Phytophotodermatitis is a phototoxic reaction caused by combined skin exposure to photosensitizing plants and ultraviolet radiation. Despite being rare, its incidence has increased. We describe a lime-induced phytophotodermatitis case.
A 6-year-old girl presented with a 5-day history of brownish linear plaques on the skin. After careful history taking, it was found the child had been cooking a lime pie and got posterior sun exposure. Her brother had similar lesions. Both family members’ lesions healed after a month.
Lime-induced phytophotodermatitis is still weakly recognized. Its bizarre configurations and the agents’ ubiquity can lead to misdiagnosis of child abuse. Exhaustive history and physical examination are crucial. It is required to raise awareness of this disease, so physicians can be prepared to identify it, to ensure the safety of the patients and to tranquilize the family.

Ramsay-Hunt syndrome is defined by varicella-zoster virus (VZV) reactivation in the geniculate ganglion of the facial nerve and its presentation involves otalgia, vesicular lesions of the outer ear and ipsilateral facial paralysis. Cranial polyneuropathy extension is rare, can sometimes take a challenging and delayed diagnosis and poor prognosis.
We illustrate a case of varicella zoster virus cranial polyneuropathy affecting V, VII, VIII, IX and X cranial nerves and consequent symptomatology that led to prolonged hospitalization with multidisciplinary approach. Despite the poor prognosis, the patient had a significant clinical and imagiological improvement. Prevention and attenuation of VZV and its complications are becoming increasingly possible and the increase in knowledge about this disease for the population and physicians can have a significant impact.

Introduction: Urinary tract infection (UTI) is one of the most common bacterial infections in pediatrics, with a wide spectrum of clinical manifestations, which can be the sentinel event for congenital anomalies of the urinary tract. Given its relevance in the emergency setting, representing up to 5%-10% of causes of fever of unknown origin, the aim was to characterize the process of urine sample collection and testing from patients suspected of UTI in a Pediatric Emergency Service (PES).
Methods: Retrospective review of urine cultures collected in the service between March 2020 and January 2024.
Results: A total of 745 urinary screenings were conducted, with a median age of 2.8 years, 60.7% of whom were female. Sample processing took an average of 1.3±0.6 days. The positivity rate in aseptic methods was 17.4%, ranging from 23% for midstream voiding to 50% for bladder puncture. Although Escherichia coli was the most frequent isolate (70.7%), it also exhibited one of the highest resistance rates to amoxicillin-clavulanic acid (33%). Other isolated germs were: Proteus at 20.7%, Staphylococcus saprophyticus at 2.3%, Klebsiella and Enterococcus at 1.5% each, and other germs at 2.3%. Resistance to cefuroxime was observed in 1.5%.
Conclusion: In this study, E. coli remains the predominant pathogen in UTI, and the increasing resistance to penicillins in our population is concerning. Cefuroxime is an effective option in empirical treatment of UTI.

Introduction: The Portuguese population is in an aging process so palliative needs should be predictably increasing. One of the barriers to timely access to palliative care is the difficulty in identifying patients who may benefit from it. These patients are mainly in the community. Therefor primary health care teams are in the best position to identify patients with potential palliative needs. We aimed to assess palliative needs in a Family Health Unit in Matosinhos.
Methods: Cross-sectional observational study in a sample of patients aged 65 years or over from a Family Health Unit in Matosinhos, using the palliative needs assessment scale – SPICT-PT™.
Results: The sample consisted of 349 patients, 56.4% female and 43.6% male. The median age was 74 years. The most prevalent pathological group was related to the circulatory system, followed by the group of endocrine diseases and oncological diseases. 25 (7.2%) patients with palliative needs were identified. These have a higher median age as well as a higher degree of dependence. This group had a greater number of diseases of the circulatory system, psychological and oncological. Of the patients with palliative needs, 6 (24%) were referred to the palliative care team.
Conclusion: The identification of 7.2% of patients with palliative needs is similar to that reported in other studies. The low number of referrals of patients with palliative needs to the palliative care team may be due to a clear difficulty of family physicians in identifying these patients or to the fact that patients are symptomatically controlled and are of low complexity. The application of this tool allows the identification of these patients and the best planning of care at various levels. The divulgation and application of the SPICT-PT™ tool in primary health care could be an added value in improving the identification of these patients, knowledge, provision and planning of care at various levels.

This article aims to raise awareness about the proper completion of medical records in the clinical process, discussing the various medico-legal repercussions that this information represents not only in the clinical evolution, but also in the medical-legal documentation that it represents in Court when assessing the Criminal Law, Labor Law, Civil Law, among others.

