Medicina Interna

A Life-Threatening Neck Pain

Martim Henriques, Olga Capontes, Rita Reis, Inês Cruz — Thu, 31 Jul 2025 00:00:00 -0700

Concurrent Cutaneous and Gastrointestinal Purpura in IgA Vasculitis

Marco Alba, Daniela Lopez, Alba Jerez Lienas, Orial Corral Magaña — Thu, 31 Jul 2025 00:00:00 -0700

Dual Challenge: Tuberculous Pericarditis Leading to Acute Constrictive Pericarditis

Thu, 31 Jul 2025 00:00:00 -0700

Constrictive pericarditis presents as a rare condition characterized by the loss of pericardial distensibility due to an inflammatory process. Tuberculosis (TB) is the leading cause of constrictive pericarditis in low-income countries and in immunocompromised patients, particularly those with human immunodeficiency virus (HIV) infection.

The authors report the case of a 24-year-old man from Brazil with a recent diagnosis of HIV infection, hospitalized for disseminated TB complicated by acute constrictive pericarditis. He underwent partial pericardiectomy, which proceeded without complications. At the time of discharge biventricular function remained preserved.

Antisynthetase Syndrome: The Synthesis of a Complex Case

Thu, 31 Jul 2025 00:00:00 -0700

Antisynthetase syndrome is an autoimmune inflammatory myopathy defined by the presence of anti-aminoacyl-tRNA synthetase antibodies, associated with the development of myositis, interstitial lung disease and/or arthritis. It is a rare entity, little known and underdiagnosed, with only two cases published in Portugal.

We report the case of a 62-year-old black woman admitted with interstitial lung disease, associated with respiratory failure and restrictive ventilatory pattern, whose etiological diagnosis was hampered by various complications and obstacles to clinical reasoning. The progression to fibrosis was notorious within a few months and was only halted by the introduction of immunosuppressive therapy following the definitive diagnosis of SAS, confirmed by the presence of anti-PL7 and PL 12 antibodies.

This is the first reported case of antisynthetase co-positivity in the literature, aiming to raise medical awareness about the importance of screening for the presence of antisynthetase antibodies in patients with interstitial lung disease.

Curriculum Proposal for Respiratory Diseases Training During Internal Medicine Residence

Thu, 31 Jul 2025 00:00:00 -0700

Introduction: Respiratory diseases are among the leading causes of morbidity and mortality in Portugal and across Europe. Portuguese Internal Medicine training program covers knowledge in this area, but in a generic way.

We present a curricular proposal for training in respiratory diseases in Internal Medicine in Portugal, inspired by the recommendations of the European Respiratory Society, aiming to adapt and harmonize training in the field of respiratory diseases. We developed a proposal that includes milestones and entrustable professional activities, with the goal of facilitating a competency-based evaluation. This innovative approach allows the curriculum to be flexible, adjusting to the individual learning pace of the Internal Medicine Residents, and not just the elapsed time from the beginning of the training.

Methods: We used questionnaires sent to internists with experience in managing respiratory patients, department directors, local responsible for training, and residents in Interna Medicine to ensure a comprehensive consensus on the competencies that should be integrated into the training.

Results: The results from the 88 responses obtained indicate a strong consensus for the inclusion of 196 objectives out of the 262 initially analyzed, with 97 of these objectives receiving strong recommendations from all consulted groups.

We discuss how our curricular proposal can benefit both trainees and trainers by aligning the training with the crucial competencies required for the practice of Internal Medicine.

Conclusion: In conclusion, we propose a significant improvement in Internal Medicine training in the respiratory area, based on a broad consensus and the ability to adapt teaching to the individual needs of the interns, which promotes a more dynamic and competency-oriented medical education.

Risk Assessment of Type 2 Diabetes in Healthcare Professionals at a Tertiary Hospital

Thu, 31 Jul 2025 00:00:00 -0700

Introduction: Type 2 diabetes (T2D) is a multifactorial disease influenced by sedentary behaviors and erratic eating habits. Simple, practical, and non-invasive surveys can help identify individuals at increased risk of developing T2D.

Methods: This cross-sectional observational study applied the Finnish Diabetes Risk Score (FINDRISC) and the International Physical Activity Questionnaire (IPAQ) to healthcare professionals at a tertiary hospital. The variables studied were those included in FINDRISC and IPAQ. Personal history of diabetes was an exclusion criterion. Data were analyzed using IBM SPSS Statistics, version 27.

