Acta medica portuguesa最新文献

{"title":"Valproate in Psychiatric Practice: Risks to Fertility and Future Generations.","authors":"Margarida Alves, Diana Durães, Cátia Santos","doi":"10.20344/amp.22284","DOIUrl":"https://doi.org/10.20344/amp.22284","url":null,"abstract":"","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":"38 1","pages":"56-57"},"PeriodicalIF":0.8,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142918972","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":"Iron Skin Staining: A Rare but Permanent Complication Following IV Iron Infusion.","authors":"Tiago Dias da Costa, António Mateus-Pinheiro, Sónia Moreira","doi":"10.20344/amp.22136","DOIUrl":"10.20344/amp.22136","url":null,"abstract":"","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":" ","pages":"52-53"},"PeriodicalIF":0.8,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142666843","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":"[Healthcare-Associated Infections in Pediatric Patients: A Decade of Experience in an Intensive Care Unit].","authors":"Cátia Martins, Daniela Lima, Mariana Cortez Ferreira, Joana Verdelho Andrade, Andrea Dias","doi":"10.20344/amp.22279","DOIUrl":"https://doi.org/10.20344/amp.22279","url":null,"abstract":"<p><strong>Introduction: </strong>Healthcare-associated infections are an important cause of morbidity and mortality in the pediatric population and a growing problem in intensive care services. However, limited data are available on these infections in the Portuguese pediatric population. This study aimed to estimate its prevalence rate in a Portuguese pediatric intensive care unit, identifying the most frequent microorganisms and their antibiotic resistance profiles.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted, including patients admitted to a pediatric intensive care unit between January 1, 2014 and December 31, 2023, who were diagnosed with healthcare-associated infections during hospitalization.</p><p><strong>Results: </strong>A total of 248 nosocomial infections were identified, corresponding to a prevalence rate of 6.3%, mostly in infants. Pneumonia (45.2%) and bacteremia (14.5%) were the most frequent infections. Gram-negative bacteria, specifically Escherichia coli, Pseudomonas aeruginosa and Klebsiella pneumoniae, were the most common pathogens. Over the last five years (2019 - 2023), there was a global increase in antibiotic resistance. The prevalence of infections with ESBL-producing bacteria, MRSA and ERC was 8.5%, 1.6%, and 0.4%, respectively, higher in the period from 2019 to 2023. Among 97 screening tests, 45 colonizations were identified in 41 patients: 40 with ESBL and 5 with ERC, with no MRSA colonizations detected. Sepsis occurred in 29.8% of cases, and the mortality rate was 11.7%, with 4.0% directly attributed to healthcare-associated infections. Risk factors for pneumonia included exposure to endotracheal tubes and prolonged invasive ventilation (OR = 2.5; 95% CI, 1.1 to 5.9, p = 0.03; and OR = 1.9; 95% CI, 1.1 to 3.4, p = 0.011; respectively).</p><p><strong>Conclusion: </strong>Implementing effective strategies to prevent and control resistant bacteria is essential to safeguard current therapies, enhance patient safety, and protect public health.</p>","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":"38 1","pages":"23-36"},"PeriodicalIF":0.8,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142918928","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":"[Disease Caused by Filoviruses: An Update].","authors":"Rafael Marx de Andrade, Andreia Paulos, Emília Valadas, Vitor Laerte Pinto Junior","doi":"10.20344/amp.21911","DOIUrl":"10.20344/amp.21911","url":null,"abstract":"<p><p>The Marburg and Ebola viruses belong to the Filoviridae family and are known to cause emerging zoonotic diseases. These viruses have a high case fatality rate and are easily transmissible from person to person, which makes them capable of triggering outbreaks, including in non-endemic regions, and are also considered agents of bioterrorism. Fruit bats are the natural reservoirs of these filoviruses. Transmission to humans occurs through direct contact with bodily fluids or tissues from infected animals or humans. The most severe form of filovirus disease manifests as mucocutaneous hemorrhage, often accompanied by multiorgan failure, which is the main cause of death. Traditionally, these diseases are classified in the group of viral hemorrhagic fevers, although this term is being abandoned, as there are not always hemorrhagic manifestations or fever in the patient's clinical history. Currently, no specific antiviral treatment for filovirus disease exists, and the therapeutic approach consists of supportive measures. However, for the Zaire Ebola virus (EBOV), monoclonal antibodies have already been licensed for treatment and post-exposure prophylaxis, in addition to three vaccines available. Due to the public health importance and the possibility of cases outside Africa, this review aims to improve clinical knowledge and the approach to suspected cases of FD. Improved surveillance and preparedness for potential global outbreaks are essential measures to effectively respond to these public health threats and to ensure that healthcare professionals are well-informed and prepared to deal with these diseases.