Acta medica portuguesa最新文献

{"title":"Selective Digestive Decontamination in Hemato-Oncological Patients Colonized with Carbapenem-Resistant Enterobacterales.","authors":"Sara De Abreu Luís, Carla Mimoso Santos","doi":"10.20344/amp.23139","DOIUrl":"10.20344/amp.23139","url":null,"abstract":"<p><p>Infections caused by multidrug-resistant Gram-negative bacteria, including carbapenem-resistant Enterobacterales, are a global threat and their gradual increase is alarming. They represent a major challenge to public health because of limited therapeutic options and high case-fatality rates. Hemato-oncological patients represent a high-risk subpopulation for these types of infections, more specifically in previous carbapenem-resistant Enterobacterales colonized patients, because of severe immunosuppression not only due to the disease itself but also due to treatment like intensive chemotherapy or allogeneic hematopoietic stem cell transplant. Selective digestive decontamination is a prophylactic intervention with the purpose of reducing or eliminating gut colonization by pathogenic agents, preserving beneficial endogenous flora but its application remains controversial due to great heterogeneity amongst studies. However, in this review we intend to examine the role of selective digestive decontamination in context of high-risk patients such as hemato-oncological carbapenem-resistant Enterobacterales carriers who will receive highly immunosuppressive treatments, as it appears to be an appealing short-term strategy for the prevention of difficult-to-treat infections.</p>","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":" ","pages":"561-567"},"PeriodicalIF":1.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144820336","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":"Antithrombotic Treatment After Valve-in-Valve, Valve-in-Ring, and Valve-in-MAC Procedures: A Systematic Review and Meta-Analysis.","authors":"Gonçalo Terleira Batista, Gonçalo Costa, Joana Delgado Silva, Lino Gonçalves","doi":"10.20344/amp.22905","DOIUrl":"10.20344/amp.22905","url":null,"abstract":"<p><strong>Introduction: </strong>While antithrombotic therapy following transcatheter valve implantation has been extensively studied in various clinical trials, there remains a notable gap in evidence regarding the optimal approach following valve-in-valve (ViV), valve-in-ring (ViR) and valve-in-mitral annular calcification (ViMAC) procedures, warranting further assessment. This gap is particularly concerning due to the apparent increased risk of thrombosis associated with ViV interventions. The aim of this systematic review was to explore the potential benefits of anticoagulation in ViV, ViR, and ViMAC procedures.</p><p><strong>Methods: </strong>We searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials, as well as the grey literature, for observational and interventional studies published until December 2023. Trials were included if a comparative analysis between the two antithrombotic strategies was feasible and excluded if patients under 18 years old were analysed. The primary efficacy endpoints were incidence of clinical and total valve thrombosis (VT), major bleeding was the sole safety primary endpoint. Additional analyses were performed regarding valves in the mitral position and valve type. The risk of bias was evaluated using the Newcastle-Ottawa scale. Data was assessed using the Review Manager 5.4 software.</p><p><strong>Results: </strong>A total of five observational and one case series were included (n = 614 on anticoagulation and n = 468 on antiplatelets), comprising a total of 1082 participants. Clinical VT rates were 4.2% for all procedures, and patients on anticoagulants were associated with a a lower risk of clinical VT (1.1% vs 8.3%; OR: 0.18; 95% CI: 0.07 - 0.42, I2: 0%) and total VT (1.3% vs 8.5%; OR: 0.16; 95% CI: 0.07 - 0.37, I2: 0%). Regarding bleeding events, the existing literature did not provide adequate information to enable a thorough analysis.</p><p><strong>Conclusion: </strong>Our study suggests a potential benefit of anticoagulation regimens to decrease the high rates of VT following valve-in-valve, valve-in-ring and valve-in-mitral annular calcification procedures. However, the lack of randomized controlled trials and data on bleeding and mortality emphasises the necessity for further research.</p>","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":" ","pages":"528-537"},"PeriodicalIF":1.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144673692","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":"Atrial Fibrillation Patterns on Ambulatory Electrocardiogram Monitoring and Risk of Stroke.","authors":"Oleksii Skakun, Ihor Vandzhura, Yaroslava Vandzhura, Roksolana Denina, Pavlo Zvonar","doi":"10.20344/amp.23199","DOIUrl":"https://doi.org/10.20344/amp.23199","url":null,"abstract":"","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":"38 9","pages":"597-598"},"PeriodicalIF":1.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144938560","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":"[Medicine for Peace: An Ethical and Professional Imperative].","authors":"Carlos Cortes","doi":"10.20344/amp.23881","DOIUrl":"https://doi.org/10.20344/amp.23881","url":null,"abstract":"","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":"38 9","pages":"601-602"},"PeriodicalIF":1.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144938551","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":"Bone Infarction of the Jaw with Regional Hematoma Collections: A Rare Complication in Sickle Cell Disease.","authors":"Luísa Castello-Branco Ribeiro, Sofia Grilo, Carlos Escobar","doi":"10.20344/amp.23141","DOIUrl":"10.20344/amp.23141","url":null,"abstract":"","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":" ","pages":"577-578"},"PeriodicalIF":1.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144705966","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":"Communication in Neonatal Intensive Care: Translation and Validation of the \"Parents' Experiences of Communication in Neonatal Care\" Questionnaire for the Portuguese Population.","authors":"Rita Melo Parente, Rita Guerreiro, Laura Garcia, Bruno Sanches, Raquel Gomes, Maria Clara Rocha, Anselmo Costa","doi":"10.20344/amp.22739","DOIUrl":"https://doi.org/10.20344/amp.22739","url":null,"abstract":"<p><strong>Introduction: </strong>Communication is a fundamental aspect in healthcare, more so in fragile environments such as Neonatology. To optimize communication strategies with parents, it is essential to assess its quality. The aim of this study was to validate, for the Portuguese population, an instrument for assessing the quality of communication between healthcare professionals and parents in neonatal care units.