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.

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.

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.

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.

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.

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.

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.

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.

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.

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.