Computer vision has emerged as a transformative technology with the potential to significantly enhance surgical practices' safety, efficiency, precision, and training. By leveraging advanced algorithms and artificial intelligence, computer vision applications offer real-time analysis of visual data during surgical procedures, enabling automated decision support, performance assessment, and intraoperative guidance. This article delves into the recent developments in computer vision technology within the realm of surgery, particularly focusing on its application in minimally invasive procedures. It also discusses the current state of computer vision in surgery while exploring its practical applications. The article highlights the challenges that must be overcome for widespread clinical adoption, emphasizing the crucial role of collective efforts in addressing these obstacles. With a balanced focus on both the technical advancements and the practical implications, this manuscript provides a comprehensive overview of the role of computer vision in modern surgery.

A 25-year-old man, with a history of Crohn's disease undergoing biological treatment, seeks Open Consultation for low back pain and a fever spike. Due to low back pain associated with alarming signs, he is referred to the Emergency Department, where he undergoes imaging and analytical studies, showing slight leukocytosis. Discharged with a presumed diagnosis of nonspecific low back pain. The clinical condition progressively worsens.Upon reassessment, he exhibits a positive Patrick's test. Another imaging study is requested, showing no abnormalities. Magnetic resonance imaging is performed, diagnosing infectious sacroiliitis with extensive abscesses.
During hospitalization, multiple cycles of antibiotic therapy are administered and several attempts to drain the collections are unsuccessful. Discharged after 54 days with progressive functional recovery. This case aims to alert to the increased susceptibility to infections associated with the use of biological agents and the added complexity in managing patients with inflammatory bowel disease.

Fibromyalgia affects about 1.78% of the population worldwide and has been recognized and studied since the 16th century. Despite that, the etiopathogenesis of fibromyalgia is still unknown. Consequently, there is still an ongoing debate whether fibromyalgia should be considered within the category of somatization disorders, or as a central pain sensitization syndrome, or even as a peripheral nerve disease. We consider that this is a relevant issue, since it impacts the referral of these patients to the different healthcare professionals, the type of assessment that is provided and the therapeutic approaches that are proposed to them.
Several aspects point to similarities between fibromyalgia and somatic symptom disorder: both diagnoses share high comorbidity with several psychiatric disorders, a history of childhood trauma, the presence of alexithymia and other personality traits, insecure attachment styles and comorbidity with the so-called chronic overlapping pain conditions. Therefore, we hypothesize that fibromyalgia can be conceptualized as a somatic symptom disorder. However, the debate continues, since there is still a lack of scientific evidence supporting either in favor or against this perspective. More studies are needed to unveil the etiopathogenesis behind these two diagnoses.

Introduction: The prevalence of nocturnal enuresis (NE) is 5%-15% in school age (SA) children and may affect children and their families quality of life (QoL). This project aims to estimate the NE prevalence in school age children in four family health units (FHU) in the North region of Portugal e evaluate the QoL impact.
Methods: Multicentric cross-sectional and descriptive study was conducted in four FHU, after the Ethics Committee approval. SA children, who attended the medical check-up, were invited to fill a anonymous survey. The statistical analysis was conducted using Excel^® and SPSS^®.
Results: There were 158 participants, 60.1% female, median age of 6 (IIQ 5-7). Eighteen (11.4%) of children had NE, most of them were male (66.7%) and 5-6 years old (66.7%). It was found a positive correlation between NE and gender (p=0.014), family history (FH) (p=0.021) and diurnal enuresis (p=0.034). Regarding QoL (n=14), the most affected subscales were family relations, self-esteem and social relations.
Conclusion: Although the reduced sample may affect the interpretation of the results, NE prevalence and positive association between NE and male gender and FH obtained corroborate the previous data. Also, the QoL shows negative impact in children and their families. Therefore, this project reafirms the importance of correct workup and management of NE.

Non-adherence to treatment it is quite common and underestimated in an increasingly aging population and hand in hand with multimorbidity, compromising outcomes and increasing healthcare costs. Adherence is a dynamic process simultaneously influenced by multiple factors, related or not to the patient, that must be considered before and after prescription and subject to continuous monitoring over time. Addressing these factors and adapting them individually, with reinforcement of intrinsic motivation and involvement of the patient in the therapeutic strategy can be one of the most effective measures in combating chronic diseases and, consequently, improving health outcomes.

Pacifiers are an integral part of homes around the world, when a newborn is present. Its use has become a culturally rooted habit, followed by most parents/caregivers, but fears have arisen that the use of this object could have a negative influence on the success of breastfeeding.
This review article presents the most recent results from the literature on the influence of pacifiers on breastfeeding, addressing the importance of breastfeeding and the main advantages and disadvantages of pacifier use. Observational studies show a possible correlation between pacifier use and breastfeeding failure, but this association has not been confirmed in more robust studies such as randomized clinical trials.
In view of the scientific evidence presented, the authors consider that pacifier should be used, if that is the parents’ will, making a shared and informed decision.

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.