Acta medica portuguesa最新文献

{"title":"[Value-Based Healthcare in the Treatment of Age-Related Macular Degeneration: Clinical and Patient-Reported Outcomes from a Portuguese Multicenter Study].","authors":"Ana Gama-Castro, António Ferrão-Mendes, Rita Rodrigues, Inês Figueiredo, Francisca Bragança, Rita Laiginhas, Ana Maria Cunha, Miguel Lume, Rufino Silva, Ângela Carneiro","doi":"10.20344/amp.24246","DOIUrl":"https://doi.org/10.20344/amp.24246","url":null,"abstract":"<p><strong>Introduction: </strong>This study aimed to describe and compare patient-reported outcome measures (PROMs) and objective clinical outcome measures (CROMs) in the treatment of age-related macular degeneration (AMD), exploring the concordance between these measures within a value-based healthcare (VBH) framework.</p><p><strong>Methods: </strong>This prospective, multicenter, observational, real-world study was conducted at three tertiary referral hospitals specializing in the treatment of neovascular AMD. Clinical outcomes (CROMs) and patient-reported outcomes (PROMs) were analyzed using the National Eye Institute Visual Functioning Questionnaire 25 (NEI VFQ-25) questionnaire as a functional assessment tool. Data were collected at baseline and at three, six, and 12 months following initiation of intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy. Statistical analysis was primarily descriptive. The comparison between baseline and 12 months in the global NEI VFQ-25 score was performed using the Wilcoxon signed-rank test for paired samples. Concordance between CROMs and PROMs was assessed using the intraclass correlation coefficient (ICC).</p><p><strong>Results: </strong>A total of 235 eyes were included, receiving 2338 intravitreal injections. The mean age of participants was 81 years (SD = 8.57), and 55.8% were female. The mean baseline NEI VFQ-25 score was 67.83 (SD = 10.39). The median best-corrected visual acuity was 63 ETDRS letters (interquartile range [P25 - P75]: 41 - 75) at baseline, increasing to 65 letters at three months and remaining stable through 12 months of follow-up. The comparison between baseline and 12 months revealed a statistically significant difference in visual acuity (Wilcoxon signed-rank test, Z = 4.2; p < 0.001). A reduction in the proportion of patients classified as legally blind was observed, together with an increase in the proportion of patients in the reading-vision and driving-vision categories. At 12 months, 58.7% of patients reported stabilization or improvement in visual function on the NEI VFQ-25 questionnaire. Concordance between the variation in visual acuity and the variation in the global NEI VFQ-25 score showed good agreement between CROMs and PROMs (ICC = 0.76; p < 0.001).</p><p><strong>Conclusion: </strong>The integrated analysis of CROMs and PROMs suggests that anti-VEGF treatment for neovascular AMD is associated with stabilization or improvement in visual acuity and patients' perceived visual function. The implementation of the VBH-AMD model proved feasible in a real-world clinical setting, reinforcing the importance of integrating patient-centered measures into the evaluation of therapeutic outcomes.</p>","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":"39 5","pages":"332-339"},"PeriodicalIF":1.0,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147855552","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Primary Cutaneous Diffuse Large B-Cell Lymphoma, Leg Type].","authors":"Inês Tribolet de Abreu, Miguel Reis","doi":"10.20344/amp.24251","DOIUrl":"https://doi.org/10.20344/amp.24251","url":null,"abstract":"","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":"39 5","pages":"364-365"},"PeriodicalIF":1.0,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147855542","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pheochromocytoma and Paraganglioma: Incidence and Comparative Analysis Between Familial and Sporadic Cases in a Portuguese Single Center.","authors":"Patrícia Da Cunha Brito, Natacha Paixão, Diana Borges Duarte","doi":"10.20344/amp.24192","DOIUrl":"https://doi.org/10.20344/amp.24192","url":null,"abstract":"<p><p>Pheochromocytomas and paragangliomas are rare neuroendocrine tumors, with an estimated incidence rate of two to eight cases per million people, and one of the highest heritability rates among neoplasms, with a genetic cause identified in approximately 40% of cases. This study analyzed cases diagnosed within the referral area of Unidade Local de Saúde de Braga between 2004 and 2024, aiming to estimate incidence, characterize the population, and compare sporadic and familial pheochromocytomas and paragangliomas. A total of 85 patients were identified, corresponding to 87 cases, with an average annual incidence of 5.3 cases per million between 2012 and 2024 and a rising trend over the study period. Genetic testing was performed in 61 patients, revealing 43 sporadic and 20 familial cases. The age at diagnosis was significantly lower in familial cases (43.4 ± 12.7 years; p < 0.001). Metastatic disease occurred only in patients with familial pheochromocytomas and paragangliomas, four and six years after diagnosis, while recurrences were observed exclusively in sporadic cases, with a median of seven years after complete remission. These findings highlight the importance of genetic testing and long-term follow-up in patients with pheochromocytoma and paraganglioma, given the risk of metastasis and recurrence even several years after the initial diagnosis.