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.

Abstract P6-08-25: Outcome of breast cancer patients treated in the private health care in Brazil

Background

Developing countries like Brazil often present a dichotomous health care system, where patients may be treated in either public or private institutions that differ substantially in terms of level of access to diagnostic and therapeutics procedures. Herein, we present the first report of a comprehensive study to assess real-world data in breast cancer patients treated in the private health care in Brazil.

Methods

This is a prospective study of breast cancer patients treated in a private health care institution, comprising six unities in Rio de Janeiro and surroundings. Eligible patients were at least 18 years old and had a histology-proven diagnosis of breast cancer between July 2012 and November 2016. For this analysis, only female patients with an invasive component were included. Patients with prior malignancies and those who initiated therapy in other institutions were excluded. Patients or relatives were contacted by telephone to ensure that all information was annotated. Data quality was certified by regular monitoring. This study was approved by the local Research Ethics Committee.

Results

One thousand three hundred and ninety patients were enrolled. One hundred sixty were excluded in this analysis, 11 due to male gender and 151 with exclusively in situ carcinoma. The report comprises 1230 female patients, predominantly diagnosed in early (79.0% stages I-II) or locally advanced (16.1% stage III) stages. One thousand thirty-three (84.0%) patients had hormone receptor (HR)-positive tumors, and 185 (15.0%) were HER2 positive. One hundred twenty-six (10.2%) cases were triple negative. The primary tumor was resected in 89.0% of times, most often through breast-conserving surgery (55.1%). Axillary lymph nodes were assessed in 83.4% of cases, and 32.0% required complete axillary dissection. Chemotherapy was used in 61.3% of cases, and radiation therapy in 59.6%. Patients with locally advanced disease received more aggressive therapy than patients with early stage (higher rates of mastectomy, axillary dissection and chemotherapy use). After a median follow up of 22.5 months (95% CI, 21.09-23.90), 54 (4.4%) deaths were reported. The estimated 2-year overall survival (OS) was 95.3%. 2-year OS was significantly longer among patients with stages I-II (97.9% and 97.5%, respectively) than in stages III and IV (89.4% and 69.5%, respectively) (p&lt;0.01). HER2/HR status (p&lt;0.01) and tumor grade (p=0.05) were also correlated to OS in the overall cohort, however triple-negative cases were only prognostic in stage III. Age (p=0.10), menopausal status (p=0.74), and histological subtype (p=0.55) were not correlated to OS.

Conclusion

To our knowledge, this is the most comprehensive and best-annotated study in breast cancer patients treated in the private health care in Brazil. More oncological interventions were used in advanced stages, reflecting international recommendations, but also a need to pursue early diagnoses, where outcome is optimal despite less aggressive therapy. Outcomes are favorably similar to the current literature from developed countries in all stages. The data provided helps comprehending the current scenario of breast cancer presentation and treatment in Brazil, and may serve as a foundation to guide resource allocation in the years to come.

Citation Format: Boukai A, Gonçalves AC, Andrade PM, Carvalho N, Almeida T, Lemos F, Padoan M, Teich NS, Araujo LH. Outcome of breast cancer patients treated in the private health care in Brazil [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P6-08-25.

A selective emissive chromogenic and fluorogenic seleno-coumarin probe for Cu2+ detection in aprotic media

