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- The Role of Multidimensional Prognostic Index to Identify Hospitalized Older Adults with COVID-19 Who Can Benefit from Remdesivir Treatment: An Observational, Prospective, Multicenter Study.Publication . Custodero, Carlo; Veronese, Nicola; Topinkova, Eva; Michalkova, Helena; Polidori, Maria Cristina; Cella, Alberto; Cruz-Jentoft, Alfonso J; von Arnim, Christine A F; Azzini, Margherita; Gruner, Heidi; Castagna, Alberto; Cenderello, Giovanni; Custureri, Romina; Zieschang, Tania; Padovani, Alessandro; Sanchez-Garcia, Elisabet; Pilotto, AlbertoBackground: Data regarding the importance of multidimensional frailty to guide clinical decision making for remdesivir use in older patients with coronavirus disease 2019 (COVID-19) are largely unexplored. Objective: The aim of this research was to evaluate if the Multidimensional Prognostic Index (MPI), a multidimensional frailty tool based on the Comprehensive Geriatric Assessment (CGA), may help physicians in identifying older hospitalized patients affected by COVID-19 who might benefit from the use of remdesivir. Methods: This was a multicenter, prospective study of older adults hospitalized for COVID-19 in 10 European hospitals, followed-up for 90 days after hospital discharge. A standardized CGA was performed at hospital admission and the MPI was calculated, with a final score ranging between 0 (lowest mortality risk) and 1 (highest mortality risk). We assessed survival with Cox regression, and the impact of remdesivir on mortality (overall and in hospital) with propensity score analysis, stratified by MPI = 0.50. Results: Among 496 older adults hospitalized for COVID-19 (mean age 80 years, female 59.9%), 140 (28.2% of patients) were treated with remdesivir. During the 90 days of follow-up, 175 deaths were reported, 115 in hospital. Remdesivir treatment significantly reduced the risk of overall mortality (hazard ratio [HR] 0.54, 95% confidence interval CI 0.35-0.83 in the propensity score analysis) in the sample as whole. Stratifying the population, based on MPI score, the effect was observed only in less frail participants (HR 0.47, 95% CI 0.22-0.96 in propensity score analysis), but not in frailer subjects. In-hospital mortality was not influenced by remdesivir use. Conclusions: MPI could help to identify less frail older adults hospitalized for COVID-19 who could benefit more from remdesivir treatment in terms of long-term survival.
- Chylothorax as an Unusual Initial Manifestation of Diffuse Large B-Cell Lymphoma in an 86-Year-Old Woman: A Reflection of Diagnostic Reasoning and Age in Therapeutic Decisions.Publication . Ramos, Diogo Dias; Hirschfeld, Amanda; Fiúza M Rua, Inês; Valente, André; Serrano, Ana MChylothorax is a rare presentation of lymphoproliferative disorders, responsible for only a small proportion of non-traumatic pleural effusions in large series. In older adults, its recognition can be challenging, often delaying diagnosis and treatment. We report an 86-year-old woman admitted with progressive dyspnea and a large right pleural effusion. Thoracentesis yielded a milky fluid with high triglycerides, confirming chylothorax. Cytology was negative for malignant cells, and a CT scan revealed an extensive retroperitoneal mass encasing the aorta and inferior vena cava, highly suggestive of lymphoproliferative disease. An inguinal lymph node biopsy established the diagnosis of diffuse large B-cell lymphoma. The patient was managed with a low-fat diet enriched with medium-chain triglycerides, subcutaneous octreotide, and chest drainage, leading to complete resolution of the effusion. Corticosteroid therapy was initiated, resulting in clinical improvement, weight gain and marked recovery of performance status, leading to the discharge of the patient. She was subsequently referred to Haematology and proposed for chemotherapy. Despite advanced age, the patient achieved significant improvement, reinforcing that chronological age alone should not preclude adequate therapy and even in very old patients, targeted treatment can yield meaningful recovery and quality of life.
