Acta medica portuguesa最新文献

{"title":"Update on Generalized Pustular Psoriasis.","authors":"Tiago Torres, Joana Antunes, Rui Tavares Bello, Paulo Varela, Martinha Henrique, Gabriela Marques Pinto, Américo Figueiredo, Osvaldo Correia, Paulo Filipe, Francisco Menezes Brandão","doi":"10.20344/amp.22672","DOIUrl":"10.20344/amp.22672","url":null,"abstract":"<p><p>Generalized pustular psoriasis (GPP) is a rare but severe inflammatory skin disease characterized by the eruption of widespread sterile pustules, often accompanied by systemic inflammation. Although GPP can coexist with plaque psoriasis, it is increasingly recognized as a distinct entity with unique clinicopathological, immunologic, and genetic features. The dysregulated IL-36 pathway, including mutations in the IL36RN gene, is implicated in GPP pathogenesis, providing a molecular basis for targeted therapies. Diagnosing GPP requires a comprehensive evaluation, including clinical presentation, potential triggers, patient history, histopathologic findings, and laboratory results. Disease severity must be assessed through both cutaneous symptoms and systemic involvement, as GPP flares can lead to life-threatening complications such as sepsis and multi-organ failure. Historically, GPP treatment primarily relied on therapies approved for plaque psoriasis, despite their limited specificity for this condition. Recent advances in understanding the molecular mechanisms of GPP, particularly the central role of interleukin-36 pathway, have led to the development of targeted therapies for this rare condition. Currently, spesolimab is the only therapy specifically approved for treating GPP flares in adolescents and adults, in both Europe and the United States of America. However, the management of GPP remains complex and challenging. This narrative review provides an overview of the epidemiology, pathophysiology, clinical features, comorbidities, and evolving therapeutic strategies for GPP.</p>","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":"38 5","pages":"321-330"},"PeriodicalIF":0.8,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143955646","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":"Attitudes and Perceptions of Portuguese Psychiatrists and Psychologists on the Clinical Use of Ketamine.","authors":"Pedro Mota, Jorge Encantado, Laura C Carvalho, Catarina Cunha, Albert Garcia-Romeu, Matthew W Johnson, Pedro J Teixeira","doi":"10.20344/amp.22815","DOIUrl":"https://doi.org/10.20344/amp.22815","url":null,"abstract":"<p><strong>Introduction: </strong>Ketamine has garnered attention for its rapid efficacy in alleviating depressive symptoms in treatment-resistant depression, offering a novel mechanism as a non-monoaminergic agent. Despite its potential, limited research has explored mental health professionals' perspectives on its use. This study assesses the attitudes, knowledge, and concerns of Portuguese psychiatrists and psychologists regarding the clinical application of ketamine in treatment-resistant depression.</p><p><strong>Methods: </strong>A cross-sectional survey study was conducted from June 2022 to January 2024 among Portuguese psychiatrists and psychologists. The anonymous online questionnaire assessed perceptions of ketamine's therapeutic utility, risks, and knowledge sources. Statistical analyses examined subgroup differences by age, sex, profession, and prior psychedelic use.</p><p><strong>Results: </strong>Among 156 participants (mean age = 37.2; 68.6% female), 53.8% were psychologists, and 46.2% were psychiatrists or trainees in Psychiatry. Only 35.9% reported substantial knowledge of ketamine's therapeutic potential, while 59% were open to integrating it clinically. The majority expressed interest in training, though 73% raised concerns about inadequate professional training. Significant differences emerged, with psychiatrists reporting higher knowledge levels and openness to ketamine compared to psychologists, while younger professionals showed greater interest in training and usage.</p><p><strong>Conclusion: </strong>There was a favorable attitude toward ketamine use among Portuguese psychiatrists and psychologists, yet substantial educational gaps remain. Customized training addressing age, sex, and professional background is essential for safe and effective clinical integration of ketamine in treatment-resistant depression. Further studies should focus on longitudinal outcomes of ketamine treatment under standardized protocols to ensure efficacy and safety in clinical practice.</p>","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":"38 5","pages":"297-306"},"PeriodicalIF":0.8,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143957217","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":"Reusing Patient Data to Train Artificial Intelligence for Medical Devices in the European Union.","authors":"Yuri Ladeia, Nuno Sousa","doi":"10.20344/amp.22509","DOIUrl":"https://doi.org/10.20344/amp.22509","url":null,"abstract":"","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":"38 5","pages":"285-287"},"PeriodicalIF":0.8,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143957941","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":"Addressing Burnout and Enhancing Efficiency with Digital Health.","authors":"Mariana Constante, Filipa Monteiro, Leticia Santos","doi":"10.20344/amp.22814","DOIUrl":"https://doi.org/10.20344/amp.22814","url":null,"abstract":"","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":"38 5","pages":"356"},"PeriodicalIF":0.8,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143951889","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":"Evaluation of Survival and Neurodevelopment in Neonates Born Very Preterm at a Tertiary Centre in Portugal.","authors":"Margarida Camacho-Sampaio, Catarina Cordeiro, Catarina Leuzinger-Dias, Ana Dias, Dolores Faria, Adelaide Taborda","doi":"10.20344/amp.22345","DOIUrl":"https://doi.org/10.20344/amp.22345","url":null,"abstract":"<p><strong>Introduction: </strong>Advances in medical care have significantly improved survival rates for preterm infants globally, leading to an increase of population of newborns at neurological risk. Knowledge of gestational age-specific outcomes is essential to guide and provide the best medical care. This study aimed to evaluate the impact of gestational age in mortality and neurodevelopment of very preterm infants. As a secondary objective, we aimed to determine the influence of perinatal factors on the combined outcome of neurodevelopmental impairment or death.