Acta medica portuguesa最新文献

{"title":"Advancing Access to Intestinal Microbiota Transplant: Bridging the Gap Between National Practices and the European Strategy.","authors":"Liliana Dinis, Helder Pinheiro, Pedro Póvoa, Conceição Calhau, Diogo Pestana, Cláudia Marques","doi":"10.20344/amp.22750","DOIUrl":"10.20344/amp.22750","url":null,"abstract":"<p><p>Clostridioides difficile is an opportunistic pathogen that can cause a range of conditions, from asymptomatic carriage to severe illness, posing a significant public health threat due to its high mortality rates and substantial healthcare costs. Traditional treatment options, including antibiotics, often fail to eradicate the infection, leading to recurrent cases that severely impact patients' lives. Intestinal microbiota transplant (IMT) has emerged as an effective strategy for decolonizing pathogenic agents, demonstrating safety and efficacy, particularly in treating recurrent Clostridioides difficile infection (rCDI). Despite its potential, access to IMT is limited due to safety concerns, logistical challenges, and a lack of proper guidance, underscoring the urgent need for structured intestinal microbiota banks (IMBs). These organized facilities are crucial for the collection, screening, processing, and distribution of intestinal microbiota preparations, thereby facilitating the clinical application of IMT. In this narrative review, we discuss the relevance of applying IMT for the treatment of rCDI in Europe, with a focus on Portugal. We highlight the existence and distribution of IMBs across Europe and their importance in improving access to IMT. This review also addresses the challenges in creating an IMB and the development of such a structure in Portugal as a centralized repository for high-quality, standardized microbiota preparations, making IMT accessible for national hospitals. Additionally, it emphasizes the need to raise awareness among healthcare providers and the public to support the broader adoption of IMT.</p>","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":" ","pages":"639-647"},"PeriodicalIF":1.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144938513","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":"Mother-Baby Day Hospitals: An Effective Option for Perinatal Mental Health Care?","authors":"Catarina P Desport, Liliana C Castro","doi":"10.20344/amp.23236","DOIUrl":"https://doi.org/10.20344/amp.23236","url":null,"abstract":"","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":"38 10","pages":"669"},"PeriodicalIF":1.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145228498","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":"Remote Consultations in Clinical Practice: A Review of Modalities and Current Challenges.","authors":"Tiago Cunha Reis","doi":"10.20344/amp.22628","DOIUrl":"10.20344/amp.22628","url":null,"abstract":"","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":" ","pages":"605-607"},"PeriodicalIF":1.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144131976","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":"[Nitrous Oxide-Induced Toxic Myeloneuropathy: Illustration of a Pediatric Case].","authors":"Raquel Da Costa Neves, Ana Luísa Gouveia, Clara Marecos, Sandra Jacinto, Paula Rocha","doi":"10.20344/amp.23568","DOIUrl":"https://doi.org/10.20344/amp.23568","url":null,"abstract":"","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":"38 10","pages":"672-673"},"PeriodicalIF":1.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145228509","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":"[Diagnosis and Laboratory Follow-Up of Patients with Multiple Myeloma: Guidelines from the Portuguese Multiple Myeloma Group].","authors":"Ana Marta Pires, João Pedro Barreto, Joana Caetano, Maria José Soares, Catarina Geraldes, Bruno Fernandes, Margarida Coucelo, Sérgio Chacim, Henrique Coelho, Cecília Correia, Ana Paula Cruz, Manuel Cunha, Maria Rosário Cunha, Nuno Cunha, Patrícia Ferraz, José Guilherme Freitas, Rui Henrique, Susana Lisboa, Paulo Lúcio, Artur Paiva, Cláudia Pedrosa, Inês Ramos, Ana Bela Sarmento, Patrícia Seabra, Joana Sevilha, Maria José Rego de Sousa, Sara Sousa, Teresa Sousa, Márcio Tavares, Fernanda Trigo, Rui Bergantim, Adriana Roque, Cristina João","doi":"10.20344/amp.22909","DOIUrl":"10.20344/amp.22909","url":null,"abstract":"<p><p>Multiple myeloma is a neoplasm of plasma cells that in most cases is associated with the secretion of monoclonal immunoglobulins and can involve multiple organs. Its timely diagnosis is essential to limit or avoid