- Mordedura de Víbora Cornuda: Caso Clínico e Revisão de Abordagem TerapêuticaPublication . Gante, Cristiano; Watts Soares, Adriana; Brazete, João; Terceiro, Rafael; Rato, FátimaA mordedura de víbora-cornuda (Vipera latastei), espécie endémica da Península Ibérica, provoca habitualmente toxicidade local e hematológica, podendo originar coagulopatia de consumo. Apresenta-se o caso de um homem de 39 anos mordido no quarto dedo da mão esquerda. A primeira dose de soro antiofídico (ViperFav®) foi administrada 10 horas após o incidente, com necessidade de duas doses adicionais por persistência de coagulopatia e trombocitopenia transitória. Implementaram-se medidas adjuvantes, cuja utilização e benefícios se encontram em discussão na comunidade médica: oxigenoterapia hiperbárica (10 sessões) e penso transdérmico de nitroglicerina para otimizar a perfusão local. A evolução foi favorável, com preservação da viabilidade digital e resolução laboratorial progressiva. Este caso evidencia a importância da administração precoce do antídoto, da vigilância hematológica contínua e o potencial benefício de integrar terapêuticas adjuvantes na prevenção de necrose e complicações sistémicas. A abordagem multidisciplinar permitiu a recuperação funcional completa sem sequelas.
- Tuberculous Subclavian Artery Pseudoaneurysm in a Young Male With Hemoptysis.Publication . Soares, Ana Raquel; Eusébio, Sofia; Fiúza, Pedro; Pack, Tiago; Ribeiro, Tiago FSubclavian artery pseudoaneurysms (SAPs) are rare and most often secondary to trauma. On the contrary, a mycotic origin is exceedingly rare, and defining this etiology can become challenging. We present a rare case of a tuberculous SAP in a young patient. A 19-year-old male patient with no past medical history and no relevant epidemiological context presented to the ED with three-day left pleuritic thoracalgia and hemoptysis. A chest roentgenogram revealed a left paratracheal opacity, and a CT angiography revealed a voluminous left SAP. Accordingly, endovascular surgical treatment of the SAP was performed, with complete symptom remission. Although mycotic etiology was suspected, the first microbiological assays were negative. Following six months asymptomatic, hemoptysis recurred, and a bronchoscopy was performed. Mycobacterial cultures of bronchoalveolar lavage were positive for , and tuberculous left SAP and pulmonary tuberculosis were ultimately confirmed. Treatment with first-line anti-tuberculosis drugs was completed without associated complications and with symptom resolution. This case highlights that in the presence of a non-traumatic arterial pseudoaneurysm, the diagnosis of tuberculosis should always be considered and carefully investigated. An approach with a combination of anti-tuberculous therapy and surgery seems the most appropriate in these cases. When endovascular treatment is performed, follow-up must be maintained to exclude future complications, particularly those related to possible infection of the prosthetic vascular material.
- Beyond the Norm: Gastroenteritis-Induced Atypical Hemolytic Uremic Syndrome in the Absence of Complement Dysfunction.Publication . Bernardino, Rita; Leão, Rodrigo; Ghiletchi, Angela; Coelho, Carolina; Sampaio, BeatrizAtypical hemolytic uremic syndrome (aHUS) is a complex disorder characterized by thrombotic microangiopathy, typically driven by complement dysregulation. While most cases of aHUS are linked to genetic abnormalities in the complement system, sporadic instances occur without identifiable genetic or complement involvement. This report discusses the case of a 38-year-old woman who developed aHUS following gastroenteritis, marked by acute kidney injury requiring dialysis, yet displayed normal complement levels. This case highlights the diagnostic and management challenges in aHUS when traditional disease markers are absent and emphasizes the importance of tailored therapeutic approaches.
