INTRODUCTION: Given the rising rates of overweight and obesity, a growing number of individuals are seeking guidance from nutrition practitioners. This study aimed to assess adherence to nutrition intervention (Mediter-ranean Diet, MD) and its association with adiposity.
METHODS: We conducted this observational study at Hospital CUF Tejo with a sample of 53 patients with overweight and obesity regularly attending nutrition appointments. Participants completed a structured online questionnaire, and adherence to the MD was assessed through the PREDIMED questionnaire (low ? 5; mod-erate 6–9; high ?10). The number of appointments attended, follow-up duration, anthropometric and body composition data were extracted from clinical records.
RESULTS: Participants attended, on average, 3 nutrition consultations and had a moderate adherence to the MD. Weight, BMI and waist circumference significantly decreased after nutritional counselling, with a maintenance of weight and BMI 1 year and 10 months post-treatment. Age was positively and significantly associated with MD adherence (? = 0.047; 95% CI: 0.001;0.094). Male sex was associated with higher weight (? = 13.105; 95% CI: 7.663;18.547) and waist circumference (? = 6.695; 95% CI: 2.106;11.284) at the last nutrition appointment. Physical activity was negatively associated with waist circumference at the last appointment (? = -4.342; 95% CI: -8.648;-0.037). No association was observed between MD adherence and adiposity-related markers at the last nutrition consultation.
CONCLUSION: Tailored nutritional counselling provided by a nutrition professional in patients with overweight and obesity results in moderate adherence to the intervention and a reduction of adiposity-related markers.

INTRODUCTION: The increasing number of breast cancer diagnoses, allied with a higher survival rate, brings new challenges. One of them is related to quality of life (QoL): understanding its dimensions with the goal of health resources optimization and continuous improvement of the QoL of women with breast cancer using Value-Based Healthcare (VBH) as the guiding concept.
METHODS: Observational, retrospective, longitudinal and descriptive-correlational study. EORTC QLQ-C30/ BR23 questionnaires were applied at different moments of follow-up to women with breast cancer followed in a private health institution for 2 years (n = 61).
RESULTS: Satisfactory QoL levels after 2 years of the diagnosis were identified. In the baseline moment, several factors that exert influence in the QoL of these women stand out: cognitive, social and sexual function; body image, future perspectives and the fatigue, pain, and secondary effects symptoms. After 2 years, these factors multiply and cover most of the questionnaire’s dimensions. Older women show lower global levels of QoL as well as worse physical and sexual function, and sexual satisfaction. Younger women show a positive QoL level trend, while older women show a negative trend.
CONCLUSION: QoL and its dimensions are not immutable. Health professionals and health institutions’ interven-tions must be dynamic and holistic to respond to women with breast cancer’s complex needs related to their QoL. Human, technical and material resources’ optimization, as well as a deepening of QoL-related knowledge, are ever more relevant to improve the health of all the people affected by this disease using VBH as the guiding concept.

Introduction: We intended to assess the prevalence of sexual dysfunction in men receiving opioid substitution therapy in a Portuguese center, which domains of sexual function are affected, and which factors influence sexual dysfunction.
Methods: We conducted a self-administered form, including: sociodemographic and clinical characterization; maintenance treatment with methadone or buprenorphine; presence of anxiety/depression, assessed with Hos-pital Anxiety and Depression Scale; sexual dysfunction, assessed with Massachusetts General Hospital – Sexual Functioning Questionnaire; erectile dysfunction, assessed with International Index of Erectile Function.
Results: A total of eighty-two patients participated in the study. Of these, 80.5% were receiving methadone treat-ment, with a mean current dose of 53.5 mg, a mean duration of treatment of 12.6 years, and a mean maximum dose of 86.2 mg. Buprenorphine was used by 19.5% of participants, with a mean current dose of 5.74 mg, a mean duration of treatment of 10.4 years, and a mean maximum dose of 8.07 mg. Antidepressants and antipsychotics were taken by 23.8% and 14.8% of participants, respectively. Anxiety and depression were present in 43.5% and 46.2% of cases, respectively. The Massachusetts General Hospital – Sexual Functioning Questionnaire revealed that 42.1% had sexual dysfunction and the item with the lowest score was general satisfaction. The International Index of Erectile Function revealed that 67.9% had erectile dysfunction and the item with the lowest score was achieving and maintaining an erection. There were no statistically significant differences between patients treated with methadone or buprenorphine, regarding the presence of sexual dysfunction and erectile dysfunction. The factors significantly correlated with sexual dysfunction were: age, professional status, maximum methadone dose used by the patient, anxiety, and depression. The factors significantly correlated with erectile dysfunction, e não; maximum methadone dose used by the patient, tobacco, anxiety and depression.
Conclusion: We did not find evidence to switch from methadone to buprenorphine, if sexual dysfunction arises. Anxiety and depression seem to be the factors most correlated with sexual dysfunction and erectile dysfunction.

