Acta medica portuguesa最新文献

{"title":"Operationalization of Involuntary Treatment in a Prison Setting: A Perspective in Light of the New Mental Health Law in Portugal.","authors":"Susana Pinto Almeida, Sérgio M Martinho","doi":"10.20344/amp.22684","DOIUrl":"10.20344/amp.22684","url":null,"abstract":"","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":" ","pages":"366-368"},"PeriodicalIF":0.8,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143778669","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":"Successful Management of Extensive Rhino-Orbito-Cerebral Mucormycosis: Prompt Neuroimaging-Supported Diagnosis and Aggressive Antifungal and Surgical Treatment.","authors":"Estela Carvalho Sousa, Ana Carolina Monteiro, Sara De Carvalho","doi":"10.20344/amp.22967","DOIUrl":"https://doi.org/10.20344/amp.22967","url":null,"abstract":"","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":"38 6-7","pages":"429-430"},"PeriodicalIF":0.8,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144525965","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 Portuguese Physicians' Perspective regarding the Restructuring of the Medical Career: A Cross-Sectional Study].","authors":"Guida Da Ponte, António Manuel Oliveira, Henrique Soares, João Pedro Aniceto, João Paulo Farias, Luís Filipe Silva, João Bernardo Pego, João Álvaro Correia da Cunha, Helena Ramalho","doi":"10.20344/amp.22971","DOIUrl":"https://doi.org/10.20344/amp.22971","url":null,"abstract":"<p><strong>Introduction: </strong>The medical career (MC) has been, in Portugal, a pillar and a guarantee of quality in the organization and provision of healthcare. Currently, it consists of two levels and three categories, with progression possible by two ways, both related to the remuneration system. However, we are currently witnessing a concerning stagnation in the career progression of doctors in Portugal. The main aim of this study was to evaluate the perception, opinion, and challenges related to the MC in Portugal.</p><p><strong>Methods: </strong>A questionnaire was applied to doctors registered in the Portuguese Medical Association (n = 61 317) between December 2024 and January 2025. Both quantitative and qualitative analyses were performed.</p><p><strong>Results: </strong>A response rate of 9.36% was obtained. The majority of doctors were aged between 30 and 40 years, were women, held the category of senior attending physician, worked in the public sector, and in hospital-based specialties. There was consensus on the relationship between the MC and the quality of healthcare (91.45%), the need for restructuring the MC (87.57%), the integration of residency into the MC (92.58%), the cross-sector nature of the MC (78.1%), and the association of career progression with remuneration progression (95.86%). Most doctors felt that the MC should have more levels (55.63%).</p><p><strong>Conclusion: </strong>The results support the perception of the importance of the MC for the quality of care provided. A consensus is evident among doctors regarding the need for restructuring the MC, with proposals such as the reintegration of the residency program and the creation of new technical-scientific levels. Although most doctors who responded to the questionnaire work in the public sector, there was a clear consensus about the cross-sector nature of the MC. However, the implementation of this cross-sector nature proves to be a challenge, especially when combined with the consensus that career progression should always involve a pay rise, which is crucial for the recognition of medical work.</p>","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":"38 6-7","pages":"369-376"},"PeriodicalIF":0.8,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144525958","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":"[Substance Use Disorder as a Comorbidity in Patients with Attention Deficit Hyperactivity Disorder].","authors":"Maria Inês Ribeiro, Gustavo França","doi":"10.20344/amp.21937","DOIUrl":"10.20344/amp.21937","url":null,"abstract":"<p><p>Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder manifested by inattention and/or hyperactivity and impulsivity. It is a disorder that begins in childhood but can persist into adulthood. It is associated with the emergence of various comorbidities, including, very often, the development of substance use disorders (SUD). When present simultaneously, they contribute to more severe presentations of both conditions and makes treatment more complex and challenging. Despite being different conditions, they have potentially common etiological pathways. The main aims of this article were to study the correlation between ADHD and SUD, particularly concerning the prevalence of this association, etiology and what are the best diagnostic and treatment strategies. We conclude that SUD is one of the most common comorbidities among ADHD patients, with genetic factors, neuroanatomical and neurophysiological impairments correlating both conditions. Patients with ADHD and SUD have an earlier onset of SUD, heavier abuse and worse outcomes. Special attention to this disorder is recommended in patients with ADHD. Furthermore, an active search for ADHD in patients with SUD is highly recommended, which can be carried out in the first place with self-reported scales. The appropriate treatment seems to involve a combination of pharmacological and non-pharmacological approaches, with strategies targeting both conditions.