Results: Twenty-two respondents with diabetes were excluded. Of the remaining 279 individuals, 68.4% were under 45 years of age, and 2.6% were 65 years or older; 51.6% were physicians, 12.3% nurses, 8.2% healthcare assistants or senior technicians, and 6.1% diagnostic and therapeutic technicians. The mean body mass index (BMI) was 23.8 ± 3.7 kg/m². About half had a family history of T2D. The median FINDRISC score was 5 (minimum 0, maximum 22). Around two-thirds of the healthcare professionals were at low risk, with only 4.5% at high risk and 0.4% at very high risk; physicians appeared to have the lowest risk among the professional groups.

Conclusion: The prevalence of T2D was similar to the estimated rate for the Portuguese population. Most respondents had a normal BMI, regular physical activity, and a diet rich in fruits and vegetables, which may explain their low risk of developing T2D. The FINDRISC questionnaire could be valuable in screening, especially when the risk of T2D is elevated.

The Importance of a Heart Failure Unit in Reducing the Number of Emergency Episodes and Hospital Admissions

João Oliveira, José Alvarelhão, Inês Pintor, Joana — Thu, 31 Jul 2025 00:00:00 -0700

Introduction: Heart failure (HF) is a complex and multifactorial clinical syndrome with high morbidity and mortality and high healthcare costs. The integration of patients with HF into special and multidisciplinary follow-up programs aims to improve quality of life by reducing adverse events and economic costs.

The aim of this work is to analyse the impact of a HF unit of the Internal Medicine Service in reducing emergency episodes and hospitalizations related to HF.

Methods: This is a retrospective observational study that compares the proportion of adverse events related to HF between the period up to six months before and the period six months after patients were admitted to the HF unit through the Emergency Service and hospitalizations. The comparison was performed using the McNemar test.

Results: The difference in the proportion of adverse events between the period up to six months before (66%) and the period six months after admission to the unit (31%) was statistically significant (p <0.001).

Conclusion: The work of the HF unit has a positive effect on reducing the number of adverse events in these patients, removing them from the decompensation conditions that overload emergency services and hospital beds.

Psychiatric Outcomes at 3 and 6 Months in Critically Ill SARS-CoV-2 Survivors: Prospective Study in a Portuguese Cohort

Thu, 31 Jul 2025 00:00:00 -0700

Introduction: Although mid and long-term psychiatric sequelae are predicted, few studies have focused on critically ill SARS-CoV-2 survivors from Portugal.

We aimed to evaluate mid-term prevalence of psychiatric disease and respective predictors in COVID-19 survivors.

Methods: This is a longitudinal prospective study of critically ill COVID-19 survivors followed up at 3 (T3) and 6 (T6) months after discharge. A set of validated tools, including the GAD-7 for anxiety, PHQ-9 for depression, and PCL-V for PTSD was administered at both visits. Provisional diagnosis of anxiety, depression and PTSD was made if GAD-7≥10, PHQ-9≥10 and PCL-V≥31. Written informed consent was obtained.

Results: A total of 149 patients discharged after COVID-19 hospitalization, were recruited to an outpatient visit at T3 and T6. Of those, 117 completed the test battery. Participants’ age ranged from 25 to 85 years with mean values 64.0±15.5, and 45 (38.5%) were female. Mean age-adjusted Charlson Comorbidity Index was 2.6±2.0 and 51 (43.6%) had at least one comorbidity. Twenty-nine patients (24.8%) presented with psychiatric comorbidities. Regarding education, 56.4% completed primary education, while 8.5% had university or postgraduate qualifications. Twenty patients (17.1%) were single, divorced or widowed.

Prevalence of psychiatric conditions at T3 and T6 was 22.2% vs 12.0% (p= 0.012) for anxiety, 23.1% vs 11.1% (p=0.007) for depression and 7.7% vs 2.6% (p= 0.031) for PTSD, respectively. Significant improvement between evaluations was noted in all mean PCL-V domains. Univariate analysis was conducted for anxiety and depression provisional diagnosis at T6. Female gender [OR 4.86 (CI 95% 1.42-16.60), p= 0.012] and ferritin levels [OR 8.25 (CI 95% 1.04-65.60), p= 0.046] seem to correlate with anxiety. Similarly, mMRC dyspnea scale [OR 1.62 (CI 95% 1.05-2.51), p= 0.031] and psychiatric background [OR 3.44 (CI 95% 1.36-8.66), p= 0.009] were correlated to depression. We did not find association between age, education, marital status, length of stay, do not intubate order, invasive mechanical ventilation and laboratory findings during hospitalization, and anxiety or depression.

