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Porto Moniz, Portugal

Froes F.,Centro Hospitalar Lisbon Norte | Froes F.,New University of Lisbon
Acta Medica Portuguesa

Introduction and Objectives: Herpes zoster and post-herpetic neuralgia increasing incidence is related to ageing. These conditions can be very debilitating and have an important impact in patients' quality of life. In an ageing population like the Portuguese, is expected that the burden of herpes zoster and post-herpetic neuralgia rises, nevertheless, a specific surveillance system for zoster does not exist in the country, and data regarding the incidence of herpes zoster and the burden of the disease in Portugal in the last decades was not found. In Portugal, the vaccine is still not available. Scaling the burden of disease is important to support public health policies regarding zoster vaccination. Material and Methods: We carried out a retrospective analysis from encoded information from the Portuguese Ministery of Health database for hospital admissions which included all individuals with a primary diagnosis of Herpes Zoster (IDC-9-CM 053), who were discharged between 2000 and 2010. Results: In Portugal, between 2000 and 2010, 1 706 hospital admissions with primary diagnosis of herpes zoster occurred. The majority of the patients were elderly. Eleven percent of the patients had potentially severe immunocompromise. The predominant disease was uncomplicated herpes zoster, followed by nervous system and ophthalmic herpes zoster. Mean hospital stay length was 9.3 days, increasing with age. There was a 1% case fatality rate. Considering the 2000-2009 period and the adult population only, the average annual incidence rate of hospitalization with primary diagnosis of herpes zoster in Portugal was 1.9/100 000 inhabitants, increasing with age. Conclusion: This study confirms that, in Portugal, severe herpes zoster is related to ageing and associated with significant morbidity, mortality and health resources allocation. © Ordem dos Médicos 2013. Source

Dias J.M.,Centro Hospitalar Lisbon Norte
Journal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases

Pachydermodactyly is a superficial benign fibromatosis of unknown etiology; it is rare, more frequent in adolescent males, and characterized by painless swelling of the proximal interphalangeal joints(PIP) of the hands. Histologic examination of the skin shows epidermal hyperplasia and increased number of dermal fibroblasts and collagen fibers.We report the case of a 16-year-old adolescent boy who presented swelling of the lateral and dorsal regions of all the metacarpophalangeal and PIP joints of the left hand and PIP and metacarpophalangeal joints of the second and fifth fingers of the right hand, with 3 years of evolution and no arthritis or functional impairment. Results of complementary diagnostic examinations were normal, with the exception of hand ultra sound that showed skin thickening, without synovial proliferation or joint effusion. Skin biopsy confirmed pachydermodactyly. The patient under went aesthetic surgery with good outcome, without recurrence.This rare condition should be distinguished from idiopathic juvenile arthritis and other entities such as knuckle pads syndrome. Source

Conceicao I.,Centro Hospitalar Lisbon Norte | Conceicao I.,University of Lisbon

Familial amyloid polyneuropathy (FAP) is an autosomal dominant disorder characterized by the extracellular deposition of transthyretin (TTR) fibrils in several tissues, particularly in the peripheral nervous system. The largest focus of the disease is in Portugal where the age of disease onset shows a wide range (1778 years), with 80% of cases developing symptoms before age 40. The characteristic fiber length-dependent sensory-motor and autonomic neuropathy are the neurological hallmark of TTR-FAP. Additional cardiovascular, gastrointestinal (GI), renal and ocular symptoms are the main systemic manifestations that account for phenotypic heterogeneity. © 2012 Informa UK, Ltd. Source

Hypersensitivity reactions (HSRs) to platinum drugs and taxanes are increasing in cancer patients, and rapid drug desensitization has emerged as a safe and effective method to reintroduce these drugs in reactive patients. Optimal management of patients presenting HSRs to chemotherapy depends on the use of various diagnostic tools, which include measurement of mast cell/basophil mediator release following a HSR and skin testing. Serum tryptase should be measured in patients presenting chemotherapy HSRs, and its elevation would support mast cell/basophil activation. Skin testing to platinum drugs has a high sensitivity and specificity and is critical to guide the management of platinum-reactive patients. Taxane skin testing is also emerging as a useful diagnostic and risk stratification tool in the evaluation of patients with HSRs to taxanes. Platinum sIgE assays have been recently developed and can be helpful in combination with skin testing or as an alternative when skin testing is not available. Source

Froes F.,Centro Hospitalar Lisbon Norte | Diniz A.,Centro Hospitalar Lisbon Norte | Serrado M.,Centro Hospitalar Lisbon Norte | Nunes B.,Instituto Nacional Of Saude Dr Ricardo Jorge
European Respiratory Journal

Recent studies in the USA and northern Europe have shown an increase in community-acquired pneumonia (CAP). In southern Europe, this increase has not yet been documented. We carried out a retrospective analysis from encoded information from the Portuguese database for hospital admissions that included all individuals aged ≥18 years, with a primary diagnosis of pneumonia, who were discharged between 2000 and 2009. We excluded patients infected with HIV, individuals immunocompromised as a result of anti-cancer or immunosuppressive treatment, and transplant recipients. Of the 294 027 admissions for CAP, 56% were male. The mean age was 73.1 years and the median age 77 years. Between 2000 and 2009, there was a 5% increase in the average age of patients admitted with CAP. Admissions for CAP represented 3.7% of total admissions of adult patients. The average annual rate of hospital admissions for adults with CAP was 3.61 per 1000 total population, rising to 13.4 for those aged ≥65 years. Between 2000-2004 and 2005-2009 the average annual rate of hospital admission for CAP per 1000 population increased by 28.2%. Hospital admissions for CAP in Portugal increased between 2000 and 2009. It has grown consistently over time, varying according to age with males over-represented. Copyright©ERS 2013. Source

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