Acta medica portuguesa最新文献

Pediatric sarcopenia is an emerging health issue that affects muscle development, strength, and overall well-being in children and adolescents. While it was initially linked to aging, recent studies highlight its presence in younger populations, particularly among those with chronic conditions. This condition affects growth and neurodevelopment in the short term and is associated with an increased risk of long-term complications, namely metabolic and cardiovascular diseases. Several factors contribute to pediatric sarcopenia, including inadequate prenatal nutrition, low birth weight, genetic susceptibility, insufficient dietary protein intake, sedentary behaviors, obesity, metabolic imbalances, and chronic illnesses. Reduced muscle mass impairs bone health, delays growth spurts, and affects physical performance, which may result in a lower quality of life. In children with chronic diseases, sarcopenia exacerbates clinical outcomes, prolongs hospital stays, and increases the likelihood of complications. Diagnosing sarcopenia in children is complex due to differing growth patterns. Existing assessment methods, such as imaging techniques and body composition analysis, lack standardized reference values tailored to pediatric populations, which makes early detection challenging. Preventive strategies emphasize physical activity, especially resistance exercises (muscle strengthening), reduced screen time, improved dietary habits, and sleep hygiene. Innovative treatments are being explored, including targeted drug delivery to the muscle to minimize side effects, regenerative approaches utilizing nanoparticles, and myostatin inhibitors for stimulating muscle growth. Stem cell therapy and biomaterial-based muscle reconstruction are also under investigation; however, pediatric-specific therapeutic guidelines remain undefined. Early intervention is crucial for reducing its negative effects and fostering healthier developmental paths.

Introduction: Involuntary hospitalization of a patient with a mental disorder is broadly defined as the admission to an inpatient unit without the patient's consent. Literature suggests that involuntary hospitalizations are associated with low levels of treatment satisfaction, avoidance of mental health care, and an increased risk of emergency involuntary re-hospitalization. Despite being a lifesaving treatment, involuntary admissions can also be stigmatizing, undermine the long-term therapeutic relationship and reduce adherence to care. In this context, little research has been conducted to evaluate how shifting a patient's hospitalization from involuntary to voluntary affects health outcomes, such as psychiatric decompensation and healthcare use. The main aim of this study was to identify and assess the frequency of readmissions within one year among patients who transitioned to voluntary treatment, compared with those who remained involuntarily treated.

Methods: An observational retrospective study was conducted using secondary data from medical records of adult inpatients involuntarily admitted to the inpatient psychiatry department of Unidade Local de Saúde São João. All involuntary hospitalizations occurring between January 1st and December 31st, 2022, were classified into two distinct groups: patients who were initially admitted involuntarily and subsequently converted to voluntary hospitalization during their stay or patients who remained under involuntary hospitalization until discharge. Data registered in medical records within one year after the index hospitalization was collected and assessed (whether structured data or free text entries). Descriptive and comparative analyses were performed.

Results: A total of 120 patients were included. More patients converted to voluntary hospitalization (60.8%) than remained involuntarily hospitalized (39.2%). In comparison to voluntary inpatients, involuntary inpatients had significantly higher readmission rates within one year (36.2% vs 15.3%, p = 0.009) and were more often readmitted under involuntary status (88.2% vs 45.5%, p = 0.030).

Conclusion: Involuntary hospitalization was associated with worse outcomes within one year, underscoring the need for its use to be proportional to the risk and subject to periodic review. Conversion to voluntary hospitalization is reasonable, respects patient autonomy and, provided that appropriate treatment is maintained, does not worsen psychiatric decompensation.

Immune checkpoint inhibitors (ICPIs)-induced endocrine immune-related adverse events (irAEs) are common, can appear concurrently, and can be overlooked due to their nonspecific presentation overlapping with cancer-related symptoms. We describe the case of a 47-year-old woman with metastatic colorectal cancer treated with combined ICPI therapy. She presented thyrotoxicosis right after starting therapy, evolving into overt primary hypothyroidism, after two months, followed by abrupt-onset diabetes mellitus and hypophysisits-related secondary adrenal insufficiency and central hypothyroidism, six months after starting ICPIs. This case illustrates the complexity of diagnosing and managing overlapping endocrine irAEs, and the importance of high clinical suspicion. Clinical manifestations were attributed to the cancer and diabetes diagnosis, delaying recognition of adrenal insufficiency. Central hypothyroidism was initially interpreted as iatrogenic thyrotoxicosis. Glucocorticoid supplementation worsened diabetes management. Clinical and biochemical follow-up is essential in patients with ICPIs. Prompt recognition is essential to avoid life-threatening complications and ensure optimal long-term management.

