Portuguese-speaking African Countries Research Articles

Post-independence health research productivity in Portuguese-speaking African countries: A bibliometric analysis of 43 years of research and higher education in Mozambique

BackgroundAfrica has a high double burden of infectious and non-communicable diseases underscoring the critical need for robust scientific research. However, it is also associated with low scientific research productivity. Mozambique, which gained independence in 1975, serves as a poignant example. However, there remains a notable scarcity of evidence evaluating the country's trajectory in scientific and academic development. This study aims to evaluate 43 years of health-related scientific knowledge production through bibliometric analysis, focusing on key indicators. Additionally, it seeks to characterize the higher education institutions within the country. MethodsThe data was retrieved from the Web of Science Core Collection using an advanced search tool with Boolean research strategies, covering the period from 1976 to 2022 for all PALOP and 1976 to 2019 for Mozambique. To map Mozambican higher institutions, information was sourced from the Ministry of Science Technology and Higher Education database. Descriptive statistics were employed to summarize the findings, while the VOSviewer program version 1.6.19 was utilized to visualize distance-based bibliometric networks, focusing on co-authorship among institutions and keyword co-occurrence. ResultsPortuguese-speaking African countries (PALOP) contribute 2.5 % (10,933 out of 442,309) to Africa's total scientific output, with Mozambique leading at 63.6 % (6,951 publications) followed by Angola at 16.6 % (1,811 publications). All PALOP countries experienced decreased scientific productivity during the third year of the COVID-19 pandemic. In Mozambique, over 70 % (1,710 out of 2,380) of health-related publications from 2011 to 2019 were concentrated in this period. Key journals for health sciences include PLOS ONE, Malaria Journal, and Tropical Medicine & International Health, focusing on HIV, malaria, and tuberculosis. Higher education institutions in Mozambique show regional disparities, with 67.9 % in the South and only 8.9 % in the North, indicating significant inequality in their distribution across the country. ConclusionThis study highlights Mozambique's significant progress in health research productivity over 43 years, establishing it as a leader among PALOP countries. The substantial increase in publications, particularly after 2008, underscores the nation's growing research capacity and commitment to addressing critical health challenges such as HIV, malaria, and tuberculosis. However, regional disparities in higher education access and limited research contributions from private universities remain high in Mozambique.

Health literacy strengths and needs among migrant communities from Portuguese-speaking African countries in Portugal: a cross-sectional study.

Health literacy among migrants is a matter of public health and social justice. Migrants from diverse backgrounds encounter challenges such as linguistic barriers, cultural disparities, restricted access to health services, and heterogeneous migration statuses. Addressing these challenges requires careful consideration of their unique experiences and needs to promote equitable health outcomes. This can hinder their ability to navigate the healthcare system, understand health information, and engage in health-promoting behaviours. However, there is still a significant gap in our understanding of health literacy within migrant communities. This study has a dual aim: to identify health literacy strengths and needs among migrants from Portuguese-speaking African Countries (PALOP) countries in the Lisbon Metropolitan Area and to examine associations between demographic, socioeconomic, migration and health condition characteristics and the health literacy domains. A cross-sectional survey was conducted. Data were collected from 506 PALOP migrants using the Health Literacy Questionnaire (HLQ). We also collected demographic, socioeconomic, migration, and health condition data. We employed multiple linear regression to understand the relationship between the HLQ nine domains and these characteristics. The HLQ scores revealed distinct patterns of health literacy between the groups. Health literacy needs were particularly evident in the domains related to feeling understood and supported by healthcare providers and navigating the healthcare system. Conversely, higher scores and potential strengths were observed in actively managing one's health and understanding enough health information to make informed decisions. However, in these, the average scores suggest that a high proportion of people recognised difficulties. 'The results also indicated that a higher educational level was associated with increased health literacy. In contrast, low self-perceived health status, living alone, shorter duration of residence in Portugal, and being either undocumented or in the process of obtaining legal status were associated with lower health literacy. Our study highlights the importance of migration-related variables and self-reported health status in understanding health literacy among migrant communities. Factors such as length of stay and low self-perceived health status are associated with potentially disadvantageous levels of health literacy, which could exacerbate health inequalities. Assessing these variables is critical to identify gaps in health literacy and develop tailored interventions to reduce health inequalities.