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study of all infants born before completing 32 weeks of gestational age, admitted to the Neonatal Intensive Care Unit in a tertiary maternity hospital in Portugal from 2013 to 2021. Neurodevelopment was assessed at 24 months of corrected age, using Griffiths Mental Developmental Scales II. Moderate to severe neurodevelopment impairment was considered in the presence of at least one of the following criteria: global development quotient < 70, cerebral palsy, severe visual impairment or profound sensorineural deafness.</p><p><strong>Results: </strong>There were 311 very preterm infants assessed for eligibility, 10.9% neonatal deaths and 11.9% losses to follow-up. Neurodevelopment evaluation was performed on 274 infants, of whom 6.2% (17/274) had moderate to severe neurodevelopment impairment: 7.5% (5/67) born before 28 weeks of gestational age and 5.8% (12/207) between 28 - 31 weeks. Global development quotient < 70 was verified in 4.7% of cases. Cerebral palsy was diagnosed in 3.3%, severe visual impairment in 0.7% and profound sensorineural deafness in 0.7%. The survival rate without moderate to severe neurodevelopment impairment exceeded deaths at 25 weeks and was > 86% from 28 weeks onward. In multivariable logistic regression analysis, gestational age was identified as a protective factor for moderate to severe neurodevelopment impairment or death (aOR 0.81; CI 95% 0.68 - 0.98), whereas male sex (aOR 3.19; CI 95% 1.57 - 6.71) and resuscitation with tracheal intubation (aOR 8.17; CI 95% 3.16 - 20.96) were independent risk factors.</p><p><strong>Conclusion: </strong>This study reaffirms gestational age as a key determinant of survival and neurodevelopmental outcomes in very preterm infants, with those born before 28 weeks facing higher risks of mortality and severe neurodevelopmental impairments. Understanding local survival rates and neurodevelopmental outcomes is paramount for guiding perinatal decision-making and providing accurate evidence-based counseling to parents of preterm infants.</p>","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":"38 5","pages":"288-296"},"PeriodicalIF":0.8,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143964660","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":"[Interstitial Ectopic Pregnancy: A Rare Case].","authors":"Inês Jorge, Helena Gomes, Njila Amaral","doi":"10.20344/amp.22545","DOIUrl":"https://doi.org/10.20344/amp.22545","url":null,"abstract":"","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":"38 5","pages":"348-349"},"PeriodicalIF":0.8,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143955728","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 Headache to Diagnosis: A Case of Pediatric Cerebral Abscess.","authors":"Antunes de Azevedo Barroso, Inês Aires Martins, Sara Matos, Andreia Maravilha Moreira","doi":"10.20344/amp.22441","DOIUrl":"https://doi.org/10.20344/amp.22441","url":null,"abstract":"","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":"38 5","pages":"334-335"},"PeriodicalIF":0.8,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143960438","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":"[Headache Management in Portugal: Consensus among the Portuguese Headache and Neurology Societies, the Portuguese Association of General and Family Medicine, and MiGRA].","authors":"Raquel Gil-Gouveia, Elsa Parreira, Isabel Pavão Martins, Isabel Luzeiro, Raúl Marques Pereira, Madalena Plácido, Filipe Palavra","doi":"10.20344/amp.22496","DOIUrl":"10.20344/amp.22496","url":null,"abstract":"<p><p>Headaches are a significant cause of global disability, with migraines ranking second of all conditions in terms of years lived with disability. Most headache patients, including those with migraine, can and should be effectively diagnosed, treated, and managed in primary healthcare settings. This approach not only reduces the disability associated with these conditions but also prevents progression to chronic forms or the development of medication overuse. The establishment of an efficient referral network, involving patient associations and healthcare professionals beyond primary care, is essential to ensure adequate support for more complex cases and to promote population health in a timely and effective manner. These guidelines for diagnosis, treatment, and referral are the result of a consensus among the Portuguese Headache Society, the Portuguese Society of Neurology, the Portuguese Association of Family Medicine, and MiGRA Portugal, the Portuguese association of migraine and headache patients. This document was designed to empower all physicians to contribute effectively to the management of these conditions.</p>","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":"38 5","pages":"336-347"},"PeriodicalIF":0.8,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143968566","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":"Paediatric Meningioangiomatosis PD-L1+: A Case Report.","authors":"Gabriele Gaggero, Silvia Bozzano, Antonia Ramaglia, Claudia Milanaccio, Marco Pavanello","doi":"10.20344/amp.22276","DOIUrl":"https://doi.org/10.20344/amp.22276","url":null,"abstract":"","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":"38 5","pages":"350-351"},"PeriodicalIF":0.8,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143955703","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":"Hiperferritinemia Hereditária: Um Desafio Diagnóstico.","authors":"Mariana Gradim, Fátima Ferreira","doi":"10.20344/amp.22802","DOIUrl":"https://doi.org/10.20344/amp.22802","url":null,"abstract":"","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":"38 5","pages":"354-355"},"PeriodicalIF":0.8,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143952897","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}