Ahead of Print

  • Últimas Horas/Dias de Vida num Hospital Versus Domicílio

    The Last Hours/Days of Life at Hospital Versus at Home

    Ana Margarida Pedro Antunes Ferreira Gaudêncio

    Population aging is one of the main social transformations of the 21st century, with implications for all sectors of society.The aging is accompanied by an increase in the prevalence of oncological and chronic, progressive diseases, witha high degree of functional dependence, cognitive decline, decreased quality of life and an increase in the mortality rate.
    The social transformation that we are witnessing implies the urgent need to plan the allocation of end-of-life supportservices, namely the development of palliative care.
    Worldwide, the end of life is very common in a hospital and Portugal is no exception. Several studies have demonstratedenormous variability in the quality of end-of-life care in acute hospitals. Some studies highlight the problemof this kind of care in acute hospitals, as well as the great difficulty that doctors have in deciding when to suspendcurative care and initiate palliative support.
    According to some data, most Portuguese prefer to die at home, however, the reality is different. The lack of access tomedical care is one of the main reasons for refusing the death process at home. Most family members, although theycan defend death at home, understand that it should occur in the hospital due to the need for permanent care and thelack of home support that guaranteed quality care.
    So, there is an urgent need to rethink national health policies, seeking to improve accessibility to palliative care, namelywith the creation of community/home teams, in order to improve the support of these patients at home and thusfree the acute hospitals.

    Date: 2022-09-21
  • Escrever, Rever e Editar em Ciência

    Writing, Reviewing and Editing in Science

    João Subtil
    Date: 2022-09-21
  • Tecnologias e Brincadeiras: Uma Infância a Mudar?

    Technologies and Play: A Childhood in Change?

    Sofia Rocha Teixeira, Sandrine Dias, Ana Rita Sousa, Joana Gomes Amorim

    Playing is the most natural and spontaneous way for children to express themselves. That plays an important role in child development. The technological and digital boom that has been taking hold in recent years is changing the way children play, replacing time outdoors with hours in front of screens – television, tablets, smartphones, computers.
    Potential risks of excessive use of technologies include not only physical inactivity, overweight and obesity, but also impairment of cognitive and intellectual development, language and even social interactions and relationships. On the other hand, peer-play promotes active learning, based on the acquisition of social and emotional interaction skills.
    Information for caregivers of our children is essential and the latest guidelines advise to limit the daily screen time, not recommending its use to children under 24 months.
    Although opinions are not entirely consensual on the positive or negative impact on children’s development, technologies are naturally present in their lives and in their play. Thus, the ideal will be a balance between the use of electronic devices and traditional games. Such results can only be achieved with the close collaboration of the family doctor, not only with the families and guardians, teachers and educators, but also with the child himself. The time with the doctor is an opportunity to clarify risks and promote healthy habits, for a full development and a happy childhood.

    Date: 2022-09-14
  • Obesity and Depression: Two Sides of The Same Coin?

    Obesidade e Depressão: Duas Faces da Mesma Moeda?

    Cátia Fernandes Santos

    Not applicable.

    Date: 2022-09-14
  • A Teoria da Vinculação nos Alicerces da Saúde Mental

    Attachment Theory in Foundations of Mental Health

    Frederica Vian
    Date: 2022-09-14
  • Colecistite Aguda Alitiásica: A Propósito de uma Causa Inusitada