‘So do you hear me? And “how” do you hear me?’ Perceptions of lecturers on students from Portuguese-speaking African countries in Portuguese higher education

ABSTRACT The internationalisation of Portuguese higher education implies multicultural challenges arising from the Portuguese language variation. Nevertheless, the perceptions of lecturers about their students are rarely analysed, though influencing learning. This will be the focus of our article, using focus groups. Findings show that lecturers experience unexpected situations of incomprehension with students speaking varieties of Portuguese, while profiling differently students’ sociolinguistic characteristics. Thirdly, participants differ on strategies applied to overcome difficulties encountered, such as pedagogical and monitoring. Our conclusions highlight the need to deconstruct lecturers’ ideologies as listening subjects of Portuguese language varieties and its socialisation, designing solutions promoting their capacity-building.

Applying Next-Generation Sequencing to Track HIV-1 Drug Resistance Mutations Circulating in Portugal.

The global scale-up of antiretroviral treatment (ART) offers significant health benefits by suppressing HIV-1 replication and increasing CD4 cell counts. However, incomplete viral suppression poses a potential threat for the emergence of drug resistance mutations (DRMs), limiting ART options, and increasing HIV transmission. We investigated the patterns of transmitted drug resistance (TDR) and acquired drug resistance (ADR) among HIV-1 patients in Portugal. Data were obtained from 1050 HIV-1 patient samples submitted for HIV drug resistance (HIVDR) testing from January 2022 to June 2023. Evaluation of DRM affecting viral susceptibility to nucleoside/tide reverse transcriptase inhibitors (NRTIs), non-nucleoside reverse transcriptase inhibitors (NNRTIs), protease inhibitors (PIs), and integrase strand transfer inhibitors (INSTIs) was performed using an NGS technology, the Vela Diagnostics Sentosa SQ HIV-1 Genotyping Assay. About 71% of patients were ART naïve and 29% were experienced. Overall, 20% presented with any DRM. The prevalence of TDR and ADR was 12.6% and 41.1%, respectively. M184V, T215S, and M41L mutations for NRTI, K103N for NNRTI, and M46I/L for PIs were frequent in naïve and treated patients. E138K and R263K mutations against INSTIs were more frequent in naïve than treated patients. TDR and ADR to INSTIs were 0.3% and 7%, respectively. Patients aged 50 or over (OR: 1.81, p = 0.015), originating from Portuguese-speaking African countries (PALOPs) (OR: 1.55, p = 0.050), HIV-1 subtype G (OR: 1.78, p = 0.010), and with CD4 < 200 cells/mm3 (OR: 1.70, p = 0.043) were more likely to present with DRMs, while the males (OR: 0.63, p = 0.003) with a viral load between 4.1 to 5.0 Log10 (OR: 0.55, p = 0.003) or greater than 5.0 Log10 (OR: 0.52, p < 0.001), had lower chances of presenting with DRMs. We present the first evidence on TDR and ADR to INSTI regimens in followed up patients presenting for healthcare in Portugal. We observed low levels of TDR to INSTIs among ART-naïve and moderate levels in ART-exposed patients. Regimens containing PIs could be an alternative second line in patients with intermediate or high-level drug resistance, especially against second-generation INSTIs (dolutegravir, bictegravir, and cabotegravir).

HLA frequency distribution of the Portuguese bone marrow donor registry.