Frey’s syndrome is a neuronal dysfunction characterized by transient erythema and warmth of the face, typically unilateral, in the territory of the auriculotemporal nerve, occurring after food intake. Although it is more common in adults, it can also present in pediatric age. We describe the case of a 7-month-old infant with unilateral erythema over the temporal and mandibular regions, non-painful and non-pruritic, appearing immediately after food ingestion and resolving spontaneously within minutes. The clinical picture is consistent with Frey’s syndrome, a condition often mistaken for food allergy due to its temporal association with food introduction. Early recognition of this condition helps avoid extensive and unnecessary investigations.

Ovarian teratomas are germ cell tumours, being mature cystic teratoma the most common variant.
This case describes a 38-year-old woman, 14 weeks and 4 days pregnant, with abdominal pain in the left quadrant. On abdominal palpation, was found a hard mass, with intense pain upon mobilization. It was requested an abdominal ultrasound that revealed a heterogeneous isoechoic nodular area in the left ovary measuring 91 x 79 x 65 mm. A pelvic nuclear magnetic resonance was performed and identified a Rokitansky nodule. She performed a left oophorectomy at 19 weeks, without complications.
Mature cystic teratoma of the ovary, despite being a rare disorder, is the most common benign ovarian tumor during pregnancy.

Although being relatively uncommon, testicular primary germ cell tumours represent most of testicular tumours in young and middle-aged men. Metastatic disease accounts for up to ten percent of initial presentation.
A 31-year-old man presented with a two-week history worsening left lumbar pain radiating to the ipsilateral lower limb associated with claudication. The straight leg raise test was positive. Therapeutic failure prompted a computed tomography scan, revealing an incidental retroperitoneal mass suspicious of metastatic adenopathy.
The patient underwent retroperitoneal mass dissection, followed by right radical orchiectomy. Pathological specimen analysis revealed a burned-out testicular tumour.
Burned-out testicular tumours are a rare entity that may present as extragonadal metastatic germ cell tumours, often targeting the retroperitoneal region, with spontaneous histological regression of the primary testicular lesion. These tumours are usually a challenging diagnosis, emphasizing the importance of physical examination and scrotal ultrasound in the initial approach to these lesions.

Tuberculosis is a systemic disease with various presentations, and extrapulmonary tuberculosis often poses a diagnostic challenge. This article describes the case of a 25-year-old woman from Nepal who presented with persistent abdominal pain associated with fever, asthenia, and anorexia. Investigations revealed multiple necrotic lymphadenopathies and intrahepatic fluid collections, suggesting abscesses. After multiple investigations, including biopsies, the patient was diagnosed with ganglionic and hepatic tuberculosis, an extremely rare condition. The patient started anti-tubercular therapy and showed gradual improvement. This case underscores the importance of considering extrapulmonary tuberculosis in the differential diagnosis, especially in regions with immigrant populations from endemic areas.

