Ahead of Print

  • Magnetic Resonance Imaging Role in Metastatic Liver Disease

    O Papel da Ressonância Magnética em Doença Hepática Metastática

    Tomás França de Santana, José Laert, Nuno Lupi Manso, Gustavo Felipe Luersen, António Pedro Matos

    The objective of this study is to provide a comprehensive overview of the utilization of magnetic resonance imaging (MRI) in the identification, characterization, and monitoring of liver metastatic disease, in contrast to alternative imaging modalities, through a bibliographical review and illustrative examples from the author’s clinical practice.
    The advantages of MRI in this specific context will be explored, emphasizing the utility of hepatospecific contrast agents and the limitations associated with alternative imaging modalities.
    A comparative analysis of these methods shows that MRI is the most sensitive and specific modality, even more so when using hepatospecific contrast agents, proving to have cost-effectiveness benefits in patient management.
    It is the authors’ opinion that, provided the technique is available, oncological patient staging where hepatic metastatic disease is a concern should include an abdominal MRI, if possible, with hepatospecific contrast.

    Date: 2024-05-07
  • Efeitos do Uso de Chupeta no Sucesso e Duração da Amamentação

    Effects of Pacifier Use on the Success and Duration of Breastfeeding

    João Nunes Sousa, Raquel Peixoto, Maria Inês Ferreira

    Pacifiers are an integral part of homes around the world, when a newborn is present. Its use has become a culturally rooted habit, followed by most parents/caregivers, but fears have arisen that the use of this object could have a negative influence on the success of breastfeeding.
    This review article presents the most recent results from the literature on the influence of pacifiers on breastfeeding, addressing the importance of breastfeeding and the main advantages and disadvantages of pacifier use. Observational studies show a possible correlation between pacifier use and breastfeeding failure, but this association has not been confirmed in more robust studies such as randomized clinical trials.
    In view of the scientific evidence presented, the authors consider that pacifier should be used, if that is the parents’ will, making a shared and informed decision.

    Date: 2024-05-07
  • Fenómeno Harlequin: um Recém-Nascido com Duas cores

    Harlequin Phenomenon: a Newborn with Two Colours

    Gustavo Teixeira, Mariana Domingues, Diana Simão Raimundo, Ana Laura Esteves
    Date: 2024-05-07
  • Incumprimento Terapêutico: O Grande Fator de Risco

    Non-Adherence to Treatment: The Great Risk Factor

    Dina Isabel Campos

    Non-adherence to treatment it is quite common and underestimated in an increasingly aging population and hand in hand with multimorbidity, compromising outcomes and increasing healthcare costs. Adherence is a dynamic process simultaneously influenced by multiple factors, related or not to the patient, that must be considered before and after prescription and subject to continuous monitoring over time. Addressing these factors and adapting them individually, with reinforcement of intrinsic motivation and involvement of the patient in the therapeutic strategy can be one of the most effective measures in combating chronic diseases and, consequently, improving health outcomes.

    Date: 2024-05-07
  • Miopericardite por SARS-CoV-2: A Propósito de um Caso

    Myopericarditis by SARS-CoV-2: A Case Report

    Eulália Antunes, Joana Lopes, Carla Campinho Ferreira, Sofia Caridade, Vânia Gomes, Isabel Silva

    SARS-CoV-2 infection can be followed by several cardiovascular complications such as pulmonary thromboembolism, myocardial injury and pericarditis.
    This case refers to a 48-year-old man with a one year history of unstable angina who presented to the emergency department with chest pain, dyspnea, dry cough and fever. He was admitted with the diagnosis of pulmonary thromboembolism associated with pulmonary infarction and pneumonia. During hospitalization he developed chest pain. The electrocardiogram showed slight elevation of the ST segment with superior concave slop in the inferior and lateral leads and depression of the PR interval. In addition, there was an increase in myocardial necrosis markers, raising the suspicion of myopericarditis. Given a history of flu-like syndrome in the 3 weeks before admission, he collected serology for SARS-CoV-2 with an IgG value > 100 u/mL (cut-off of 10 u/mL). Lysine acetylsalicylate was started with resolution of chest pain. Three months later, the patient was asymptomatic with reversal of the electrocardiographic findings.

