Introduction. Chronic kidney disease (CKD) causes significant morbidity and mortality worldwide. Diagnosis involves a minimum of 3 months of impaired kidney function or kidney damage. This study aimed to evaluate the use of albuminuria testing as a CKD screening tool in a primary health care (PHC) facility in the North of Portugal.
Methods. Observational retrospective study involving a sample of 400 adults registered in a PHC facility in Por- tugal. Sociodemographic and clinical data from January to December 2023 were collected.
Results. Inclusion criteria were met by 188 patients, of whom 63.8% were female, the median age was 62 years and the mean systolic blood pressure was 126 ± 18 mmHg. In total, 38.8% of participants had hypertension and 17.0% had diabetes mellitus. Albuminuria was measured in 58 patients (30.9%), 89.7% of whom had normoalbu- minuria. Albuminuria testing was conducted in 81.2% of diabetic patients and 61.6% of hypertensive patients. Associations between albuminuria measurement and advanced age, presence of comorbidities and higher blood glucose and blood pressure were found.
Conclusion. Despite its accessibility and importance, there is a significant gap in albuminuria testing in PHC. CKD screening in high-risk patients is essential to slow its progression and to decrease its burden.

Introduction: The Three-question Health Literacy screener (THLSQ) allows to screen health literacy (HL) aiming to adapt it culturally and validate it for European Portuguese.
Methods: Ethical authorization and author´s permission, translation and back translation, verification of reliability and readability of THLSQ, 3 questions to answer on an ordinal scale between 1 and 5, 5 being the best answer, allowing summation. Convergent validation with quality of life, socio-economic level, gender, presence of mul- timorbidity and polypharmacotherapy and self-perception of Health Literacy in social conversation networks and face-to-face.
Results: it was verified in the adaptation high readability for low ages and reliability. In a sample of n = 297, the internal consistency was 0.707, Cronbach's Alpha, 0.565 to 0.833 if item eliminated. The sum of THLSQ was significantly higher in social netwoks application, p = 0.024 and correlated significantly with socio-economic level, r=+ 0.393, p =<0.001, age, r=-0.369, p <0.001, and "What do you think your level of Health Literacy is" r=0.359, p =<0.001. Significant differences, better in those who did not report multimorbidity, p =0.001, being in Good QoL, p <0.001, and not having polipharmacotherapy, p <0.001, were also found.
Conclusion: The cultural adaptation and validation of the TQHLS was possible.

Introduction: Up to 10%-15% of strokes are hemorrhagic. Its incidence is rising due to an elderly population and an increasing use of anticoagulation. Risk factor control is crucial to reduce comorbidity, mortality, and costs of hemorrhagic stroke.
Methods: Patients with hemorrhagic stroke hospitalized during a period of 11 years were analysed.
Conclusion: Hemorrhagic stroke prevalence was inferior to that described in the literature. Arterial hypertension was the main risk factor, which is concordant with deep hemorrhages as the main localization. Only 14% of patients were anticoagulated, which is lower than we expected given the comorbidities we identified. Although impaired consciousness was not a common clinical feature, the degree of disability was significant. The mortality rate reported was lower than that previously reported in the literature. The stroke unit admits patients with better premorbid functional status who could have better outcomes than those admitted to the ward, introducing a possible selection bias.

Acute adrenal crisis is a rare but severe condition. Clinical symptoms are diverse and non-specific, therefore, the diagnosis of this condition relies heavily on a high level of clinical suspicion and should be considered, if relevant, regardless of the patient's medical history. Timely treatment is crucial to the survival of patients with this condition. The case of a woman with a history of adrenal insufficiency due to non-classic 21-hydroxylase deficiency exemplifies the importance of recognizing warning signs that may indicate an acute adrenal crisis.This condition is life-threatening and can be initially assessed in the context of primary healthcare, making it essential for family physicians to be aware of this condition and how to prevent it and recognize it promptly. The failure to adjust chronic corticosteroid therapy in the face of respiratory infection was likely the triggering factor for the acute adrenal crisis.

Introduction: Streptococcus pneumoniae is an important cause of infection in humans, causing invasive pneumococcal disease (IPD). Patients with diabetes are more susceptible and vulnerable to infection and serious illness, and antipneumococcal vaccination (VApn) is recommended to prevent IPD. The estimated prevalence of diabetes in Portugal is 13.6% and, despite the benefits of VApn, only 5% of them are immunized. The objective of this work is to identify vaccination coverage with the VApn schedule in adult users with diabetes at the Esporões Family Health Unit (Braga, Portugal) (n = 310) and increase it.
Methods: Collection and initial analysis of data using MIM@UF and Microsoft Excel to understand vaccination coverage. Planning interventions, training professionals and creating support material. Definition of evaluation quality criteria. Measures to raise awareness among users in the target group about vaccination and health education. Project implementation (April 2023 and August 2024). Results analysis.
Results: The pre-intervention VApn coverage rate with the complete regimen was 5% (n = 15) of the study population. After the intervention, vaccination coverage with the complete schedule increased to 28% (n= 90).
Conclusion: The authors consider that this work achieved the main proposed objectives. The authors express their desire to continue implementing this work, to progressively increase vaccination coverage.