</p>","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":"39 5","pages":"344-348"},"PeriodicalIF":1.0,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147855599","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Retropharyngeal Metastasis: A Rare and Frequently Aggressive Presentation of Papillary Thyroid Carcinoma].","authors":"Mariana Caldeira, Carmen Alonso, Ana Branco, Telma Mendes, Paula Soares","doi":"10.20344/amp.24464","DOIUrl":"https://doi.org/10.20344/amp.24464","url":null,"abstract":"","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":"39 5","pages":"323-325"},"PeriodicalIF":1.0,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147855512","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Mechanical Insufflation-Exsufflation: A Strategy in Oncological Palliative Care].","authors":"Gonçalo Soares, Inês Santos, Maria Teresa Amaral","doi":"10.20344/amp.24324","DOIUrl":"https://doi.org/10.20344/amp.24324","url":null,"abstract":"","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":"39 5","pages":"374"},"PeriodicalIF":1.0,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147855610","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Valproate‑Associated Acute Pancreatitis in a Child with Autism Spectrum Disorder].","authors":"Catarina M Nascimento, Sandra Pires","doi":"10.20344/amp.24269","DOIUrl":"https://doi.org/10.20344/amp.24269","url":null,"abstract":"","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":"39 5","pages":"377-378"},"PeriodicalIF":1.0,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147855575","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Universal Screening for Sexually Transmitted Infections in Pregnancy: An Urgent Need in Portugal.","authors":"Swasilanne Bandeira, Joana Vasconcelos, Mariana Teixeira, Beatriz Costa, Paula Rocha","doi":"10.20344/amp.24190","DOIUrl":"https://doi.org/10.20344/amp.24190","url":null,"abstract":"","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":"39 5","pages":"372-373"},"PeriodicalIF":1.0,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147855537","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Immunoglobulin Replacement Therapy in Antibody Production Defects].","authors":"Ana Bernardino, Nuzhat Abdurrachid, Cláudia Varandas, Ruben Duarte Ferreira, Emília Faria, Sara P Silva, Susana L Silva","doi":"10.20344/amp.24119","DOIUrl":"https://doi.org/10.20344/amp.24119","url":null,"abstract":"<p><p>Immunoglobulin replacement therapy is an essential approach for treating patients with inborn errors of immunity that impair humoral response. The main goal of immunoglobulin replacement treatment is to provide antibodies passively, preventing severe or recurrent infections, as well as medium/long-term complications. Currently, there are different administration routes: intravenous, conventional subcutaneous, and facilitated subcutaneous with recombinant hyaluronidase. Therefore, the choice of the administration route should be individualized, with the active participation of the patient and guidance from healthcare professionals regarding the advantages and limitations of each option. This guideline aims to clarify the available immunoglobulin treatment modalities, provide practical guidance for their selection, and thereby promote better treatment adherence and effectiveness, leading to improved clinical stability for patients.</p>","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":"39 5","pages":"366-371"},"PeriodicalIF":1.0,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147855514","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Airway Clearance Devices in Pediatrics: A Future Reality?]","authors":"Filomena Santos, Alberto Nascimento Santos","doi":"10.20344/amp.24099","DOIUrl":"https://doi.org/10.20344/amp.24099","url":null,"abstract":"","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147759550","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Management of the Patient with Suspected Sepsis or Septic Shock: Clinical Recommendations for the Portuguese Prehospital Setting].","authors":"Adelaide Moutinho, Fábio Martins, Joana Fontes, José Lopes, Lénia Ferreira, Solange Mega, Ana Vaz Cristino, Eduardo Cernadas, Francisco Abecacis, João Gonçalves Pereira, João João Mendes, Paulo Almeida, Paulo Mergulhão, Ana Margarida Correia","doi":"10.20344/amp.24178","DOIUrl":"https://doi.org/10.20344/amp.24178","url":null,"abstract":"<p><p>Sepsis is a time-dependent medical emergency associated with high morbidity and mortality. Early recognition and appropriate prehospital management are critical for prognosis. Despite the existence of the Sepsis Fast Track standardized by the Directorate-General of Health (Direção-Geral da Saúde), there has been underreporting of suspected sepsis cases, highlighting the urgent need to review the alert criteria. In addition, Portugal lacked specific guidelines for its activation and management in the pre-hospital setting. Considering these facts, this article aims to produce evidence-based recommendations for the standardization of the recognition and treatment of sepsis and septic shock in the Portuguese pre-hospital context, in line with the latest international guidelines and the operational capabilities of the Integrated Medical Emergency System. This guideline is the result of a comprehensive review of the literature, integrating international consensus and adapting it to the Portuguese context. For that matter, inclusion and exclusion criteria are defined for sepsis alert in the pre-hospital context, prioritizing early identification through suspected infection or changes in temperature and organ dysfunction or clinical indicators of severity, such as NEWS/NEWS2 ≥ 5, Shock Index ≥ 0.7, Mottling ≥ 2, capillary refill time > 2 seconds. Treatment depends on the type of intervention, including oxygen therapy, positioning, and temperature control for basic life support teams; balanced crystalloids, parenteral antipyretics, and early initiation of vasopressor support for differentiated teams, subject to certain assumptions for immediate life support teams. Empirical antibiotic therapy is also recommended in cases of septic shock handled by teams with a physician, namely Emergency Medical and Resuscitation Vehicles and Emergency Helicopter Service. The article also standardizes both clinical records and alert activation via the iTeams® platform and manual registries. This first national guideline for sepsis in the pre-hospital setting establishes uniform, evidence-based procedures for early recognition and treatment in this context, contributing to improved clinical outcomes, optimization of resources, and strengthened inter-hospital coordination within the sepsis fast track.</p>","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147759505","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}