Acta medica portuguesa最新文献

{"title":"Imported Malaria in Portugal: A Retrospective Analysis from a Tertiary Public Hospital.","authors":"Tomás Valença Ferreira, Gonçalo Alves Silva, Vitor Duque","doi":"10.20344/amp.23694","DOIUrl":"https://doi.org/10.20344/amp.23694","url":null,"abstract":"<p><p>Imported malaria remains a clinical and public health challenge in non-endemic countries. This retrospective study analyzed all adult malaria cases diagnosed at Hospitais da Universidade de Coimbra between 2020 and 2024, and the aim was to characterize the epidemiological profile, assess the impact of previous malaria history, and identify biomarkers associated with disease severity. A total of 88 patients were included, mostly male expatriates, with exposure primarily in Angola. Previous malaria history was reported in 52.3% of cases. Severe malaria was diagnosed in 25.0% of patients, being significantly more frequent among those without a prior history of the disease (p = 0.027). These patients had significantly higher creatinine (p = 0.009) and lactate dehydrogenase (p = 0.038) levels, suggesting an increased risk of complications. Urea and parasitemia were independently associated with longer hospital stay (p < 0.001 and p = 0.016, respectively), used here as a proxy for severity. These findings support the hypothesis of semi-immunity in previously exposed individuals and highlight the potential of laboratory biomarkers for clinical risk stratification. Continuous surveillance and targeted prevention strategies for non-immune and semi-immune travelers remain essential, especially in countries like Portugal, where malaria reintroduction can be a real concern.</p>","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145353472","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":"Obstruction of Transplanted Kidney from Urinary Catheter Misplacement.","authors":"Vítor Fernandes, Joana Andrade Lopes, Alberto Costa Silva","doi":"10.20344/amp.23634","DOIUrl":"https://doi.org/10.20344/amp.23634","url":null,"abstract":"","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145342568","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":"Fabella in a Pediatric Patient: A Rare Anatomical Variant with Clinical Relevance.","authors":"Tomás Ferrão, Catarina Tavares, João Nascimento","doi":"10.20344/amp.23543","DOIUrl":"https://doi.org/10.20344/amp.23543","url":null,"abstract":"","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145327977","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":"Pediatric Sarcopenia: What do We Know?","authors":"Marília Marques, Fátima Baptista","doi":"10.20344/amp.23301","DOIUrl":"https://doi.org/10.20344/amp.23301","url":null,"abstract":"<p><p>Pediatric sarcopenia is an emerging health issue that affects muscle development, strength, and overall well-being in children and adolescents. While it was initially linked to aging, recent studies highlight its presence in younger populations, particularly among those with chronic conditions. This condition affects growth and neurodevelopment in the short term and is associated with an increased risk of long-term complications, namely metabolic and cardiovascular diseases. Several factors contribute to pediatric sarcopenia, including inadequate prenatal nutrition, low birth weight, genetic susceptibility, insufficient dietary protein intake, sedentary behaviors, obesity, metabolic imbalances, and chronic illnesses. Reduced muscle mass impairs bone health, delays growth spurts, and affects physical performance, which may result in a lower quality of life. In children with chronic diseases, sarcopenia exacerbates clinical outcomes, prolongs hospital stays, and increases the likelihood of complications. Diagnosing sarcopenia in children is complex due to differing growth patterns. Existing assessment methods, such as imaging techniques and body composition analysis, lack standardized reference values tailored to pediatric populations, which makes early detection challenging. Preventive strategies emphasize physical activity, especially resistance exercises (muscle strengthening), reduced screen time, improved dietary habits, and sleep hygiene. Innovative treatments are being explored, including targeted drug delivery to the muscle to minimize side effects, regenerative approaches utilizing nanoparticles, and myostatin inhibitors for stimulating muscle growth. Stem cell therapy and biomaterial-based muscle reconstruction are also under investigation; however, pediatric-specific therapeutic guidelines remain undefined. Early intervention is crucial for reducing its negative effects and fostering healthier developmental paths.</p>","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145312291","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 Complex Case of Koolen-De Vries Syndrome Associated with Hypopituitarism and Type 1 Diabetes Mellitus.","authors":"Mafalda Félix Cabral, Francisco Branco Caetano, Carla Conceição, Diana Oliveira Antunes, Lurdes Lopes","doi":"10.20344/amp.22709","DOIUrl":"https://doi.org/10.20344/amp.22709","url":null,"abstract":"<p><p>Complex diseases arise from the interplay of genetic and environmental factors. We present a case where complex diseases seem to coexist. A 12-month-old girl was referred for short stature and hypotonia. Initial evaluation revealed central hypothyroidism, growth hormone deficiency and a small pituitary gland with ectopic neurohypophysis. Replacement therapy improved growth, but developmental delay and strabismus ensued. At age 10, she experienced a first seizure treated with levetiracetam. At age 12, she presented diabetic ketoacidosis and functional insulin therapy was started; positive autoantibodies confirmed autoimmune etiology. Initial genetic testing performed by microarray analysis retrieved normal results, but exome sequencing revealed a heterozygous pathogenic variant in KANSL1 gene, allowing for the diagnosis of Koolen-de Vries syndrome. In this patient, Koolen-de Vries syndrome presented initially as hypopituitarism and only later epilepsy. Afterwards, type 1 diabetes mellitus ensued, highlighting the complexity of intertwined conditions.