irreversible damage and dysfunction of target organs. Appropriate initial stratification of patients allows for optimization in the selection and sequence of therapy, as well as proper follow-up during treatment and monitoring, impacting survival. These laboratory guidelines from the Portuguese Multiple Myeloma Group provide recommendations for the diagnosis and laboratory follow-up of patients with multiple myeloma. The follow-up and diagnosis of patients with other clinically significant monoclonal gammopathies were not included in this text. This article was based on international guidelines, scientific publications, and the experience of a panel of specialists in clinical and laboratory fields dedicated to the study and treatment of multiple myeloma.</p>","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":" ","pages":"654-668"},"PeriodicalIF":1.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144938577","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":"Reactive Infectious Mucocutaneous Eruption: A Rising Enigma.","authors":"Joana Lage, Ana Lemos, Ana Garcia, Tiago Silva, Catarina Gouveia","doi":"10.20344/amp.22792","DOIUrl":"https://doi.org/10.20344/amp.22792","url":null,"abstract":"<p><p>Reactive infectious mucocutaneous eruption is a rare condition that predominantly occurs in pediatric patients following a respiratory infection, most commonly caused by Mycoplasma pneumoniae. It is characterized by prominent mucositis, usually with minimal or absent skin involvement. We present the case of a nine-year-old male admitted with severe oral mucositis and a penile lesion compromising bladder emptying. During hospitalization, dispersed cutaneous lesions emerged along with bilateral conjunctival hyperemia. The etiological investigation detected Mycoplasma pneumoniae in respiratory secretions, with positive IgM and IgG serology. Treatment included azithromycin, intravenous immunoglobulin and methylprednisolone, resulting in progressive clinical improvement. This case highlights the importance of recognizing reactive infectious mucocutaneous eruption. It can be challenging to differentiate from Stevens-Johnson syndrome, but it tends to have a more favorable clinical course. Early initiation of supportive care and multidisciplinary support are crucial for a good prognosis.</p>","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":"38 10","pages":"648-651"},"PeriodicalIF":1.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145228532","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 Potential of a New Population Screening: Preventing Osteoporotic Fractures.","authors":"Tiago Silva, Andreia Costa, Ricardo J O Ferreira","doi":"10.20344/amp.23360","DOIUrl":"https://doi.org/10.20344/amp.23360","url":null,"abstract":"","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":"38 10","pages":"674-675"},"PeriodicalIF":1.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145228595","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":"Awareness and Barriers to Guideline Adherence: Slovenian Family Physicians Survey and Qualitative Feedback.","authors":"Luka Petravić, Neža Kralj Rotar, Vojislav Ivetić","doi":"10.20344/amp.23293","DOIUrl":"10.20344/amp.23293","url":null,"abstract":"<p><strong>Introduction: </strong>Clinical practice guidelines are essential for standardizing care, yet adherence in primary care remains inconsistent globally. The aim of this study was to assess the use of clinical guidelines by family physicians in Slovenia for diagnosing and managing common conditions, to explore factors influencing guideline awareness and decision-making, and to identify barriers to adherence.</p><p><strong>Methods: </strong>A nationwide cross-sectional study surveyed family medicine specialists and trainees across public and private practices in rural and urban Slovenia. Participants completed an online questionnaire to evaluate their awareness of professional guidelines (27 guidelines made by Slovenian healthcare professionals). Furthermore, they were tested on guideline-aligned decisions (five clinical vignettes). The last question in the survey was an open-ended question on the main obstacles associated with the use of clinical guidelines.