- Amiodarone-Induced Interstitial Pneumonia: A Cause of Respiratory Failure.Publication . Eusébio, Sofia; Soares, Ana Raquel; Fiúza, Pedro; Garcia, TeresaAmiodarone, a widely used antiarrhythmic medication, is effective for managing various types of cardiac arrhythmias. However, due to its high lipid solubility and long half-life, amiodarone accumulates in various organs, particularly the lungs. Pulmonary toxicity, while rare (1% to 5% incidence), is among the most serious adverse effects of amiodarone, with interstitial pneumonitis (IP) being the most prevalent form of lung toxicity. Recognized risk factors are old age, high daily doses, and long-lasting therapy. Amiodarone-induced interstitial pneumonia (AIP) is a rare but serious complication of amiodarone therapy, often presenting as progressive respiratory failure. Patients with AIP typically present with nonspecific respiratory symptoms, including dyspnea, cough, and occasionally fever, making the initial diagnosis challenging. Diagnosing AIP requires a combination of clinical, radiological, and histological data, with computed tomography (CT) often revealing ground-glass opacities and interstitial thickening. Management of AIP focuses on discontinuing amiodarone and initiating corticosteroid therapy. Early withdrawal of amiodarone is crucial for symptom resolution and preventing progression to severe lung injury or irreversible fibrosis. We report an 89-year-old female patient with chronic use of amiodarone who was medicated with high doses of the drug during hospitalization and started presenting signs of respiratory failure. The radiological findings were consistent with AIP, and the patient improved with drug discontinuation and a trial of glucocorticoid therapy. AIP is a critical but preventable cause of respiratory failure in patients undergoing antiarrhythmic therapy. Awareness among healthcare providers about this complication, along with timely diagnosis and management, is essential to improving patient outcomes.
- One-Minute Sit-to-Stand Test Versus Six-Minute-Walk Test in Post-COVID-19 Patients: A Cross-Sectional Observational Study.Publication . Duarte-Silva, Marta; Fiúza, Pedro; Reis, Neuza; Toscano-Rico, MiguelSimplified field tests have gained increasing interest for the assessment of functional capacity in patients with post-COVID-19 condition; however, direct comparisons of functional performance and physiological responses between the 1-min sit-to-stand test (1MSTST) and the 6-min walk test (6MWT) remain limited. This study aimed to examine the associations between the two tests by evaluating functional performance, cardiopulmonary responses, oxygen desaturation, perceived exertion, and peripheral muscle strength. Furthermore, we explored whether the 1MSTST can be used as a complementary assessment, particularly within telerehabilitation pathways and in contexts where resource-intensive testing is not feasible. We conducted a cross-sectional observational study of adults recovering from moderate to severe COVID-19 between May and July 2021. Participants performed both the 1MSTST and 6MWT on the same day. Functional performance, peak heart rate, nadir peripheral oxygen saturation (SpO), perceived exertion, and handgrip dynamometry were recorded. Associations between test performances were assessed using correlation and partial correlation analyses, including adjustment for peripheral muscle strength. Fifty-four patients were included. A moderate correlation was observed between 1MSTST repetitions and 6MWT distance (Spearman's ρ = 0.47, < 0.001), which was attenuated after adjustment for muscle strength and demographic variables. Peak heart rate and nadir SpO responses were strongly correlated between tests (r = 0.75 and ρ = 0.83, respectively; both < 0.001), with no significant differences in magnitude. Exercise-induced oxygen desaturation (≥4% SpO drop) occurred at similar frequencies during both tests. Perceived exertion increased similarly following the 1MSTST and the 6MWT. : In post-COVID-19 patients, the 1 min sit-to-stand test shows moderate concordance with the 6 min walk test for functional performance and strong agreement in cardiopulmonary responses. These findings suggest that the two tests assess overlapping but distinct aspects of functional capacity. This supports the use of the 1MSTST as a pragmatic complementary assessment when standard walking tests are not feasible, particularly within telerehabilitation pathways, primary care, and resource-limited settings.
