FM - Contribuições em Revistas Científicas / Contribution to Journals
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- Postprandial metabolic responses to a glycomacropeptide-based protein substitute in different meal contexts-implications for phenylketonuria (PKU)Publication . Rodrigues, Catarina; Jácome-Pacheco, Dúnio; Barreiros-Mota, Inês; Ismael, Shamila; Maia-Santos, Gilberto; Noronha, Tiago; Almeida, Maria João; Castela, Inês; Santos, Jéssica; Florindo, Cristina; Gomes, Alexandra Filipa; Cadio, João; Calhau, Conceição; Pestana, Diogo; Araujo, João Ricardo; MacDonald, Anita; Faria, Ana; Rocha, Júlio CésarBackground: Casein glycomacropeptide supplemented with amino acids (CGMP-AA) is used in the treatment of phenylketonuria (PKU). However, its acute metabolic effects when consumed with other foods remain poorly understood. This study investigated the impact CGMP-AA consumed alone or with two low-protein meals providing carbohydrates with either fibre or fat. Methods: In this randomised crossover trial, fifteen healthy adults (27.0 ± 7.9 y; 7 females) consumed: A) CGMP-AA alone; B) CGMP-AA with low-protein bread and unpeeled apple; or C) CGMP-AA with lowprotein bread and olive oil. Blood samples were collected over 120 min to assess glucose, insulin, Cpeptide, amino acids, and appetite-related hormones (glucose-dependent insulinotropic polypeptide (GIP), glucagon-like peptide-1 (GLP-1), and peptide YY (PYY)). Results: Co-ingestion with low-protein foods had limited effects on total essential and large neutral amino acid concentrations over 120 min, but increased Tyr incremental area under the curve (iAUC(0–120min)) and peak concentration (Cmax) compared with CGMP-AA alone. Meal B elicited the highest glucose, insulin, and C-peptide iAUC(0–120min) and Cmax, followed by meal C, whereas meal A induced minimal glycaemic and insulinaemic excursions. Meal C produced the greatest GIP response, whereas GLP-1 and PYY did not differ between test meals. Conclusions: In healthy adults, CGMP-AA elicited distinct acute postprandial responses depending on whether it was consumed alone or with low-protein foods. CGMP-AA consumed with food is not metabolically equivalent to CGMP-AA consumed alone, and carbohydrate-with-fibre and carbohydrate with-fat meal contexts affect distinct aspects of the postprandial response. These findings should be confirmed in individuals with PKU before being translated into dietary recommendations.
- From 2D to 3D colorectal cancer patient-derived organoids (PDOs) and in vivo models: copper(II) complexes as promising new antitumor agentsPublication . Choroba, Katarzyna; Cordeiro, Sandra; Sequeira, Rita; Machura, Barbara; Erfurt, Karol; Guedes, Ana; Mascarenhas-Lemos, Luis; Cravo, Marília; Baptista, Pedro V.; Fernandes, Alexandra R.Two copper(II) complexes, (1) [CuCl2(tmp-terpy)] and (2) {[CuCl(tmp-terpy)]·PF6}n, (tmp-terpy-4′-(3,4,5- trimethoxy-phenyl)-2,2′:6′,2″-terpyridine) were designed, characterized, and evaluated for cytotoxicity in 2D human cell models (HCT116, HCT116-DoxR, and in normal primary fibroblasts), and 3D colorectal cancer (CRC) spheroids and patient-derived organoids (PDOs). Both complexes demonstrated potent antiproliferative effects, alone and in combination with the FOLFOX (FF), across all 3D models. Importantly, the cytotoxic effects of complex 1 were significantly more pronounced in tumor-derived PDOs than in normal tissue-derived PDOs. Complex 1 induced reactive oxygen species (ROS) production, triggering intrinsic apoptosis and autophagy, consistent with a multimodal anticancer mechanism. It also exerted a cytostatic effect, as shown by delayed cell-cycle progression, and antiangiogenic activity in vivo without systemic toxicity. Notably, cotreatment of complex 1 with FF significantly potentiated cytotoxicity in 3D tumor spheroids and PDOs tumor-derived-PDOs. [CuCl2(tmp-terpy)] alone or in combination with the FF regimen warrants further evaluation in advanced preclinical models.