The Portuguese donor Registry of CEDACE was the fifth largest per capita bone marrow donor Registry of the WMDA as of 2019 and has yet to be thoroughly analyzed. We aimed to characterize its various aspects, including demographics and HLA allele and haplotype frequencies, to evaluate the genetic matching propensity score and ultimately further develop it. We described and compared characteristics of the donor population with census data and used an Expectation-Maximization algorithm and analyses of molecular variance to assess haplotype frequencies and establish phylogenetic distances between regions and districts within the country. We identified 396545 donors, corresponding to 3.85% of the Portuguese population; the median donor age was 39 years, with 60.4% of female donors. Most donors were Portuguese nationals, although 40 other nationalities were present, with a significant proportion of donors from Brazil and Portuguese-speaking African Countries; almost all donors self-reported as Western, with the second largest group reporting African ancestry. There was an asymmetric contribution of donors from different districts and regions, with most coming from coastal districts and few from the southern districts and autonomous regions; foreign and self-declared non-Western donors were mainly located in the Metropolitan Area of Lisbon and the South. Although most donors were typed in three loci (HLA-A, HLA-B and HLA-DRB1), only 44% were also typed in HLA-C, 1.28% in HLA-DQB1 and only 0.77% in all five loci and in high-resolution. There were varying allele and haplotype frequencies across districts and regions, with the most common three loci, low-resolution haplotypes, being HLA-A*01~B*08~DRB1*03, A*29~B*44~DRB1*07 and HLA-A*02~B*44~DRB1*04; some haplotypes were more prevalent in the South, others in the North and a few in the autonomous regions; African and foreign donors presented relevant differences in haplotype frequency distributions, including rare haplotypes of potential interest. We also report on four loci, low-resolution frequency distributions. Using AMOVA, we compared genetic distances between districts and regions, which recapitulated the country's geography. Our analysis showed potential paths to optimization of the Registry, including increasing the male donor pool and focusing on underrepresented districts and particular populations of interest, such as donors from Portuguese-speaking African countries.

Fellowship in surgical oncology: The results of an experience in Portuguese-speaking African countries

Cancer incidence rates are increasing worldwide including in Portuguese speaking African countries. We present the results of the fellowship in surgical oncology promoted by the Portuguese Institute of Oncology in Porto (IPO), Fernando Pessoa University, Portugal, and the Calouste Gulbenkian Foundation, which involved the training of residents and surgeons from Portuguese-speaking African countries in Portugal. The program's structure and content was the same of UMES/ESSO. The hands-on activity took place at the IPO. After the fellowship, a theoretical and practical assessment was held, and all fellows scored above the threshold to pass. The surgical performance of the fellows was assessed in their workplaces in Africa. The impact of the training was evaluated by a questionnaire completed by all the fellows. It was reported an increase in knowledge, skills and organizational skills that fellows are committed to implement. As the fellowship is certified by a Portuguese University, it may be recognized by the Local Health and University Authorities, impacting on the professional progression of fellows.

Health Literacy of a Migrant community in Portugal on environmental health risks

Abstract Background Social, cultural and environmental factors are crucial for the health of migrants. Health Literacy is a fundamental contribution, giving them greater capacity and making it possible to reduce health inequalities. The aim of this study was to characterize the perception and behavior of a migrant community residing in Portugal, in view of the health risks resulting from the environmental conditions in which they live, and to identify their level of Health Literacy. Methods Cross-sectional, descriptive, exploratory study. Data collection was obtained through the application of the “Health Literacy Questionnaire” (Osborne, 2013), complemented with sociodemographic and environmental indicators referring to the physical space and social context of residence. The questionnaires were applied to a sample of the population, coming from Portuguese-speaking African countries, with 101 participants. Data analysis involved measures of descriptive and inferential statistics. Results Of the data obtained, 77.2% reported having problems with humidity in their homes, with poor behavior in terms of heat (64.4%) and cold (90.1%). 76% reported insect and rodent infestations inside their homes. The presence of stagnant water (43.6%), organic waste (29.8%) and poor electrical networks (26.9%) were the main environmental problems identified. About Health Literacy, “Feeling understood and supported by health professionals’ and “Finding good health information”, registered lower levels, with the remaining ones being generally below the average of the scale. internal consistency ranged between 0.71 and 0.92. Conclusions Data analysis showed the precariousness of housing and the inadequacy of support infrastructure, with inherent environmental risks to health. The existence of low levels of Health Literacy was found in most of the domains considered. The results supported and justified the elaboration of a community intervention project with the involvement of local partners. Key messages • Knowing the environmental determinants is essential for disease prevention and health promotion. • Health Literacy is an indispensable vehicle for reducing inequalities in migrant populations.