- Vaccination of Older Adults in Portugal: Recommendations from the Geriatrics Study Group of the Portuguese Society of Internal Medicine.Publication . Sousa Almeida, Paulo Ricardo; Sarmento, Gonçalo; Gruner, Heidi; Veríssimo, Rafaela; Duque, SofiaOlder persons are more susceptible to infections and have a higher risk of serious complications, with a worse functional and vital prognosis. Vaccination is an effective strategy with a favorable safety profile for preventing infections and promoting healthy aging. In view of the clinical evidence and the vaccines available in Portugal in the first half of 2025, the Geriatrics Study Group of the Portuguese Society of Internal Medicine presents a proposal for vaccination of adults aged 65 years or older. The experts also point out the need to create a national lifelong vaccination program that includes older people to increase vaccination coverage and reduce the impact of infections in this population. Although the document focuses on people aged 65 years or older, vaccination against some diseases should start earlier. This article outlines five main recommendations: 1) Annual influenza and COVID-19 vaccination for all adults aged 50 years or older, with those aged 65 years or older receiving the high-dose trivalent influenza vaccine; 2) Respiratory syncytial virus vaccination for all adults aged 60 years or older and adults aged 18 - 59 years with risk factors, prioritizing people aged 75 years or older and those aged 50 years or older with risk factors; 3) Pneumococcal vaccination with the 20-valent or 21-valent pneumococcal conjugate vaccine for all adults aged 50 years or older and adults aged 18 - 49 years with risk factors; 4) Herpes zoster vaccination with the recombinant vaccine for all adults aged 50 years or older and adults aged 18 - 49 years at high risk of herpes zoster; 5) From the age of 65 years, booster vaccination against tetanus, diphtheria and pertussis every 10 years.
- Anti-Melanoma Differentiation-Associated Protein 5 (MDA5)-Positive Dermatomyositis With Rapidly Progressive Interstitial Lung Disease (ILD): A Rare and Lethal Entity to Recognize Early.Publication . Bernardino, Rita; Ferreira, Inês; Valente, André; Loureiro, ConceiçãoAnti-melanoma differentiation-associated protein 5 (anti-MDA5) clinically linked amyopathic dermatomyositis (CADM) is a rare autoimmune condition strongly linked to rapidly progressive interstitial lung disease (RP-ILD), a life-threatening complication. We present a 63-year-old female patient with anti-MDA5-positive CADM, who developed RP-ILD with an imaging pattern consistent with organizing pneumonia. She presented with Gottron's papules, periungual erythema, progressive dyspnea, and anorexia. Despite timely initiation of combination immunosuppressive therapy with corticosteroids, rituximab, and mycophenolate, her disease progressed rapidly, complicated by infections and treatment intolerance, culminating in acute respiratory failure. This case underscores the aggressive nature of anti-MDA5-positive CADM with RP-ILD, highlighting the critical need for prompt recognition and comprehensive multidisciplinary care. Urgent research efforts are essential to develop and refine treatment strategies for this life-threatening disease.
- Systemic Effects of Anabolic-Androgenic Steroid Abuse: A Case in Primary Care.Publication . de Carvalho Vilarinho, Margarida; Cernadas, Joana; Marques Ferreira, MiguelAnabolic-androgenic steroid (AAS) abuse is a growing public health concern due to its wide-ranging physical and psychological effects. This case report highlights the multisystemic consequences of prolonged AAS use in a 30-year-old male presenting initially with a minor respiratory infection during a consultation in his healthcare center. Despite his primary complaint, upon physical examination, muscle hypertrophy, bilateral gynecomastia, and suspected testicular atrophy were observed, prompting further investigation. Laboratory findings showed high levels of testosterone, suppressed gonadotropins, elevated estradiol, dyslipidemia, and liver enzyme elevation, consistent with chronic AAS abuse. Imaging confirmed gynecomastia, and the patient was diagnosed with hypertension, likely secondary to AAS use. Despite counseling on the potential short- and long-term health risks, the patient chose to continue AAS use. Ongoing follow-up in primary care, however, made it possible for the patient to return to care after one year, when he presented with depressive symptoms and body image dissatisfaction following steroid cessation, demonstrating the critical role of family physicians in early detection, patient education, and motivational support. This case shows the importance of a thorough approach in identifying AAS abuse and managing its systemic effects to mitigate potentially perilous health outcomes.