Acta medica portuguesa最新文献

{"title":"Automated Adjustment of the Fraction of Inspired Oxygen (FiO2) and the Time Spent in Normoxemia in Preterm Infants.","authors":"Gustavo Rocha, Paulo Soares, Filipa Flor-de-Lima, Rita Amaral","doi":"10.20344/amp.22397","DOIUrl":"10.20344/amp.22397","url":null,"abstract":"<p><strong>Introduction: </strong>The challenge of maintaining normoxemia in preterm infants undergoing respiratory support and oxygen therapy has led to the development of closed-loop automatic control systems for FiO2. The aim of this study was to assess the effectiveness of these systems in maintaining SpO2 within a target range (90% - 94%) in preterm neonates receiving supplemental oxygen.</p><p><strong>Methods: </strong>We conducted a single-centre prospective study over a three-year period (2020 - 2023) including preterm infants with a gestational age < 33 weeks who received supplemental oxygen within the first 24 hours of life and either invasive or non-invasive respiratory support. The closed-loop automatic control of FiO2 used was the Predictive Intelligent Control of Oxygenation feature on Fabian® ventilators. Two groups were randomized and compared, one receiving automatic plus manual control of FiO2, and the other receiving routine manual control. Uni- and multivariable regression analyses (linear or Poisson) were used to evaluate the association between the use of closed-loop automatic control of FiO2 and the parameters of manual adjustments, hypoxemia, hyperoxemia, and normoxemia.</p><p><strong>Results: </strong>The study included 89 patients, of which 45 received automatic plus manual control of FiO2 and 44 received routine manual control. The first group required fewer manual adjustments of FiO2, experienced fewer episodes of hypoxemia and hyperoxemia (p < 0.002), and spent more time with SpO2 within the target range (p < 0.001), compared to the second group. After adjustment for confounding, the total time spent in normoxemia was higher when in automatic plus manual control of FiO2 (β = 81.5; 95%CI: 47.9 - 115.2, p < 0.001).</p><p><strong>Conclusion: </strong>The use of closed-loop automatic control of FiO2 seems feasible and was associated with fewer episodes of hypoxia and hyperoxia, thereby maintaining SpO2 within normal limits for longer periods. Additionally, it has been shown to be associated with a reduction in manual interventions.</p>","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":"38 4","pages":"208-216"},"PeriodicalIF":0.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143787551","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":"[Practical Guidance on the Detection of NTRK Fusions in Sarcomas: Current Status and Diagnostic Challenges].","authors":"Isabel Fernandes, Daniela Macedo, Emanuel Gouveia, Ana Ferreira, Jorge Lima, Dolores Lopez, Cecília Melo-Alvim, Alice Carvalho, Paulo Tavares, Paulo Rodrigues-Santos, Pedro Cardoso, Manuel Magalhães, Paula Vieira, Joaquim Brito, Cristina Mendes, Joana Rodrigues, Eduardo Netto, Vânia Oliveira, Catarina Sousa, Miguel Henriques Abreu, Filomena Pina, Hugo Vasques","doi":"10.20344/amp.21925","DOIUrl":"10.20344/amp.21925","url":null,"abstract":"<p><p>Sarcomas are a rare and heterogeneous group of mesenchymal malignant tumors and account for approximately 1% of all adult cancers and around 20% of all pediatric solid tumors in Europe. Technology advances have enabled a more accurate and efficient characterization of the molecular mechanisms underlying the pathogenesis of sarcoma subtypes and revealed novel and unexpected therapeutic targets with prognostic/predictive biomarkers, namely the neurotrophic tyrosine receptor kinase (NTRK) gene fusion. The NTRK fusion assessment has recently become a standard part of management for patients with unresectable locally advanced or metastatic cancers and has been identified in various tumor types. In the more prevalent adult and pediatric sarcomas, NTRK fusions are present in 1% and 20%, respectively, and in more than 90% of very rare subsets of tumors. The inhibition of TRK activity with first-generation TRK inhibitors has been found to be effective and well tolerated in adult and pediatric patients, independently of the tumor type. Overall, the therapeutic benefit to those patients compensates for the difficulties of identifying NTRK gene fusions. However, the rarity and diagnostic complexity of NTRK gene fusions raise several questions and challenges for clinicians. To address these issues, an expert panel of medical and pediatric oncologists, radiologists, surgeons, orthopedists, and pathologists reviewed the recent literature and discussed the current status and challenges, proposing a diagnostic algorithm for identifying NTRK fusion sarcomas. The aim of this article is to review the updated information on this issue and to provide the experts' recommendations and practical guidance on the optimal management of patients with soft tissue sarcomas, infantile fibrosarcoma, gastrointestinal stromal tumors, and osteosarcoma.</p>","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":"38 4","pages":"266-275"},"PeriodicalIF":0.