    Date: 2024-05-07
  • Reusable Diapers and Motor Development: Is There any Influence?

    Fraldas Reutilizáveis e Desenvolvimento Motor: Existe alguma Influência?

    Marta Barros, Mariana Sá Pinto, Joana Brandão Silva, Maria Adriana Rangel
    Date: 2024-05-07
  • Manuel José Leitão e os Primórdios da Neurocirurgia em Portugal: Diagnóstico e Tratamento das Fracturas Vertebrais

    Manuel José Leitão and the Beginning of the Neurosurgery in Portugal: Diagnosis and Treatment of Vertebral Fractures

    Rui Pires de Carvalho, Carlos Vieira Reis

    Several Portuguese surgeons of the eighteenth and early nineteenth centuries wrote and published treatises of relevance to the time on anatomy and surgery. An example of a surgeon that strived for theoretical and practical progress in these areas is that of Manuel José Leitão, Surgeon of the Royal House, Examiner of the Board of “Protomedicato”, Major Surgeon of the Cavalry Regiment of Chaves and Professor of Anatomy and Surgery of the Military Hospital of the same city, at the end of the eighteenth century.

    Date: 2024-03-14
  • Avaliação da Formação em Medicina Interna no Internato Formação Geral

    Evaluation of the Internal Medicine Internship in General Residency

    Diogo Dias, Filipe Alfaiate, Ana Vieira, Sandra Lucas, Andreia Bernardino

    INTRODUCTION: General population and medical community are focused on the urge of medical education. The portuguese general residency (Internato de Formação Geral) is the first step for clinical practice in our country. To improve medical education in our unit, the authors decided to evaluate the Internal Medicine rotation.
    METHODS: A questionnaire using Likert scales was sent to the 48 medical residents who completed the Internal Medicine rotation between 2020 and 2021. We evaluated the unit’s capacity to integrate these doctors, as well as to promote moments that help them to acquire autonomy and knowledge.
    RESULTS: We obtain 24 (50%) answers. 21% of the residents were not introduced to the unit and rotation goals were not communicated in 63% cases. Said to have been well received in the medical team 79%. Educational moments were classified as sufficient or less in 54%, however 63% categorized high their learning.
    CONCLUSION: After analysing the results, we proposed changes to improve medical education in our unit. Internal Medicine, with its holistic approach and broad range of pathologies, it’s an essential pilar of medical education that should not be diminished.

    Date: 2024-03-04
  • Dilemas Éticos no Idoso em Cuidados Paliativos

    Ethical Dilemmas in the Elderly in Palliative Care

    Gonçalo Soares
    Date: 2024-03-04
  • Reflexão Crítica sobre Saúde Mental na Infância e na Adolescência, em Portugal

    Critical Reflection on Child and Adolescent Mental Health, in Portugal

    Tânia B. Cavaco, Filipa Martins Silva

    Child and Adolescence Mental Health is a clinical area in growing demand in care, resulting in increased health care needs, the response to which has not been accompanied by proportional investment and financing in this area, in Portugal. In addition to these problems, there is a great shortage of mental health professionals, along with a centralization of these professionals in large urban centers. This insufficient response has also repercussions at different levels of treatment, particularly in community instances and specialty consultancy work.
    This is also the case in more differentiated outpatient, acute inpatient or residential inpatient regimes, such as in Training and Autonomy Residences, for teenagers, within the scope of continued care. Also in the social sector, the supply appears to be unresponsive and below the needs of young people, as we find a saturated system, with poorly specialized professionals and great turnover of technicians in institutions. This leads to perpetuation of cycles of greater psycho-affective instability and psychopathological worsening for more vulnerable young people. We are faced with a framework that is more conducive to the development and maintenance of mental disorders, and greater clinical severity, making preventive intervention increasingly important, although prevention and public health policies are still insufficient to meet national needs. Faced with a saturated system and a shortage of human resources, the use of coercive measures may become more common, particularly in children and adolescents, who must be monitored and integrated within the scope of quaternary prevention. Despite adversities across health and social systems, it is important to promote patients’ respect and autonomy, ensuring their integrity and informed consent, in light of the mental health law.

