FM - Contribuições em Revistas Científicas / Contribution to Journals
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- 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.
- Transforming mental health care - policy implementationPublication . Ribeiro, H. Prata; Mackay, P.; Azevedo, E.; Bettencourt, N.Introduction: The Autonomous Region of the Azores faced considerable challenges in providing comprehensive, efficient, and integrated mental health care services, exacerbated by geographical isolation, resource constraints, and the absence of a cohesive system for referrals and quality assessment in mental health care. Objectives: Despite the recognized need, the integration of mental health services into primary health care (PHC) and the broader health system in the Azores was fragmented. Key issues included lengthy waiting lists, inadequate referral systems between primary care and specialized psychiatric services, and a lack of standardized quality assessment and performance indicators for mental health care. Additionally, there was a significant need for community mental health teams, emergency management of agitated patients, and comprehensive training for health professionals in psychiatric care. Methods: Through collaborative efforts, the region achieved notable advancements, including the creation of referral criteria from PHC to psychiatry services, structuring inter-service referrals, reactivation of Community Mental Health Teams, and establishment of a “Physician’s Bank.” Noteworthy was the elimination of a waiting list of over 1,000 patients and the development of quality assessment and performance indicators. The construction of a courtyard for involuntarily hospitalized patients and the creation of an emergency room on Faial Island further exemplified the tangible improvements in patient care and system efficiency. Training programs were extensively implemented across various professional groups, enhancing the capacity for mental health care delivery at all levels. Results: The integration efforts underscored the value of cross-sector collaboration, stakeholder engagement, and the adaptation of models like the SURE framework and COM-B theory to address the multifaceted barriers to mental health care integration. Key facilitators included the development of guidelines, training, and clinical supervision, alongside innovative approaches to public health interventions. Conclusions: The transformative work in the Azores exemplifies how integrated care models, supported by strategic collaborations and policy reforms, can significantly enhance mental health service delivery in geographically isolated regions. It underscores the importance of systemic approaches to training, infrastructure development, and stakeholder engagement in achieving sustainable improvements in mental health care.
- Structural versus functionally-informed supratotal resection: where do we stand?Publication . Chowdhury, Yasir A.; Gullan, Richard; Ashkan, Keyoumars; Vergani, Francesco; Bhangoo, Ranjeev; Lavrador, José Pedro
- Troponin/lymphocyte ratio: anticipating immunotherapy-induced myocarditisPublication . Miranda, Inês; Augusto, João Bicho