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143787540","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":"[Congenital Sideroblastic Anemia and Iron Overload in Older Age].","authors":"Mariana Gradim, Fátima Ferreira","doi":"10.20344/amp.22803","DOIUrl":"https://doi.org/10.20344/amp.22803","url":null,"abstract":"","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":"38 4","pages":"279-280"},"PeriodicalIF":0.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143787519","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":"Differences in the Psychopharmacological Trajectories of School-Age Children with Attention-Deficit/Hyperactivity Disorder with and without Intellectual Disability.","authors":"Francisca Bastos Maia, Vânia Martins Miranda","doi":"10.20344/amp.20712","DOIUrl":"10.20344/amp.20712","url":null,"abstract":"<p><strong>Introduction: </strong>Attention-deficit/hyperactivity disorder (ADHD) affects 5% - 7% of school-aged children, while intellectual disability (IDD) affects approximately 1% of the general population. Diagnosing and treating ADHD in individuals with IDD is challenging, not only due to communication difficulties but also because of psychiatric comorbidities that may be present. These factors can result in underdiagnosis of ADHD and increased prescribing of other psychotropic medications. The aim of this study was to determine differences in psychopharmacological treatment (number of prescribed psychostimulants, inefficacy, adverse effects) and in the number of comorbidities and other prescribed psychotropic drugs between patients with ADHD, with and without ID.</p><p><strong>Methods: </strong>In the study, 845 children were included, divided into two groups: 574 with ADHD without ID and 271 with ADHD with ID. Microsoft® Excel® was used to calculate the Student's t-test, and statistical significance was assumed using the standard p-value of < 0.05.</p><p><strong>Results: </strong>No significant differences were found in the average number of psychostimulants prescribed between groups (p = 0.57). Among those with ADHD without ID, 52.4% switched psychostimulants, while in the group with ADHD and ID, this change occurred in 56.1%. Statistically significant differences were found in the average number of other psychotropic medications prescribed per patient (p < 0.05) and in the number of antipsychotics prescribed (p < 0.05). Although our study showed more antipsychotic prescriptions for patients with ID compared to those without ID, some studies report similar use of antipsychotics between these groups. Additionally, the group with ID presented significantly more comorbidities than the group without ID (p < 0.05). These findings are aligned with the literature, which indicates a higher prevalence of psychiatric comorbidities in samples of patients with ID compared to those without ID (50% vs 18%).</p><p><strong>Conclusion: </strong>Individuals with ID are diagnosed with more psychiatric comorbidities and are prescribed more psychotropic drugs. Additionally, more adverse effects and inefficacy with psychostimulants in ID populations require careful monitoring after initiation.</p>","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":"38 4","pages":"228-236"},"PeriodicalIF":0.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143787506","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":"[Perception of Health-Related Quality of Life in Stroke Patients in a Continuing Care Unit: A Follow-Up Study].","authors":"José Grilo Gonçalves, Manuel Teixeira Verissimo, Daniela Figueiredo","doi":"10.20344/amp.22181","DOIUrl":"10.20344/amp.22181","url":null,"abstract":"<p><p>Stroke continues to be one of the main causes of death in Portugal, with a prevalence rate of 8% in individuals aged 50 or over. The objectives of this study were to evaluate the perception of quality of life (QoL) related to health in patients with stroke, after discharge from the Integrated Continuing Care Unit (UCCI), and to evaluate the factors that influence health-related QoL. An observational, longitudinal and descJá agora riptive study was carried out with patients aged 65 years or older with a history of stroke and hospital discharge in central Portugal. They were observed in two time points: six and 12 months after discharge from the UCCI. Data was collected using self-completion questionnaires, namely the Portuguese version of the Stroke Scale Quality of Life (SS-QoL). Considering follow-up losses, a total of 128 individuals were included. All SS-QoL dimensions showed improvements from six to 12 months post-discharge. The variables \"personality\" and \"mental capacity\" showed the best evolution. The present study allows us to understand the evolution of the QoL of these users, including the most affected factors over time and that influence post-stroke rehabilitation.</p>","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":"38 4","pages":"245-249"},"PeriodicalIF":0.