FM - Contribuições em Revistas Científicas / Contribution to Journals
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- Acromegaly in humans and cats: pathophysiological, clinical and management resemblances and differencesPublication . Lopes-Pinto, Mariana; Marques, Patrícia Lunet; Lacerda-Nobre, Ema; Miceli, Diego; Leal, Rodolfo Oliveira; Marques, PedroObjective: Acromegaly is a disorder associated with excessive levels of growth hormone (GH) and insulin-like growth factor-1 (IGF-1). In general, GH/IGF-1 excess leads to morphologic craniofacial and acral changes as well as cardiometabolic complications, but the phenotypic changes and clinical presentation of acromegaly differ across species. Here, we review the pathophysiology, clinical presentation and management of acromegaly in humans and cats, and we provide a systematic comparison between this disease across these different species. Design: A comprehensive literature review of pathophysiology, clinical features, diagnosis and management of acromegaly in humans and in cats was performed. Results: Acromegaly is associated with prominent craniofacial changes in both species: frontal bossing, enlarged nose, ears and lips, and protuberant cheekbones are typically encountered in humans, whereas increased width of the head and skull enlargement are commonly found in cats. Malocclusion, prognathism, dental diastema and upper airway obstruction by soft tissue enlargement are reported in both species, as well as continuous growth and widening of extremities resulting in osteoarticular compromise. Increase of articular joint cartilage thickness, vertebral fractures and spine malalignment is more evident in humans, while arthropathy and spondylosis deformans may also occur in cats. Generalized organomegaly is equally observed in both species. Other similarities between humans and cats with acromegaly include heart failure, ventricular hypertrophy, diabetes mellitus, and an overall increased cardiometabolic risk. In GH-secreting pituitary tumours, local compressive effects and behavioral changes are mostly observed in humans, but also present in cats. Cutis verticis gyrata and skin tags are exclusively found in humans, while palmigrade/plantigrade stance may occur in some acromegalic cats. Serum IGF-1 is used for acromegaly diagnosis in both species, but an oral glucose tolerance test with GH measurement is only useful in humans, as glucose load does not inhibit GH secretion in cats. Imaging studies are regularly performed in both species after biochemical diagnosis of acromegaly. Hypophysectomy is the first line treatment for humans and cats, although not always available in veterinary medicine. Conclusion: Acromegaly in humans and cats has substantial similarities, as a result of common pathophysiological mechanisms, however species-specific features may be found.
- And the quest continues…Publication . Mendes, Lígia
- A digital tool for self-reporting cardiovascular risk factors: the RADICAL studyPublication . Santos, José Ferreira; Castela, Inês; Madeira, Sara Gamboa; Furtado, Sofia; Pereira, Hugo Vieira; Teixeira, Diana; Dores, HélderAims: Cardiovascular diseases remain the leading cause of death worldwide. Risk stratification and early interventions are essential to overcome this reality. The RADICAL Study (Risk Assessment via Digital Input for Cardiovascular And Lifestyle Factors) aimed to evaluate the prevalence of self-reported cardiovascular risk factors in individuals without known cardiovascular disease using a digital tool. Methods and results: A digital self-reported cardiovascular risk stratification tool, comprising 23 questions about classical and lifestyle cardiovascular risk factors, was completed by 4149 individuals aged 40–69 years (median age 53.0 [47.0; 60.0] years; 78 % women). Among the cardiovascular risk factors, 40.9 % reported hypercholesterolemia, 26.8 % hypertension, 17.3 % smoking, 5.8 % diabetes, 58.4 % physical inactivity, 19.4 % obesity, 33.7 % sleep less than 7 h/night, and 12.1 % had composite dietary risk factors. Most of the participants (89.9 %) referred having at least one of the eight cardiovascular risk factors. Women had 27 % higher odds of having at least one cardiovascular risk factor compared to men (OR = 1.27, 95 % CI [1.00, 1.60]). Participants aged 50–59 years also had higher odds of having at least one CV risk factor compared to those aged 40–49 years (OR = 1.35, 95 % CI [1.07, 1.70]). Conclusion: The RADICAL Study reveals a high prevalence of cardiovascular risk factors in adults without known cardiovascular disease. Beyond the relevance of traditional risk factors, such as hypercholesterolemia and hypertension, the results regarding physical activity, dietary and sleeping habits are concerning. A self-reported cardiovascular risk identification digital tool could be feasible and help to improve cardiovascular prevention.