    Date: 2024-03-04
  • Hipocalcemia Sintomática Tardia: Um Relato de Caso

    Late Symptomatic Hypocalcemia: A Case Report

    Sofia Machado, Jéssica Tavares

    Secondary hypoparathyroidism is a possible consequence after total thyroidectomy. This leads to the risk of hypocalcemia and the consequent associated symptoms that fluctuate from mild cases such as paresthesias and cramps, to severe cases such as laryngospasm or arrhythmias. Usually, the symptoms appear in the post-operative period, and its late manifestation is not frequent.
    We present a case of an 86-year-old patient with a history of thyroid dysfunction, with a presentation of late hypocalcemia, whose motor manifestations triggered etiological investigation and subsequent articulation with secondary health care.
    When faced with a patient with suspected hypocalcemia, it is important to perform a complete physical examination, along with an analytical study and subsequent ion replacement. In acute situations, the patient should be evaluated in a hospital emergency room. Due to the longitudinally of care, the family physician is responsible
    for clinical suspicion and management of late presentations of uncommon clinical cases.

    Date: 2024-02-21
  • Tiroide Lingual: Apresentação de Caso Clínico

    Lingual Thyroid: A Case Report

    Patrícia Lopes, Cristina Bacelar, Inês Sousa, Tiffany Leite Costa

    Hypothyroidism is a common disease, usually managed in primary health care. In its initial study, it is important to consider the hypothesis of lingual thyroid, even though it is a rare anomaly.
    Female patient, 48 years old, recently transferred from another health unit, presents for her first doctor appointment. When asked, mentions that in her early adolescence, after a thyroid ultrasound, she was informed that “born without thyroid” (sic), being medicated with levothyroxine 0.175 mg once a day since then. As a relevant family history, mentions that her mother and niece have thyroid pathology. On physical examination, there was no thyroid tissue in its normal pre-tracheal location.
    The thyroid ultrasound performed revealed the absence of thyroid in its usual topography. The analytical study of thyroid function revealed no changes. Thyroid scintigraphy was then requested, which demonstrated a focus of radiopharmaceutical uptake in the topography of the mouth, compatible with functioning thyroid tissue in an ectopic location. The patient was referred to a general surgery consultation and proposed for ectopic thyroid resection surgery, which was uneventful.
    In this case, the investigation triggered by the suspicion of a rare entity, even years after the initial diagnosis of hypothyroidism was central, showing the privileged position of the family doctor in the study and guidance of their patients.

    Date: 2024-02-21
  • Ver de Fora para Dentro: Um Caso de Leucemia Cutis no Contexto de Leucemia Linfoide Crónica

    Look from Outside In: A Case of Leukemia Cutis in the Context of Chronic Lymphoid Leukemia

    Mariana Assis Rocha, Ermelindo Tavares

    Chronic lymphoid leukemia is the most common leukemia in Western countries, appearing at an average age of 70 years. Its etiology is not known, but it is thought that genetic and environmental factors may have an influence.
    Male, 68 years old, with a 2-year history of chronic lymphoid leukemia. It started about 6 months ago, with papular lesions on the scalp and face. A biopsy was performed with a histological result compatible with leukemia cutis.
    Leukemia cutis is characterized by a neoplastic infiltration on the skin. Its prevalence varies depending on the type of leukemia associated, and it can present in multiple ways and in different locations. Although chronic lymphoid leukemia is the most common leukemia worldwide, leukemia cutis is more frequent in acute myeloid leukemia. Since it is a systemic manifestation of poor prognosis, it is important that we take it into account.

    Date: 2024-01-17
  • Uma Surpresa ao Nascimento: A Propósito de um Caso Clínico

    A Surprise at Birth: Description of a Case

    Sofia Azevedo Vale, Bárbara Mendes Pereira
    Date: 2024-01-16
  • Uterine Niche: A Pathology to Consider

    Nicho Uterino: Uma Patologia a Considerar

    Francisca Mendes, Joana Balseiro, Filipa Alves, Joana Sousa, Joana Teles Sanches, Joana Alves

