Acta medica portuguesa最新文献

{"title":"[Meningitis Due to Haemophilus influenzae Serotype A and Adenovirus: A Rare Case of Co-Infection in a Six-Month-Old Infant].","authors":"Inês Mazeda, Joana Ventura Lourenço, David Nascimento Moreira, Gracinda Oliveira, Isabel Mendes","doi":"10.20344/amp.21725","DOIUrl":"https://doi.org/10.20344/amp.21725","url":null,"abstract":"<p><p>Haemophilus influenzae serotype A is a rare cause of meningitis and invasive disease in pediatric patients. A six-month-old infant presented to the emergency room with fever, cough and nasal drip. On admission, the infant was alert and hemodynamically stable but progressively became more lethargic with bulging of the fontanelle. The blood tests revealed a normal leukocyte count and elevated C-reactive protein. Cytology and biochemistry of the cerebrospinal fluid were consistent with bacterial meningitis and treatment with ceftriaxone was initiated. Both blood and cerebrospinal fluid cultures were positive for Haemophilus influenzae. Serotyping of the strain identified Haemophilus influenzae serotype A. Viral detection in cerebrospinal fluid and nasopharyngeal aspirate tested positive for adenovirus. The infant completed 10 days of antibiotic therapy and was fully recovered upon discharge. Although cases of Haemophilus influenzae serotype a meningitis are rare, invasive disease caused by non-B serotypes as well as non-encapsulated isolates have been increasing, emphasizing the need for monitoring and continuous epidemiological surveillance.</p>","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":"38 1","pages":"49-51"},"PeriodicalIF":0.8,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142918942","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 Emergence of Multiculturalism in Portuguese Neonatal Care: Challenges and Strategies].","authors":"Inês Paiva-Ferreira, Mafalda Moreira, Inês Ferreira-Costa, Joana Machado-Morais, Carmen Carvalho","doi":"10.20344/amp.22191","DOIUrl":"https://doi.org/10.20344/amp.22191","url":null,"abstract":"","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":"38 1","pages":"1-4"},"PeriodicalIF":0.8,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142918943","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":"[Medication Reconciliation in Primary Care: Practices, Knowledge and Attitudes in the Lisbon and Tagus Valley Health Region].","authors":"Raquel Ascenção, Mariana Almeida, Cristina Ribeiro, Paula Broeiro, João Costa","doi":"10.20344/amp.21629","DOIUrl":"https://doi.org/10.20344/amp.21629","url":null,"abstract":"<p><strong>Introduction: </strong>Despite the importance of medication reconciliation for the continuity of care, there is currently no information on the practices, knowledge, and attitudes of Portuguese family doctors on this subject. This study aimed to characterize the formal medication reconciliation procedures in the Lisbon and Tagus Valley Health Region, as well as the perception of family doctors in this region about what they know, how they think and how they practice medication reconciliation.</p><p><strong>Methods: </strong>We conducted an observational, cross-sectional and descriptive study, using two observation units: primary health care units (study 1) and family doctors (study 2) in the Lisbon and Tagus Valley Health Region. Data was collected through two self-completed questionnaires, which were made available online.</p><p><strong>Results: </strong>A total of 89 primary healthcare units and 208 family doctors participated in the study (31% and 12% response rates, respectively). Only one in four units (n = 22/89) had a formal medication reconciliation procedure. Among the units with a formal procedure, there was variability in some parameters, although all procedures included physicians. More than 70% (n = 150; 72.1%) of family physicians reported having previous contact with the term 'medication reconciliation', and a half (n = 104; 50.0%) reported carrying out medication reconciliation in more than 75% of consultations after hospital discharge. No differences were identified regarding the frequency with which family physicians practice medication reconciliation after hospital discharge depending on age, gender, type of unit where they work, and volume of consultations. Most family physicians (n = 155; 74.5%) included the three steps recommended by the Directorate-General for Health at the time and resolved discrepancies without contacting the hospital physician (n = 168; 88.8%). Family physicians recognize the importance of medication reconciliation (more than 95% agree/completely agree), although the level of agreement regarding their responsibility for this practice is lower.