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143787536","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":"Ramsay Hunt Syndrome: Clinical Presentation, Diagnostic Challenges, and Treatment Efficacy.","authors":"Pedro Henrique Segatt, André Dias Almeida Mucci de Aguiar, Bruno Fernandes Barros Brehme de Abreu, Marcelo de Queiroz Pereira da Silva, Márcio Luí S Duarte","doi":"10.20344/amp.22534","DOIUrl":"https://doi.org/10.20344/amp.22534","url":null,"abstract":"","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":"38 4","pages":"283-284"},"PeriodicalIF":0.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143787597","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":"PRIMARY-HF: Heart Failure Screening in Primary Care using Point-of-Care.","authors":"Jonathan Dos Santos, João Pedro Nobre, João Pedro Ferreira, Maria Inês M Marques, Miguel Henriques, Nuno Cardim, Tiago Villanueva, Alexandra Gonçalves","doi":"10.20344/amp.22463","DOIUrl":"10.20344/amp.22463","url":null,"abstract":"<p><strong>Introduction: </strong>Heart failure is a major health challenge with high morbidity and socioeconomic burden, especially when diagnosis is delayed. In primary care, HF detection can be challenging due to symptoms overlapping with other conditions, limited access to diagnostic tools, and resource constraints. This study explores the use of natriuretic peptides (NT-proBNP) and point-of-care ultrasound (POCUS) with artificial intelligence integration as tools to improve HF screening and management in primary care. This study aims to determine whether NT-proBNP testing alone or combined with cardiac POCUS improves heart failure diagnosis and management in primary care settings, and to evaluate the cost-effectiveness of this approach.</p><p><strong>Methods: </strong>This randomized controlled trial will involve patients aged 50 or older with suspected HF or cardiovascular risk factors, recruited across four primary care centers. Participants will be randomly assigned to one of four groups: standard of care (SoC), SoC with NT-proBNP, SoC with NT-proBNP and POCUS, and SoC with POCUS. Primary outcomes include new HF diagnosis, initiation of guideline-directed medical therapy, and improvement in health-related quality of life. Secondary outcomes include cost-effectiveness and the quality assessment of POCUS performed by trained primary care physicians. The integration of NT-proBNP and POCUS in primary care may enhance early heart failure diagnosis, optimize therapy, improve patient quality of life, and reduce healthcare costs associated with heart failure misdiagnosis and delayed treatment. This study could support the broader adoption of accessible diagnostic tools to improve heart failure management in primary care.</p>","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":" ","pages":"237-244"},"PeriodicalIF":0.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143490347","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":"Recurrent Syncope During Migraine Attacks.","authors":"Mariana Dias da Costa, Beatriz Nunes Vicente, Filipa Dourado Sotero, Isabel Pavão Martins","doi":"10.20344/amp.22134","DOIUrl":"10.20344/amp.22134","url":null,"abstract":"<p><p>Migraine is a cyclic condition with attacks consisting mainly of intense headaches, sensory intolerance, and nausea or vomiting. Loss of consciousness during attacks is often attributed exclusively to a neurally mediated reflex to pain, although it may also be due to migraine's autonomic impairment, with cardiac conduction abnormalities, probably in relation to a degree of reduced sympathetic function. We report the case of a 51-year-old woman presenting episodes of syncope exclusively after vomiting during migraine attacks. A 24-hour Holter monitoring performed during a migraine attack disclosed an intermittent complete atrioventricular block coincident with an episode of syncope. The patient was implanted with a pacemaker without further syncopes on subsequent attacks. This case highlights the importance of clinical suspicion and investigation of syncope during migraine attacks. Recurrent syncope during migraine should not be attributed to pain to avoid misdiagnosis and ensure the treatment of other important causes of syncope.</p>","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":" ","pages":"182-184"},"PeriodicalIF":0.8,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142738000","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":"[Papulonecrotic Tuberculid as Manifestation of Lymph Node Tuberculosis].","authors":"José Ramos, Hugo Leme, Ângela Roda, João Alves","doi":"10.20344/amp.22669","DOIUrl":"10.20344/amp.22669","url":null,"abstract":"","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":" ","pages":"199-200"},"PeriodicalIF":0.8,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143389844","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":"Cutaneous Manifestations Related to Glycemic Control.","authors":"Alexandra Ramos Rodrigues, Ana Luísa Matos, Carlos Pedro Mendes","doi":"10.20344/amp.22239","DOIUrl":"10.20344/amp.22239","url":null,"abstract":"","PeriodicalId":7059,"journal":{"name":"Acta medica portuguesa","volume":" ","pages":"185-186"},"PeriodicalIF":0.8,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143073268","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}