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- Addressing critical fungal pathogens under a One Health perspective: key insights from the Portuguese Association of Medical MycologyPublication . Sabino, Raquel; Antunes, F.; Araujo, Ricardo; Bezerra, Ana Rita; Brandão, João; Carneiro, C.; Carvalho, Agostinho; Carvalho, D.; Conceição, I. C.; Medeiros, F. Cota; Cruz, C.; Duarte, E.; Holum, Stephanie; Matos, O.; Maltez, Fernando; Mendonça, Alexandre; Moura, Gabriela; Pereira, A.; Rodrigues, Célia Fortuna; Teixeira, P.; Valdoleiros, S. R.; Veríssimo, C.; Viegas, CarlaFungal infections have emerged as a significant public health concern, especially with the increasing incidence of severe mycoses caused by pathogens such as Aspergillus fumigatus, Candida auris, Candida albicans, and Cryptococcus neoformans. These fungi, listed as critical priorities by the World Health Organization, pose a heightened risk due to the rising prevalence of antifungal resistance and their severe impact on immunocompromised individuals. This article, coordinated by the Portuguese Association of Medical Mycology, emphasizes the importance of adopting a One Health approach to comprehensively address fungal threats. Drawing on interdisciplinary collaboration, the association aims to foster greater awareness, improve diagnostic capabilities, and stimulate research and public health policies in Portugal, but also at the global level. The paper outlines key strategies for surveillance, prevention, and innovation in fungal diagnostics and therapeutics. Moreover, it emphasizes the urgent need for national coordination and international cooperation in managing fungal infections, advocating for integrative approaches that link human, animal, and environmental health. By presenting a consolidated overview of current challenges and future priorities, this work seeks to enhance preparedness and response mechanisms in the face of escalating fungal threats.
- Adenocarcinoma seroso do endométrio: estudo de casoPublication . Luís, A.; Vieira, D.; Tavares, D.; Roque, Ruben; Mendonça, Paula; André, S.O adenocarcinoma do endométrio é uma das neoplasias malignas do trato genital feminino mais frequente em países da Europa Ocidental e América do Norte. Mais de 90% dos casos ocorre em mulheres com idade superior a 50 anos e apenas 4% dos casos surgem antes dos 40 anos. O presente caso clínico diz respeito a mulher de 74 anos com perdas vaginais hemáticas, lesão ulcerada vaginal e útero aumentado, com massa polipoide na cavidade endometrial. Foi realizada uma colpocitologia, cujo diagnóstico foi de adenocarcinoma sem outra especificação (SOE). Posteriormente, foi feita uma biópsia da massa polipóide cujo exame histológico e realização de painel imunohistoquímico confirmaram carcinoma de origem endometrial, constatando também que a paciente é portadora de mutações associadas ao Síndrome de Lynch nos microssatélites PMS2, MLH1, MLH6 e MSH2. Como avaliação pré-tratamento realizou-se ressonância magnética pélvica que mostrou distensão da cavidade endometrial provocada por tumor do endométrio. A utente foi submetida a histerectomia total com anexectomia bilateral, em que o diagnóstico final foi de carcinoma seroso do endométrio.
- Adverse events identified by a trigger tool as indicators of patient safety and safety management in a medical departmentPublication . Pierdevara, Ludmila; Porcel-Gálvez, Ana Maria; Eiras , MargaridaBackground: Adverse events (AEs) in hospital settings pose a significant threat to patient safety, particularly in patients with multiple comorbidities. Systematic detection tools, such as the Global Trigger Tool, have proven to be more sensitive than traditional voluntary reporting systems in identifying AEs. Objective: This study analyzes the prevalence, characteristics, and factors associated with the occurrence of AEs in an internal medicine department, focusing on patients with multiple morbidities, using a combined approach that integrates the European Portuguese version of the Global Trigger Tool (GTT-PT) and a voluntary reporting system. Methods: This observational, retrospective, exploratory study was conducted in four internal medicine departments at a Portuguese hospital center. A total of 360 randomly selected clinical records were included in this study. AEs were identified using the GTT-PT and by analyzing voluntary incident reports. Sociodemographic and clinical variables were analyzed using binary logistic regression. Results: A total of 718 AEs were identified, of which 564 (78.6%) occurred during hospitalization. Most events were of moderate severity (categories E and F in the Institute for Healthcare Improvement classification). Length of hospital stay was the main predictor of AEs occurrence (odds ratio [OR] range 1.011-1.173). The use of a nasogastric tube was also significantly associated with increased AE risk (OR = 6.693). The GTT-PT detected significantly more events than the voluntary reporting system. Conclusion: The combined use of the GTT-PT and voluntary reporting systems is highly effective in detecting AEs in internal medicine settings. Length of hospital stay and use of invasive devices are key factors associated with AE occurrence. These findings underscore the importance of institutional policies that support a non-punitive safety culture and encourage the systematic integration of proactive monitoring methodologies into clinical practice.