- EBV and MSI status in gastric cancer: does it matter?Publication . Nascimento, Catarina Neto do; Mascarenhas-Lemos, Luís; Silva, João Ricardo; Marques, Diogo Sousa; Gouveia, Catarina Ferreira; Faria, Ana; Velho, Sónia; Garrido, Rita; Maio, Rui; Costa, Andreia; Pontes, Patrícia; Wen, Xiaogang; Gullo, Irene; Cravo, Marília; Carneiro, FátimaWe investigated the impactof microsatellite instability (MSI) and Epstein–Barr virus (EBV) status in gastric cancer (GC), regarding response to perioperative chemotherapy (POPChT), overall survival (OS), and progression-free survival (PFS). We included 137 cases of operated GC, 51 of which were submitted to POPChT. MSI status was determined by multiplex PCR and EBV status by EBV-encoded RNA in situ hybridization. Thirty-seven (27%) cases presented as MSI-high, and seven (5.1%) were EBV+. Concerning tumor regression after POPChT, no differences were observed between the molecular subtypes, but females were more likely to respond (p = 0.062). No significant differences were found in OS or PFS between different subtypes. In multivariate analysis, age (HR 1.02, IC 95% 1.002–1.056, p = 0.033) and positive lymph nodes (HR 1.82, IC 95% 1.034–3.211, p = 0.038) were the only prognostic factors for OS. However, females with MSI-high tumors treated with POPChT demonstrated a significantly increased OS compared to females with MSS tumors (p = 0.031). In conclusion, we found a high proportion of MSI-high cases. MSI and EBV status did not influence OS or PFS either in patients submitted to POPChT or surgery alone. However, superior survival of females with MSI-high tumors suggests that sex disparities and molecular classification may influence treatment options in GC.
- Effectiveness of palbociclib with aromatase inhibitors for the treatment of advanced breast cancer in an exposure implications for clinical practiceretrospective cohort study:Publication . Costa, Filipa Alves da; Borges, Fábio Cardoso; Ramos, Adriana; Mayer, Alexandra; Brito, Claudia; Ramos, Catarina; Bernardo, Catarina; Cossito, Mariane; Furtado, Cláudia; Ferreira, Arlindo R.; Martins-Branco, Diogo; Miranda, Ana da Costa; Lourenço, AntónioBackground: New drugs for locally advanced or metastatic breast cancer have led to clinical benefits, aside with increasing costs to healthcare systems. The current financing model for health technology assessment (HTA) privileges real-world data. As part of the ongoing HTA, this study aimed to evaluate the effectiveness of palbociclib with aromatase inhibitors (AI) and compare it with the efficacy reported in PALOMA-2. Methods: A population-based retrospective exposure cohort study was conducted including all patients initiating treatment in Portugal with palbociclib under early access use and registered in the National Oncology Registry. The primary outcome was progression free survival (PFS). Secondary outcomes considered included time to palbociclib failure (TPF), overall survival (OS), time to next treatment (TTNT), and proportion of patients discontinuing treatment due to adverse events (AEs). The Kaplan–Meier method was used and median, 1- and 2-year survival rates were computed, with two-sided 95% confidence intervals (95%CI). STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) guidelines for reporting observational studies were used. Results: There were 131 patients included. Median follow-up was 28.3 months (IQR: 22.7–35.2) and median duration of treatment was 17.5 months (IQR: 7.8–29.1). Median PFS was 19.5 months (95%CI 14.2–24.2), corresponding to a 1-year PFS rate of 67.9% (95%CI 59.2–75.2) and a 2-year PFS rate of 42.0% (95%CI 33.5–50.3). Sensitivity analysis showed median PFS would increase slightly when excluding those not initiating treatment with the recommended dose, raising to 19.8 months (95%CI 14.4–28.9). By considering only patients meeting PALOMA-2 criteria, we could observe a major difference in treatment outcomes, with a mean PFS of 28.8 months (95%CI 19.4–36.0). TPF was 19.8 months (95%CI 14.2–24.9). Median OS was not reached. Median TTNT was 22.5 months (95%CI 18.0–29.8). A total of 14 patients discontinued palbociclib because of AEs (10.7%). Conclusions: Data suggest palbociclib with AI to have an effectiveness of 28.8 months, when used in patients with overlapping characteristics to those used in PALOMA-2. However, when used outside of these eligibility criteria, namely in patients with less favorable prognosis (e.g., presence of visceral disease), the benefits are inferior, even though still favorable.
