FM - Contribuições em Revistas Científicas / Contribution to Journals
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- The persistent burden of rheumatic heart disease in AfricaPublication . Ferreira, Hilaryano da Silva; Morais, Humberto
- Breaking free from prognostic paralysis in chronic advanced diseasesPublication . Neto, Isabel Galriça; Sarmento, Teresa; Bruera, Eduardo
- The effectiveness of the gut microbiota modulation on ADHD in adults: a systematic reviewPublication . Gomes, Andreia; Siopa, Carlos; Pestana, Pedro Câmara; Novais, FilipaPurpose of Review: To critically assess the effectiveness of gut microbiota modulation (GMM) as a complementary approach for managing Attention Deficit Hyperactivity Disorder (ADHD) in adults. Methods: A systematic review was conducted following the JBI Manual for Evidence Synthesis, with searches in PubMed, Web of Science, Cochrane Database, ClinicalTrials.gov, EMBASE/Ovid, and APA PsycInfo. Results: Among 3,591 identified studies, only three randomized controlled trials met the inclusion criteria. One study reported improvements in inattention, while another found benefits in hyperactivity. Additionally, synbiotics and probiotics showed positive effects on emotional dysregulation, inflammatory markers, and gastrointestinal symptoms, reinforcing the link between gut microbiota and ADHD. However, the evidence remains inconsistent, and the studies are heterogeneous in methodology and outcomes. Summary: This review highlights the potential of GMM, particularly to enhance the management of refractory ADHD or for patients who experience significant side effects from conventional treatments. However, due to the very limited evidence, further high-quality, standardized trials are needed to determine its effectiveness, identify optimal bacterial strains and dosages, and develop more personalized treatment approaches, for better patient outcomes and functioning.
- Electronic health records-based research in cardiology: the time has come for pragmatic trialsPublication . Seabra, Daniel; Oliveira, Afonso; Gavina, CristinaRandomized clinical trials (RCTs) are the cornerstone of evidence-based medicine, as they minimize bias in the allocation of interventions. However, RCTs performed in a very selective population and overcontrolled conditions may impair the generalizability of results. Moreover, increasing running costs and regulatory complexity compromise the conduct of these studies. The need for pragmatic trial designs, with streamlined procedures and low running costs, will shape the short-term future of research in RCTs. Electronic health records (EHR) are routinely collected as part of the treatment of patients. These provide large amounts of data at no significant cost. The so-called “real-world data” are often used in observational studies with unavoidable bias. However, by combining the randomization of large numbers of patients with the data collected in EHRs, it is possible to answer very relevant clinical questions at a relatively low cost. In this review, we describe how the integration of EHR and randomization is fostering innovative approaches to the conduct of RCTs in Cardiology.
- Association of statin use on survival outcomes of patients with early-stage HER2-positive breast cancer in the APHINITY trialPublication . Maurer, Christian; Agostinetto, Elisa; Ameye, Lieveke; Lambertini, Matteo; Martel, Samuel; Ponde, Noam; Brandão, Mariana; Poggio, Francesca; Ferreira, Arlindo; Schiff, Rachel; Angelis, Carmine De; Gelber, Richard D.; Dent, Susan; Thomssen, Christoph; Piccart, Martine; Azambuja, Evandro dePurpose There is evidence that statins might improve the outcome of patients with breast cancer. The role of statins in patients with early HER2-positive breast cancer is unknown. Therefore, we explored the association between statin use and survival outcomes in early HER2-positive breast cancer patients in the phase III APHINITY trial (adjuvant pertuzumab/ trastuzumab). Methods All patients (intent-to-treat population, n=4804) were included (6.2 years median follow-up database). The primary objective was to investigate the association of statin use on invasive disease-free survival (IDFS), distant relapse-free interval (DRFI), and overall survival (OS). Patients who received statins at baseline, or started statins within 1 year from randomization were considered statin users. Survival curves were estimated using the Kaplan–Meier method. We used a Cox proportional hazards model for multivariate analysis. Results Overall, 423 (8.8%) patients were classifed as statin users. They were older, more often postmenopausal, had a higher body mass index, more often diabetes, hypertension, coronary heart disease and hyperlipidemia, had smaller sized tumors, were treated more often with breast conserving surgery, and less often with anthracycline-containing regimens. Overall, 508 IDFS events (12.8% among statin users and 10.4% among non-statin users) and 272 deaths (8.5% and 5.4%, respectively) occurred. In multivariate analysis, statin use was not associated with IDFS (HR, 1.11; 95% CI, 0.80–1.52), DRFI (HR, 1.21; 95% CI, 0.81–1.81) nor OS (HR, 1.16; 95% CI, 0.78–1.73). Conclusion In APHINITY, statin use was not associated with improved survival outcomes. These results must be interpreted with caution due to the exploratory nature of the analysis and the associated limitations.
- 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.
- 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.
- Do cognitive subtypes exist in people at clinical high risk for psychosis? Results from the EU-GEI studyPublication . EU-GEI High Risk Study; Gifford, George; Avila, Alessia; Kempton, Matthew J.; Fusar-Poli, Paolo; Mccutcheon, Robert A.; Coutts, Fiona; Tognin, Stefania; Valmaggia, Lucia; Haan, Lieuwe de; Gaag, Mark van der; Nelson, Barnaby; Pantelis, Christos; Riecher-Rössler, Anita; Bressan, Rodrigo; Barrantes-Vidal, Neus; Krebs, Marie-Odile; Glenthoj, Birte; Ruhrmann, Stephan; Sachs, Gabriele; Rutten, Bart P. F.; Os, Jim van; McGuire, PhilipBackground and Hypothesis: Cognition has been associated with socio-occupational functioning in individuals at Clinical High Risk for Psychosis (CHR-P). The present study hypothesized that clustering CHR-P participants based on cognitive data could reveal clinically meaningful subtypes. Study Design: A cohort of 291 CHR-P subjects was recruited through the multicentre EU-GEI high-risk study. We explored whether an underlying cluster structure was present in the cognition data. Clustering of cognition data was performed using k-means clustering and density-based spatial clustering of applications with noise. Cognitive subtypes were validated by comparing differences in functioning, psychosis symptoms, transition outcome, and grey matter volume between clusters. Network analysis was used to further examine relationships between cognition scores and clinical symptoms. Study Results: No underlying cluster structure was found in the cognitive data. K-means clustering produced “spared” and “impaired” cognition clusters similar to those reported in previous studies. However, these clusters were not associated with differences in functioning, symptomatology, outcome, or grey matter volume. Network analysis identifed cognition and symptoms/functioning measures that formed separate subnetworks of associations. Conclusions: Stratifying patients according to cognitive performance has the potential to inform clinical care. However, we did not fnd evidence of cognitive clusters in this CHR-P sample. We suggest that care needs to be taken in inferring the existence of distinct cognitive subtypes from unsupervised learning studies. Future research in CHR-P samples could explore the existence of cognitive subtypes across a wider range of cognitive domains.
- 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.
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