INTRODUCTION: Major lower limb amputation is often the last resort procedure for patients with advanced peripheral artery disease and is associated with substantial mortality. Preoperative biomarkers such as haemoglobin and albumin may provide valuable prognostic information by reflecting oxygen-carrying capacity, nutritional status and systemic inflammation. This study aimed to evaluate the association between preoperative haemoglobin and albumin levels and survival among patients undergoing major lower-limb amputation. METHODS: A retrospective single-centre study was conducted, including all patients who underwent major lower limb amputation between June 2016 and December 2023 at a tertiary vascular surgery centre. Preoperative haemoglobin and albumin levels were collected from medical records. Patients were stratified according to survival status during follow-up. Independent samples t-tests were used to compare mean values between groups. Cox proportional hazards regression was performed to identify independent predictors of mortality, adjusting for relevant comorbidities. RESULTS: A total of 585 patients were included (mean age 72±12 years; 66% male), with 61% of patients undergoing transfemoral amputation. During follow-up, 66 patients (11.3%) died. Mean preoperative haemoglobin and albumin levels were significantly higher among survivors (haemoglobin: 10.46 vs 10.06 g/dL p = 0.015; albumin: 3.25 vs 2.94 g/dL p = 0.019. In multivariable Cox regression analysis, cerebrovascular disease (HR 1.50 p = 0.003, congestive heart failure (HR 1.53 p = 0.007), atrial fibrillation (HR 1.49 p = 0.008), and haemoglobin (HR 0.93 per g/dL p = 0.048) were independently associated with mortality. As albumin levels were available for only 99 patients, albumin was analysed separately and showed a strong association with improved survival in univariable analysis. (HR 0.488 p = 0.001). CONCLUSION: Preoperative haemoglobin is an independent predictor of survival following major lower limb amputation, underscoring the importance of preoperative optimisation and risk stratification. Although albumin demonstrated a significant protective association in univariate analysis, further multivariable validation is required. Incorporating these biomarkers into perioperative assessment protocols may improve the identification of high-risk patients and guide targeted interventions.

Introdução: O nosso objetivo foi estudar a associação entre elevações extremas da velocidade de sedimentação (VS) (>100 mm/h) e a distribuição por categorias de doenças, doenças, idade, sexo, níveis de proteína C-reactiva e sobrevida a 5 anos. Métodos: Estudo retrospetivo de todos os doentes com elevação extrema da VS avaliados num hospital português de 1 de Janeiro de 2008 a 31 de Dezembro de 2012. Variáveis independentes incluíram categorias de doenças, subcategorias,idade, sexo e níveis de PCR. A situação vital e data de morte foram determinadas pelo uso do Sistema de Prescrição Eléctrica português. Resultados: Uma VS superior a 100 mm/h foi determinada em 681 doentes (1,5% de todas as avaliações de VS). A categoria diagnóstica mais frequente foi infecção (461, 65,1%), seguida de neoplasia (107, 15,1%), e de inflamação/ autoimunidade (85, 12,0%). A doença mais prevalente foi a pneumonia (227, 33,3% de todos os doentes). A infeção era menos provável nos doentes de ambulatório (20,7%), assim como a neoplasia em mulheres (11,4%). A mortalidade a cinco anos foi de 70,3%, superior nos doentes com neoplasia (83%) e inferior nos doentes com inflamação/autoimunidade (45,9%). Conclusão: Verificámos que quase todos os doentes com elevação extrema da VS têm uma etiologia identificável, com infecção a ser a causa em cerca de dois terços e a pneumonia a ser responsável em cerca de um terço de todos os doentes. A infecção foi menos provável em doentes de ambulatório, assim como a neoplasia em mulheres. Os níveis de VS e de PCR têm fraca correlação nestes doentes. A mortalidade a cinco anos foi de 70,3%, com a sobrevida a ser significativamente menor em doentes com neoplasia, e superior em doentes com inflamação/autoimunidade. Estes resultados poderão auxiliar à avaliação diagnóstica e prognóstica dos doentes com elevações extremas da VS.