</p><p><strong>Conclusion: </strong>The proportion of primary health care units with a formal medication reconciliation procedure is low. Family doctors in the Lisbon and Tagus Valley Region value medication reconciliation, although they do not include it in all consultations after hospital admission. Communication between levels of care and the standardization of processes are areas with potential for improvement to promote the safe and patient-centered use of medication.</p>","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":"38 1","pages":"5-15"},"PeriodicalIF":0.8,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142918850","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":"Medical Treatment of Osteomyelitis due to Carbapenemase-Producing Klebsiella pneumoniae in Diabetes-Related Foot Disease.","authors":"Renata Barbosa, Susana Garrido, Luís Costa, Rui Carvalho","doi":"10.20344/amp.22152","DOIUrl":"https://doi.org/10.20344/amp.22152","url":null,"abstract":"","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":"38 1","pages":"55-56"},"PeriodicalIF":0.8,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142918965","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 Relationship Between Obesity and Neuropsychiatric Disorders: Prevalence, Neurobiology, and Clinical Practice.","authors":"Cátia Pinheiro Ramos, Luís Paulino Ferreira","doi":"10.20344/amp.22385","DOIUrl":"https://doi.org/10.20344/amp.22385","url":null,"abstract":"","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":"38 1","pages":"54"},"PeriodicalIF":0.8,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142918969","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":"Economic Impact of Surveillance of Head Trauma Patients with Coagulopathy and Normal Initial Computed Tomography Scan (ECO-NCT).","authors":"Tiago Ribeiro da Costa, Rodrigo Batata, Susana Oliveira, Armindo Fernandes, Sérgio Sousa, Filipe Vaz Silva, Vasco Sá Pinto, Márcia Tizziani, Eduardo Cunha, Alfredo Calheiros","doi":"10.20344/amp.21661","DOIUrl":"https://doi.org/10.20344/amp.21661","url":null,"abstract":"<p><strong>Introduction: </strong>According to the Portuguese clinical guidelines published in 1999, patients with traumatic brain injury and coagulopathies should remain in-hospital for 24 hours for clinical and image surveillance, despite having an admission computed tomography (CT) scan showing no intracranial lesions. Growing evidence suggests this practice is not only void of clinical relevance, but that it can also be potentially harmful for the patient. Nevertheless, up until now there is no published data concerning the economic impact of this clinical practice.</p><p><strong>Methods: </strong>A cost analysis compared retrospective data from patients admitted to our emergency department during 2022 with a hypothetical scenario in which a patient with an admission CT scan without traumatic lesions was discharged. Clinical data was also retrieved concerning the rate of a delayed intracranial bleeding on 24-hour CT scan and mortality at a six-month-period after discharge. Direct costs for the national health service were determined in terms of funding and time invested by medical teams.</p><p><strong>Results: </strong>From a sample of 440 patients, 436 remained in-hospital for a 24-hour clinical and image surveillance, of which only two (0.5%) showed a new intracranial lesion on the second CT-scan. Neither of these two patients required therapeutic measures to control bleeding and were discharged 36 hours after admission. Out of 440 patients, one patient (0.2%) died of cardiac arrest during the 24-hour surveillance period, despite having an initial normal CT scan showing no brain lesions. Our current surveillance practice directly amounted to €163 157.00, whereas the cost of our hypothetical scenario amounted to €29 480.00: a difference of €133 677.00. The application of our surveillance guideline also meant that nine emergency shifts were devoted to this task, compared to 4.6 hypothetical shifts if patients were discharged after an initial CT scan without traumatic intracranial lesions.