Dealing with Diverse Cultures and Needs: How Have Higher Education Institutions in Portugal Responded to COVID-19?

This article seeks to provide a comprehensive analysis of the strategies implemented by Portuguese higher education institutions in addressing cultural diversity and meeting the demands of international students, particularly in the context of the COVID-19 pandemic outbreak. In methodological terms, this is a qualitative study in which more than 40 in-depth interviews were conducted with degree mobility students from Brazil, Portuguese-speaking African Countries, China and Syria, who were already in Portugal when the pandemic was declared in the country in March 2020. Through the lens of multiculturalism, which understands that higher education should be inclusive and equal for all, we found that higher education institutions in Portugal did not provide adequate support to its international student body at a time of so many challenges and uncertainties. Our data indicate that higher education institutions in Portugal need to make more efforts towards fostering a diverse and inclusive environment, whilst taking into account the complex needs of international students.

Genetic Diversity and Population Structure of Cowpea (Vigna unguiculata (L.) Walp.) Landraces from Portugal and Mozambique.

Cowpea (Vigna unguiculata (L.) Walp.) is currently a legume crop of minor importance in Europe but a highly relevant staple crop in Africa and the second most cultivated legume in Mozambique. In Portugal and Mozambique, cowpea's phenotypic and genetic variation has been maintained locally by farmers in some areas. We used the molecular markers SSR, SilicoDArT and SNP to analyze the genetic diversity and population structure of 97 cowpea accessions, mainly from Portugal (Southern Europe) and Mozambique (Southern Africa). As far as we know, this is the first time that the genetic variation and the relationship between cowpea landraces collected in Portugal with those originated in Mozambique is reported. Despite the shared historical past, the Portuguese landraces did not share a common genetic background with those from Mozambique, and two different gene pools were revealed. Knowledge of the genetic structure of cowpea landraces offers an opportunity for individual selection within landraces adapted to particular eco-physiological conditions and suggests the existence of a valuable gene pool for exploitation in future Portugal-PALOP (Portuguese-speaking African countries) cowpea breeding programs.

Outcomes in Pregnant Women with Valvular Heart Disease from Portuguese-Speaking African Countries Treated in Portugal through an International Agreement of Health Cooperation.

We performed a clinical audit of maternal and fetal outcomes in pregnant women with valvular heart disease (VHD) from Portuguese-speaking African countries who were transferred for their care, during a twenty-year period, through a memorandum of agreement of international cooperation. A retrospective analysis of 81 pregnancies in 45 patients with VHD (median age 24, interquartile range 22-29 years) from 2000 to 2020 was performed. The main outcome measures were maternal cardiovascular and fetal outcomes. History of rheumatic heart disease was present in 60 (74.1%) pregnancies. Most were in New York Heart Association (NYHA) functional class I or II; at the first evaluation, 35 (43.2%) were on cardiac medication and 49 (60.5%) were anticoagulated. Forty-eight pregnancies had at least one valvular prosthesis, including 38 mechanical heart valves. During pregnancy, deterioration in NYHA functional class occurred in 35 (42.0%), and eight (9.9%) patients required initiation or intensified cardiac medication. Mechanical valve thrombosis complicated four (4.9%) pregnancies, all cases on heparin, and resulted in one maternal death. Haemorrhagic complications happened in 7 (8.6%) anticoagulated patients, in the immediate postpartum or puerperal period. The 81 pregnancies resulted in 56 (69.1%) live births, while miscarriage and fetal malformations occurred in 19 (23.5%) and 12 (14.8%) pregnancies, respectively. In multivariate analysis, vitamin K antagonist therapy was the only independent predictor of an unsuccessful pregnancy (p = 0.048). In a high-income country, successful pregnancy was possible with low rate of maternal events in women with VHD transferred from five low-middle income countries in Africa. The use of anticoagulation with a vitamin K antagonist was associated with an unsuccessful pregnancy.

