decreasing of SLEDAI score from disease presentation to the last evaluation. The SLEDAI at diagnosis, the maximum SLEDAI and the incidence of complications were significantly higher in patients with neurolupus and/or lupus nephritis. Therapy included oral steroids (87.5%), hydroxychloroquine (85.7%), azathioprine (55.4%), IV cyclophosphamide (28.6%) along with other drugs. Six (10.7%) patients were treated with rituximab. Long-term remission was achieved in 32%, disease was active in 68%, adverse reactions to therapy occurred in 53.6% and complications/severe manifestations in 23.2%. Two patients died, being active disease and severe infection the causes of death. Conclusions: This study suggests that in our patients the clinical and laboratory features observed were similar to juvenile systemic lupus erythematosus patients from other series. Clinical outcome was favourable in the present study. Complications from therapy were frequent. Objective: To define the pattern of disease expression and to gain better understanding in patients with juvenile onset systemic lupus erythematosus (SLE) in Portugal. Methods: The features of unselected patients with systemic lupus erythematosus who had disease onset before the age of 18 years were retrospectively analysed in three Portuguese centres with Pediatric Rheumatology Clinic over a 24-year period (1987-2011). Demographic,clinical and laboratory manifestations, therapy and outcome were assessed. Results: A cohort of 56 patients with a mean age at disease onset of 12.6��4.04 years (mean��1SD) (range, 1.0-17.0 years) and a mean period of follow-up of 5.5��5.4 years. Forty six (82.1%) patients were female. The most common disease manifestations were musculoskeletal (87.5%), mucocutaneous (80.3%) and haematological abnormalities (75%). Lupus nephritis was diagnosed in 46.4% of patients and consisted of glomerular ne - phritis in all cases. Neuropsychiatric manifestations occurred in 21.4% but severe central nervous system complications were uncommon, as brain infarcts and organic brain syndrome in 4 (7.1%) patients. Antinuclear antibodies and anti-double stranded DNA were positive in most patients in (98.2% and 71.4% respectively), as well as low C3 and/or C4 were observed frequently (85.7%). Generally, most patients had a good response to therapy as demonstrated by a significant decreasing of SLEDAI score from disease presentation to the last evaluation. The SLEDAI at diagnosis, the maximum SLEDAI and the incidence of complications were significantly higher in patients with neurolupus and/or lupus nephritis. Therapy included oral steroids (87.5%), hydroxychloroquine (85.7%), azathioprine (55.4%), IV cyclophosphamide (28.6%) along with other drugs. Six (10.7%) patients were treated with rituximab. Long-term remission was achieved in 32%, disease was active in 68%, adverse reactions to therapy occurred in 53.6% and complications/severe manifestations in 23.2%. Two patients died, being active disease and severe infection the causes of death. Conclusions: This study suggests that in our patients the clinical and laboratory features observed were similar to juvenile systemic lupus erythematosus patients from other series. Clinical outcome was favourable in the present study. Complications from therapy were frequent.

Botulismo Infantil em Portugal ��� Um Lactente com Hipotonia

O Botulismo Infantil (BI) constitui uma s��ndrome neuroparal��tica rara, potencialmente fatal, causada pela neurotoxina do Clostridium botulinum. Descreve-se o primeiro caso reportado desde o in��cio da notifica����o obrigat��ria em Portugal (1999). Lactente de dois meses, internado por prostra����o, dificuldade alimentar e obstipa����o. Constatou-se envolvimento inicial dos pares cranianos associado a fraqueza muscular progressiva, descendente e sim��trica. Constitu��am factores de risco o consumo de mel caseiro e o banho com ervas de camomila. A confirma����o diagn��stica foi efectuada pela pesquisa de esporos de Clostridium botulinum nas fezes e pela prova de inocula����o em ratinhos. O tratamento implicou suporte respirat��rio e nutricional, e imunoglobulina humana anti-toxina, com evolu����o favor��vel. A cl��nica e o contexto epidemiol��gico s��o importantes para o diagn��stico, permitindo a institui����o precoce do tratamento.

First Diabetic Retinopathy Prevalence Study in Portugal: RETINODIAB Study-Evaluation of the Screening Programme for Lisbon and Tagus Valley Region

BACKGROUND/AIMS: In Portugal, so far, there is no study or even accurate data on the prevalence of diabetic retinopathy (DR), based on a large representative sample and on a long-term follow-up. The objective of our study was to determine the prevalence of DR based on a national screening community-based programme. METHODS: A 5-year retrospective analysis of the RETINODIAB screening programme results was implemented in Lisbon and Tagus Valley area between July 2009 and October 2014. We estimated the prevalence of retinopathy for all patients with type 2 diabetes and studied the association between known risk factors and retinopathy emergence at their first screening. RESULTS: Throughout this period, from a total of 103���102 DR readable screening examinations, 52���739 corresponded to patients who attended RETINODIAB screening at entry. Globally, DR was detected in 8584 patients (16.3%). Of these, 5484 patients (10.4%) had mild non-proliferative (NP) DR, 1457 patients (2.8%) had moderate NPDR and 672 (1.3%) had severe NPDR. Finally, 971 patients (1.8%) had proliferative DR requiring urgent referral to an ophthalmologist. The presence of any DR, non-referable DR or referable DR was strongly associated with increasing duration of diabetes and earlier age at diagnosis. CONCLUSIONS: The prevalence rate of DR in our study (16.3%) was slightly lower than other published international data. The RETINODIAB network proved to be an effective screening programme as it improved DR screening in Lisbon and Tagus Valley surrounding area

Tuberculose Infantil em Portugal

Dos n��meros recentemente publicados pela Direc����o Geral da Sa��de / N��cleo de Tuberculose e Doen��as Respirat��rias relativos aos anos de 1992 e 1993 e pelo Instituto Nacional de Estat��stica relativos a 1994, conclui-se que os casos de Tuberculose (TB) notificados pouco t��m decrescido nos ��ltimos 15 anos: descida m��dia anual de 6,3% para os casos em geral e 14% para os menores de 15 anos; a taxa global de incid��ncia apurada em 1994 voltou a subir ��� 51,1 (52,4 no Continente). Para o autor a melhoria das taxas de incid��ncia de TB infantil, sobretudo at�� 1991/1992, ficou a dever-se aos melhores cuidados na assist��ncia materno-infantil, com uma maior cobertura pedi��trica e obst��trica por todo o Pa��s, e �� vacina����o generalizada dos rec��m-nascidos com o BCG. Esta cobertura n��o ia al��m de 40% em 1975, atingiu os 75% em 1985 e chegou aos 91% em 1993. Esta evolu����o de TB infantil n��o deve dar lugar a nenhum optimismo porque a TB infantil depende inteiramente das taxas de TB do adulto e se estas n��o melhorarem, o paralelismo vai reaparecer para continuar. As medidas positivas que permitiram a significativa melhoria das taxas de incid��ncia da TB infantil at�� 1991/1992 est��o esgotadas se, no combate �� TB do adulto, medidas urgentes n��o forem tomadas a curto prazo.