</p>","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145297939","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":"Internato de Formação Especializada em Doenças Infeciosas: Caracterização e Perceção sobre o Ambiente Clínico de Aprendizagem.","authors":"José Ganicho, Ana Raquel Garrote, Maria José Manata, Fernando Maltez, Raquel Tavares","doi":"10.20344/amp.23187","DOIUrl":"https://doi.org/10.20344/amp.23187","url":null,"abstract":"<p><strong>Introduction: </strong>The World Health Organization identified 13 critical threats to global health for the coming decade, including infectious disease prevention and antimicrobial resistance. Given the ongoing advancements in scientific evidence, it is imperative to discuss the Infectious Diseases training program. The aim of this study was to characterize and explore the respondents' perceptions regarding Infectious Diseases training and the clinical learning environment.</p><p><strong>Methods: </strong>A survey was developed to assess the clinical learning environment, targeting residents and young specialists who completed their training within the past five years.</p><p><strong>Results: </strong>The questionnaire received 73 responses, 75.3% from residents. Most respondents agreed with the duration of Internal Medicine (83.5%), Microbiology (76.7%), and General Infectious Diseases (71.2%) rotations, but considered that the Intensive Care rotation should last less than six months. The areas of Infection Control/Antibiotic Stewardship and Immunosuppression/Infectious Risk were suggested as mandatory rotations by 84.9% and 65.8% of participants, respectively. Most respondents (67.1%) considered prolonged Internal Medicine Emergency rotations beyond the first year detrimental. In contrast, 84.6% of ARS Norte participants only performed this activity during the first year, whereas 86.8% of ARS LVT participants continued, at least, until the fourth year. Regarding clinical and scientific output, ARS Norte interns reported, on average, higher numbers of weekly assisted (21.7 vs 17.1) and performed (20.8 vs 17.7) appointments, as well as higher annual participation (3.7 vs 3.1) and presentations (2.8 vs 2.4) in scientific events, published articles (1.1 vs 0.6), and weekly study hours (7.4 vs 4.5), compared with ARS LVT. The main challenges reported were a lack of dedicated study time during working hours, scientific updates, and clinical practice in Internal Medicine Emergency rotations. Regarding the evaluation of the residency program, only 2.7% agreed completely with the current exam model and 1.37% with the current curriculum grid. The majority (64.4%) of participants considered themselves at least satisfied with the specialty.</p><p><strong>Conclusion: </strong>The results suggest a need to review the Infectious Diseases training program, include new areas of specialization, and discuss evaluation models throughout residency. Regional asymmetries were observed in emergency work, clinical and scientific output, which affect the equity and quality of training. Discussion of the Infectious Diseases training program is crucial for adapting the curriculum to current and future challenges.</p>","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145278711","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 Lymph Node Metastases in Papillary Thyroid Carcinoma: A Case Series and Literature Review.","authors":"Henrique Pina, Daniela Cavaco, Ricardo Nogueira, Valeriano Leite","doi":"10.20344/amp.22908","DOIUrl":"https://doi.org/10.20344/amp.22908","url":null,"abstract":"<p><strong>Introduction: </strong>The prevalence of retropharyngeal lymph node metastases in papillary thyroid carcinoma is low. The objective of this retrospective study was to assess our institutional experience with the management of such metastases and to compare results with other published series.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of patients diagnosed with papillary thyroid carcinoma and retropharyngeal lymph node metastases who were followed at the Endocrinology Department of the Instituto Português de Oncologia de Lisboa Francisco Gentil. To identify published cases in the literature, a comprehensive search was conducted using the Medline and PubMed databases from January 1970 to June 2025.</p><p><strong>Results: </strong>We have identified a total of 15 patients. Twelve (80.0%) were women. The median age at initial surgery was 55.7 years (range 20.6 - 84.0 years) and the median duration of follow-up was 9.8 years (range 0.5 - 36.3 years). Five patients (33.3%) were diagnosed with retropharyngeal lymph node metastases during initial tumor staging and 10 (66.7%) in the follow-up, in eight patients (80.0%) due to biochemical persistence of the disease, and in two (20.0%) after cervical lymph node recurrence. Of the 15 patients, seven (46.7%) received no treatment for retropharyngeal lymph node metastases (surveillance group), and eight (53.3%) were treated (therapy group) and, from these, four (26.7%) underwent surgery, two (13.3%) received radiotherapy, one (6.7%) underwent radiosurgery and one (6.7%) underwent both surgery and radiotherapy.