- Acute cardiovascular manifestations of hypocortisolismPublication . Gerardo, Filipa; Mateus, Carolina; Passos, Mariana; Santos, Miguel; Faria, Daniel; Fialho, Inês; Roque, David; Augusto, João Bicho
- Deep-learning denoising for ultrahigh-resolution photon-counting detector CT: phantom and in vivo evaluation of non-calcified coronary plaquesPublication . Hyska, Sardi; Hagar, Muhammad Taha; Osoria-Velasquez, José; Fink, Nicola; Ricke, Jens; Halfmann, Moritz C.; Marques, Hugo; McVeigh, Elliot; Wesbey, George; Maurovich-Horvat, Pál; Szilveszter, Bálint; Emrich, Tilman; Varga-Szemes, Akos; Vecsey-Nagy, MilanTo assess the value of convolutional neural network (CNN)-based denoising for the evaluation of non-calcified coronary plaques on ultrahigh-resolution (UHR) photon-counting detector (PCD) coronary CT angiography (CCTA). A dynamic phantom containing lipid-rich and fibrotic plaques with 50%-diameter stenosis (PDS) was scanned on PCD-CT under varying conditions. For in-vivo imaging, consecutive patients with non-calcified coronary plaques (NCPs) who underwent CCTA with PCD-CT were included. Image series were reconstructed using a sharp vascular kernel (Bv64) with slice thicknesses of 0.2 mm/0.4 mm, quantum iterative reconstruction (QIR) levels 3/4, and with/without CNN denoising. Phantom-based line-profile analysis yielded edge-width at half maximum (EWHM) and 10–90% rise distance as sharpness metrics. Plaque contrast-to-noise ratio (CNR) and PDS were assessed in the phantom and in patients. Two readers evaluated subjective image quality (noise, diagnostic confidence) using a four-point Likert scale. Pairwise comparisons were performed using a Bonferroni-corrected p < 0.002 for significance. Fifty-five patients (median age 74 [66.5–78] years; 19 women) with 97 NCPs were included. Phantom-based sharpness metrics remained unchanged after denoising (all pairwise p > 0.051). CNN denoising increased plaque CNR consistently in the phantom (fibrotic: 0.80–1.64 to 0.92–2.06; lipid-rich: 0.21–0.34 to 0.35–0.46) and in vivo (0.99–2.07 to 1.37–2.92, all pairwise p < 0.001). Denoising did not alter PDS values in phantom or in vivo plaques (all pairwise p > 0.006). Subjective image noise and diagnostic confidence improved across all reconstructions (all pairwise p < 0.001). CNN-based denoising of UHR PCD-CT improves image quality of non-calcified coronary plaques, while preserving sharpness and quantitative stenosis metrics.
- Low-dose colchicine for secondary prevention: a systematic review and meta-analysis of randomized clinical trialsPublication . Sousa, Rita Barbosa; Pereira, Joana Certo; Presume, João; Gomes, Daniel A.; Oliveira, Afonso Félix de; Ferreira, Jorge
- Practical guide on acute heart failure management: from hospital admission to outpatient carePublication . Pimenta, Joana; Ferreira, João Pedro; Vasques-Nóvoa, Francisco; Roque, David; Araújo, Inês; Lourenço, César; Costa, Susana Dias da; Gonçalves, Sara; Neto, Ana; Almeida, Filipa; Sarmento, Pedro Moraes; Agostinho, João; Marques, Irene; Martins, ElisabeteAcute heart failure (AHF) presents significant clinical and economic challenges that require a comprehensive, evidence-based strategy extending from in-hospital management to post-discharge care. Patients with AHF usually require prompt initiation or intensification of HF-directed treatment, which commonly includes intravenous diuretics, and frequently culminates in unplanned hospitalization. Despite therapeutic advances, AHF is still associated with poor outcomes, with in-hospital mortality in Portugal reaching 12.4%. Based on the expertise and clinical experience of a panel of cardiology and internal medicine specialists, this paper provides a practical guide to AHF management over the patient journey, which has been adapted to align with the specificities of the Portuguese national healthcare system: hospital admission, initial management of AHF, in-hospital management of stable phase, pre-discharge and transition of care. This practical guide highlights the importance of optimizing guideline-directed medical therapy by tailoring and rapidly uptitrating treatments to reduce mortality and readmissions. It is equally essential that structured, multidisciplinary transition-of-care programs are established that promote continuity and coordination across care settings.