</p>","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":" ","pages":"398-407"},"PeriodicalIF":0.8,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143957512","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":"Use of ChatGPT in HIV Infection Counselling and Literacy.","authors":"José Ganicho, Maria Carlos, Gonçalo Cristóvão, Claudina Cruz, Marta Leal, Ana Raquel Garrote, Diogo Bento, Diana Seixas, Maria José Manata, Fernando Maltez","doi":"10.20344/amp.22805","DOIUrl":"https://doi.org/10.20344/amp.22805","url":null,"abstract":"<p><strong>Introduction: </strong>Artificial intelligence is an area that has been transforming various sectors of society. One of these tools is ChatGPT (chat generative pre-trained transformer), a large language model-based platform developed to understand language patterns and generate answers. The accessibility, answers in real-time, and privacy make ChatGPT a platform with enormous potential in health counseling. The aim of this study was to explore the potential of ChatGPT in health counseling and literacy regarding HIV infection and pre-exposure prophylaxis (PrEP).</p><p><strong>Methods: </strong>A team of five experts in infectious diseases was consulted regarding the five most frequently asked questions by patients regarding initial HIV diagnosis and PrEP. The questions were submitted to the ChatGPT-4 version and the quality of the answers was reviewed based on a Likert scale from 1 to 5 (from 'strongly disagree' to 'strongly agree'). The evaluation of the expert's team followed a set of eight criteria: accuracy, clarity, relevance, depth, objectivity, conciseness, timeliness, and suitability for the target audience.</p><p><strong>Results: </strong>The five most frequently asked questions by patients regarding HIV infection and the mean evaluation of the answers were: \"What does it mean to have HIV? Will I die sooner?\" (4.25), \"Does HIV infection have a cure? Will I ever be able to stop taking medication?\" (4.35), \"Can I transmit my infection to other people? How to avoid it?\" (4.03), \"What are the adverse effects of the antiretroviral treatment?\" (3.53), \"Can I have unprotected sexual relationships? What are the risks?\" (4.53). Regarding PrEP, the more frequently asked questions were: \"I want to start pre-exposure prophylaxis. Is it safe?\" (4.58), \"What are the different regimens of pre-exposure prophylaxis?\" (4.63), \"After I start taking pre-exposure prophylaxis, do I have to take it forever?\" (3.95), \"What are the adverse effects of pre-exposure prophylaxis?\" (4.63), \"Does pre-exposure prophylaxis protect against other sexually transmitted infections or do I have to use condoms?\" (4.60).</p><p><strong>Conclusion: </strong>Only two answers received a rating below four on the 1 - 5 Likert scale, highlighting ChatGPT's potential as a promising tool for health counselling and literacy, provided ethical and legal concerns are effectively addressed.</p>","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":"38 6-7","pages":"385-392"},"PeriodicalIF":0.8,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144525966","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":"Multiple Sclerosis Disease-Modifying Treatment Algorithms: 2025 Positioning of the Portuguese Multiple Sclerosis Study Group.","authors":"Carlos Capela, Ernestina Santos, Filipe Palavra, Joana Guimarães, João Cerqueira, José Vale, Lívia Sousa, Sónia Batista, Maria José Sá","doi":"10.20344/amp.22380","DOIUrl":"10.20344/amp.22380","url":null,"abstract":"<p><p>Multiple sclerosis (MS) is a chronic autoimmune-mediated neurodegenerative disease characterized by inflammation, demyelination, and axonal/neuronal damage in the central nervous system. In Portugal, the prevalence of MS is approximately 64.4 per 100 000 individuals. It is typically diagnosed in young adults aged 30 to 40, with a higher incidence in women, although it can also affect children/adolescents and the elderly. Recent advances in MS treatment include the development and approval of several new disease-modifying therapies (DMTs) such as ocrelizumab, cladribine, siponimod, and