- Ageing affects the CD4+ T cell polarization and mucosal tropism induced by TLR2/TLR4-activated dendritic cellsPublication . Zúquete, Sara; Ferreira, Mariana; Delgado, Inês L.; Rosa, Maria teresa; Mendes, Ana Catarina; Santos, Dulce; Nolasco, Sofia; Graça, Luís; Leitão, Alexandre; Basto, Afonso P.Toll-like receptor (TLR)2 activation induces aldehyde dehydrogenase enzymes in non-mucosal dendritic cells (DCs), enabling them to metabolize vitamin A into all-trans retinoic acid, which induces the expression of mucosal-homing molecules (α4β7 and CCR9) in the activated T cells. Recently, we have shown that the simultaneous activation of non-mucosal DCs through TLR2 and TLR4 maintains such capacity while reinforcing the polarization of primed CD4+ T cells towards Th1. Here, we observed that TLR2/TLR4 stimulation of aged DCs leads to the production of less TNFα and more IL-10, and that CD4+ T cells primed by those DCs express lower levels of the mucosal homing receptor CCR9 and produce less type-1 (IFNγ) and more type-2 (IL-4 and IL-13) cytokines. These results emphasize the importance of considering the age-related alterations in DC function when developing novel immunomodulation strategies that rely on the DC-T cell crosstalk through stimulation of pattern recognition receptors.
- Analyzing the reliability and cost of the most commonly used dosimeters for personal ultraviolet radiation monitoring: a rapid reviewPublication . Caetano, Marco; Gregório, João; Paulo, Marília SilvaTo identify the most used dosimeters for monitoring ultraviolet radiation (UVR) and analyze their reliability and cost for individual UV exposure monitoring, this study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. An extensive search of the PubMed, Scopus, and Web of Science databases, covering 2005–2023, was conducted, including examining reference lists of retrieved studies. Of the 1202 records, 52 were eligible for analysis. Three types of dosimeters were identified: photosensitive, photochromic, and electronic dosimeters. Photosensitive dosimeters were utilized for 1236 samples across the studies, while photochromic dosimeters were employed for 360 samples. Electronic dosimeters, with a sample size of 3632, were the most extensively studied. This study highlights the variety of resources available for UVR assessment and the significance of specific dosimeter types in this field. Although few studies have explored the costs associated with dosimeter use, electronic dosimeters are the most cost-effective for radiation monitoring and provide the highest accuracy for measuring UVR exposure. Electronic dosimeters, known for real-time data and high precision, are reliable but costly, being approximately 16.5 times more expensive than photosensitive dosimeters and 160 times more expensive than photochromic dosimeters. Photosensitive dosimeters suit large-scale personal use, and photochromic sensors such as polysulphone dosimeters are also reliable. Additional costs for data analysis software, laboratory equipment, or external analysis services may be incurred, especially for advanced research-grade sensors.
- Applicability of MRI-only technique in external beam radiotherapy: dosimetric evaluation, IGRT, and quality assurance (a systematic review)Publication . Pereira, Daniel; Pereira, Luís; Barbosa, J.; Caetano, MarcoIntroduction: Magnetic Resonance Imaging (MRI) provides superior soft tissue contrast compared to planning Computed Tomography (pCT). Although pCT remains the standard method in radiotherapy planning due to its provision of electron density information required for dose calculations, the MRI-only technique can replace pCT by generating synthetic CTs (sCTs) that supply the necessary density data. Methods: A systematic literature review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The literature search was performed in April 2025 across the PubMed, Scopus, and Web of Science databases, applying inclusion and exclusion criteria defined using the PICOS model. The included studies were assessed using the "Appraising the Evidence: Reviewing Disparate Data Systematically" tool, and extracted data were synthesised in a narrative summary table. Results: A total of 41 studies were included, covering different anatomical regions. The studies reported non-significant differences in dose-volume histograms (DVH) between sCT and CT. Gamma analysis conformity evaluations showed pass rates >87.4 %. The deviations across various image registrations remained <2 mm for translational displacements and <1.2° for rotations. Discrepancies between sCT-CT and sCT-Cone Beam CT were ≤1 %. Conclusion: The MRI-only technique proved to be feasible for use in the central nervous system and pelvic regions, both in terms of dosimetry and image-guided verification. In head and neck oncology, the focus was exclusively on dosimetric planning. Further studies are required to validate and expand the applicability of this technique to other anatomical sites. Implications for practice: These findings reinforce the applicability and versatility of the MRI-only approach across multiple anatomical regions and therapeutic contexts, highlighting its potential to improve patient comfort and streamline clinical workflows.