- Delayed intervention in a giant coronary bypass saphenous graft aneurysm: a case reportPublication . Passos, Mariana; Gerardo, Filipa; Loureiro, José; Magno, Pedro; Augusto, João Bicho
- Dexamethasone in brain tumor patients: a real-world pharmacovigilance auditPublication . Prasad, Vindhya; Elhag, Ali; Onyiriuka, Louis; Mthunzi, Engelbert; Hatch, Sarah; Naeem, Awais; Noureldin, Fatmahelzahraa; Marchi, Francesco; Raslan, Ahmed; Chowdhury, Yasir A.; Shapey, Jonathan; Gullan, Richard; Bhangoo, Ranjeev; Vergani, Francesco; Ashkan, Keyoumars; Lavrador, José PedroIntroduction: Dexamethasone is routinely prescribed for the management of peritumoral edema in brain tumor patients. Despite available orientations for its management in neuro-oncology patients, the individual needs according to the natural history of the disease and treatment options allied to a hierarchical system with multiple teams involved poses significant challenges in its real-world application. Methods: We conducted a retrospective single-centre observational study of 316 brain tumor referrals to a tertiary neurosurgical center over a 3-month period. Data was extracted from referral notes, multidisciplinary team (MDT) documentation and clinical records. Steroid-related variables such as indication, dose, duration, weaning plan, complications, and follow-up practices were collected alongside demographic and clinical data. Results: Of 316 referrals, 210 patients (66.5%) were started on steroids at baseline, yet only 6% had a documented weaning plan at that point. MDT referral occurred in 252 patients (79.7%), where steroid initiation was significantly associated with surgical management (χ2 = 13.1, p < 0.001). However, only 28.8% of MDT-referred patients had a documented steroid plan, with higher rates in surgical patients (41.3%) than those managed conservatively or with best supportive care (BSC) (16.5%, p < 0.001). Steroid-related complications occurred in 11.4% (24/210) of patients, most commonly wound infections. Prolonged steroid use (>2 weeks) (OR = 3.5, [95% CI: 1.1–11.0], p = 0.04), and absence of an MDT steroid plan (OR = 4.2, [95% CI: 1.2–15.0], p = 0.03) were significant predictors of complications, particularly of Common Terminology Criteria for Adverse Events (CTCAE) Grade 2–3 severity. Nurse-led clinic follow-up was more common in surgical patients (91%) than BSC patients (24.6%, p < 0.001) and supported steroid monitoring. Discussion: Prolonged steroid use and incomplete documentation of steroid plan were associated with increased steroid-related complications highlighting the need for more robust prescribing protocols and improved multidisciplinary follow-up.
- Large language models in cardiovascular prevention: a narrative review and governance frameworkPublication . Ferreira Santos, José; Dores, HélderBackground: Large language models (LLMs) are becoming progressively integrated into clinical practice; however, their role in cardiovascular (CV) prevention remains unclear. This review synthesizes current evidence on LLM applications in preventive cardiology and proposes a governance framework for their safe translation into practice. Methods: We conducted a comprehensive narrative review of literature published between January 2015 and November 2025. Evidence was synthesized across three functional domains: (1) patient applications for health literacy and behavior change; (2) clinician applications for decision support and workflow efficiency; and (3) system applications for automated data extraction, registry construction, and quality surveillance. Results: Evidence suggests that while LLMs generate empathetic, guideline-concordant patient education, they lack the nuance required for unsupervised, personalized advice. For clinicians, LLMs effectively summarize clinical notes and draft documentation but remain unreliable for deterministic risk calculations and autonomous decision-making. System-facing applications demonstrate potential for automated phenotyping and multimodal risk prediction. However, safe deployment is constrained by hallucinations, temporal obsolescence, automation bias, and data privacy concerns. Conclusions: LLMs could help mitigate structural barriers in CV prevention but should presently be deployed only as supervised “reasoning engines” that augment, rather than replace, clinician judgment. To guide the transition from in silico performance to bedside practice, we propose the C.A.R.D.I.O. framework (Clinical validation, Auditability, Risk stratification, Data privacy, Integration, and Ongoing vigilance) as a roadmap for responsible integration.