Pediatric tuberculosis under six years old: an 18-year experience of a level II hospital

Background: Tuberculosis disease under six years is an indicator of recent transmission within the community. We aim to characterize tuberculosis disease in children under six years in a pediatric department of a level II hospital in the Lisbon metropolitan area, which serves a high percentage of immigrants from Portuguese-speaking African countries. Methods: Retrospective and descriptive study of tuberculosis disease cases treated in our Department between January 2004 and December 2021 (18 years). Descriptive analysis of the collected data was performed using SPSS Statistics® 25. Results: 25 patients were included, 60% diagnosed between 2016 and 2021. Five patients were born in countries with high TB incidence and 11 other patients had immigrant families from such countries. Ten out of 13 patients not immunized with BCG had the recommendation to do so. A close contact with tuberculosis was known in 15 patients, and in seven of those the system for TB prevention failed. At diagnosis: 4/25 patients had disseminated tuberculosis (three miliary and one congenital). Conclusions: The increase in tuberculosis disease cases under six years in the last three years points to some pitfalls in tuberculosis surveillance and transmission prevention. New studies and institutional protocols are needed to improve the effectiveness of the network involved in TB prevention and treatment.

Portugal’s cartographic responsibility in Africa

This article covers the safety of navigation in Africa and considers the significant limitations both in the hydrographic surveys of several coastal countries, and the production and updating of nautical charting. This responsibility is internationally assumed by other members of the International Hydrographic Organization (IHO). In the case of the maritime spaces of the Portuguese-speaking African countries (Cape Verde, Guinea-Bissau, São Tomé and Príncipe, Angola and Mozambique) it has been the responsibility of Portugal, through the Hydrographic Institute (IHPT). IHPT ensures the production of their nautical mapping, which includes a structured and regular collection of hydrographic data, carried out under bilateral cooperation agreements. This responsibility is usually designated to a Primary Charting Authority (PCA). Over the last 20 years, IHPT has taken advantage of a number of opportunities to support Portuguese-speaking African countries. This has ensured considerable steps have been taken to improve hydrographic surveys, the production of new nautical cartography and supporting the development of capabilities in marine sciences and techniques. This is currently one of the IHPTs most relevant programs involving a notable effort; the purpose of this article is its dissemination.

The “damned of inclusion”, or the normalization of the discourses and social processes of criminalisation of young adults in Portugal: a complex set of social, legal and criminal disruptions

Portugal, with circa 10 million inhabitants, has almost 800 young people, aged 16-24 years, serving prison sentences. The majority comes from low-income families living in sensitive urban areas of Lisbon and Oporto, with low levels of education, and many are Afro-Portuguese or come from African Portuguese-speaking countries. These young people are thus identified with the neighbourhoods where they live, portrayed as violent and problematic. The narratives from the actors of the justice system we interviewed suggest that such depiction results from a set of plural disruptions – social, legal, and institutional – leading to the selectivity and criminalisation of this group of young people. We thus call them the “damned of inclusion” since the plurality of exclusions affecting them hasn’t been addressed holistically by the social inclusion programs created in the last decades. Since these young men are “caught under the radar”, there seems to be a criminal reaction from the law, the judicial practices and the prison system – which turns into a normalizing response.