    Acute Acalculous Cholecystitis: About an Unusual Cause

    Maria João Guimarães, Ana Cristina Carvalho, Sameira Gonçalves, João Dinis

    Acute acalculous cholecystitis is an acute inflammation of the gallbladder in the absence of gallstones and with multifactorial pathogenesis. Mainly seen in patients with multiple comorbidities or immunosuppressive states, being associated with greater morbidity and mortality compared to the lithiasic entity.
    Patient, female, 50 years old, with recent SARS-CoV-2 infection. Used teleconsultation for epigastric pain with dorsal irradiation, with four days of evolution, associated with nausea, with symptomatic improvement that day. An urgent abdominal ultrasound, analytical study and upper digestive endoscopy were requested.
    The ultrasound showed “acute acalculous cholecystitis”. She was referred to the emergency department, with subsequent laparotomy revealing a pyloric perforation caused by a fishbone with contiguity vesicular inflammation.
    Acute acalculous cholecystitis comprises from 2%-15% of all cases of acute cholecystitis and occurs mainly over the age of 60 and in males. Our patient did not have the typical biotype, comorbidities and clinical features of this pathology.
    Recent SARS-CoV-2 infection has raised suspicion of a possible etiological role, opposed after surgery. Ingestion of foreign bodies is considered common, mostly presenting a benign course, with complications in less than 1% of cases. The patient presented few predisposing factors of foreign bodies ingestion. A computerized tomography scan in the pre-surgical period could have clarified the etiology and contributed to guide the procedure.
    Here is a clinical case of an unusual pathology, of rare etiology, in an atypical patient, with a successful outcome in the middle of the COVID-19 pandemic.

    Date: 2022-09-01
  • (In)Appropriate Prescription in the Elderly in Primary Health Care

    Prescrição (In)Apropriada no Idoso em Cuidados de Saúde Primários

    Graça Cardoso, José Guilherme Pereira

    Western societies have witnessed a sharp aging of their population in recent decades. This paradigm shift is reflected in the health care provided to the community, with a growing need to adapt to the aging of the population. The purpose of this article is to understand how the greater number of elderly people affect clinical practice in primary health care and to highlight the tools and mechanisms to be used in the (in)appropriate prescription and prevention of iatrogenesis in this group. Knowing that adverse drug reactions are one of the main reasons for morbidity and mortality in the older population, strategies should be adopted, by prescribing clinicians, to protect these patients who are already debilitated. A systematic approach, when introducing a new therapy, or reviewing it, and the use of prescription support tools, should be some of the practices that should be implemented in clinical practice in primary health care.

    Date: 2022-09-01
  • Disfunção Sexual Persistente e Antidepressivos Inibidores Seletivos da Recaptação da Serotonina: Mito ou Realidade?

    Persistent Sexual Dysfunction and Selective Serotonin Reuptake Inhibitors: Myth or Reality?

    Carlos José Marinho Figueiredo, José Diogo Silva Castro Faria Freitas, Maria do Céu Ferreira

    Selective serotonin reuptake inhibitors antidepressants are psychopharmaceuticals frequently used in clinical practice in the fields of General Practice and Psychiatry for the treatment of depressive and anxiety disorders. The high prescription of this class of antidepressants results from their profile of efficacy, safety and tolerability.
    It is clinically consensual that this pharmacological class can interfere with the various phases of the sexual response during antidepressant treatment. However, more and more cases have been reported in the literature, in which sexual dysfunction is not reversible after discontinuation of the drug, configuring a new persistent clinical entity, whose pathophysiological substrate is currently under intense scientific investigation. Reviewing the recent published literature in this matter and raising awareness of physicians about this new entity reveals itself as a priority with potential implications, particularly on the approach of psychiatric pathologies so prevalent in the current society.

    Date: 2022-09-01
  • “Pseudo-Geyser Sign” as the First Presentation of Septic Arthritis of the Shoulder

    “Pseudo-Geyser Sign” como Primeira Apresentação de Artrite Sética do Ombro

    Madalena Peixoto de Sousa Braga, Joana P. Sousa, João Torres

    Massive rotator cuff tears can lead to large cysts, extending from the subacromial space through the acromioclavicular joint into a subcutaneous cyst, with a typical “geyser sign” on magnetic resonance imaging (MRI). To our knowledge, no cases of transdeltoid pseudo-cyst as first manifestation of septic arthritis have ever been reported.
    A 79-year-old female presented to the Emergency Department (ED) with a two-day evolution of a painful tumefaction over her right shoulder. She had been admitted to the ED 16 days before, after being bitten by a dog. Tumefaction drainage revealed a total cell count of 50320 cells/mL. MRI revealed glenohumeral joint cavity’s fluid “decompression” through the deltoid. Septic arthritis was presumed as the cause of the pseudo-cyst, configuring a “pseudo-geyser sign” on MRI.
    Septic arthritis is an orthopedic emergency, whose early diagnosis, ED referral and treatment are crucial.