Introduction: Clinical characteristics of Portuguese inpatients with coronavirus disease 2019 (COVID-19) are scarce. We aim to describe the demographic characteristics, clinical course and outcomes of hospitalized patients with COVID-19 and to analyze risk factors for in-hospital mortality. Material and Methods: Ambispective cohort study of adult COVID-19 patients admitted to a Portuguese tertiary hospital between March and August 2020. Asymptomatic, pregnant and all patients admitted due to social reasons were excluded. Results: Of the 432 admitted patients, 279 individuals were included. The median age was 69 years and 57% were male. The most common comorbidities were high blood pressure (66.3%), dyslipidemia (33.3%), diabetes (27.1%) and cardiovascular disease (CVD) (26.5%). The most common symptoms included fever (74.4%), cough (67.0%) and dyspnea (59.9%). Ferritin, C-reactive protein and D-dimer levels were elevated in 86.3%, 74.8% and 73.9% of patients, respectively. Mortality rate was 17.3%. 32.3% of the patients developed acute respiratory distress syndrome, 31.9% were admitted to intensive care unit and 20.8% were ventilated. In multivariable analysis, age (OR 1.04, 95% CI 1.01–1.09, p=0.023), CVD (OR 2.68, 95% CI 1.21–5.93, p=0.015) and lymphocyte count <0.5x109/L (OR 6.61, 95% CI 2.23–19.62, p=0.001) were risk factors for in-hospital mortality. Discussion: Our demographics, clinical and severity outcomes are in-line with international reports. Compared to other European countries, our less expressive in-hospital mortality rate might reflect a modestly controlled first outbreak in our country. Conclusion: This single-center study provides data on the clinical characteristics and outcomes of hospitalized patients with COVID-19 in Portugal.

Introduction: Official data shows increased excess all- -cause mortality in 2020 compared to 2019. Fear of exposure constrained medical evaluations which were delayed by either choice or imposition. Going to the emergency department (ED) was no exception. Our objective was to compare demographic, clinical and analytical characteristics of patients who died in a COVID-19 dedicated ED with the same period of 2019. Material and Methods: Retrospective study analysing patient discharge notes who have died during ED permanence between March 18th and June 22nd of 2019 and in the same period of 2020. Statistical analysis was performed using IBM SPSS software. Results: A total of 33 patients died in 2019 whereas 99 died in 2020 during the analysed period, representing a mortality rate of 0.34% and 1.89%, respectively. Only 4.04% (n = 4) of deceased patients tested positive for SARS-CoV-2 in 2020, while all showed severe respiratory infections. There was a statistically significant difference concerning length of stay in ED (p < 0.01), being bedridden (p = 0.04), dementia (p = 0.03) and presence of respiratory failure at admission (p = 0.001). There were no differences regarding demographic data, comorbidities, and other analytical parameters. Conclusion: In 2020, deaths in the ED occurred among more vulnerable patients and with more severe disease. It was the later demand for hospital care, particularly in the worsening of chronic diseases, that irreversibly conditioned this outcome, especially in the context of chronic diseases exacerbation. Furthermore, the number of deaths that can be attributed to COVID-19 is negligible, deserving reflection and readaptation of good practices ensuring that patients are admitted to the ED within the recommended time and in accordance with the suspected pathologies.

Introduction: The aging of the population is an inescapablereality. Recently published statistical data shows that thepopulation aged 100 years or over has shown a strong increase in Portugal. However, there are few studies characterizing such an elderly population which almost invariably isadmitted to hospital at some point.Methods: A retrospective study of patients aged 100 years orover hospitalized in the department of Internal Medicine from01/01/2006 to 31/12/2016.Results: In the period under analysis, there were 172 admissions (< 0.4% of the total) corresponding to 130 patients. Theaverage age was 101.1 years, with 74.4% of the patients being female. A percentage of 51.7% of the patients came fromtheir domiciles, and the degree of dependence for daily lifeactivities evaluated as being “totally dependent” in 60.5% ofcases. Analysis of the personal histories revealed that 46.7%of patients had 2 or 3 comorbidities, with arterial hypertension, heart failure and dementia being the most prevalent.Polypharmacy was present in 41.8% of patients. Infectiouspathology of the respiratory system stood out as the reasonfor hospitalization (57.6%) and as the direct cause of death(52.1%). A mortality rate of 41.3% was found.Conclusion: Hospital admissions for centenarian patientshave been steadily increasing over the years, and these aregenerally associated with a worsening degree of functional dependency and, consequently, higher socioeconomiccosts. This study made it possible to better characterize thispopulation in order to adopt more appropriate responses tothese hospitalizations.