    Uterine niche is a recess located in the anterior wall of the uterine isthmus, over the cesarean section scar. This condition is often asymptomatic, but it can be associated with symptoms such as abnormal uterine bleeding, pelvic pain and secondary infertility. Endovaginal ultrasound is the first-line diagnostic method. Treatment includes hormonal methods or surgery, and surgical treatment seems to be the most effective in resolving symptoms. We describe the case of a 37-year-old woman, with an obstetric history of a pregnancy with cesarean delivery, who complained of pelvic pain and menstrual irregularity. An endovaginal ultrasound was requested, which reported the presence of a “… echogenic oval formation with well-defined limits measuring 28x17 mm in the topography of the cesarean scar.” After a clinical discussion with a doctor specializing in Gynecology, the patient was referred to a hospital consultation in this specialty for investigation. The diagnosis of uterine niche was confirmed, and the treatment consisted of the placement of an intrauterine system.

    Date: 2023-11-10
  • Um Caso Bicudo: Um Relato sobre um Pneumotórax

    A Sharp Case: A Report of a Pneumothorax

    Pedro Pereira, Iolanda Silva, Joana Alves, Mélanie Magalhães, Inês Francisco, Lídia Gomes

    Acupuncture is a therapy that is over 2000 years old, having recently become popular as a practice in Western culture. This therapy consists of inserting fine needles to alleviate symptoms such as pain or nausea. This article focuses on a pneumothorax secondary to acupuncture case. A 20-year-old man came to the Emergency Department with pleuritic pain in the right scapular region. The pain appeared after an acupuncture session performed for low back pain. On physical examination, a eupneic patient was observed, but with some difficulty in completing sentences, with O2 saturation of 98% in room air, with a slight decrease in vesicular murmur on auscultation of the upper right hemithorax and hypertympanism on percussion of the same area, with notorious pain facies, pain on right intercostal palpation and two dorsal punctiform wounds compatible with the insertion of needles.
    Chest X-ray revealed a right pneumothorax, so a chest drain was placed. After resolution, the user was discharged with indication for control in primary health care.

    Date: 2023-11-10
  • Síndrome de Dropped Head: Apresentação Rara de Miastenia Gravis

    Dropped Head Syndrome: Rare Manifestation of Myasthenia Gravis

    João Mendes Sobral, Carolina Quental, Joana Ferreira, Daniel Bertoluci Brito, Ana Rocha

    Myasthenia gravis is an autoimmune disease of the neuromuscular junction that is characterized by muscle weakness and fatigue. Dropped head syndrome is a rare complication of myasthenia gravis and is manifested by a head drop resulting from progressive weakness of the flexor and extensor muscles of the neck. Targeted treatment of myasthenia gravis is associated with a recovery of neck strength, thus reducing the negative impact on daily life caused by this disease. It is essential that all healthcare professionals recognize the association between these two entities. We present the clinical case of a 68-year-old female initially evaluated in primary health care for head drop. The diagnosis of myasthenia gravis was only made one month after the initial appointment when other symptoms such as hypophonia and dysphagia were already present. Treatment with intravenous immunoglobulin allowed the recovery of strength in the extensor muscles of the neck.

    Date: 2023-11-08
  • Montelucaste e Eventos Neuropsiquiátricos em Idade Pediátrica: Qual a Evidência?

    Montelukast and Neuropsychiatric Events in Children: What is the Evidence?

    Raquel Lima, Mafalda Sá Moreira, Leonor Rocha, João Nuno Carneiro, José Miguel Azevedo

    Childhood asthma is a prevalent chronic illness, and the medication montelukast is frequently used as treatment. However, this drug has been linked to neuropsychiatric events that have potentially fatal outcomes. The objective of this review paper was to evaluate the available evidence on this association between montelukast and neuropsychiatric events in children. From an analysis of 17 articles and 1 clinical guidance standard identified by a bibliographic search method, only 5 fulfilled the previously defined inclusion criteria. These selected studies provide support for the existence of possible occurrences of montelukast-induced neuropsychiatric symptoms among asthmatic pediatric patients administered with the medication. Therefore, healthcare providers need to be informed about these risks while making prescribing decisions for young patients who are taking montelukast or undergoing follow-up care subsequently. More multicenter studies are needed, with robust samples, longer follow-up period and well-defined methodology, to clarify the association of montelukast with neuropsychiatric events in children.

    Date: 2023-11-08