INTRODUCTION: Obstructive sleep apnea (OSA) is a chronic disease with significant morbimortality. This study aimed at evaluating the follow-up of patients with OSA treated with ventilotherapy in primary care (PC) and physicians’ knowledge about the matter.
METHODS: Descriptive-analytical cross-sectional study. A questionnaire was applied to a sample of PC doctors. Questions regarded demographic features of the physicians, their knowledge of the clinical practice guideline (CPG) number 022/2014, clinical information provided at the time of hospital consultation discharge and collected during follow-up consultations in PC. Descriptive and inferential analysis of the data were performed.
RESULTS: The survey response rate of 41.4%.Among the physicians surveyed, 43.4% indicated they were aware of the CPG content, and 50.9% conducted at least one follow-up consultation annually. The majority asked questions about symptoms related to OSA to at least 75% of the patients. While 32% of doctors accessed ventilotherapy report information in more than 50% of consultations, 17% reported no access whatsoever.
CONCLUSION: The study revealed weaknesses in the follow-up of patients with OSA treated with ventilotherapy. As the sample size in this study is limited, more studies are required to obtain more solid results that can be extrapolated. Carrying out educational sessions may be valuable to optimize the follow-up of these patients in PC.

Visual snow syndrome is characterized by the continuous presence of a visual disturbance, described as dynamic dots throughout the visual field, combined with at least two other symptoms, including palinopsia, enhanced entoptic phenomena, photophobia and nyctalopia. Migraine and tinnitus are the most prevalent comorbidities. We report the case of a 51-year-old patient with a recent onset of visual snow syndrome with enhanced entoptic phenomena, photophobia and nyctalopia. The patient had a history of migraine without aura, tinnitus and sporadic episodes of vertigo, and developed visual snow following episodes of visual aura. He also reported photopsia triggered by head movements. Lamotrigine therapy partially improved symptoms. Considering the extant literature, this case is discussed to draw attention to this recently described syndrome that is often misinterpreted as a non-organic disorder.

Introduction: Dementia, as an abnormal and pathological aging, requires close and constant care, making these patients a challenge for their families and caregivers. Therefore, palliative care home teams are a valuable asset in providing care for these patients. This study aims to characterize, in general, patients with dementia followed a palliative care home team (PCHT) from a hospital over 2 years, evaluating, in particular, the classes of drugs used in symptomatic control, prevalent symptoms, comorbidities, feeding route, complications and place of death.
Methods: Data were collected through the analysis of patients' clinical records, excluding those without clinical information in the record, without a diagnosis of dementia, or with follow-up outside the defined time frame. A database was used to record the results.
Results: Of the 335 patients followed by a PCHT for 2 years, 39 had a diagnosis of dementia. In these patients with dementia, 36 were polymedicated in the first evaluation by PCHT. Regarding comorbidities, only 2 patients did not present multiple pathologies. In terms of hospitalizations, 30 patients did not have any hospital admissions during the follow-up period. In 79% of cases, death occurred at the location where the patient resided (home/nursing home/continuing care unit).
Conclusion: Advanced dementia is associated with multiple complications. In the end-of-life, care goals focus on the patient's comfort, allowing the patient to remain in their family environment, with the goal, as much as possible, to the final outcome to be at at home, Characterizing this population has proven to be of crucial importance for a better future approach, in order to improve care strategies for this population

Introduction: Urinary tract infections are very common in the community and are one of the most common reasons for antibiotic prescription. Our objective was to identify the most frequent microorganisms present in urine cultures in Primary Health Care, at a Local Health Unit and their sensitivity profile to some antibiotics.
Methods: Observational and retrospective study based on bacteriological identification in urine cultures obtained between January/2020 and December/2021. Individuals of both genders and ages 15 and over were included.
Results: The total number of urine cultures obtained was 2788, 83% from female patients, and 17% from males. In males, unlike females, there were no significant differences between age groups regarding the isolates agents. The most frequently isolated agent in both sexes was Escherichia coli (64.89%), and its sensitivity to fosfomycin is over 98% in all age groups, and equal to or less than 75% to amoxicillin-clavulanic acid.
Conclusion: Empirical treatment of uncomplicated cystitis should target Escherichia coli. Amoxicillin-clavulanic acid should not be considered as empirical treatment, except in patients with a history of lithiasis. Pivmecillinam would be a viable option if available for prescription in the community. Antibiotic selection should be appropriate and in accordance with local resistance patterns and based on data from more recent studies, since the variability of antibiotic sensitivities can change.

Retroperitoneal fibrosis constitutes a challenge in the differential diagnosis with other entities, due to its clinical presentation. The authors present a clinical case of idiopathic retroperitoneal fibrosis, which initially presented as unilateral obstructive uropathy, revealing the need for imaging tests at an early stage of the symptoms.

Introduction: Esophageal atresia (EA) is a rare congenital malformation, with mainly postnatal diagnosis, although prenatal suspicion has improved. Until surgery, these newborns need monitoring in Neonatal Intensive Care Unit (NICU). Despite mortality reduction, morbidity remains a concern. The aim of this study was to characterize the prenatal, delivery and postnatal data of EA newborns at a level three reference center.
Methods: An anonymized retrospective study was performed from eighteen newborns diagnosed with EA, born between January 2007 – December 2021, who were admitted to the NICU of a level three center. Data was collected using neonate´s medical records, compiled with Microsoft Excel and analyzed by IBM SPSS statistics.
Results: There was no sex prevalence and no preponderance in advanced mother’s age. Prenatal suspicion consisted on ultrasound (polyhydramnios/stomach non-visualization), where EA type A had higher reports. Higher incidence of EA was found in premature newborns. An association between lower gestational age and the presence of polyhydramnios was found. Other congenital anomalies associated were common, mostly cardiac. The prevalence of EA type C and short-gap was found. Gastroesophageal reflux and esophageal stenosis were frequent
comorbidities.
Conclusion: Improvement in prenatal and postnatal surveillance/evaluation could reduce morbimortality and improve management of these neonates. As mortality reduced, further research is needed to target morbidity and quality of life.

Palliative care through a holistic and multidisciplinary vision allows you to define a care plan centered on the patient, by integrating their narrative. Thus, narrative medicine is a therapeutic strategy that can change the dominant problematic stories, by enabling the construction of a new narrative and allowing a positive influence on the patient's entire therapeutic process. The clinical case refers to a patient with advanced breast cancer, followed by the home palliative care team, which required a narrative medicine approach, in the sense of reconstructing the image that neoplasia affected her life (with a perspective of suffering, resignation and frustration in the face of illness). Applied to the perceived stress and subjective happiness scale. A favorable response was obtained, with the deconstruction of a life passage that marked her reality, allowing the suffering, although present, to be experienced with acceptance and serenity, thus improving the quality of life of this patient.

Smith-Magenis syndrome is a rare disease characterized by developmental delay, behavioral changes and sleep problems secondary to circadian rhythm deregulation of melatonin. With growth there is a progressive worsening of sleep problems and violent behaviors.
This is a case of a child with Smith-Magenis syndrome with severe behavioral and sleeping problems in which the association of a ?-blocker during the day with melatonin of prolonged release at night achieved a satisfactory control of symptomatology. Although the literature available suggests acebutolol (?-1 selective blocker), propranolol (?-blocker non-selective) was used given the broad availability and vast experience of use in Portugal. The scientific literature available on pharmacological approaches in Smith-Magenis syndrome is scarce even regarding the prescription of ?-blockers. No article could be found concerning propranolol use in the particular case of this syndrome.