</p><p><strong>Conclusion: </strong>In spite of apparently not adding any clinical value to our practice, our in-hospital surveillance may represent a significant financial and time-consuming burden, costing five times as much and demanding our medical teams twice as much work when compared to a scenario without clinical surveillance and 24-hour CT scans.</p>","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":"38 1","pages":"16-22"},"PeriodicalIF":0.8,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142918946","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":"Iron Skin Staining: A Rare but Permanent Complication Following IV Iron Infusion.","authors":"Tiago Dias da Costa, António Mateus-Pinheiro, Sónia Moreira","doi":"10.20344/amp.22136","DOIUrl":"10.20344/amp.22136","url":null,"abstract":"","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":" ","pages":"52-53"},"PeriodicalIF":0.8,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142666843","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":"Infection and Immunosuppression as Causes for Immune Dysfunction Presenting as Hemophagocytic Lymphohistiocytosis and Thrombotic Microangiopathy.","authors":"Henrique Atalaia-Barbacena, Maria Ana Quadros Flores, Inês Matias Lopes, Margarida Guiomar, Patrícia Howell-Monteiro","doi":"10.20344/amp.21969","DOIUrl":"https://doi.org/10.20344/amp.21969","url":null,"abstract":"","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":"38 1","pages":"57-60"},"PeriodicalIF":0.8,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142918951","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 in Psychiatric Practice: Risks to Fertility and Future Generations.","authors":"Margarida Alves, Diana Durães, Cátia Santos","doi":"10.20344/amp.22284","DOIUrl":"https://doi.org/10.20344/amp.22284","url":null,"abstract":"","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":"38 1","pages":"56-57"},"PeriodicalIF":0.8,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142918972","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":"[Healthcare-Associated Infections in Pediatric Patients: A Decade of Experience in an Intensive Care Unit].","authors":"Cátia Martins, Daniela Lima, Mariana Cortez Ferreira, Joana Verdelho Andrade, Andrea Dias","doi":"10.20344/amp.22279","DOIUrl":"https://doi.org/10.20344/amp.22279","url":null,"abstract":"<p><strong>Introduction: </strong>Healthcare-associated infections are an important cause of morbidity and mortality in the pediatric population and a growing problem in intensive care services. However, limited data are available on these infections in the Portuguese pediatric population. This study aimed to estimate its prevalence rate in a Portuguese pediatric intensive care unit, identifying the most frequent microorganisms and their antibiotic resistance profiles.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted, including patients admitted to a pediatric intensive care unit between January 1, 2014 and December 31, 2023, who were diagnosed with healthcare-associated infections during hospitalization.</p><p><strong>Results: </strong>A total of 248 nosocomial infections were identified, corresponding to a prevalence rate of 6.3%, mostly in infants. Pneumonia (45.2%) and bacteremia (14.5%) were the most frequent infections. Gram-negative bacteria, specifically Escherichia coli, Pseudomonas aeruginosa and Klebsiella pneumoniae, were the most common pathogens. Over the last five years (2019 - 2023), there was a global increase in antibiotic resistance. The prevalence of infections with ESBL-producing bacteria, MRSA and ERC was 8.5%, 1.6%, and 0.4%, respectively, higher in the period from 2019 to 2023. Among 97 screening tests, 45 colonizations were identified in 41 patients: 40 with ESBL and 5 with ERC, with no MRSA colonizations detected. Sepsis occurred in 29.8% of cases, and the mortality rate was 11.7%, with 4.0% directly attributed to healthcare-associated infections. Risk factors for pneumonia included exposure to endotracheal tubes and prolonged invasive ventilation (OR = 2.5; 95% CI, 1.1 to 5.9, p = 0.03; and OR = 1.9; 95% CI, 1.1 to 3.4, p = 0.011; respectively).</p><p><strong>Conclusion: </strong>Implementing effective strategies to prevent and control resistant bacteria is essential to safeguard current therapies, enhance patient safety, and protect public health.</p>","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":"38 1","pages":"23-36"},"PeriodicalIF":0.8,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142918928","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}