A new selenium containing coumarin (compound 7) was designed and synthesized from the amide linkage between coumarin-519 (6) and 2-(butylselanyl)ethanamine (5). The molecular structure of 7 was accurately characterized, and its photophysical properties in acetonitrile, ethanol and chloroform solutions were studied by absorption, stationary and time-resolved fluorescence spectroscopies. Changes in the solvent polarity affected the Stokes shift, quantum yields and lifetime of the excited states. The spectroscopic behavior of compound 7 was evaluated in the presence of different monovalent, divalent and trivalent metallic cations (Na⁺, K⁺, Ca²⁺, Co²⁺, Ni²⁺, Cu²⁺, Zn²⁺, Cd²⁺, Pb²⁺, Hg²⁺, Hg⁺, Ag⁺, Al³⁺, Fe³⁺, Ga³⁺ and Cr³⁺) in acetonitrile solution. Among the tested cations, 7 exhibited high selective interaction with Cu²⁺, which was evidenced by the not expected absorption hypsocromic shift (usually coumarin-519 gives red-shifted complexes) and intense chelation-enhanced fluorescence quenching (CHEQ). We performed spectrophotometric and spectrofluorimetric titrations of 7 upon addition of Cu²⁺. From these data, the minimal detectable and quantifiable amounts were calculated and found to be 0.2 and 0.4 μmol L^-1 by absorption and 0.6 and 1.0 μmol L^-1 by emission, respectively. The 7-Cu²⁺ compound presented the 1 : 1 stoichiometry and the stability constant values of absorption and emission were found to be log β = 5.78 and log β = 6.32 respectively. Taking into account the high selectivity of the 7-Cu²⁺ compound in organic solvent systems, and considering the role of copper in organic transformations, it can be regarded as a promising fluorescent sensor for studies concerning the determination of oxidation-dependent transient entities in organic reactions like those involving cuprates. Additionally, it can be used for the detection and quantification of this metal cation in vitro in aprotic biological systems.

Selective cytotoxicity and cell death induced by human amniotic membrane in hepatocellular carcinoma

Hepatocellular carcinoma (HCC) has a worldwide high incidence and mortality. For this reason, it is essential to invest in new therapies for this type of cancer. Our team already proved that human amniotic membrane (hAM) is able to inhibit the metabolic activity of several human cancer cell lines, including HCC cell lines. Taking into account the previously performed work, this experimental study aimed to investigate the pathways by which hAM protein extracts (hAMPEs) act on HCC. Our results showed that hAMPE reduce the metabolic activity, protein content and DNA content in a dose- and time-dependent manner in all HCC cell lines. This therapy presents selective cytotoxicity, since it was not able to inhibit a non-tumorigenic human cell line. In addition, hAMPE induced cell morphology alterations in all HCC cell lines, but death type is cell line dependent, as proved by in vitro and in vivo studies. In conclusion, hAMPE have a promising role in HCC therapy, since it is capable of inducing HCC cytotoxicity and cell death.

Oxidative stress and mitochondrial dysfunction play a role in myelodysplastic syndrome development, diagnosis, and prognosis: A pilot study

The imbalance between reactive oxygen species (ROS) production and their elimination by antioxidants leads to oxidative stress. Depending on their concentration, ROS can trigger apoptosis or stimulate cell proliferation. We hypothesized that oxidative stress and mitochondrial dysfunction may participate not only in apoptosis detected in some myelodysplastic syndrome (MDS) patients, but also in increasing proliferation in other patients. We investigated the involvement of oxidative stress and mitochondrial dysfunction in MDS pathogenesis, as well as assessed their diagnostic and prognostic values. Intracellular peroxides, superoxide, superoxide/peroxides ratio, reduced glutathione (GSH), and mitochondrial membrane potential (Δψ(mit)) levels were analyzed in bone marrow cells from 27 MDS patients and 12 controls, by flow cytometry. We observed that all bone marrow cell types from MDS patients had increased intracellular peroxide levels and decreased GSH content, compared with control cells. Moreover, oxidative stress levels were MDS subtype- and risk group-dependent. Low-risk patients had the highest ROS levels, which can be related with their high apoptosis; and intermediate-2-risk patients had high Δψ(mit) that may be associated with their proliferative potential. GSH levels were negatively correlated with transfusion dependency, and peroxide levels were positively correlated with serum ferritin level. GSH content proved to be an accurate parameter to discriminate patients from controls. Finally, patients with high ROS or low GSH levels, as well as high superoxide/peroxides ratio had lower overall survival. Our results suggest that oxidative stress and mitochondrial dysfunction are involved in MDS development, and that oxidative stress parameters may constitute novel diagnosis and/or prognosis biomarkers for MDS.