- Frequency, sociodemographic, and neuropsychological features of patients with subjective cognitive decline diagnosed using different neuropsychological criteriaPublication . Pestana, Pedro Câmara; Cardoso, Sandra; Guerreiro, Manuela; Maroco, João; Jessen, Frank; Couto, Frederico Simões do; Mendonça, Alexandre deBackground: Subjective Cognitive Decline (SCD) is recognized as a risk stage for future cognitive impairment and dementia. The criteria for SCD include normal performance on neuropsychological testing; however, there is a lack of consensus regarding standard score cut-offs for neuropsychological tests to define cognitive impairment and to differentiate between SCD and Mild Cognitive Impairment (MCI). This study aimed to assess the frequency of SCD diagnosis using various neuropsychological definitions of cognitive normality and to characterize the sociodemographic and neuropsychological features of SCD patients diagnosed under these criteria. Methods: The Cognitive Complaints Cohort (CCC) participants were diagnosed following Subjective Cognitive Decline Initiative (SCD-I) criteria. Normal cognitive performance was defined by the absence of Mild Cognitive Impairment (MCI) according to the five sets of MCI neuropsychologically based criteria defined by Jak and Bondi. Descriptive statistics were used to analyze sociodemographic, clinical, and neuropsychological data. A bootstrap methodology was employed to estimate the mean and 95% confidence intervals (CI) for specific parameters of interest, namely the SMC scale (subjective memory complaints scale), Mini-Mental State Examination (MMSE), Blessed Dementia Rating Scale – first part (BDRS first part), and Geriatric Depression Scale (GDS). Results: Among the 1268 subjects included, the prevalence of SCD diagnosis exhibited substantial variation across SCD-I criteria using different neuropsychological definitions of cognitive normality (ranging from 16.4 to 81.3%). When using the most conservative criteria to define cognitive impairment (2 tests within a cognitive domain > 1.5 SD below age-adjusted means), the resulting Conservative SCD group had poorer global cognitive function (MMSE: mean 27.15, 95% CI 27.00-27.31), whereas when using the most liberal criteria to define cognitive impairment (only one test > 1 SD below age-adjusted means) the resulting Liberal SCD group had superior performance in daily-life functioning (BDRS first part: mean 0.30, 95% CI 0.23–0.38). However, subjective cognitive complaints and neuropsychiatric symptoms did not significantly differ among SCD diagnostic groups. Conclusions: The utilization of diagnostic criteria using distinct neuropsychological definitions of cognitive normality significantly impacts the frequency of SCD diagnosis and characterizes different patient populations. Consequently, it is essential to specify the criterion when diagnosing a SCD patient and to understand the risks and benefits of using different criteria to define cognitive impairment.
- Moringa as a household water purification method – community perception and pilot study in Guinea-BissauPublication . Bancessi, Aducabe; Teodósio, Rosa; Duarte, Elizabeth; Baldé, Aladje; Catarino, Luís; Nazareth, TeresaBackground: Public perceptions of water-related issues are still under-researched topics. The current paper intends to explore a local community’s perceptions regarding household water purification (HWP) strategies, namely before and after trying a new method: moringa seeds powder (moringa-teabag). Methods: In September 2020, six focus group discussions (N = 65) assessing perceptions about the usefulness of Moringa oleifera Lam (Moringaceae) as a HWP method (before moringa-based HWP trials), and questionnaires (N = 104) evaluating successes and identifying difficulties (after one week of moringa-based HWP trials). Participants were all women aged over 18 years, living in Ondame, Biombo region, Guinea-Bissau. Data were analyzed using qualitative and quantitative approaches. Results: The focus group discussions revealed that people are aware of the fact that water can transmit diseases. Although certain persons showed concern about shallow well water safety, people generally underestimate the risk, as they trust tubewell water. Not everyone had an understanding of what water contamination is, or the concept of medical importance. Some respondents declared they use traditional methods such as boiling and bleach to treat water before drinking. However, those who reported no kind of treatment indicated reasons such as lack of time, cost, and bleach’s taste and smell. In the questionnaire, more than half of the participants (68%) reported treating water before consumption. Nevertheless, these results are not consistent with our field notes. Participants demonstrated a strong belief in the capacity of moringa-teabags to purify water and even consider them better or much better (81%) than other methods. Participants asked for more information on moringa-teabag for household water purification. Conclusion: More information on water treatment and water safety would help to raise public awareness about waterborne diseases. These findings could be used to promote greater adherence to moringa-based HWP as an alternative to household water treatment.
