Acta medica portuguesa最新文献

{"title":"Magnetic Resonance Imaging in Multiple Sclerosis: An Analysis of the Implementation of the Portuguese Consensus.","authors":"Ricardo Soares Dos Reis, Alyne Cordeiro, Ana João Marques, Ana Rita Castro, Cristiana Silva, Duarte Carapinha, Francisca Ferreira, Miguel Schön, Daniela Jardim Pereira, João Paulo Gabriel, Luís Ruano, Mariana Santos, Miguel Grunho, Mónica Santos, José Vale, Maria José Sá","doi":"10.20344/amp.22637","DOIUrl":"https://doi.org/10.20344/amp.22637","url":null,"abstract":"<p><strong>Introduction: </strong>Magnetic resonance imaging (MRI) plays a critical role in diagnosing and monitoring people with multiple sclerosis (MS). The 2020 Portuguese Consensus on Magnetic Resonance Imaging in Multiple Sclerosis aimed to standardize MRI use. This study evaluated the implementation of the consensus in clinical practice.</p><p><strong>Methods: </strong>This is an observational, retrospective, longitudinal and multicentric study comprising patients diagnosed with MS between 2019 and 2022 from seven hospital centers in Portugal. We collected demographic data and details regarding MRI requests, protocols, and reports. We performed descriptive and comparative analyses between the period before and after guideline publication.</p><p><strong>Results: </strong>We included 242 patients, mainly female (66.0%), with a mean age of 37 (SD 13). A total of 989 MRIs were performed, 69.1% follow-ups, 68.1% brain MRIs, and 31.9% spinal cord MRIs. Around half of the MRI requests fulfilled all the recommended information. All mandatory sequences in the neuroimaging protocol were performed in 82.5% of brain MRIs and 71.1% of spinal cord MRIs. None of the reports fulfilled all the suggested parameters. Magnetic resonance imaging technical description and imaging findings had the least compliance, mainly concerning gadolinium information (0.85%), lesion load (18.6%), and atrophy characterization (27.1%). After the implementation of the consensus, physicians reported the MS phenotype more often (p < 0.05) and neuroradiologists reported more technical parameters (p < 0.05). When MRIs were performed in a private setting, neuroimaging protocols were similar, but the reports fulfilled more frequently the suggested topics regarding the conclusion (p < 0.05).</p><p><strong>Conclusion: </strong>This study suggests incomplete adherence to the Portuguese Consensus on MRI in MS. Information provided by the physician in MRI requests was often insufficient, which could hamper MRI protocol planning. Magnetic resonance imaging reports were frequently lacking relevant information for the diagnosis and follow-up of MS patients. Further efforts are needed to ensure full implementation and optimize MS care.</p>","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144558774","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":"The Contribution of Simulated Patients to Undergraduate Medical Education: A Pathway to Educational Excellence.","authors":"Paulo Oom","doi":"10.20344/amp.22902","DOIUrl":"https://doi.org/10.20344/amp.22902","url":null,"abstract":"<p><p>The aim of this narrative review is to explore the state of the art in using simulated patients' methodology, highlighting its benefits and advocating for its widespread adoption as a cornerstone of excellence in training. The use of patients in undergraduate medical education is essential and recommended at an early stage of medical training. However, using real patients is accompanied by several difficulties, such as patient privacy and the unpredictability of patient conditions. Simulated patients are now an integral part of medical school faculty. They should be viewed as some of their most valuable collaborators as their spectrum of activity has been progressively expanding, and they are taking on new challenges and responsibilities. Its efficient use leads to the development of technical competence in performing procedures and the ability to make decisions about diagnosis or treatment. They are also essential in training the ability to communicate efficiently with patients and work as a team. The use of simulated patients to teach physical examination has dramatically expanded its use, with emphasis on training in gynecological or breast examination in women or genital and rectal examination in men. The possibility for the student to receive feedback from the simulated patient during or after the simulation represents a unique opportunity for the student to understand the 'patient's' point of view and reflect on their limitations and opportunities for improvement. Using simulated patients in medical assessment ensures that students are exposed to the same clinical scenario and evaluated according to the same criteria. The simulated patient, acting as a performance evaluator, provides a level of reliability identical to that of clinical evaluators, enhancing the credibility of the assessment process. The development of hybrid scenarios allows the combined use of simulated patients and simulators to increase the realism of the simulation scenario. From an administrative perspective, using simulated patients in medical education involves recruitment and training, and the biggest challenge is the financial resources it requires. [...].