Pediatric Tuberculosis: 12 Years of Experience in a Tertiary Referral Center in Portugal

The diagnosis of tuberculosis in children is a challenge namely because extrapulmonary tuberculosis and severe disease are more frequent in this age group. The aim of this study was to evaluate and reflect about severe tuberculosis in pediatric age, in a metropolitan area of Lisbon. Descriptive study about patients under 18 years of age admitted with tuberculosis disease in a tertiary pediatric hospital, from 2008 to 2019 (12 years). We report 145 patients, average of 12 cases/year, with an increase in the last three years. Median age of 12.9 years, 42.8% born in Portuguese-speaking African countries and 20% had a chronic disease. The diagnosis was pulmonary tuberculosis in 52.4% (n = 76) and extrapulmonary tuberculosis in 47.6%: lymphatic (n = 26), skeletal (n = 15), miliary (n = 8), meningeal (n = 7), peritoneal/ intestinal (n = 6), pleural (n = 4), renal (n = 1), cutaneous (n = 1), thoracic wall (n = 1) and salivary glands (n = 1). The tuberculin test was positive in 78/99 (78.8%) and Interferon Gamma Release Assay in 61/90 (67.8%). In 20.7% (n = 30) acid-fast bacilli were identified in gastric aspirate/sputum and the agent was identified in 59.3% (n = 86). Tuberculosis was resistant in 11% (n = 16). Patients with extrapulmonary tuberculosis were younger (p = 0.006) and had more prolonged therapy (p < 0.001). Therapy-related complications occurred in 11% (n = 16). One patient died (with terminal cancer). This study highlights the need for screening of tuberculosis in children from endemic countries, patients with immunosuppression and chronic disease.

Tuberculosis contact investigation in African Portuguese-speaking countries at End TB Strategy era: a scoping review

ObjectivesThe contact investigation of tuberculosis (TB) index case is one of the critical elements pointed by the WHO to reach the end of the TB epidemic. The scoping review aimed...

Differential patterns of postmigration HIV-1 infection acquisition among Portuguese immigrants of different geographical origins.

To investigate the dynamics of phylogenetic transmission clusters involving immigrants of Portuguese Speaking Countries living in Portugal. We included genomic sequences, sociodemographic and clinical data from 772 HIV migrants followed in Portugal between 2001 and 2017. To reconstruct HIV-1 transmission clusters, we applied phylogenetic inference from 16 454 patients: 772 migrants, 2973 Portuguese and 12 709 global controls linked to demographic and clinical data. Transmission clusters were defined using: clusters with SH greater than 90% (phylogenetic support), genetic distance less than 3.5% and clusters that included greater than 66% of patients from one specific geographic origin compared with the total of sequences within the cluster. Logistic regression was performed to assess factors associated with clustering. Three hundred and six (39.6%) of migrants were included in transmission clusters. This proportion differed substantially by region of origin [Brazil 54% vs. Portuguese Speaking African Countries (PALOPs) 36%, P < 0.0001] and HIV-1 infecting subtype (B 52%, 43% subtype G and 32% CRF02_AG, P < 0.001). Belonging to a transmission cluster was independently associated with treatment-naive patients, CD4+ greater than 500, with recent calendar years of sampling, origin from PALOPs and with seroconversion. Among Brazilian migrants - mainly infected with subtype B - 40.6% were infected by Portuguese. Among migrants from PALOPs - mainly infected with subtypes G and CFR02_AG - the transmission occurred predominantly within the migrants' community (53 and 80%, respectively). The acquisition of infection among immigrants living in Portugal differs according to the country of origin. These results can contribute to monitor the HIV epidemic and prevent new HIV infections among migrants.

