Acta medica portuguesa最新文献

{"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":"https://doi.org/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":""},"PeriodicalIF":1.0,"publicationDate":"2025-08-29","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":"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":"https://doi.org/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":""},"PeriodicalIF":1.0,"publicationDate":"2025-08-27","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":"Dorsal Hand Involvement in Porphyria Cutanea Tarda.","authors":"Gilberto Pires da Rosa, Manuel Bernardo Costa, Alberto Mota","doi":"10.20344/amp.23220","DOIUrl":"https://doi.org/10.20344/amp.23220","url":null,"abstract":"","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144938521","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":""},"PeriodicalIF":1.0,"publicationDate":"2025-08-19","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":"January 2021 and COVID-19 in Portugal: The Deadliest Month since 1919.","authors":"Filipe Froes, Marta Reis, António Diniz","doi":"10.20344/amp.23023","DOIUrl":"https://doi.org/10.20344/amp.23023","url":null,"abstract":"<p><p>The COVID-19 pandemic was the second pandemic of the 21st century and lasted 1150 days, from March 11, 2020, to May 5, 2023. It was one of the deadliest pandemics of the last century, alongside the 'Spanish flu' pandemic of 1918-1919. In Portugal, it was responsible for the deaths of 26 655 residents, with the year 2021 recording the highest mortality, with 11 991 deaths. In the first three years of the pandemic, all-cause mortality in Portugal exceeded 1200 deaths per 100 000 inhabitants, representing the highest values since 1957. The greatest impact of the pandemic occurred between December 2020 and February 2021, with 37 days of more than 4000 hospital admission beds occupied daily, 39 days of more than 600 intensive care unit beds occupied daily, and 20 days with more than 200 daily deaths. The month with the greatest impact was January 2021, with 5805 deaths due to COVID-19. The peak of hospital admissions occurred on January 31, 2021, with 6869 beds occupied, and the peak of mortality was on January 30, 2021, with 297 deaths. In absolute numbers, the monthly all-cause mortality in January 2021 in Portugal was the highest recorded since 1919.</p>","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144783204","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":"Sporotrichosis with Bone and Joint Manifestations: A Diagnostic Challenge.","authors":"Bernardo Reis Simões de Jesus, Daniel Pires Penteado Ribeiro, Márcio Luí S Duarte","doi":"10.20344/amp.23062","DOIUrl":"10.20344/amp.23062","url":null,"abstract":"","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":" ","pages":"514-515"},"PeriodicalIF":1.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144172302","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":"Magnetic Resonance Imaging in Multiple Sclerosis: An Analysis of the Implementation of the Portuguese Consensus.","authors":"Alyne Cordeiro, Ana João Marques, Ana Rita Castro, Cristiana Silva, Duarte Carapinha, Francisca Ferreira, Miguel Schön, Daniela Jardim Pereira, João Paulo Gabriel, Luís Ruano, Mariana Santos, Miguel Grunho, Mónica Santos, José Vale, Maria José Sá, Ricardo Soares Dos Reis","doi":"10.20344/amp.22637","DOIUrl":"10.20344/amp.22637","url":null,"abstract":"<p><strong>Introduction: </strong>Magnetic resonance imaging (MRI) plays a critical role in diagnosing and monitoring people with multiple sclerosis (MS). The 2020 Portuguese Consensus on Magnetic Resonance Imaging in Multiple Sclerosis aimed to standardize MRI use. This study evaluated the implementation of the consensus in clinical practice.</p><p><strong>Methods: </strong>This is an observational, retrospective, longitudinal and multicentric study comprising patients diagnosed with MS between 2019 and 2022 from seven hospital centers in Portugal. We collected demographic data and details regarding MRI requests, protocols, and reports. We performed descriptive and comparative analyses between the period before and after guideline publication.</p><p><strong>Results: </strong>We included 242 patients, mainly female (66.0%), with a mean age of 37 (SD 13). A total of 989 MRIs were performed, 69.1% follow-ups, 68.1% brain MRIs, and 31.9% spinal cord MRIs. Around half of the MRI requests fulfilled all the recommended information. All mandatory sequences in the neuroimaging protocol were performed in 82.5% of brain MRIs and 71.1% of spinal cord MRIs. None of the reports fulfilled all the suggested parameters. Magnetic resonance imaging technical description and imaging findings had the least compliance, mainly concerning gadolinium information (0.85%), lesion load (18.6%), and atrophy characterization (27.1%). After the implementation of the consensus, physicians reported the MS phenotype more often (p < 0.05) and neuroradiologists reported more technical parameters (p < 0.05). When MRIs were performed in a private setting, neuroimaging protocols were similar, but the reports fulfilled more frequently the suggested topics regarding the conclusion (p < 0.05).