Understanding nurses' perceptions of the nursing consultation they conduct enables the enhancement of patient care. To describe and comprehend the inherent characteristics of the experience lived by nurses in nursing consultations, we conducted a qualitative, phenomenological, exploratory, and descriptive investigation. Seven nurses who work in the respective consultation participated in the study. Data were collected through semi-structured interviews and subjected to thematic content analysis. The data analysis revealed seven central themes: Opinions, Significance, Emotions and Feelings, Challenges, Relevant Aspects, Facilitating Factors, and Personal Impact. In conclusion, the nursing consultation fosters a patient-nurse proximity that eases the health-disease transition, and professional development is promoted through education and the sharing of experiences. However, structural and process improvements must be implemented to address dissatisfaction and the need to manage emotions and feelings. These improvements should involve in-person, interdependent practice that connects the various stakeholders to enhance patient and professional satisfaction.

Apresenta-se um caso clínico de policitemia secundária à síndrome de apneia obstrutiva do sono (SAOS), sem patologia respiratória concomitante. Doente do sexo masculino, com SAOS ligeira (Índice de Apneia-Hipopneia = 14,8/h e dessaturação mínima de oxigénio de 82%), função nasal comprometida e policitemia (hemoglobina = 18 g/dL; hematócrito > 50%). Iniciou tratamento com ventilação em pressão positiva contínua (CPAP), que permitiu a resolução completa dos eventos respiratórios. Contudo, o doente referiu desconforto com o CPAP, pelo que se realizou endoscopia do sono induzido por fármacos com poligrafia em simultâneo. Procedeu-se à redução intersticial dos cornetos inferiores por radiofrequência e a fisioterapia, o que melhorou significativamente a adesão ao CPAP, sem desconforto adicional. Ao fim de dois meses, verificou-se redução da hemoglobina para 16,4 g/dL e do hematócrito para 48%, ambos estáveis. Este caso reforça a importância de uma abordagem multidisciplinar e individualizada na avaliação e tratamento da SAOS.

Hiccups are a very uncomfortable experience for palliative care patients and can greatly impact their quality of life.
Physical manoeuvres can often terminate acute hiccups. Persistent and intractable hiccups that continue for progresdays or months are rare and difficult to treat. In situations where no reversible cause is identified, or where physical manoeuvres have failed, a systematic approach is required.
The causes of hiccups may be divided into central and peripheral types. The drugs of choice for central causes of persistent hiccups are baclofen and gabapentin as an alternative, with metoclopramide recommended as the first choice for peripheral causes.
The management of persistent hiccups presents a clinical challenge requiring further research on pathophysiology and treatment strategies. With this case report we provide a brief overview of the causes and treatment of this condition.

Authors present a case of leucocytoclastic vasculitis secondary to exuberant conjunctivitis caused by Staphylococcus aureus in a young man with a history of allergy to various environmental factors, atopic dermatitis and chronic sinusitis. After anamnesis, laboratory tests, photographic documentation and a histopathological study, the diagnosis of leucocytoclastic vasculitis was confirmed. The patient was hospitalized and underwent targeted antibiotic treatment combined with high doses of corticosteroids. The therapeutic response was favorably progressive, with the dermal maculopapular lesions disappearing and his general condition improving, with the resolution of the infectious process.

We reviewed an innovative project in undergraduate medical education, which used problem-based learning and concept maps in pathophysiology teaching. We analyzed publications starting in 1995 and until 2024, to identify factors contributing to its continuity and impact, nationally and internationally.
Problem-based learning was based on the methodology developed by Howard Barrows, a founder of the method. In 1998, we published, internationally, the results of this initial experience, completed by three international publications.
In the early 21st century, this methodology became closer to case-based learning but maintained tutorial sessions, self-directed orientation and small group learning. Simultaneously, concept maps, developed by Novak, as leading promoter of the method, began to be used and were part of final assessment tools. In 2006, an international publication emphasized meaningful learning, recognized by tutors and students, as facilitator to understanding pathophysiological mechanisms of disease, applying basic science to explain clinical manifestations. In 2020, another international publication revisited the whole teaching and learning process.
In 2023 and 2024, two international papers were published, a BEME systematic review on the effectiveness of concept maps in critical thinking and a scoping review on the need to standardize concept maps methodology. In 2024, for the first time in Portugal, we published two international papers on the use of concept maps to promote clinical reasoning in the undergraduate teaching of Family Medicine.
Key elements of continuity and impact were: inclusion in the core curriculum, open information to students, training medical tutors, use of educational methods and materials validated internationally.

This clinical case reports on a 65-year-old woman with a previous history of facial basal cell carcinoma (BCC), initially treated with surgery, and after recurrence, with surgery and radiotherapy. Nine years later, a tooth extraction was performed in the same site where she had previously received radiation therapy, leading to the development of osteoradionecrosis (ORN).

Introduction: Severe asthma affects approximately 4%-5% of asthmatic patients and increases susceptibility to respiratory infections, including SARS-CoV-2. The impact of COVID-19 on severe asthma remains unclear. We aimed to evaluate the effects of SARS-CoV-2 infection on asthma control, quality of life, and lung function.
Methods: A retrospective study of 114 severe asthma patients followed in our severe asthma unit from March 2020 to July 2022. We compared pre- and post-COVID-19 scores of the Asthma Control Test (ACT), Control of Allergic Rhinitis and Asthma Test (CARAT), Mini Asthma Quality of Life Questionnaire (mini-AQLQ) and lung function. Statistical analysis was performed using SPSS 25 (p <0.05).
Results: Among 49 infected patients, ACT scores significantly decreased (p = 0.002). CARAT, mini-AQLQ, and lung function showed no significant differences.
Conclusion: SARS-CoV-2 infection negatively impacted asthma control, with a significant decrease in ACT scores. Further studies are needed to clarify long-term effects.