Biomedical Ethics and Regulatory Capacity Building Partnership for Portuguese-Speaking African Countries (BERC-Luso): A pioneering project

Biomedical research has a strong impact on a country’s scientific-technological and socioeconomic development. It can make a significant contribution at three different levels: promotion of public health; the exchange of knowledge within the scientific community; and economic/ financial profitability. Africa only attracts ~3.3% of the world’s clinical research. This small proportion is due to, among several factors, the absence of two fundamental aspects: specific robust legislation and capacity for regulatory and ethical evaluation. There are five Portuguese- speaking African countries – Angola, Cabo Verde, Guinea-Bissau, Mozambique and São Tomé and Príncipe. Despite presenting different degrees of clinical research development, these countries show a common serious insufficiency in the minimum conditions necessary for hosting, collaborating or leading biomedical research projects. These countries are also excluded from the support of international organisations for capacity building because of the language barrier. The Biomedical Ethics and Regulatory Capacity Building Partnership for Portuguese-Speaking African Countries (BERC-Luso) project has developed methods to build capacity and partnership through research on national law, comparisons with international standards and by issuing recommendations at a national level. Through collaborative intensive training, trainees are taught to become educators at a national level. This, in turn, creates a sustainable impact at country level. BERC-Luso is a pioneering project, owing to a combination of innovative features. The partnership project: (i) was developed exclusively in Portuguese; (ii) involves a large number of African countries, and national and international institutions; (iii) has been further enhanced by the diversity and complementarity of its action plans; and (iv) has also benefited from a broad participatory methodology based on resolution of recipients’ problems by the recipients themselves. It thus stands out as a model for similar future projects.

Introduction to the special issue on (De)constructing the right to the city: Luanda and Maputo

Portuguese-speaking African countries, namely Angola and Mozambique, faced important political-economic and social transformations after their liberations in 1975. Given the geopolitical context of...

Update of the recommendations of the Sociedade Portuguesa de Cuidados Intensivos and the Infection and Sepsis Group for the approach to COVID-19 in Intensive Care Medicine.

Introduction:The Sociedade Portuguesa de Cuidados Intensivos and the Infection and Sepsis Group have previously issued health service and management recommendations for critically ill patients with COVID-19. Due to the evolution of knowledge, the panel of experts was again convened to review the current evidence and issue updated recommendations.Methods:A national panel of experts who declared that they had no conflicts of interest regarding the development of the recommendations was assembled. Operational questions were developed based on the PICO methodology, and a rapid systematic review was conducted by consulting different bibliographic sources. The panel determined the direction and strength of the recommendations using two Delphi rounds, conducted in accordance with the principles of the GRADE system. A strong recommendation received the wording “is recommended”, and a weak recommendation was written as “is suggested.”Results:A total of 48 recommendations and 30 suggestions were issued, covering the following topics: diagnosis of SARS-CoV-2 infection, coinfection and superinfection; criteria for admission, cure and suspension of isolation; organization of services; personal protective equipment; and respiratory support and other specific therapies (antivirals, immunomodulators and anticoagulation).Conclusion:These recommendations, specifically oriented to the Portuguese reality but that may also apply to Portuguese-speaking African countries and East Timor, aim to support health professionals in the management of critically ill patients with COVID-19. They will be continuously reviewed to reflect the progress of our understanding and the treatment of this pathology.

The role of dermatology in African patients referred for health treatment in a European centre.

Owing to the migratory movement between African and European countries, we have been seeing an increasing number of dermatoses in patients with darker skin phenotypes in our clinical practice. To evaluate the support provided by outpatient dermatology consultations to such patients and to assess the most frequent dermatoses seen in this population. A retrospective 5-year study was conducted in a Portuguese hospital, which is a referral centre to several medical specialities for patients evacuated from Portuguese-speaking African countries, under a specific agreement of international cooperation in health. In total, 116 patients, with a mean age of 38years, were evaluated. In total, 47 dermatoses were identified, with the 6 most common being fungal infections (12.1%), eczema (9.5%), dyschromias (8.6%), xerosis (6.9%), acne (6%) and hair disorders (6%). This increased knowledge about the most frequent dermatoses in this population, along with their manifestations and the factors that influence them should allow better diagnosis and therapy.