Availability of heavy metals (Cd, Pb, And Cr) in agriculture from commercial fertilizers

The purpose of this study was to investigate the availability of the heavy metals cadmium (Cd), lead (Pb), and chromium (Cr) to soil and maize plants fertilized with different sources and doses of zinc (Zn) in a Rhodic Eutrudox soil. For that purpose, concentrations of Cd, Pb, and Cr were evaluated in leaf tissue and grains of maize plants and in 0-20 and 20-40 cm soil layers after fertilization with four doses of Zn from eight different sources of fertilizer. There was no accumulation of Cd, Pb, and Cr in maize grain and Cd and Cr in leaf tissue of the plants; nevertheless, there was accumulation of Pb in leaf tissue, showing its availability throughout different sources of Zn and consequent uptake by plants. Regarding the soil, it was observed that fertilizer from the different sources made Cd, Pb, and Cr available at increasing amounts proportional to increased Zn doses. Under experimental conditions, fertilization with Zn increased concentrations of heavy metals Cd, Pb and Cr in soil, further highlighting the importance of conducting more studies related to the application of mineral fertilizers for micronutrient supply and the availability of heavy metals.

Hepatocellular carcinoma and chemotherapy: the role of p53

BACKGROUND

Hepatocellular carcinoma (HCC) is the most common primary neoplasm of the liver. A major proportion of HCCs also present mutation of the gene that encodes p53, which confers chemoresistance. The main goal of this work is to investigate the effect of cisplatin, doxorubicin and 5-fluoruracil (5-FU) in three human HCC cell lines which differ in p53 expression.

METHODS

HepG2 (expressing normal p53), HuH7 (expressing mutated p53) and Hep3B2.1-7 (not expressing p53) cell lines were cultivated in the presence of cisplatin, doxorubicin and 5-FU. Cell proliferation was evaluated by the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay (MTT assay). The type of cell death and Bax and Bcl2 activation were assessed by flow cytometry.

RESULTS

It was found that for all of the cell lines studied, the agent that gave the most satisfactory results was doxorubicin. 5-FU demonstrated no activity in these cell lines.

CONCLUSIONS

For all the cell lines studied, doxorubicin was the most satisfactory agent. In HepG2 and HuH7 cell lines, it can activate Bax with statistical significance.

Accumulation of (137)Cs in Brazilian soils and its transfer to plants under different climatic conditions

The spatial distribution and behaviour of the global fallout (137)Cs in the tropical, subtropical and equatorial soil-plant systems were investigated at several upland sites in Brazil selected according to their climate characteristics, and to the agricultural importance. To determine the (137)Cs deposition density, undisturbed soil profiles were taken from 23 environments situated between the latitudes of 02 degrees N and 30 degrees S. Sampling sites located along to the equator exhibited (137)Cs deposition densities with an average value of 219Bqm(-2). Extremely low deposition densities of 1.3Bqm(-2) were found in the Amazon region. In contrast, the southern part of Brazil, located between latitudes of 20 degrees S and 34 degrees S, exhibited considerably higher deposition densities ranging from 140Bqm(-2) to 1620Bqm(-2). To examine the (137)Cs soil-to-plant transfer in the Brazilian agricultural products, 29 mainly tropical plant species, and corresponding soil samples were collected at 43 sampling locations in nine federal states of Brazil. Values of the (137)Cs concentration factor plant/soil exhibited a large range from 0.020 (beans) to 6.2 (cassava). Samples of some plant species originated from different collecting areas showed different concentration factors. The (137)Cs content of some plants collected was not measurable due to a very low (137)Cs concentration level found in the upper layers of the incremental soils. Globally, the soil-to-plant transfer of (137)Cs can be described by a logarithmic normal distribution with a geometric mean of 0.3 and a geometric standard deviation of 3.9.