</p>","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":" ","pages":"42-48"},"PeriodicalIF":0.8,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142680505","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":"Interactions between Insomnia, Sleep Disordered Breathing and Cardiometabolic Risk in Patients Complaining of Pain in the Orofacial Region.","authors":"Miguel Meira E Cruz, David Gozal, Cristina Salles, Isabel Rocha, Dominik Ettlin","doi":"10.20344/amp.22350","DOIUrl":"https://doi.org/10.20344/amp.22350","url":null,"abstract":"<p><p>The existence of intersected pathways between the mechanisms of insomnia, sleep-disordered breathing and persistent/chronic pain has been documented. Such concurrence will eventually contribute to a higher burden of cardiometabolic diseases, a main cause of death worldwide. The aim of this study was to evaluate the interactions between insomnia, sleep-disordered breathing, cardiometabolic risk, and psychosocial stress in patients seeking care at an orofacial pain clinic. Anonymized data of 1236 patients seeking care at the orofacial pain unit of the University of Zurich were analysed. Prevalence data was estimated for insomnia, sleep disordered breathing/sleep apnea and increased risk of a combination of insomnia and sleep disordered breathing/sleep apnea, both regarding demographics and cardiometabolic risk factors. Psychosocial stress factors acting as additional cardiometabolic risk factors were assessed. Among patients with persistent orofacial pain, increased risk of combination of insomnia and sleep disordered breathing/ sleep apnea was present in 11.5% of cases, and it was likely to increase psychosocial stress as an aditional independent risk factor for cardiometabolic disorder.</p>","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":"38 1","pages":"37-41"},"PeriodicalIF":0.8,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142918963","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":"Atypical Leg Ulcer in an Elderly Patient.","authors":"Keyla Sousa, João Teixeira, Joana Calvão","doi":"10.20344/amp.22117","DOIUrl":"https://doi.org/10.20344/amp.22117","url":null,"abstract":"","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":"37 12","pages":"869-870"},"PeriodicalIF":0.8,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142765280","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":"Fatal Case of Immune-Related Myocarditis and Myositis Due to Treatment with Immune Checkpoint and Tyrosine Kinase Inhibitors.","authors":"João Queirós Coelho, Joana Simões, Tomás Fonseca, Sérgio Xavier Azevedo, António Araújo","doi":"10.20344/amp.21306","DOIUrl":"10.20344/amp.21306","url":null,"abstract":"<p><p>Immune checkpoint inhibitor and tyrosine kinase inhibitor combinations have become the new standard of care in the first-line treatment of metastatic clear cell renal cell carcinoma. However, there is a growing concern regarding severe immune-related adverse events. A 78-year-old man with metastatic clear cell renal cell carcinoma, treated with pembrolizumab and axitinib, was admitted to the emergency department 30 days after initiating treatment due to rapidly progressive myositis. Myocarditis with severe ventricular dysfunction was identified. Muscular biopsy findings were compatible with inflammatory myopathy associated with immune checkpoint inhibitors. Initial treatment with high-dose corticosteroids showed an insufficient response. Therapeutic escalation on the third day with methylprednisolone, immunoglobulin, and abatacept resulted in clinical improvement. On the eleventh day, a sudden malignant arrhythmia occurred, followed by cardiac arrest. This represents one of the first case reports describing myocarditis and myositis during treatment with pembrolizumab-axitinib. While immune checkpoint inhibitor may play a major role, it is also possible that the tyrosine kinase inhibitor, while attempting to promote immune modulation, also increases severe toxicities.</p>","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":" ","pages":"865-868"},"PeriodicalIF":0.8,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142455450","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":"[Diagnostic, Therapeutic and Monitoring Approach in Suspected Neurosyphilis: Proposal for a Clinical Guideline].","authors":"Bárbara Martins, Gabriela Canelas, Rafael Dias, Beatriz Prista-Leão, Cláudio Silva, Andreia Costa, André Silva-Pinto","doi":"10.20344/amp.21847","DOIUrl":"https://doi.org/10.20344/amp.21847","url":null,"abstract":"<p><p>This clinical guideline was designed to serve as a hospital guide in the diagnostic, therapeutic, and monitoring approach to neurosyphilis, considering whether there is positivity or not for the human immunodeficiency virus. Syphilis is a sexually transmitted