Acta medica portuguesa最新文献

{"title":"[Burnout Among Residents: A Current Perspective].","authors":"Beatriz Alves, Gina Gouveia, Rita Crisóstomo, Marina Pereira","doi":"10.20344/amp.24011","DOIUrl":"10.20344/amp.24011","url":null,"abstract":"<p><p>Burnout is increasingly prevalent among medical residents, with reported rates ranging from 17% to 75% in certain studies, highlighting methodological heterogeneity and the need for further research and understanding. This literature review aims to contribute to a better understanding of this topic by examining the prevalence, assessment instruments, associated factors, consequences, and interventions related to burnout among resident physicians. To achieve this, a literature search of scientific publications from 2000 to 2024 was conducted, resulting in a total of 22 articles that met the inclusion criteria. Burnout has serious psychiatric consequences for the physician but also affects patients, since a doctor who is not able to perform effectively at work offers lower quality healthcare delivery and risks medical errors. Based on the evidence synthesized in the article, burnout among medical residents is highly prevalent, multifactorial, and strongly driven by organizational conditions, with rates frequently exceeding 50% and reaching particularly high levels in the first year of residency and in certain specialties. The findings also show that organizational and integrated institutional interventions are more effective than individual strategies alone, leading to meaningful reductions in emotional exhaustion, depersonalization, and downstream consequences for patient care and workforce retention. To address this growing issue, integrated approaches are needed, both at the institutional and personal levels.</p>","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":" ","pages":"635-640"},"PeriodicalIF":1.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148282925","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":"Letter to the Editor Regarding the Article \"Guideline Recommendations and Estimates of Excessive Screen Time in Children\".","authors":"Silvia Sztamfater","doi":"10.20344/amp.25382","DOIUrl":"https://doi.org/10.20344/amp.25382","url":null,"abstract":"","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":"39 10","pages":"672"},"PeriodicalIF":1.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149178622","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":"A Newborn with a Maxillary Gingival Mass.","authors":"Liliana Carvalho de Sousa, Lucinda Amorim Delgado, André Coelho Almeida","doi":"10.20344/amp.24856","DOIUrl":"https://doi.org/10.20344/amp.24856","url":null,"abstract":"","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":"39 10","pages":"649-650"},"PeriodicalIF":1.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149178680","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":"Drug-Induced Hepatitis Caused by Methylphenidate: A Case Report.","authors":"Diana Valbom Gonçalves, Mariana Bravo, Sónia Almeida, Sandra Ferreira, Sandra Rebimbas","doi":"10.20344/amp.23703","DOIUrl":"10.20344/amp.23703","url":null,"abstract":"<p><p>Methylphenidate (MPH) is a widely prescribed psychostimulant for the management of attention deficit hyperactivity disorder (ADHD). Although most adverse effects of MPH are transient and reversible, hepatotoxicity remains a rare but potentially serious complication. We present the case of a 12-year-old female patient with ADHD who had been receiving MPH treatment since the age of 8. After three and a half years of therapy, she did blood tests that showed a marked elevation in transaminases and gamma-glutamyl transferase. Extensive evaluation ruled out alternative causes of liver disease, and liver biopsy findings were consistent with drug-induced hepatitis. Discontinuation of MPH resulted in progressive normalization of liver enzyme levels. This case underscores the importance of regular laboratory monitoring during long-term psychostimulant therapy, particularly regarding liver function. Early recognition of abnormal biochemical findings allows for prompt discontinuation of the offending drug, reversal of hepatic injury, and prevention of more severe complications such as liver failure.</p>","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":" ","pages":"641-643"},"PeriodicalIF":1.