</p><p><strong>Methods: </strong>The Parents' Experiences of Communication in Neonatal Care questionnaire was developed in the United Kingdom to evaluate communication with parents specifically. The 28-question instrument was adapted and translated to European Portuguese following a three-step protocol: translation, review, and back-translation. Subsequently, the validation process was conducted in three stages: (1) face validity through cognitive interviews; (2) content validity through external panel evaluation; and (3) performance assessment through a four-month pilot study in a tertiary neonatal intensive care unit.</p><p><strong>Results: </strong>Cultural adaptation resulted in the removal of two questions. The remaining questions were translated to Portuguese. Cognitive interviews were conducted with a convenience sample of ten parents, leading to important revisions in two questions. Five external professionals evaluated the item's relevance in a 4-point Likert scale. Four questions presented an item content validity index value below the threshold of 0.78. Two questions were adjusted and two were eliminated at this stage. The questionnaire was delivered to 31 parents, with a total of 60 questionnaires completed. Five questions were reviewed due to a non-response rate greater than 5%, and one for exceeding 95% uniform responses. No question had a dropout rate greater than 5%, nor did any have a rate of non-informative answers exceeding 5%. A significant correlation (Kendall's Tau > 0.7) was found between three sets of questions.</p><p><strong>Conclusion: </strong>The European Portuguese version of Parents' Experiences of Communication in Neonatal Care survey contains 24 questions. This is the first comprehensive and valid instrument at national level to objectively measure satisfaction with communication of parents of children admitted to the neonatal intensive care units. Its use will enable monitoring of interventions aimed at improving communication, which is crucial for enhancing family-centered care.</p>","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":"38 9","pages":"548-556"},"PeriodicalIF":1.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144938539","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":"Osimertinib: A Game-Changer in Stage IV EGFR-Driven Lung Cancer.","authors":"Sofia Silva, Joana Duarte, Carla Simão, Margarida Felizardo","doi":"10.20344/amp.22031","DOIUrl":"10.20344/amp.22031","url":null,"abstract":"<p><p>Lung cancer has a high mortality rate; however, treatment with tyrosine kinase inhibitors targeting specific molecular alterations has significantly improved the survival of patients with advanced or metastatic non-small cell lung carcinoma (NSCLC). EGFR mutations are present in approximately 15% of NSCLC cases. Osimertinib was approved in Portugal by Infarmed (Portuguese Medicines Agency) in 2021 as a first-line therapy for advanced NSCLC with EGFR sensitizing mutations. A 55-year-old man, a former smoker, presented to the Emergency Department with a six-month history of dry cough and dyspnea that had worsened and was now accompanied by fever. Chest CT revealed multifocal pulmonary consolidations that were already present in a scan performed three months earlier. Bronchial biopsies confirmed a diagnosis of lung adenocarcinoma with an EGFR exon 19 deletion. Staging tests revealed stage IV-A disease (pulmonary metastasis and, later, right adrenal metastasis identified on PET-FDG). The patient was started on osimertinib. He was discharged and progressively recovered his baseline general condition, achieving a performance status of 0 and resuming physical activity. Despite the extensive thoracic disease, the patient achieved a complete metabolic response documented on PET-CT five months after initiating therapy, along with significant clinical improvement. Osimertinib effectively inhibits the EGFR signaling pathway and has been established as the firstline treatment for patients with stage IV disease since the FLAURA trial. However, such complete responses are rare and raise further questions about the factors influencing these responses, the optimal duration of therapy in these cases, and the role of circulating tumor DNA in therapy monitoring and discontinuation decisions.</p>","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":" ","pages":"568-572"},"PeriodicalIF":1.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143956521","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":"[Recommendations for Contraception in Women with Gynecologic Cancer: From Diagnosis to Post-Treatment].","authors":"Lúcia Correia, Mariana Teves, Mónica Pires, Amália Pacheco, Fátima Palma","doi":"10.20344/amp.22396","DOIUrl":"10.20344/amp.22396","url":null,"abstract":"<p><p>The incidence of gynecologic cancer in women of reproductive age is increasing, as is the trend towards fertility-sparing treatments, highlighting the importance of safe and effective contraceptive counseling. Selecting a contraceptive method requires careful consideration of the tumor's histological subtype, its hormonal expression, and the timing of counseling within the cancer care continuum (diagnosis, treatment, and post-treatment phases). The Portuguese Society of Contraception and the Section of Gynecologic Oncology of the Portuguese Gynecological Society present recommendations about contraception in women with gynecologic cancer who have undergone fertility-sparing treatments, from diagnosis to the end of the reproductive age.</p>","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":" ","pages":"579-587"},"PeriodicalIF":1.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143951705","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":"Acute Gastroenteritis Hospitalizations in Children with and without Risk Factors: Reflections on Rotavirus Vaccination in Portugal.","authors":"Ana Laura Martins Leite de Almeida, Rui Leite, Alberto Freitas, Inês Azevedo","doi":"10.20344/amp.22954","DOIUrl":"https://doi.org/10.20344/amp.22954","url":null,"abstract":"","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":"38 9","pages":"599-600"},"PeriodicalIF":1.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144938509","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":"[Medicine for Peace: An Ethical and Professional Imperative].","authors":"Carlos Cortes","doi":"10.20344/amp.23700","DOIUrl":"10.20344/amp.23700","url":null,"abstract":"","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":" ","pages":"519-520"},"PeriodicalIF":1.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144726431","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}