</p><p><strong>Results: </strong>Out of 660 physicians surveyed, only 57 respondents completed the questionnaire in full (8.6% response rate). Guideline awareness varied significantly (average 60.8%), with higher knowledge of guidelines for relatively common conditions (e.g., 96% for arterial hypertension versus 12% for polycythemia vera). Correct clinical decisions according to guidelines were made in 65.2% of cases (lowest average scores for osteoporosis, 57.9%, highest for dyspepsia, 69.7%). Minimal statistically significant differences emerged between family medicine specialists and trainees (decisions regarding peripheral arterial occlusive disease, p = 0.024), public or private practice types (decisions regarding low urinary tract symptoms, p = 0.037), and urban or rural practice settings (decisions regarding chronic obstructive pulmonary disease, p = 0.008 and p = 0.016). Answers to the open-ended question were divided into six categories according to the content: organizational limitations (lack of time and availability of guidelines), limitations related to the characteristics and quality of guidelines, team members' lack of knowledge or work based on experience, complex patients, non-cooperative patients, and financial limitations.</p><p><strong>Conclusion: </strong>On average, family physicians in Slovenia make clinical decisions according to guidelines in 65.2% of cases. Organizational constraints, notably workload and time pressures, are the leading obstacles to guideline adherence. Interventions such as extended consultation times, centralized digital guideline repositories, and annual update seminars are recommended. Our study highlights the need for broader research to validate strategies for enhancing guideline implementation and adherence in primary care.</p>","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":" ","pages":"619-628"},"PeriodicalIF":1.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144870798","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 Scabies Using Ivermectin in Children Under 15 kg: A Safe and Effective Option].","authors":"António Magarreiro-Silva, José Alberto Ramos, Hugo Leme, Joana Margarida Reis, Rita Pimenta","doi":"10.20344/amp.23219","DOIUrl":"https://doi.org/10.20344/amp.23219","url":null,"abstract":"","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":"38 10","pages":"670-671"},"PeriodicalIF":1.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145228491","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 Locally Advanced and Metastatic Salivary Gland Cancer: A 10-year Experience of an Oncology Center in Portugal.","authors":"Ana Raquel Teixeira, Cláudia Agostinho, Catarina Dias, Rita Soares, Marta Pina, José Dinis, Luísa Lopes-Conceição, Cláudia Vieira","doi":"10.20344/amp.22800","DOIUrl":"10.20344/amp.22800","url":null,"abstract":"<p><strong>Introduction: </strong>Scientific evidence regarding salivary gland cancer systemic treatment is limited and the therapeutic approach to locally advanced or metastatic disease is mainly based on consensus. This study aimed to evaluate treatment patterns and outcomes in patients with advanced salivary gland cancer.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study in a comprehensive cancer center in Portugal, including adult patients diagnosed with primary malignant salivary gland tumors between 2012 and 2021. Data on demographics, tumor characteristics, treatments, and outcomes were collected from institutional cancer registries and electronic medical records. The study was approved by the institutional Ethics Committee.</p><p><strong>Results: </strong>A total of 116 patients with salivary gland cancer were identified and, of these, 45 had locally advanced or metastatic disease: 24 received systemic anti-neoplastic treatment and 21 received best supportive care. One-year overall survival in systemic anti-neoplastic treatment group was 70% (versus 14% in best supportive care group, p < 0.001) and progression-free survival was 37%. The most commonly used systemic treatment was chemotherapy (n = 29, 59%). Seven patients (14%) received androgen deprivation therapy, and two patients (4%) received other targeted therapy (olaparib and erdafitinib).</p><p><strong>Conclusion: </strong>Systemic treatment was associated with significantly improved survival in patients with advanced salivary gland cancer. Despite the heterogeneity of therapeutic approaches, including emerging biomarker-driven therapies, clinical decision-making remains largely consensus-based. These findings underscore the need for further research to support personalized treatment strategies and guide evidence-based care.</p>","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":" ","pages":"608-618"},"PeriodicalIF":1.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145005793","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}