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145773178","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":"Practical Management of Cytopenias in Patients with Myelofibrosis Adapted to the Portuguese Reality.","authors":"António Medina de Almeida, Bárbara Marques, Blanca Polo, Francesca Pierdomenico, Marco Dias, Ricardo Pinto","doi":"10.20344/amp.24397","DOIUrl":"10.20344/amp.24397","url":null,"abstract":"<p><p>Cytopenias are a common clinical manifestation of myelofibrosis, particularly anemia. Although correcting cytopenias is essential to improve prognosis and quality of life of patients with myelofibrosis, there are few effective therapeutic options. Furthermore, there are no national guidelines for the management of cytopenias in myelofibrosis. To address this gap, a panel composed of six hematologists proposes an approach for patients with myelofibrosis and cytopenias adapted to clinical practice in Portugal, based on scientific evidence and clinical experience. Firstly, the etiology of the anemia should be identified. In patients with myelofibrosis-related anemia who have splenomegaly and/or constitutional symptoms, the use of Janus kinase inhibitors should be prioritized: momelotinib as monotherapy, or ruxolitinib in combination with an erythropoiesis-stimulating agent or danazol, depending on erythropoietin levels. In anemic patients without splenomegaly or constitutional symptoms, treatment with an erythropoiesis-stimulating agent, danazol, a combination of an immunomodulator with corticosteroid, or momelotinib, should be considered. In patients with treatment-induced anemia, the use of a Janus kinase inhibitor (with possible dose reduction in the case of ruxolitinib) in combination with an erythropoiesis-stimulating agent or danazol, or momelotinib as monotherapy should be considered. Thrombocytopenic patients eligible for Janus kinase inhibitors may receive ruxolitinib at a reduced dose, or momelotinib, the latter of which does not require dose reduction for thrombocytopenia. In thrombocytopenic patients without splenomegaly, constitutional symptoms, or anemia, the approach consists of monitoring or treatment with danazol, corticosteroids, or a combination of immunomodulator and corticosteroid, according to platelet count and hemorrhagic diathesis. Transfusion should be considered in patients with severe anemia or thrombocytopenia, diathesis, or the need for surgery. Symptomatic and analytical improvement, reduction of splenomegaly, and independence from or a significant decrease in transfusion support indicate a response to treatment. Treatment switch is warranted in cases of toxicity, failure, loss of clinical or hematological response after initial response, or disease progression. The implementation of these recommendations will help to optimize care for patients with myelofibrosis and cytopenias, improving clinical outcomes.</p>","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":"39 10","pages":"657-664"},"PeriodicalIF":1.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149178699","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":"Heart Failure Diagnosis in Primary Health Care: The Numbers Missing from the Consensus.","authors":"Miguel Azevedo, Liliana Sousa, Deolinda Chaves Beça, José Pedro Antunes, Jonathan Pinheiro Dos Santos","doi":"10.20344/amp.25084","DOIUrl":"https://doi.org/10.20344/amp.25084","url":null,"abstract":"","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":"39 10","pages":"666-667"},"PeriodicalIF":1.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149178649","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":"Real-World Use of Dostarlimab in Endometrial Cancer: A Portuguese Multicenter Study.","authors":"Margarida Quinto Pereira, Pedro Antunes Meireles, Ana Rita Lopes, Joana Rodrigues, Marisa Couto, Isabel Fernandes, Maria Teresa Neves, Aurora Gomes Zanga, Inês Soares de Pinho, Paulo Castro, Beatriz Castanheira, Pedro Simões, Filipa Macedo, RIta Ferreira, Deolinda Pereira, Fátima Vaz","doi":"10.20344/amp.24371","DOIUrl":"10.20344/amp.24371","url":null,"abstract":"<p><strong>Introduction: </strong>Dostarlimab has been available in Portugal for advanced or recurrent endometrial cancer post-platinum therapy via an early access program (EAP) since November 2021, with reimbursement from October 2024; its use with carboplatin and paclitaxel was authorized under an early access program in June 2024. The aim of this study was to assess the efficacy and safety of dostarlimab in a Portuguese cohort of endometrial cancer patients.</p><p><strong>Methods: </strong>This is a national multicenter retrospective cohort study involving patients treated with dostarlimab between January 2022 and January 2025 in 13 hospitals. Safety endpoints were rate of grade ≥ 3 adverse events (AE) and the treatment discontinuation rate. Efficacy endpoints were disease control rate (DCR), overall response rate (ORR) and six-month progression-free survival (PFS), in the monotherapy and the chemotherapy-combination groups.</p><p><strong>Results: </strong>The study assessed 43 patients, with a median follow-up time of six (3 - 14) months. In the chemotherapy-combination group (n = 13), mean age was 62.77 ± 8.4 years-old; the most common histological subtype was endometrioid (69.2%), but 23.1% were carcinosarcoma. Both ORR and DCR were 84.6%. In the monotherapy group (n = 30), the median number of previous treatment lines was 1 (1 - 6). Mean age was 67.43 ± 9.44 years. Endometrioid was the most prevalent histology (83.3%), followed by serous (6.6%). Overall response rate was 53.3% and DCR 63.3%. The six-month PFS was 68.4% (95% CI: 51% - 86%) in the monotherapy group and 83.1% (95% CI: 62% - 100%) in the combination group. Regarding safety, only 13.9% of patients reported grade ≥ 3 AE and the discontinuation rate was 9.3%.