</p><p><strong>Conclusion: </strong>Most patients with retropharyngeal lymph node metastases are diagnosed post-thyroidectomy, due to biochemical persistence of the disease or cervical lymphatic recurrence. Retropharyngeal lymph node metastases are commonly single and located ipsilaterally to the primary tumor and co-occur frequently with distant metastases.</p>","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145273369","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":"Palisaded Neutrophilic Granulomatous Dermatitis as the Initial Manifestation of Rheumatoid Arthritis.","authors":"José Ramos, Rodrigo Rei, Joana Nogueira, João Alves","doi":"10.20344/amp.23552","DOIUrl":"https://doi.org/10.20344/amp.23552","url":null,"abstract":"","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145249217","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":"[Non-Urgent Patients in the Emergency Department at a Hospital in Portugal: Reasons and Characteristics of Use].","authors":"Andreia Godinho de Sousa, César Alberto Dos Santos Carneiro","doi":"10.20344/amp.23644","DOIUrl":"https://doi.org/10.20344/amp.23644","url":null,"abstract":"<p><strong>Introduction: </strong>The increasing demand for emergency services has challenged healthcare systems, largely due to patients whose needs are not urgent, which account for 40.3% of admissions in Portugal.</p><p><strong>Methods: </strong>A cross-sectional study was conducted over five weeks in the emergency room (ER) of São Sebastião Hospital, Local Health Unit of Entre Douro e Vouga, involving adult patients. Data collection included the review of electronic medical records and the implementation of patient surveys in the ER. The study aimed to identify predictors of non-urgent visits to the ER, using a logistic regression model.</p><p><strong>Results: </strong>Of the 10 333 patients who visited the ER, 12.3% were classified as non-urgent. The main reasons for seeking the ER included self-perception of symptom severity, undergoing medical tests or immediate treatments, proximity to the hospital, and the perception of higher quality care. Factors such as exemption from co-payment (OR = 0.888), proximity to the hospital (OR = 0.990), having a family doctor (OR = 0.190), knowledge of acute consultations in primary care (OR = 0.428) and telephone line SNS24 (OR = 0.089) were associated with lower odds of unnecessary emergencies. Non-urgent patients were more likely to visit the ER on weekdays (OR = 1.179) and in the morning (OR = 1.637). The probability of a non-urgent episode was 1.8% higher for each additional visit to the ER (OR = 1.018).</p><p><strong>Conclusion: </strong>Inappropriate use of the ER is influenced by socioeconomic and behavioral factors. The exemption from co-payment was associated with a lower probability of unnecessary emergencies, raising questions about the effectiveness of this co-payment as a moderator of demand. Despite the availability of primary care, the ER was preferred during weekdays and in the morning. The association between awareness of alternatives to the ER and the presence of a family doctor with a lower probability of unnecessary emergencies highlights the need to improve patient health literacy and strengthen primary healthcare services.</p>","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145231102","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":"[From Preconception to Breastfeeding: What Healthcare Professionals and Women Think about Vitamin Supplementation].","authors":"Mafalda Simões, Filomena Sousa, Joana Goulão Barros, Ana Costa, Teresa Bombas","doi":"10.20344/amp.22763","DOIUrl":"https://doi.org/10.20344/amp.22763","url":null,"abstract":"<p><p>Pregnancy is a period when adopting healthy habits, such as a balanced diet and vitamin supplementation, is crucial for maternal and fetal health. Nutritional deficiencies can lead to fetal malformations, and organizations like the Directorate-General of Health recommend supplementation with folic acid and iodine. However, guidelines for other micronutrients, such as iron and zinc, remain less defined, causing uncertainty among healthcare professionals. A descriptive study conducted between March and August of 2023 assessed the perceptions of doctors, pharmacists and women regarding supplementation. Among the 230 physicians interviewed, 89.1% emphasized the importance of preconception consultations, with folic acid being the most recommended supplement. During pregnancy, 81.7% prescribed folic acid, 49.6% iron, and 60.4% iodine. However, only two-thirds of women reported postpartum supplementation, highlighting a gap in care during this phase. Among the 433 pharmacists, 48% recognized the need for greater involvement in advising on supplementation, particularly in the postpartum period, when the demand for information increases. In a survey of 1107 women, 49% did not attend a preconception consultation, often relying on informal sources for information, which hampers adherence to medical recommendations. Despite high adherence to supplementation during pregnancy, factors such as cost and fear of side effects remain barriers. Improving counselling before, during, and after pregnancy is essential, with tailored strategies involving doctors, pharmacists, and community programs to achieve better maternal and fetal health outcomes.</p>","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":"38 10","pages":"635-638"},"PeriodicalIF":1.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145228528","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}