Osteoporosis is a metabolic-based bone disease, which is one of the most frequent osteoarticular comorbidities, especially in countries with older populations, and is associated with an elevated risk of bone fractures with significant morbidity and mortality. We present a case of a 58-year-old man seen at a Primary Care facility complaining of acute low back pain. After persistence of the complaints for 3 weeks, an imaging study with lumbar computed tomography (CT) was performed, showing multiple fractures and rarefaction of bone trabeculation. The diagnosis of osteoporosis was confirmed after bone densitometry with a Z-score of -3.3 in the lumbar spine. The main secondary causes of osteoporosis have been excluded, and no family history is known. The only risk factor found was smoking (37 UMA). The patient was treated with denosumab and cholecalciferol + calcium carbonate. Assessment was requested at a Rheumatology hospital consultation and is now undergoing additional genetic study and monitoring of the disease.

Acute pancreatitis is a common, heterogeneous, and unpredictable disease with significant associated morbidity and mortality. Early recognition and timely management of this condition are essential to prevent complications. It is characterized by pancreatic inflammation, most commonly associated with increased serum amylase and lipase levels. However, this criterion is not a mandatory requirement for the diagnosis of this disease. Such a presentation is rare and may constitute a diagnostic dilemma, potentially leading to misdiagnosis and delayed treatment.This article presents a case of acute pancreatitis in which both amylase and lipase levels were within reference limits.

Benign acute childhood myositis (BACM) is a rare complication associated with viral respiratory infections, with the Influenza B virus being the most frequent agent. The disease typically begins with nonspecific symptoms, such as fever, headache, rhinorrhea, and fatigue, progressing to severe myalgias in the lower limbs. Diagnosis is clinical, and treatment is symptomatic, focusing on hydration to prevent acute kidney injury due to myoglobinuria.A seven-year-old child presented with asthenia, fever, odynophagia, and rhinorrhea, which progressed to myalgias and an inability to walk. Following confirmation of the diagnosis of myositis, the child was hospitalized for treatment with fluid therapy and oseltamivir. This case highlights the importance of early recognition of BACM, especially during influenza outbreaks, to prevent complications and provide appropriate treatment, which is reassuring for the family.

Sarcoidosis is a multisystem granulomatous disease with a challenging diagnosis due to the multiplicity of possible clinical presentations.
A 34-year-old man presented with recurrent episodes of right testicular pain and dysuria after sexual intercourse, without hematospermia, pain during penetration, or urethral discharge. He had no risky sexual behaviors. Testicular ultrasound revealed bilateral vascularized testicular lesions, the largest being 6 mm. Subsequent studies showed elevated transaminases, lactate dehydrogenase, and angiotensin-converting enzyme. Imaging with a thoraco-abdomino-pelvic computed tomography scan revealed multiple micronodularities in the testicles, lungs, liver, spleen, and lymph nodes. A liver biopsy revealed non-caseating granulomatous hepatitis lesions, supporting the diagnosis of sarcoidosis with testicular involvement.
Therefore, the diagnosis of genitourinary sarcoidosis is demanding and should be considered in the presence of nonspecific genitourinary manifestations, testicular nodularity, and/or infertility. It is crucial to correctly differentiate it from neoplastic disease to avoid unnecessary treatments with irreversible sequelae.

Carpal tunnel syndrome (CTS) is the most common nerve entrapment disorder, affecting 1% to 5% of adults, primarily women aged 40-60. It results from median nerve compression, causing pain, numbness, and reduced grip strength. Risk factors include rheumatoid arthritis, pregnancy, and hypertension. Advanced cases may present with painless skin ulcers, suggesting an ulceromutilating variant. An 83-year-old retired seamstress with hypertension, rheumatoid arthritis, and bilateral CTS, diagnosed nine years ago, developed progressive sensory-motor deficits and painless ulcers on her left hand despite successful right-hand surgery. Electromyography confirmed severe left CTS and the clinical presentation suggested an ulceromutilating variant. She was referred for corrective surgery. Painless ulcers in CTS are rare but have been reported since 1979, resulting from prolonged nerve compression and skin necrosis. Early diagnosis and surgery are crucial to prevent irreversible damage, like bone resorption. This case emphasizes the need to consider this variant in advanced CTS.

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.

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.