Ana Glória Fonseca

The Burden of Imported Malaria in Portugal 2003 to 2012

Increasing international travel and expatriation to sub-Saharan countries where malaria is endemic has raised public health concerns about the burden of imported malaria cases in Portugal. From 2009 to 2012, there was a 60% increase in malaria hospitalizations, contradicting the declining trend observed since 2003. Older age was associated with longer length of stay in hospital and higher lethality.

Asma e a nova lei do tabaco. O que mudou

January 2008 saw new legislation implanted in Portugal restricting smoking in closed public spaces. As second-hand smoke worsens asthma symptoms, it is important to understand how asthma patients feel this new legislation impacts on their well-being. A descriptive cross-sectional study was conducted in a convenience sample formed of 96 asthma patients who had Pulmonology appointments at the Pulido Valente and Santa Marta Hospitals. All data was collected from a standardised questionnaire with volunteer, anonymous and confidential answers. Epi InfoTM software was used for statistical processing purposes, and the results analysed using the chi-squared test (α = 5%). 67.7% of the patients polled were exposed to second-hand smoke until December 2007, with a higher percentage in those currently in work. A considerable percentage (39.6%) described positive changes (measured by improved performance of daily life activities, decrease in symptoms or lesser recourse to SOS medication), even though the majority did not recognise any improvement. 81.6% of those who noted positive changes said they were no longer exposed to second-hand smoke with the passing of the new legislation, and 65.8% stated that the smoking ban was the factor responsible for those changes. These results, only two months after the implementation of the legislative ban on smoking in public spaces, underline the importance of approving effective measures to create and enforce smoke-free environments, reducing worsening of symptoms and improving asthma patients’ well-being. Rev Port Pneumol 2009; XV (1): 27-42

Iron-induced thrombocytopenia in severe iron-deficiency anemia.

Iron deficiency anemia (IDA) is commonly associated with reactive thrombocytosis, but thrombocytopenia is relatively uncommon and generally associated with more severe IDA. Even more rarely described has been thrombocytopenia following iron replacement therapy to treat IDA, and the underlying mechanism remains unclear. The authors present the case of a patient with severe IDA, who developed thrombocytopenia after the initiation of iron therapy. An analysis is made of all the previous reports of similar cases, to compare and start on the path of understanding this rare entity.

Imported Malaria in Portugal 2000–2009: A Role for Hospital Statistics for Better Estimates and Surveillance

Background. Although eradicated in Portugal, malaria keeps taking its toll on travelers and migrants from endemic countries. Disease notification is mandatory but is compromised by underreporting. Methods. A retrospective study on malaria hospitalizations for 10 consecutive years (2000–2009) was conducted. Data on hospitalizations and notifications were obtained from Central Administration of Health System and Health Protection Agency, respectively. For data selection ICD-9 CM and ICD-10 were used: codes 084*, 647.4, and B50–B54. Variables were gender, age, agent and origin of infection, length of stay (LOS), lethality, and comorbidities. Analysis included description, hypothesis testing, and regression. Results. There were 2003 malaria hospitalizations and 480 notified hospitalized cases, mainly in young male adults. P. falciparum was the main agent of infection acquired mainly in sub-Saharan Africa. Lethality was 1.95% and mean LOS was 8.09 days. Older age entailed longer LOS and increased lethality. Discussion. From 2000 to 2009, there were 2003 malaria hospitalizations with decreasing annual incidence, these numbers being remarkably higher than those notified. The national database of diagnosis related groups, reflecting hospitalizations on NHS hospitals, may be an unexplored complementary source for better estimates on imported malaria.

Psychological well-being of Portuguese expatriates in Sub-Saharan Africa: a cross-sectional study

Background Psychological health problems are highlighted among the most relevant disease patterns in expatriates. The purpose of this study was to determine the psychological well-being in Portuguese expatriates in Angola and Mozambique, considering the increasing expatriation wave. Methods A cross-sectional self-administered web survey was conducted in a sample of 352 Portuguese civil expatriates in Angola and Mozambique. Clinically significant psychological distress was determined using General Health Questionnaire (GHQ)-12 and associated factors were studied using multiple logistic regression analysis. Results GHQ-12 items showed good internal consistency as reflected by the Cronbachs alpha. One-third of the screened expatriates corresponded to cases of clinically significant psychological distress. Age, country of birth, self-reported psychological symptoms and self-perception of general health in the previous 3 months were identified as independent variables associated with psychological distress. Conclusions Increasing awareness and monitoring expatriates mental health should be in the health agenda, furthermore considering them a risk group in need of evidence-based mental health expatriate preparedness. The use of user-friendly validated tools, such as GHQ-12, allowing objective assessment and surveillance of these hard to reach populations should be reinforced.

Surveillance of imported hospital requiring malaria in Portugal: can it be improved?

Although eradicated in Portugal, malaria keeps taking its toll on travellers and migrants from endemic countries. Completeness of hospital requiring malaria notification in Portugal 2000-11 was estimated, using two-source capture-recapture method. Data sources were: national surveillance database of notifiable diseases and the national database of the Diagnosis-Related Groups resulting from National Health Service (NHS) hospital episodes. The completeness of notification was 21,2% for all malaria cases and 26,5% for malaria deaths, indicating significant underreporting and urging for complementary data source in surveillance, for disease burden estimates and retrospective monitoring, namely hospital episodes statistics.

VASCULITE CUTÂNEA LEUCOCITOCLÁSICA INDUZIDA PELO PROPILTIOURACILO

Propylthiouracil (PTU) is widely used in the treatment of Hyperthyroidism. Usually well tolerated, it is though associated with antineutrophil cytoplasmic antibodies (ANCA) and, less frequently, with late-onset ANCA positive vasculitis. The authors describe the clinical case of a 45-year-old female patient with Graves’ disease for which she was being treated with PTU since 3 years before, who developed an ANCA-positive cutaneous leukocytoclastic vasculitis without systemic involvement. Initially seen as idiopathic the vasculitis was posteriorly associated with PTU. The drug was discontinued with a progressive and maintained recovery. The patient remains asymptomatic with 3 years of follow-up.