- A ascensão de genes de resistência a antibióticos em Staphylococcus aureus: revisão sistemáticaPublication . Reguinga, Patrícia; Afonso, Joana; Carmo, Matilde; Ribeiro, EdnaIntrodução – O Staphylococcus aureus resistente à meticilina (MRSA) tem-se disseminado globalmente, tornando-se endémico em muitos hospitais e comunidades. Além da meticilina, diversas estirpes de S. aureus têm mostrado resistência a uma variedade de outros antibióticos. Esta resistência é conferida por genes cuja presença e expressão são facilitadas por uma alta taxa de recombinação genética e pela capacidade de transferência horizontal de genes. A recente sequenciação dos diferentes genomas das estirpes de S. aureus e o desenvolvimento de ferramentas de bioinformática são muito promissores na identificação e caracterização de genes-alvo associados a esta resistência. Objetivo – Determinar as tendências emergentes, estirpes mais prevalentes, mecanismos moleculares subjacentes e fatores de virulência e como esses elementos estão relacionados com a resistência antimicrobiana e o sucesso das infeções causadas por diferentes estirpes de S. aureus. Métodos – Utilizaram-se as bases de dados PubMed e ScienceDirect para pesquisar artigos de janeiro de 2016 a agosto de 2024, com texto completo disponível em língua inglesa, que estudassem infeções nosocomiais por S. aureus efetuando testes de sensibilidade a antibióticos (TSA) e análise do genoma, de modo a identificar genes de resistência a antibióticos e fatores de virulência. Adicionalmente foram também pesquisados artigos no website Elicit. A seleção dos artigos e da informação foi realizada através da ferramenta Rayyan e a extração da informação pelo Microsoft Excel. Resultados – Foram incluídos quatro estudos, realizados no continente asiático, mas em diferentes regiões. Os estudos realizados na China concentraram-se principalmente nos dois clones MRSA ST239 e ST59, reconhecidos mundialmente. No estudo no Irão, realizado em cinco hospitais, os isolados MRSA demonstraram uma distribuição clonal notável que reflete a epidemiologia local. O estudo realizado nas Filipinas revelou que a maioria dos isolados de MRSA pertencia ao complexo CC30, distribuída principalmente entre o subtipo ST30 e a sua variante de locus único ST1456. Conclusão – Os dois clones ST239 e ST59 são dos mais prevalentes mundialmente em infeções nosocomiais causadas por MRSA. A maioria dos estudos demonstrou que todos os isolados de MRSA foram identificados como resistentes à penicilina e oxacilina. Os estudos que determinaram os fatores de virulência permitiram concluir que os MRSA possuem genes de virulência, sendo os mais comuns o gene chp e os genes codificadores de PVL.
- Assessing the impact of nanoplastics in biological systems: systematic review of in vitro animal studiesPublication . Viana, Maria; Tonin, Fernanda; Ladeira, CarinaNanoplastic (NP) pollution has emerged as a growing concern due to its potential impact on human health, although its adverse effects on different organ systems are not yet fully understood. This systematic scoping review, conducted following international guidelines, aimed to map the current evidence on the biological effects of NPs. In vitro animal studies assessing cellular damage caused by exposure to any type of NP were searched on PubMed, Web of Science, and Scopus. Data on primary outcomes related to genotoxicity and cytotoxicity (cell viability, oxidative stress, inflammation, DNA and cytoplasmic damage, apoptosis) were extracted from the included studies, and overall reporting quality was assessed. A total of 108 articles published between 2018 and 2024, mostly by China (54%), Spain (14%), and Italy (9%), were included. Polystyrene (PS) was the most frequently studied polymer (85%). NP sizes in solution ranged from 15 to 531 nm, with a higher prevalence in the 40–100 nm range (38%). The overall quality of studies was rated as moderate (60%), with many lacking essential details about cell culture conditions (e.g., pH of the medium, passage number, substances used). A higher frequency of negative effects from NP exposure was observed in respiratory cell lines, while immune, digestive, and hepatic cell lines showed greater resistance. Nervous, urinary, and connective tissue systems were impacted by NPs. Positively charged and smaller PS particles were consistently associated with higher toxicity across all systems. In summary, this review highlights the multifactorial nature of NP toxicity, influenced by size, surface charge, and polymer type. It also reveals a significant knowledge gap, stemming from the predominant use of immortalized monocultures exposed to commercially available PS NPs, the limited use of environmentally relevant particles, and the underutilization of advanced experimental models (e.g., organ-on-chip systems) that better mimic physiological conditions.