</p>","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144504388","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":"The Perspective of Psychiatry and Child and Adolescent Psychiatry Residents About Psychotherapy Training in Portugal.","authors":"Rui M Salgado, Orlando Von Doellinger","doi":"10.20344/amp.23076","DOIUrl":"https://doi.org/10.20344/amp.23076","url":null,"abstract":"<p><strong>Introduction: </strong>Psychotherapy is an effective treatment for various mental disorders. Most recommendations advocate training in psychotherapy for psychiatry and child and adolescent psychiatry residents. However, incorporating psychotherapy training into the curricula of psychiatric residency programs has proven difficult. In Portugal, competence in psychotherapy is not mandatory to become a psychiatrist or a child and adolescent psychiatrist. Our study aims to describe the perspectives of psychiatry and child and adolescent psychiatry residents on psychotherapy training in Portugal.</p><p><strong>Methods: </strong>The authors developed a voluntary, anonymous, online self-reported questionnaire to be applied to psychiatry and child and adolescent psychiatry residents. Data was collected during 2023.</p><p><strong>Results: </strong>The response rate was 29.9%. The main results were that most Portuguese psychiatry and child and adolescent psychiatry trainees stated that their institution did not provide psychotherapy training (95.2%) and were dissatisfied with the psychotherapy training provided by their residency centers (96.8%). All residents agreed that psychotherapy training involves a significant financial investment, and almost all (96.8%) believed it involved a substantial investment in terms of time in the long term. Likewise, most trainees (94.4%) considered psychotherapy training should be included within the residency work schedule. Crucially, psychiatry and child and adolescent psychiatry residents were interested in psychotherapy training (93.6%), and most regarded psychotherapy as a mandatory competence of the residency training program (85.7%). More than two-thirds (70.6%) of residents considered initiating or continuing psychotherapy training after residency. Regarding the modalities that should be included in the residency program, residents pointed out cognitive-behavioral therapy, family therapy, interpersonal psychotherapy, psychodynamic psychotherapy, and support psychotherapy. About 40% of respondents mentioned they were in personal psychotherapy during the residency.</p><p><strong>Conclusion: </strong>Modifications in residency curricula should seriously be considered so that future psychiatrists can be qualified to provide effective psychotherapy treatment. The authors believe they provided relevant data pooled from future psychiatrists and child and adolescent psychiatrists which can be useful to help define training in a perceived essential competence.</p>","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144493368","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":"Kaposi's Sarcoma: Demographic and Clinical Features, Histopathology, Treatment, and Outcomes in a 10-Year Lisbon Hospital Study.","authors":"Inês Pereira Amaral, Ivânia Soares, Madalena Pupo Correia, Inês Tribolet Abreu, Filipe Monteiro, Joana Antunes, Nuno Manso, Pedro De Vasconcelos, Luís Soares de Almeida, Paulo Filipe","doi":"10.20344/amp.17991","DOIUrl":"10.20344/amp.17991","url":null,"abstract":"<p><strong>Introduction: </strong>Kaposi's sarcoma (KS) is a rare angioproliferative neoplasm associated with human herpesvirus 8 infection, presenting as four subtypes: classic, endemic, iatrogenic, and epidemic. While well documented globally, comprehensive data on KS in Portugal remain scarce. The aim of this retrospective study was to provide a detailed analysis of KS cases diagnosed at Hospital Santa Maria, in Lisbon, between 2014 and 2023.</p><p><strong>Methods: </strong>A total of 113 histopathologically confirmed KS cases were included, focusing on demographic, clinical, and histopathological characteristics, as well as treatment strategies and outcomes.