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.

Introduction: Antibiotics are widely used in pediatric respiratory conditions, despite most having a viral origin. Parental self-medication of children is also common. This study aimed to analyze the knowledge, beliefs, and attitudes of parents of children under 12 years old regarding antibiotic therapy and the practice of self-medication.
Methodology: This was a multicenter, observational, descriptive, and cross-sectional study with surveys administered to parents during pediatric health consultations. Inclusion criteria were age ? 18 years, understanding of the Portuguese language, and no cognitive impairment. Exclusions included those who did not provide informed consent or whose child had never been prescribed antibiotics. Descriptive and inferential statistical analysis performed at a significance level of 0.05.
Results: A total of 447 surveys were analyzed. Self-medication was reported by 56% of respondents, primarily due to having the medication at home (62%) and considering the illness simple or similar to a previous one (76%). Information about medications was mostly provided by doctors or pharmacists, with paracetamol and ibuprofen being the most commonly used. Compliance with antibiotic recommendations was nearly universal (~100%). Only 3% of respondents administered antibiotics without a prescription. Higher levels of education and professional status were associated with better knowledge and more appropriate attitudes toward antibiotic use (Kruskal-Wallis, p <0.05).
Conclusion: Self-medication was driven by prior knowledge and ease of access to medications, with adherence to recommendations being independent of sociodemographic factors. More educated individuals exhibited more consistent attitudes, underscoring the need for effective health education campaigns.

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).

Burning mouth syndrome (BMS) is a medical condition with a complex and multifactorial etiology. It is characterized by a burning sensation, a dysaesthetic sensation, and pain in the tongue and/or oral mucosa. Since the BMS etiology is unknown, its treatment is a real challenge. This review aims to discuss the efficacy of the various therapeutic options currently available for BMS.
This review was performed by searching the literature for papers published in the last 5 years in Portuguese, English and Spanish, in the PubMed indexed database, using the terms “burning mouth syndrome”, “treatment” and “therapy”.
From 43 papers, we selected 12 clinical trials, nine systematic reviews, eight literature reviews and one meta-analysis. The results indicate the use of topical and systemic clonazepam, topic capsaicin, alpha-lipoic acid, gabapentin and selective serotonin reuptake inhibitors as the most effective therapies. Photobiomodulation therapy has shown to reduce pain. Cognitive-behavioral therapy is very effective.
Analyzing the selected studies, we found that there is a wide variety of therapeutic alternatives for BMS, namely the use of benzodiazepines, antidepressants, analgesics, anticonvulsants, saliva substitute, phototherapy, psychotherapy and others. Most studies report topical or systemic clonazepam as effective in pain control. Photobiomodulation has shown promising results in patients’ pain control and improvement in quality of life. Although there is no definitive therapy for BMS, the combination of pharmacological and cognitive-behavioral therapies seems to be more effective in symptomatic control.

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.

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.

Dystonia is a comprised of complex abnormal movements, with most cases being idiopathic. Pharmacological therapy has unfavorable results, and therefore, local botulinum toxin injections are the treatment of choice. In this paper, we report a case of cervical dystonia with a favorable response to levodopa. It is a case of idiopathic cervical dystonia, without a favorable response to local injections of botulinum toxin and a lot of drugs, which was sent to a deep brain stimulation center and, simultaneously, to a Chronic Pain Medical Consultation at the family health unit. At this consultation, treatment with levodopa was tried with a favorable response, avoiding the invasive procedure. The positive results achieved using levodopa agree with other authors who assume that levodopa could be attempted in atypical dystonia. This case highlights the importance of primary healthcare, which can prevent the need for an invasive procedure.

A 71-year-old man, a former smoker, with a history of chronic productive cough, without an established diag-nosis, consulted his primary care physician due to worsening of his usual cough pattern. Despite various studies and treatments, including inhaled bronchodilators and antibiotics, his condition progressively worsened. A chest computed tomography scan revealed a small atelectasis in the lingula, but lung function was normal. The pul-monologist advised him to accept his condition, as improvement seemed unlikely. However, due to the patient’s persistence, a bronchoscopy was performed, identifying the culprit: a chicken bone lodged in the intermediate bronchus of the right lung. After its removal, the cough returned to its baseline pattern. This case underscores the importance of considering less common etiologies when addressing chronic cough. Ignoring these can lead to misdiagnosis, prolonged patient suffering, and unnecessary treatments.

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.

Whipple disease is a rare multisystemic infection caused by the gram-positive bacillus Tropheryma whipplei. Diagnosis is difficult due to the nonspecific initial symptoms and its delay invariably affects the prognosis. This case highlights the importance of the family doctor's high index of suspicion and his role in the prompt diagnosis of a rare pathology. We present the case of a 66-year-old man initially evaluated in primary care for mandibular swelling. The diagnosis of Whipple's disease was made 2 months later, when new symptoms appeared, and the Family Doctor requested more targeted complementary diagnostic exams. Rapid coordination with hospital care in an urgent context proved to be an efficient weapon in approaching this clinical case, allowing quick initiation of antibiotic therapy, which consequently provided a favorable prognosis for the patient.

We examined the history and the impact of the Institute of Molecular Pathology and Immunology of the University of Oporto (IPATIMUP), one of Portugal’s most influential scientific institutions. Based on interviews with researchers and collaborators, as well as on an extensive review of bibliographic and institutional sources, this study explores the motivations behind its creation, the challenges faced, and the scientific achievements and collaborations that shaped its trajectory.
By integrating research, education, and service provision, the Institute has become a model of excellence in the biomedical field. This work highlights its role in advancing Science, Medicine and Health Literacy, while also addressing its future challenges and opportunities.