    Date: 2022-09-01
  • Hemorragia Subgaleal Neonatal

    Neonatal Subgaleal Hemorrhage

    Mariana Portela, Maria Ventura Nogueira, Marta Alves, Almerinda Pereira
    Date: 2022-09-01
  • Management of Post-COVID-19- Related Olfactory Dysfunction

    Abordagem das Alterações do Olfato em Doentes Recuperados da COVID-19

    Ana Catarina de Castro Gomes, Joana Soutinho, Ana Luísa Pereira

    Evidence suggests that the prevalence of olfactory dysfunction (OD) occurs in 50% of patients with COVID-19.
    Emerging data suggest a high rate of early and spontaneous recovery, but approximately 10% of patients showed no improvement at 4-6 weeks after recovery. Given the high prevalence of COVID-19, a considerable number of patients will experience this morbidity.
    Thus, the main goal of this review is to define a guideline protocol for patients recovered from COVID-19, who present with olfactory dysfunction. In those cases, it is important to start by classifying the severity of this change and rule out other possible underlying etiologies, which may require further investigation.
    The treatment with best results is olfactory training. Additionally, the use of nasal corticosteroid spray or omega-3 supplementation may be recommended.
    It should be noted that those conclusions are based upon clinical trials whose patients were infected by viruses other than SARS-CoV-2. This way, further study and validation regarding the treatment of this condition should be carried out as the pandemic progresses.

    Date: 2022-09-01
  • Sarcoma de Kaposi da Cavidade Oral

    Kaposi Sarcoma of the Oral Cavity

    Cristina Aguiar, Leandro Ribeiro, Ana Ribeiro, Artur Condé
    Date: 2022-07-20
  • Renal Neoformation: A Diagnosis to Consider

    Neoformação Renal: Um Diagnóstico a Considerar

    João Miranda, Paula Coelho, Céu Rosinha, Eduarda Marques

    Renal granulomas related to suture material are rare and usually accidental findings in imagiological studies. A 12-year-old boy, followed-up after Anderson-Hynes pyeloplasty 7 years before, was submitted to an ultrasonography that described a solid nodular lesion, possibly in the dependence of the left kidney. Subsequently, magnetic resonance imaging was performed, which reported a lesion with non-specific features, suggesting neoformation with predominant fibrous peripheric component and myxomatous center. Percutaneous biopsy was morphologically compatible with chronic xanthogranulomatous inflammatory process. Anatomopathological examination of the surgical excised lesion described histiocytic cells with frequent participation of foreign body type giant cells and granulomatous reaction in relation to exogenous suture-like material. He remains asymptomatic since then. Foreign body granulomatous pseudotumors are difficult to diagnose regarding the absence of specific imagiological features distinctive from neoplasms, requiring histological examination to confirm the diagnosis.

    Date: 2022-01-17
  • Reconciliação Terapêutica: Um Processo Complexo

    Medication Reconciliation: A Complex Process

    Ana Campos de Sousa

    Demographic aging, multiple pathologies and polymedication reinforce the importance of medication reconciliation: a complex and continuous process that aims to keep the medication list updated and complete during the various transitions between patient care. Patient safety is a main goal of medication reconciliation, which implies the prevention of medication errors, risks and possible injury associated with them, such as duplication, omission or drug interactions. This article is a reflection on the importance of medication reconciliation, its implications for the patient's health, the risks associated with its non-compliance as well as possible solutions and adaptations of health care required to quality in health.

    Date: 2022-01-14