</p><p><strong>Results: </strong>The mean age at diagnosis was 59.4 years, with a male-to-female ratio of 4.4:1. Most patients (50.4%) were of African origin. Epidemic KS (45.1%) was the most prevalent subtype. Lesions mainly affected the lower limbs (47.8%), and disseminated, mucosal, and extracutaneous involvement were more common in HIV-positive patients. Tumor-stage lesions were frequent (59.3%). Single-modality treatment was used in 53.1% of cases, while 40.7% required combined therapies. Relapse rates were highest in endemic (39.1%) and iatrogenic KS (28.6%) subtypes. The disease-specific mortality rate was 8%.</p><p><strong>Conclusion: </strong>Our findings suggest that KS remains a significant concern, particularly in immunosuppressed patients. Early diagnosis and multidisciplinary management are essential to improve outcomes. However, limitations such as potential biases from its retrospective design and the single-center scope should be considered.</p>","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144332301","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":"Gender Incongruence in Adolescents: Experience of a Tertiary Care Center in Portugal.","authors":"Joana Glória, Joana Vieira de Melo, Ana Raquel Henriques, Carla Pereira, Maria de Lurdes Sampaio","doi":"10.20344/amp.22705","DOIUrl":"https://doi.org/10.20344/amp.22705","url":null,"abstract":"","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144281954","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":"Value-Based Geriatric Care: Good News from Portugal.","authors":"Mariana Alves, Lia Marques, Lucimere Bohn, Fernando Osório, Gonçalo Sarmento, Catarina Bekerman, Adelaide Belo, Ana Farinha, Ana Viegas, Rui Buzaco, Sofia Duque","doi":"10.20344/amp.22655","DOIUrl":"https://doi.org/10.20344/amp.22655","url":null,"abstract":"","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144273854","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":"Commentary on \"Anxiety and Generalized Anxiety Disorder in Elite Athletes\".","authors":"Marcelo Andrade Silami, Elisa Melo Ferreira","doi":"10.20344/amp.23189","DOIUrl":"https://doi.org/10.20344/amp.23189","url":null,"abstract":"","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144245601","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":"Purpura Fulminans and Rickettsia Conorii Israeli Tick Typhus Infection.","authors":"Filipe Monteiro, Inês Tribolet de Abreu, Pedro De Vasconcelos, Miguel Alpalhão, Paulo Filipe","doi":"10.20344/amp.23068","DOIUrl":"https://doi.org/10.20344/amp.23068","url":null,"abstract":"","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":"38 6-7","pages":"427-428"},"PeriodicalIF":0.8,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144525964","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":"Spinocerebellar Ataxia Type 27B (SCA27B): A Hereditary Ataxia in Portugal.","authors":"Vítor Mendes Ferreira, Marta Magriço, Bruna Meira, Raquel Barbosa","doi":"10.20344/amp.22232","DOIUrl":"10.20344/amp.22232","url":null,"abstract":"<p><p>Spinocerebellar ataxia type 27B (SCA27B) is a recently discovered hereditary disease caused by (GAA)≥250 repeat expansion in the fibroblast growth factor 14 (FGF14) gene, and multiple studies have recognized it as one of the most common causes of autosomal dominant ataxia in the European population. We present the case of a 62-year-old Portuguese patient who developed a slowly progressive gait impairment associated with wide-base ataxic gait, dysarthria, left upper limb dysmetria, and dysdiadochokinesia. This pure cerebellar phenotype had an episodic worsening induced by intense physical activity and alcohol intake. The patient had an older brother with a late-onset cerebellar ataxia of unknown cause. Genetic testing detected a heterozygotic intronic FGF14 repeat expansion with complete penetrance (> 360 repeats), confirming the diagnosis of SCA27B. To our knowledge, we present the first reported case of SCA27B in the Portuguese population.</p>","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":" ","pages":"408-411"},"PeriodicalIF":0.8,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142405887","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":"[Correction to the Article \"PRIMARY-HF: Heart Failure Screening in Primary Care using Point-of-Care\"].","authors":"Jonathan Dos Santos, João Pedro Nobre, João Pedro Ferreira, Maria Inês M Marques, Miguel Henriques, Nuno Cardim, Tiago Villanueva, Alexandra Gonçalves","doi":"10.20344/amp.23337","DOIUrl":"https://doi.org/10.20344/amp.23337","url":null,"abstract":"","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":"38 6-7","pages":"433"},"PeriodicalIF":0.8,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144525955","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}