Acta medica portuguesa最新文献

Non-oncologic lower limb pain is a complex condition that influences patients' quality of life and is challenging to manage due to its multifactorial nature. Traditional pain assessment methods focus on intensity, overlooking broader patient experiences. The Best-Worst Scale (BWS) is an approach that is increasingly used in healthcare, particularly in understanding patient preferences. The aim of this study is to map the existing research, identify key concepts, evidence types, and gaps in the literature on the management and implications of non-oncologic lower limb pain with the goal of enhancing patients' quality of life using BWS methodology. A narrative review was performed and conducted between October and November 2024, in PubMed and the Revista Portuguesa de Medicina Geral e Familiar. The search strategy focused on chronic non-oncologic pain of the lower limb and another one on BWS and its application to the topic under study. From 124 articles, 16 were included. Regarding BWS, the studies describe it as a promising tool for improving healthcare research, highlighting its various applications, advantages, and limitations. They address the main concerns of osteoarthritis patients and their preferences regarding available treatments. Integrating BWS into clinical practice can lead to improved perception of pain assessment and greater patient satisfaction, shaping the treatment strategy based on patient preferences. The analysis suggests that BWS is a superior approach to other forms of assessing non-oncologic pain in the lower limbs. It may allow us to identify a mismatch between the goals of clinicians and the patient's goals. Best-worst scales to be used in this area must be carefully adjusted when in general application, and their validity and effectiveness thoroughly evaluated. Future research should focus on the implementation and development of BWS in holistic approaches, ensuring both patient-centered and evidence-based treatment. Bridging these gaps will contribute to an improvement in the quality of life of individuals suffering from non-oncologic pain in the lower limbs.

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.

Iron deficiency is a clinical condition characterized by the depletion of iron stores, potentially affecting up to 95% of pregnant women in Portugal. If not identified and treated early, this condition can progress from fatigue, tiredness and reduced work productivity to anemia, increasing the risk of maternal-fetal complications. Therefore, early detection of iron deficiency during pregnancy is crucial for promptly addressing iron deficits and preventing complications during childbirth and the postpartum period. Scientific evidence and international guidelines recognize serum ferritin as the most reliable marker for detecting iron deficiency. However, in Portugal, its measurement is not currently standardized in the pregnancy monitoring guidelines for any trimester. This lack of formal recommendation leads to a heterogeneous clinical approach, contributing to the underdiagnosis and undertreatment of iron deficiency, with a significant negative impact on maternal and fetal health. To address this gap, the Portuguese Association of Family Medicine, the Portuguese Society of Obstetrics and Maternal-Fetal Medicine, and the Anemia Working Group Portugal established a working group of four clinical experts. This group convened to develop a set of practical guidelines aimed at standardizing serum ferritin measurements across all three trimesters of pregnancy in the national healthcare system. Through these recommendations, experts aim to raise awareness among key stakeholders involved in pregnancy monitoring in Portugal and to urge national health authorities to incorporate this indicator into the digital IT systems used for pregnancy surveillance in primary healthcare. The aim of this initiative is to ensure a more effective approach to gestational iron deficiency and reduce its burden on maternal and fetal health.

This study analyses the research output expected for the final curricular evaluation of Portuguese medical residency programs, with particular focus on cardiology. All publicly available specialty-specific evaluation grids were reviewed in December 2024. Cardiology required 46 research items to attain maximum scoring, including research papers and congress abstracts stratified by journal quartile. This was the highest requirement among all specialties, compared to a median of 11 across all specialties. Uniquely, cardiology was the only specialty to quantitatively specify participation in research projects, clinical trials, and registries. In contrast, it scored below average in the most recent national residency satisfaction survey. However, no significant correlation was observed between the number of required research items and overall satisfaction. These findings suggest a potential misalignment between curricular evaluation criteria and the actual conditions of residency training. Reviewing these requirements may help create a more balanced and sustainable training environment.

Pure red cell aplasia is a rare bone marrow failure syndrome that is often overlooked, as it is potentially associated with other more common diseases. This report describes a 79-year-old man who was referred due to red cell transfusion-dependent anemia, severe reticulocytopenia, and generalized lymphadenopathies. An excisional lymph node biopsy suggested a diagnosis of follicular lymphoma. Trephine biopsy identified areas of lymphoma infiltration and a significant reduction of erythroid precursor cells. The patient was treated with four-weekly doses of rituximab; however, only after suspension of isoniazid treatment for latent tuberculosis was a complete and persistent hematologic recovery achieved. This case highlights the rarely described association between pure red cell aplasia and isoniazid in a patient with simultaneous follicular lymphoma with bone marrow involvement. Recognition of such connections is crucial for accurate diagnosis and appropriate management, as the treatment of lymphoma might not be sufficient as a sole strategy for clinical improvement.

Imported malaria remains a clinical and public health challenge in non-endemic countries. This retrospective study analyzed all adult malaria cases diagnosed at Hospitais da Universidade de Coimbra between 2020 and 2024, and the aim was to characterize the epidemiological profile, assess the impact of previous malaria history, and identify biomarkers associated with disease severity. A total of 88 patients were included, mostly male expatriates, with exposure primarily in Angola. Previous malaria history was reported in 52.3% of cases. Severe malaria was diagnosed in 25.0% of patients, being significantly more frequent among those without a prior history of the disease (p = 0.027). These patients had significantly higher creatinine (p = 0.009) and lactate dehydrogenase (p = 0.038) levels, suggesting an increased risk of complications. Urea and parasitemia were independently associated with longer hospital stay (p < 0.001 and p = 0.016, respectively), used here as a proxy for severity. These findings support the hypothesis of semi-immunity in previously exposed individuals and highlight the potential of laboratory biomarkers for clinical risk stratification. Continuous surveillance and targeted prevention strategies for non-immune and semi-immune travelers remain essential, especially in countries like Portugal, where malaria reintroduction can be a real concern.