O presente trabalho teve como objectivo a elaboração de um manual de ―Boas Práticas na Produção Cunícola‖ cumprindo o previsto na legislação comunitária e no ―Codex Alimentarius‖. Simultaneamente, pretendeu-se caracterizar a exploração cunícola da região Ribatejo e Oeste, com a respectiva avaliação do grau de cumprimento de boas práticas e da sua eventual consequência na mortalidade e rejeição de animais para abate. Realizou-se um inquérito junto da totalidade das explorações cunícolas da região do Ribatejo e Oeste, registadas nos serviços oficiais, num total de dezassete explorações, totalizando um efectivo de 6720 fêmeas reprodutoras. Nos pavilhões de crescimento e engorda, procedeu-se ainda ao levantamento mensal do número de animais mortos, de animais rejeitados para abate e da temperatura média registada nos meses de Verão. A caracterização da exploração foi realizada com dados apresentados percentualmente, para cada um dos itens analisados. O grau de cumprimento de boas práticas na exploração cunícola para cada um dos itens considerados, foi calculado e apresentado sob a forma de percentagem. As taxas de mortalidade e de rejeição dos animais foram calculadas, para cada exploração, anualmente, e para o período dos meses de Verão. As taxas de mortalidade e de rejeição de animais, calculadas nos sectores de crescimento e engorda, apresentaram valores médios dentro dos valores de referência, mas com grande heterogeneidade entre explorações, sugerindo a possibilidade de introduzir melhorias técnicas em algumas dessas explorações. Entre as boas práticas na exploração cunícola, e cuja situação de incumprimento foi associada a maiores taxas de mortalidade e de rejeição de animais, destacou-se o incumprimento de vazio sanitário, da utilização de vestuário e calçado adequados e da realização de análises periódicas à água

Ruptured Abdominal Aortic Aneurysms present with significant lethality, long hospitalization periods at intensive care units and elevated health costs. Aneurysm-related mortality is highly dependent on the clinical state and physiological reserve of the patient previous to the surgery. In order to stratify which factors may condition mortality and to understand the best candidates for surgical treatment, several scores have been published with dozens of analyzed variables. The most relevant scores are: Glasgow Aneurysm Score, Vancouver Scoring System, Hardman Index, Edinburgh Rupture Aneurysm Score (ERAS) e Vascular Study Group of New England (VSGNE). This review intends to summarize the most relevant findings and to provide a critical analysis of each aneurysm score.

Introduction: Despite significant advancements, ruptured abdominal aortic aneurysm (rAAA) remains a life-threatening condition, and the decision whether or not to proceed with surgical intervention is extremely difficult in daily practice. Previous risk prediction models of rAAA mortality developed before EVAR was an option, had their validity questioned in an era where both open repair (OR) and EVAR are available. In 2017, Healey CT et al and von Meijenfeldt GC et al (Dutch Aneurysm Score) published two new mortality prediction models, both based on easily obtained clinical variables and validated in a population submitted to either OR or EVAR. The purpose of this paper was to describe the evolving experience in rAAA management in our centre, and to validate the applicability of the aforementioned scores in our practice. Methods: The clinical data of all patients admitted in our hospital from 2010 to 2016 with the diagnosis of rAAA were retrospectively reviewed and statistical analysis using SPSS V.22 was performed. Results: A total of 71 patients were considered, including 19 EVARs and 52 ORs. There was a significant increase over time in repairs performed by EVAR, and in 2015 the annual rate of EVAR exceeded that of OR. The population of patients submitted to EVAR and OR were comparable in gender, age and co-morbidities with the exception of smoking, more common in the EVAR group (73.7% Vs 36.5%; p=0.005). No cases of intra-operative mortality were registered in the EVAR group, as opposed to 17% in the OR group (p=0,049). 30-day mortality reached 49% in the OR group and 31,6% in the EVAR group (p>0.05). Several pre-operative predictors of outcome were identified: smoking (p=0.005), pre-operative hemodynamic instability (p=0.003) and international normalized ratio (INR) at admission (p<0.0001). As for post-operative preditors of outcome, hemodynamic instability in the ICU was statistically significant (p<0,0001). Binary logistic regression concluded elevated INR and post-operative instability were independent risk predictors of outcome (p<0.05). The mortality score prediction models aforementioned were applied to our population and estimated mortality significantly correlated with real mortality (estimated mortality 41% and 45.3% Vs real mortality 45%; both p<0.0001). Pearson correlation was applied to compare scores and concluded a correlation coefficient of 0.775 (p<0.001), describing a significant positive linear correlation between scores. Conclusions: In recent years, EVAR has increasingly become the procedure of choice for rAAA in our institution. With this evolving approach to rAAA, both score prediction models were retrospectively applied and both accurately predicted mortality in the study population (p<0.001).