- Assessing the predictive value of preoperative knee function tests and self-report scores in anterior cruciate ligament injury recoveryPublication . Loureiro-Nuno, Sérgio Miguel; Romero-Morales, Carlos; López-López, Daniel; Losa-Iglesias, Marta Elena; Becerro-de-Bengoa-Vallejo, Ricardo; Gómez-Salgado, Juan; Guerra, João; Saavedra-García, Miguel ÁngelBackground: The ability to identify patients with long-term poor outcomes using clinical and functional information is limited. Identifying prognostic factors to improve long-term outcomes after anterior cruciate ligament (ACL) injury can influence and inform targeted interventions for this population. Hypothesis: Preoperative functional tests and patient-reported outcome measures predict postoperative functional recovery and satisfaction in patients undergoing first-time ACL repair, second-time ACL repair on the same knee, and bilateral ACL repair. Study design: Quasi-experimental prospective study. Level of evidence: Level 3. Methods: A total of 88 patients with ACL reconstruction were included. Subjective knee scoring systems and functional performance tests were evaluated and analyzed for correlation with results. Results: The first-time ACL injury group had lower scores in the various self-report scales: Knee injury and Osteoarthritis Outcome Score (KOOS), Lysholm Rating Scale, International Knee Documentation Committee (IKDC), and Lower Extremity Functional Scale (LEFS). Conclusion: Reduction in self-reported knee function and Y balance test performance after ACL injury are predictive factors for recovery. Estimates exceeded clinically important thresholds. Those who had already undergone surgery had clinically better thresholds, highlighting the assessment of these measures when designing presurgical rehabilitation programs.
- Assessing the quality and reliability of ChatGPT’s responses to radiotherapy-related patient queries: comparative study with GPT-3.5 and GPT-4Publication . Grilo, Ana; Marques, Catarina; Corte-Real, Maria; Carolino, Elisabete; Caetano, MarcoBackground: Patients frequently resort to the internet to access cancer information. However, these websites often lack content accuracy and readability. Recently, ChatGPT, an artificial intelligence-powered chatbot, has signified a potential paradigm shift in how patients with cancer can access vast amounts of medical information, including insights into radiotherapy. However, the quality of the information provided by ChatGPT remains unclear. This is particularly significant given the general public's limited knowledge of this treatment and concerns about its possible side effects. Furthermore, evaluating the quality of responses is crucial, as misinformation can foster a false sense of knowledge and security, lead to noncompliance, and result in delays in receiving appropriate treatment. Objective: This study aims to evaluate the quality and reliability of ChatGPT's responses to common patient queries about radiotherapy, comparing the performance of ChatGPT's two versions: GPT-3.5 and GPT-4. Methods: We selected 40 commonly asked radiotherapy questions and entered the queries in both versions of ChatGPT. Response quality and reliability were evaluated by 16 radiotherapy experts using the General Quality Score (GQS), a 5-point Likert scale, with the median GQS determined based on the experts' ratings. Consistency and similarity of responses were assessed using the cosine similarity score, which ranges from 0 (complete dissimilarity) to 1 (complete similarity). Readability was analyzed using the Flesch Reading Ease Score, ranging from 0 to 100, and the Flesch-Kincaid Grade Level, reflecting the average number of years of education required for comprehension. Statistical analyses were performed using the Mann-Whitney test and effect size, with results deemed significant at a 5% level (P=.05). To assess agreement between experts, Krippendorff α and Fleiss κ were used. Results: GPT-4 demonstrated superior performance, with a higher GQS and a lower number of scores of 1 and 2, compared to GPT-3.5. The Mann-Whitney test revealed statistically significant differences in some questions, with GPT-4 generally receiving higher ratings. The median (IQR) cosine similarity score indicated substantial similarity (0.81, IQR 0.05) and consistency in the responses of both versions (GPT-3.5: 0.85, IQR 0.04; GPT-4: 0.83, IQR 0.04). Readability scores for both versions were considered college level, with GPT-4 scoring slightly better in the Flesch Reading Ease Score (34.61) and Flesch-Kincaid Grade Level (12.32) compared to GPT-3.5 (32.98 and 13.32, respectively). Responses by both versions were deemed challenging for the general public. Conclusions: Both GPT-3.5 and GPT-4 demonstrated the capability to address radiotherapy concepts, with GPT-4 showing superior performance. However, both models present readability challenges for the general population. Although ChatGPT demonstrates potential as a valuable resource for addressing common patient queries related to radiotherapy, it is imperative to acknowledge its limitations, including the risks of misinformation and readability issues. In addition, its implementation should be supported by strategies to enhance accessibility and readability.