- Nutritional counselling in adults promoting adherence to the Mediterranean diet as adjuvant in the treatment of major depressive disorder (INDEPT): a randomized open controlled trial study protocolPublication . Sousa-Santos, Nuno; Fialho, Mónica; Madeira, Teresa; Clara, Cátia; Veiga, Sofia; Martins, Raquel; Barros, Neuza; Santos, Gabriela; Santos, Osvaldo; Almeida, Carolina; Ganança, Licínia; Campos, Rui C.; Camolas, José; Silva, Alda Pereira da; Guarino, Maria Pedro Sucena; Heitor, Maria JoãoBackground: Major Depressive Disorder (MDD) is a leading cause of disability worldwide. Approximately one-third of patients with MDD do not respond to treatment, and often exhibit elevated inflammation biomarkers, which are associated with worse prognosis. Previous research has linked healthier dietary patterns, such as the Mediterranean Diet (MedDiet), with a lower risk of MDD and symptoms of depression, potentially due to their anti-inflammatory properties. The aim of this study is to evaluate the effectiveness of a nutritional counselling intervention promoting MedDiet to alleviate symptoms of depression in adults recently diagnosed with MDD and presenting with elevated inflammation biomarkers. Methods: This study is a randomized controlled trial (RCT) that will recruit adults from outpatient clinics, between the ages of 18 and 70 years who have been diagnosed with MDD and are currently receiving treatment with the first prescribed antidepressant, and who exhibit elevated inflammation biomarkers (interleukin-6 and/or C-reactive protein). The control group will receive treatment-as-usual (TAU) only. The primary outcome of the study will be the change in symptoms of depression, as measured by the Beck Depression Inventory 2 (BDI-II), after 12 weeks of intervention. Data analysis will follow an intention-to-treat approach. Secondary outcomes will include changes in inflammation biomarkers, quality of life, adherence to the MedDiet, and cost-effectiveness of nutritional counselling. All outcomes will be assessed at baseline, after the 12-week intervention, and at 6- and 12-months post-baseline. Discussion: This study will be the first RCT to evaluate the effect of a nutritional intervention with anti-inflammatory properties, as an adjuvant in the treatment of MDD, in individuals diagnosed with MDD and elevated inflammation biomarkers. The results of this study may contribute to the development of more effective and personalized interventions for MDD patients with elevated inflammation biomarkers.
- Online information search by people with Multiple Sclerosis: a systematic reviewPublication . Berhanu, David; Leal Rato, Miguel; Canhoto, Ana Isabel; Vieira da Cunha, João; Geraldes, RuthBackground: People with Multiple Sclerosis (pwMS) search for information online about various aspects of living with their disease, but details about patterns of searching and outcomes are unclear. This means that opportunities to leverage online resources to support pwMS, and to enhance shared decision making, may be missed. We aimed to do a systematic review of the literature on digital information searching by pwMS. Methods: We performed a systematic search for studies assessing online information seeking of pwMS in MEDLINE and JSTOR databases. Studies were screened and selected by two investigators. All study designs were included, risk of bias was assessed using the Critical Appraisal Skills Programme qualitative checklist. Reports were assessed for the proportion of patients searching information online about MS, type of information sought, online tools used by patients, perceived quality of the information acquired, and impact of online searching in pwMS. Results: We identified 5 studies, including 10,090 patients. Most pwMS search for information online (53.8–82 %), which they rarely discuss with physicians. The most common topics are treatment, general disease information, symptoms, lifestyle recommendations, prognosis, and coping strategies. Patients that are younger, have a shorter disease duration, primary progressive MS, and during periods of disease worsening, are more likely to use online resources. Online information is perceived as low quality by pwMS. Conclusions: Online information search is prevalent among pwMS. Despite concerns with the quality of the available information, only a minority of pwMS will discuss the information found with their physician. These findings highlight the importance of developing and providing quality online information resources for pwMS.