notifiable disease, known as the great imitator. In around 30% of cases of untreated disease, there is a persistent central nervous system infection. Neurosyphilis is a severe and progressive form of syphilis, which can occur at any stage of the disease, with frequent delays in diagnosis and treatment. It is classified as early neurosyphilis (syphilitic meningitis, meningovascular neurosyphilis, or syphilitic gummas) and late neurosyphilis (syphilitic gummas, general paresis, or tabes dorsalis). The importance of lumbar puncture lies not only in its diagnostic value but also in evaluating the effectiveness of treatment. The treatment of this disease in all stages consists of parenteral penicillin. With this guideline, our aim is to facilitate clinical decision-making in cases of suspected neurosyphilis through a systematized, individualized, and multidisciplinary approach.</p>","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":"37 12","pages":"871-882"},"PeriodicalIF":0.8,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142765258","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":"Translation and Adaptation of the STOPP/START Criteria Version 3 for Potentially Inappropriate Prescribing in Older People to European Portuguese: A Study Protocol.","authors":"Daniela A Rodrigues, Fátima Roque, Maria Teresa Herdeiro, Luís Monteiro","doi":"10.20344/amp.21941","DOIUrl":"10.20344/amp.21941","url":null,"abstract":"<p><strong>Introduction: </strong>As the global population ages, managing medication use in older adults becomes increasingly complex due to polypharmacy and the associated risks of adverse drug events. To improve the safety and appropriateness of medication use in the older population, tools like the Screening Tool of Older Persons' Prescriptions (STOPP) and Screening Tool to Alert doctors to Right Treatment (START) criteria have been developed. The availability of updated criteria is crucial to better support healthcare professionals in Portuguese-speaking regions. The aim of this study is to translate and validate the STOPP/START version 3 criteria for Portuguese, providing an updated and useful tool for healthcare professionals.</p><p><strong>Methods and analysis: </strong>This study will be conducted through four phases: I) translation of the STOPP/START version 3 criteria to European Portuguese; II) collection of sociodemographic, clinical, and medication data; III) intrarater reliability study; and IV) interrater agreement study. This study obtained ethics approval by the Ethics Committee of the Administração Regional de Saúde do Centro, Portugal. The availability of the translated criteria will enable the integration of STOPP/START version 3 into clinical practice in Portugal, facilitating improved medication safety and appropriateness. This integration is expected to lead to better management of polypharmacy and a reduction in adverse drug events, ultimately enhancing patient outcomes and supporting evidence-based prescribing practices.</p>","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":" ","pages":"847-852"},"PeriodicalIF":0.8,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142611894","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":"Aphasia Screening Test (TeRAp): Construction and Validation for European Portuguese.","authors":"José Fonseca, Filipa Miranda, Beatriz Stein, Carolina Maruta","doi":"10.20344/amp.22233","DOIUrl":"https://doi.org/10.20344/amp.22233","url":null,"abstract":"<p><strong>Introduction: </strong>Aphasia is a common acquired language disorder following stroke or other brain injuries. However, it is not always easy to make a differential diagnosis with another communication disorder. Communication assessment in acute phases of the stroke, when the patient is bedridden or when there is no time for a more in-depth assessment, needs to be done with a formal screening test that has normative data. The aim of this study was to develop the Aphasia Screening Test (TeRAp) in digital format (appWeb) and present its clinimetric values.</p><p><strong>Methods: </strong>A screening test (TeRAp) was built in appWeb format that assesses the main areas of language processing and automatically provides a diagnostic hypothesis. A group of people with aphasia was evaluated and their performance was compared with three control groups, one of healthy people and two groups of people with neurological conditions, one with dysarthria and the other with mild cognitive impairment.</p><p><strong>Results: </strong>Ceiling values were obtained in all the tests. Sensitivity values of 1 and specificity values of 0.99 were obtained for the presence of aphasia.</p><p><strong>Conclusion: </strong>An online aphasia screening test was developed, with excellent sensitivity and specificity results, which can be used by any health professional.</p>","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":"37 12","pages":"831-837"},"PeriodicalIF":0.8,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142765265","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}