others, thus expanding options for relapsing-remitting MS (RRMS). However, the options for progressive forms of MS remain limited. In Portugal, MS management strategies, guided by the 2015 recommendations of the Directorate-General of Health and the Portuguese medicines agency, need updating to incorporate recent scientific evidence and clinical expertise. The aim of this manuscript is to highlight gaps in current Portuguese MS treatment algorithms and propose enhancements aligned with global standards, thus improving treatment selection and patient outcomes in the Portuguese healthcare system. Developed by nine Portuguese neurology experts from the Portuguese Multiple Sclerosis Study Group, this document not only provides evidence and clinical practice-based recommendations but also includes DMT algorithms tailored for various MS subtypes, including radiologically and clinically isolated syndromes, RRMS, progressive MS, and specific situations in MS treatment such as pediatric-onset MS, late-onset MS, pregnancy and breastfeeding. This document provides evidence- and clinical practice-based recommendations to optimize decision-making during MS management in Portuguese centers. The experts aim to prompt the urgent revision of national MS treatment frameworks, incorporating the latest advancements in MS research and international guidelines, to reduce the socio-economic burden on the national healthcare system and improve the long-term health outcomes of MS patients.</p>","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":" ","pages":"414-426"},"PeriodicalIF":0.8,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143959466","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":"[Ending Nuclear Weapons, Before they End Us].","authors":"Kamran Abbasi, Parveen Ali, Virginia Barbour, Marion Birch, Inga Blum, Peter Doherty, Andy Haines, Ira Helfand, Richard Horton, Kati Juva, Jose F Lapena, Robert Mash, Olga Mironova, Arun Mitra, Carlos Monteiro, Elena N Naumova, David Onazi, Tilman Ruff, Peush Sahni, James Tumwine, Carlos Umaña, Paul Yonga, Chris Zielinski","doi":"10.20344/amp.23271","DOIUrl":"https://doi.org/10.20344/amp.23271","url":null,"abstract":"","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":"38 6-7","pages":"357-359"},"PeriodicalIF":0.8,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144525956","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":"[Infective Endocarditis in Children: Challenges and Evolving Profile in Portugal].","authors":"João Fernandes Pedro, Catarina De Sousa","doi":"10.20344/amp.23314","DOIUrl":"https://doi.org/10.20344/amp.23314","url":null,"abstract":"","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":"38 6-7","pages":"360-362"},"PeriodicalIF":0.8,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144525957","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":"https://doi.org/10.20344/amp.22628","url":null,"abstract":"","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2025-05-23","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":"Clinical Outcomes of Chemo-Immunotherapy for Extensive Stage Small Cell Lung Cancer: A Real-World Single Centre Study in Portugal.","authors":"David Noivo, Maria Bragança, Ana Sofia Vilariça, Filipa Ferro, Andrea Lopes Machado, Direndra Hasmucrai, Paula Alves","doi":"10.20344/amp.22546","DOIUrl":"10.20344/amp.22546","url":null,"abstract":"<p><p>Small cell lung cancer (SCLC) is an aggressive type of lung cancer. Recent studies have provided a new hope by adding atezolizumab to the standard treatment of extensive disease SCLC (E-SCLC). The aim of our study was to evaluate the real-life performance of atezolizumab plus chemotherapy in extensive stage SCLC in a Portuguese setting. Data was collected on twenty patients (70% were male with a mean age of 66.9 years) in treatment at a tertiary hospital in Portugal with E-SCLC treated with chemotherapy and atezolizumab between July 2022 and February 2024. All patients received a carboplatin plus etoposide regimen in combination with atezolizumab. The overall response rate was 55% (95% CI: 31.5 - 76.9) and the disease control rate was 70% (95% CI: 45.7 - 88.1). The median overall survival (OS) and progression-free survival (PFS) was 9.7 (95% CI:5.08 - 14.32) and 7.17 (95% CI:3.28 - 11.05) months, respectively. In total, 13 (65%) patients experienced disease progression and 10 (50%) died during follow-up from events related to the disease. Patients with a performance status score ≥ 2 had lower PFS (p = 0.003) and OS (p = 0.001). To the best of our knowledge, this is the first real-world clinical study in Portugal to evaluate real life outcomes for this combination therapy.</p>","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143595815","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}