Acta medica portuguesa最新文献

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.

Pregnancy is a period when adopting healthy habits, such as a balanced diet and vitamin supplementation, is crucial for maternal and fetal health. Nutritional deficiencies can lead to fetal malformations, and organizations like the Directorate-General of Health recommend supplementation with folic acid and iodine. However, guidelines for other micronutrients, such as iron and zinc, remain less defined, causing uncertainty among healthcare professionals. A descriptive study conducted between March and August of 2023 assessed the perceptions of doctors, pharmacists and women regarding supplementation. Among the 230 physicians interviewed, 89.1% emphasized the importance of preconception consultations, with folic acid being the most recommended supplement. During pregnancy, 81.7% prescribed folic acid, 49.6% iron, and 60.4% iodine. However, only two-thirds of women reported postpartum supplementation, highlighting a gap in care during this phase. Among the 433 pharmacists, 48% recognized the need for greater involvement in advising on supplementation, particularly in the postpartum period, when the demand for information increases. In a survey of 1107 women, 49% did not attend a preconception consultation, often relying on informal sources for information, which hampers adherence to medical recommendations. Despite high adherence to supplementation during pregnancy, factors such as cost and fear of side effects remain barriers. Improving counselling before, during, and after pregnancy is essential, with tailored strategies involving doctors, pharmacists, and community programs to achieve better maternal and fetal health outcomes.

Clostridioides difficile is an opportunistic pathogen that can cause a range of conditions, from asymptomatic carriage to severe illness, posing a significant public health threat due to its high mortality rates and substantial healthcare costs. Traditional treatment options, including antibiotics, often fail to eradicate the infection, leading to recurrent cases that severely impact patients' lives. Intestinal microbiota transplant (IMT) has emerged as an effective strategy for decolonizing pathogenic agents, demonstrating safety and efficacy, particularly in treating recurrent Clostridioides difficile infection (rCDI). Despite its potential, access to IMT is limited due to safety concerns, logistical challenges, and a lack of proper guidance, underscoring the urgent need for structured intestinal microbiota banks (IMBs). These organized facilities are crucial for the collection, screening, processing, and distribution of intestinal microbiota preparations, thereby facilitating the clinical application of IMT. In this narrative review, we discuss the relevance of applying IMT for the treatment of rCDI in Europe, with a focus on Portugal. We highlight the existence and distribution of IMBs across Europe and their importance in improving access to IMT. This review also addresses the challenges in creating an IMB and the development of such a structure in Portugal as a centralized repository for high-quality, standardized microbiota preparations, making IMT accessible for national hospitals. Additionally, it emphasizes the need to raise awareness among healthcare providers and the public to support the broader adoption of IMT.

Reactive infectious mucocutaneous eruption is a rare condition that predominantly occurs in pediatric patients following a respiratory infection, most commonly caused by Mycoplasma pneumoniae. It is characterized by prominent mucositis, usually with minimal or absent skin involvement. We present the case of a nine-year-old male admitted with severe oral mucositis and a penile lesion compromising bladder emptying. During hospitalization, dispersed cutaneous lesions emerged along with bilateral conjunctival hyperemia. The etiological investigation detected Mycoplasma pneumoniae in respiratory secretions, with positive IgM and IgG serology. Treatment included azithromycin, intravenous immunoglobulin and methylprednisolone, resulting in progressive clinical improvement. This case highlights the importance of recognizing reactive infectious mucocutaneous eruption. It can be challenging to differentiate from Stevens-Johnson syndrome, but it tends to have a more favorable clinical course. Early initiation of supportive care and multidisciplinary support are crucial for a good prognosis.

Multiple myeloma is a neoplasm of plasma cells that in most cases is associated with the secretion of monoclonal immunoglobulins and can involve multiple organs. Its timely diagnosis is essential to limit or avoid irreversible damage and dysfunction of target organs. Appropriate initial stratification of patients allows for optimization in the selection and sequence of therapy, as well as proper follow-up during treatment and monitoring, impacting survival. These laboratory guidelines from the Portuguese Multiple Myeloma Group provide recommendations for the diagnosis and laboratory follow-up of patients with multiple myeloma. The follow-up and diagnosis of patients with other clinically significant monoclonal gammopathies were not included in this text. This article was based on international guidelines, scientific publications, and the experience of a panel of specialists in clinical and laboratory fields dedicated to the study and treatment of multiple myeloma.