Conclusion: Among critically ill SARS-CoV-2 survivors, clinically significant anxiety, depression and PTSD were observed 3 and 6 months after discharge. However substantial improvement over time was perceived. In our study, the risk of anxiety correlated with female gender and the risk of depression with mMRC dyspnea scale and psychiatric background.

Long-term Surveillance in Prostate Cancer Management: Facts and Pitfalls

Tiago Silva, António Mateus-Pinheiro, Vítor Sousa, Sónia Moreira, Lèlita Santos — Thu, 31 Jul 2025 00:00:00 -0700

Non-Steroidal Mineralocorticoid Receptor Antagonists, a New Pharmacological Class - What's the Future?

Mariana Jeremias Macedo, Daniela Augusto, Telmo Borges Coelho — Thu, 31 Jul 2025 00:00:00 -0700

Empowering Patients: Advancing Shared Decision-Making in Portuguese Healthcare

Francisca Torres Sarmento, Mariana Alves — Thu, 31 Jul 2025 00:00:00 -0700

Redefining Care: Ethics and Portugal's Journey to Restraint-Free Healthcare

Paula Cerqueira, Sara Pereira, Raquel Costa, Ana Garrido Gomes, Bárbara Sousa — Thu, 31 Jul 2025 00:00:00 -0700

The ethical use of physical restraints in medical wards is a critical issue that requires careful consideration of patient autonomy, dignity, and safety. This article explores the complex ethical landscape surrounding the application of physical restraints, focusing on core principles such as respect for autonomy, beneficence, non-maleficence, and justice. Restraints should be justified through thorough assessment and documentation, emphasizing minimizing harm and involving patients or their representatives in decision-making. Ethical guidelines recommend regularly monitoring and reviewing restraint practices, prioritizing patient comfort and dignity, and exploring alternative strategies for managing challenging behaviors. Additionally, this article examines Portugal’s regulatory framework and legal standards, which emphasize restraint as a last-resort measure, highlighting the importance of necessity, proportionality, informed consent, and ongoing monitoring. By fostering a culture of empathy, transparency, and continuous improvement, Portuguese healthcare practices illustrate a model for ethically responsible restraint use that aligns with national and international standards.

Decisive Integrated Care for an Efficient National Health Service

João Araújo Correia — Thu, 31 Jul 2025 00:00:00 -0700

Sub-Specialist in Adult Urgency and Emergency Medicine: An Unpostponable Need

Maria da Luz Brazão, Sandra Alves Morais — Thu, 31 Jul 2025 00:00:00 -0700

The College of Internal Medicine Speciality (CIMS) proposed the creation of the subspeciality in adult urgent and emergency medicine (AUEM), which has the support of the Portuguese Society of Internal Medicine's Centre for the Study of Urgency and Acute Patients (NEUrgMI). We see this as an essential step towards meeting the growing challenges of hospital emergency services (ES) in Portugal.

Although it could be argued that the fragmentation of Internal Medicine into subspecialities could threaten its integrative essence, in reality, the perception is that the AUEM subspeciality, far from fragmenting, reinforces the importance of a global approach to the patient, by combining a generalist vision with differentiated technical skills. In this way, we will empower internists to treat patients and lead and coordinate teams in critical situations, ensuring higher-quality patient care.

The admission criteria defined by the AUEM, although rigorous, reflect the high level of responsibility required. Mandatory practical experience in the ES, demonstration of specialized technical skills and participation in training and research in the field are essential to training professionals capable of acting in the various scenarios that make up the complexity of medical emergencies.

At the same time, a balance is advocated between the practice of care in the subspeciality and in the other fields of Internal Medicine (hospitalization, outpatient consultations, among others), ensuring that the subspecialist internist maintains a wide-ranging, competence, which will benefit the patient throughout the various stages of the disease's evolution.

The UEMA subspeciality seeks to strengthen the internist's role in the health system, guaranteeing a high-quality approach to the patient in the ES and promoting professional growth through recertification and continuous training.

Still on the Eternal Problem of Urgency Departments in Portugal

Maria João Lobão — Thu, 31 Jul 2025 00:00:00 -0700

The Change and New Qualities

José Mariz — Thu, 31 Jul 2025 00:00:00 -0700