</p><p><strong>Conclusion: </strong>This study suggests incomplete adherence to the Portuguese Consensus on MRI in MS. Information provided by the physician in MRI requests was often insufficient, which could hamper MRI protocol planning. Magnetic resonance imaging reports were frequently lacking relevant information for the diagnosis and follow-up of MS patients. Further efforts are needed to ensure full implementation and optimize MS care.</p>","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":" ","pages":"446-459"},"PeriodicalIF":1.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144558774","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":"Subdural Hematoma in an Infant with Glutaric Aciduria Type 1: A Case Report on Conservative Management.","authors":"Lúcia Marques, Patrícia Lipari Pinto, Hugo Loureiro Cadilha, Patrícia Janeiro, Ana Gaspar","doi":"10.20344/amp.23093","DOIUrl":"10.20344/amp.23093","url":null,"abstract":"<p><p>Glutaric aciduria type 1 is an inherited metabolic disorder associated with subdural hematomas, possibly due to the widening of external cerebrospinal fluid spaces. We present the case of an infant with macrocephaly since birth, diagnosed with glutaric aciduria type 1 through newborn screening, who exhibited accelerated cephalic growth during follow-up. At eight months of age, cranial magnetic resonance imaging revealed bilateral subdural hematomas with intracranial mass effect. The infant displayed no signs of intracranial hypertension, history of trauma, or signs of abuse. Although surgical treatment was considered, a multidisciplinary discussion led to the decision to manage conservatively with close monitoring. The patient remained clinically stable, and imaging showed a clear reduction in the dimensions of the hematomas. This case highlights that conservative management can be an effective approach for large subdural hematomas with mass effect in glutaric aciduria type 1, provided there is no associated symptomatology, thereby avoiding the risk of metabolic decompensation.</p>","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":"38 8","pages":"496-501"},"PeriodicalIF":1.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144797941","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":"Gender Incongruence in Adolescents: Experience of a Tertiary Care Center in Portugal.","authors":"Joana Glória, Joana Vieira de Melo, Ana Raquel Henriques, Carla Pereira, Maria de Lurdes Sampaio","doi":"10.20344/amp.22705","DOIUrl":"10.20344/amp.22705","url":null,"abstract":"","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":" ","pages":"516-517"},"PeriodicalIF":1.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144281954","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":"[Authorization Processes for Access to Hospital Clinical Records: The Case of a Multicenter Study].","authors":"Rafael Rocha, Carla Maia, Luzia Gonçalves, Cláudia Conceição","doi":"10.20344/amp.22816","DOIUrl":"10.20344/amp.22816","url":null,"abstract":"<p><p>Clinical practice generates a wealth of data daily, collected for the purpose of providing healthcare. However, this data holds the potential to contribute to the generation of knowledge. The aim of this study was to describe the process of submitting requests for access to clinical records for research and the heterogeneity in the evaluation of a national research project by the boards of directors and ethics committees of hospitals, hospital centers, and local health units within the Portuguese national health service. The procedures and waiting times are described. The results of this study highlight considerable variability in the process of submitting requests for access to clinical data and the evaluation of research protocols. They also reveal lengthy waiting times for obtaining authorizations. This study underscores the urgent need to continue the discussion on the ethical and legal issues involved in studies requiring access to clinical records or other health data.</p>","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":" ","pages":"480-483"},"PeriodicalIF":1.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144141083","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}