</p><p><strong>Conclusion: </strong>The results show compatible findings with current data regarding efficacy and manageable toxicity and may support the role of an early access program in improving treatment availability for patients with limited therapeutic options.</p>","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":"39 10","pages":"608-616"},"PeriodicalIF":1.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149178688","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":"[Guidelines for the Management of Secondary Hypogammaglobulinemia in Multiple Sclerosis Patients on Anti-CD20 Monoclonal Antibody Therapy].","authors":"André Aires Fernandes, Ana Lídia Neves, Daniela Ferro, Mafalda Seabra, Ricardo Soares Dos Reis, Teresa Mendonça, Cândida Abreu, Joana Guimarães, Pedro Abreu","doi":"10.20344/amp.24365","DOIUrl":"10.20344/amp.24365","url":null,"abstract":"<p><p>Hypogammaglobulinemia is a common laboratory complication in patients with multiple sclerosis treated with anti-CD20 monoclonal antibodies, and it may be associated with an increased risk of infections. This guideline, developed by the Cerebrospinal Fluid Study and Research Unit of Unidade Local de Saúde São João, proposes a structured approach for the assessment and management of this condition. It outlines strategies for infection risk mitigation both before and during therapy, as well as the indications for initiating immunoglobulin replacement therapy when appropriate. The aim is to support clinical decision-making by promoting a safe, individualized, and patient-centered intervention.</p>","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":" ","pages":"651-656"},"PeriodicalIF":1.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148443706","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":"Incidence and Management of Postherpetic Neuralgia in Primary Care: A Multicentre Retrospective Study.","authors":"Alcino Duarte, Inês Gonçalo, Inês Lopes, Isabel Carneiro Santos, João Carlos Silveira, Pedro Ferreira de Lemos, Daniel Humberto Pozza, Célia Duarte Cruz","doi":"10.20344/amp.24735","DOIUrl":"10.20344/amp.24735","url":null,"abstract":"<p><strong>Introduction: </strong>This study aimed to characterize postherpetic neuralgia (PHN) in herpes zoster (HZ) patients in primary care and assess its treatment. The secondary objectives included evaluating pain records and analgesic prescriptions.</p><p><strong>Methods: </strong>A multicentric observational, descriptive, longitudinal, and retrospective study was conducted in five Family Health Units, including adult patients diagnosed with HZ between January 2013, and December 2023, using the S70 code (International Classification of Primary Care - ICPC-2). Duplicate cases, pregnant women, and deceased individuals at time of data collection were excluded.</p><p><strong>Results: </strong>We included 735 individuals with HZ, 65% of whom were female and 81.2% were aged 50 years or older. The thoracoabdominal region was the most frequently affected, accounting for 43.7% of cases. In the initial assessment antivirals were prescribed to 81.1% and analgesics to 60.7%, predominantly nonsteroidal anti-inflammatory drugs. The cumulative incidence of PHN was 8.6% and every patient was receiving pain medication. No significant association was found between antiviral therapy and PHN (p = 0.165) or between depression/anxiety and PHN (p = 0.154). Additionally, in a complete‑case analysis, the absence of an analgesic prescription in the first consultation was associated with higher odds of PHN, although this association was not statistically significant (OR = 1.60; 95% CI 0.25 - 10.05, p = 0.546). The incidence of postherpetic neuralgia appeared slightly lower than prior reports.</p><p><strong>Conclusion: </strong>Antiviral use showed no association with subsequent PHN, whereas the absence of an analgesic prescription in the first consultation was associated with a higher risk of diagnosis, reinforcing the need for timely pain control. Depression and anxiety were common but not linked to PHN. Despite retrospective limitations, these findings emphasize that systematic pain assessment and early analgesic intervention in primary care can lessen the PHN burden.</p>","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":"39 10","pages":"599-607"},"PeriodicalIF":1.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149178712","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":"Treatment of Tobacco and Nicotine Dependence: What's New in the Guidelines.","authors":"Ana Rute Marques, Ana Cláudia Ramos","doi":"10.20344/amp.25096","DOIUrl":"https://doi.org/10.20344/amp.25096","url":null,"abstract":"","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":"39 10","pages":"665"},"PeriodicalIF":1.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149178675","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}