A 33-year-old woman with sickle cell disease presented with severe lumbar pain. Initially stable, she experienced rapid deterioration within the first 24 hours, developing respiratory failure, fever, and impaired consciousness. Chest imaging revealed extensive bilateral infiltrates, and laboratory tests showed severe anemia, thrombocytopenia, and elevated inflammatory markers. She required mechanical ventilation, exchange transfusions, and antibiotics. Parvovirus B19 infection was confirmed. After nine days, she improved, but neurological recovery was delayed. Magnetic resonance imaging revealed cerebral microhemorrhages consistent with critical illness-associated cerebral microbleeds. She was discharged after a 34-day hospitalization. This case highlights two severe and potentially life-threatening complications of sickle cell disease, namely acute chest syndrome and critical illness-associated cerebral microbleeds, underscoring the importance of early recognition and aggressive management.

Introduction: Medical education must adapt to society's needs, ensuring that the skills acquired by students align with those perceived as necessary for high-quality medical practice. The aim of this study was to assess the perceptions of medical trainees who graduated from University of Coimbra's Faculty of Medicine between 2020/21 and 2022/23, currently working as foundation year or specialty trainee doctors, regarding competencies acquired during training. Secondarily, we aimed to evaluate differences across medical career stages.

Methods: We applied an online questionnaire (5-point Likert scale) covering five domains: general competencies, practical skills, emergency department performance, communication skills, and professional values. Descriptive and inferential statistics were applied.

Results: The sample included 381 participants (193 foundation year doctors and 188 specialty trainees). The highest-rated competencies were medical ethics, holistic patient approach, history-taking and clinical communication. Areas of perceived deficiency involved technical procedures, therapeutic management and prescribing, patient social navigation, palliative care, leadership skills and National Health Service organizational knowledge. Differences were observed between career stages in problem-solving, prescribing, team leadership and pressure management.

Conclusion: These findings highlight the need to restructure training and strengthen practical instruction and develop non-technical competencies, to better prepare future doctors for clinical challenges.

Immune checkpoint inhibitors (ICI), particularly antibodies targeting programmed death receptor-1 (PD-1) and its ligand, programmed death-ligand 1, have been rarely associated with the development of immune-mediated diabetes mellitus. To the best of our knowledge, we report the first published case of immune-mediated diabetes mellitus associated with dostarlimab-a monoclonal antibody targeting PD-1-in a 78-year-old woman diagnosed with endometrial adenocarcinoma and persistent peritoneal disease. Following six cycles of dostarlimab, she presented with diabetic ketoacidosis. Despite negative autoimmune antibodies, her relatively low HbA1c and C-peptide levels together with her clinical presentation were highly suggestive of ICI-induced diabetes mellitus. Following stabilization with intravenous fluids and insulin infusion, she was transitioned to a basal-bolus insulin regimen. Dostarlimab was discontinued, and restaging showed resolution of peritoneal disease. This case emphasizes the importance of early detection and management of ICI-induced diabetes mellitus.

High-flow nasal cannula (HFNC) is a gas delivery system that provides heated and humidified air at higher flow rates than conventional oxygen therapy. While studies on the role of HFNC as a long-term treatment for chronic respiratory failure are limited, most of them focus on patients with chronic obstructive pulmonary disease. We present the case of a woman with severe bronchiectasis and chronic hypercapnic respiratory failure under nocturnal non-invasive ventilation (NIV) and 24-hour conventional oxygen therapy, who experienced multiple and prolonged hospital admissions. Long-term daytime HFNC was initiated, maintaining nocturnal NIV, resulting in significant improvements in dyspnea, better secretion management, and a reduction in exacerbation rates. While more research is needed, HFNC should be considered for long-term management of chronic respiratory failure in patients with bronchiectasis.