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Browsing ESTeSL - Artigos by Sustainable Development Goals (SDG) "03:Saúde de Qualidade"
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- 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.
- 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.
- 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.
- Balloon pulmonary angioplasty and riociguat in the management of chronic thromboembolic pulmonary hypertension: a systematic reviewPublication . Araújo, Patrícia; Calé, Rita; Pereira, Ernesto; Ferreira, Filipa; Alegria, Sofia; Pereira, Hélder; Coelho, AndréBackground: No systematic review has been published comparing the effectiveness and safety of balloon pulmonary angioplasty (BPA) and riociguat in patients with chronic thromboembolic pulmonary hypertension (CTEPH) across studies that evaluate both treatment methods. Methods: A literature search was conducted using PubMed, ScienceDirect, and Elsevier. Clinical, functional, and hemodynamic effectiveness criteria were analysed, as well as complications related to both interventions. Results: Five studies were reviewed, including randomized clinical trials and observational studies, comprising 184 patients who underwent riociguat and BPA, 94 patients who underwent BPA alone, and 79 who underwent riociguat alone. Patients receiving combination therapy demonstrated a more significant improvement in WHO-FC, PVR, and CO (≈1.13 L/min) than monotherapy (BPA: ≈0.45 L/min and riociguat: ≈0.84 L/min). Regarding the 6MWD, patients who started with Riociguat before combination therapy showed a greater improvement (≈78 m) than those on monotherapy (BPA: ≈46.9 m and riociguat: ≈38.2 m). The reduction in mPAP was greater in patients treated with BPA alone (≈-17.6 mmHg) compared to riociguat alone (≈-5.4 mmHg) or combination therapy (≈-12.2 mmHg). In the BPA group, the rate of life-threatening complications was very low, with haemoptysis or pulmonary haemorrhage being the most common adverse events (15%-44%). In the riociguat group, dizziness, headaches, gastrointestinal reflux, vomiting, and nausea were reported (15%-23%). Among patients undergoing both treatments, the vascular injury rate was <11 %, with the most common adverse event being the need for non-invasive ventilation (30 %). Conclusions: Combination therapy appears to be more effective than monotherapy, without being associated with major adverse events in patients diagnosed with CTEPH.
- Biomonitorização da exposição profissional ao crómio hexavalente: contributo para proposta de valores-limite biológicosPublication . Pinhal, Hermínia; Nogueira, Ana; Santos, Sílvia; Ribeiro, Edna; Ladeira, Carina; Viegas, SusanaO crómio hexavalente (Cr(VI)) é um agente cancerígeno para o ser humano, estando na origem de cancro no pulmão. As indústrias em que ocorre exposição ao Cr (VI) incluem a produção, utilização e soldadura de metais e ligas contendo crómio. O presente estudo tem como objetivo analisar os resultados de monitorização ambiental e biológica da exposição profissional ao Cr (VI) no âmbito da participação portuguesa na Iniciativa Europeia de Biomonitorização Humana (HBM4EU). O estudo envolveu 50 trabalhadores expostos a Cr (VI) e 27 controlos. Realizou-se monitorização ambiental, por amostragem pessoal do ar, para estudar a exposição a Cr (VI) e monitorização biológica (urina e eritrócitos). Os resultados obtidos neste estudo sugerem que os pintores são o grupo com maior exposição externa e interna ao Cr (VI). Os trabalhadores dos banhos eletrolíticos apresentam uma exposição relevante, quando comparada com o valor limite de exposição de 0,005 mg/m3 apesar de consideravelmente inferior à dos pintores. Os resultados das medições de Cr-U pós-turno, quando agregados ao nível do grupo profissional apresentaram boa correlação (ρ=0,63) com a fração respirável de Cr (VI) no ar, apoiando a utilização do Cr-U para a biomonitorização da exposição ao Cr (VI) nos locais de trabalho. A diferente cinética dos indicadores biológicos estudados pode ser a razão pela qual não se verificou uma boa correlação entre Cr-U pós-turno e Cr-RBC (ρ<0,5), no entanto podem fornecer informação complementar relevante para a prevenção.
- Boosting knowledge on occupational exposure to microbial contamination in Portuguese carpentriesPublication . Dias, Marta; Gomes, Bianca; Pena, Pedro; Cervantes, Renata; Rodriguez, Margarida; Riesenberger, Bruna; Marques, Liliana; Carolino, Elisabete; Twarużek, Magdalena; Kosicki, Robert; Soszczynska. Ewelina; Caetano, Liliana Aranha; Viegas, Susana; Viegas, CarlaIntroduction: Wood industry workers face health risks due to exposure to microorganisms and their metabolites. This study aimed to characterize seasonal microbial contamination, antifungal resistance, mycotoxins, cytotoxicity, and particulate matter in Portuguese carpentries, to reduce exposure and promote safe working conditions. Methods: Conducted in six carpentries in Lisbon, Portugal, the sampling strategy encompassed active and passive sampling methods to assess microbial contamination. A Handheld Particle Counter HH3016-IAQ was used to monitor particulate matter size, temperature, and humidity. Results: The highest fungal load was in the cold season, with Aspergillus sp. being the predominant species, and the highest bacterial load was in the warm season. Reduced susceptibility to azoles was observed in both seasons, with greater species diversity in the cold season. In the warm season, Nidulantes and Fumigati sections of Aspergillus were detected by RT-PCR, with Fumigati being the most prevalent; in the cold season, only Nidulantes were detected. Mycotoxins, mainly fumonisins, were more prevalent in the warm season; in the cold season, griseofulvin was the most prevalent mycotoxin. Cytotoxicity was more prevalent in A549 cells than in SK cells. Settled dust caused greater cytotoxicity in SK cells, and filters from the vacuumed dust in A549 cells. Higher particulate matter concentrations in the sampled indoor areas suggest a significant contribution of indoor activities to workers’ exposure. Discussion: The study highlights concerns about seasonal variations in microbial contamination, emphasizing the potential for respiratory diseases, invasive infections by azole-resistant fungi, mycotoxin exposure, and cytotoxicity in lung cells due to co-exposure to fungi, particulate matter, and mycotoxins influenced by environmental conditions.
- Bronchodilator responsiveness and future chronic airflow obstruction: a multinational longitudinal studyPublication . Knox-Brown, Ben; Algharbi, Fahad; Mulhern, Octavia; Potts, James; Harrabi, Imed; Janson, Christer; Nielsen, Rune; Agarwal, Dhiraj; Malinovschi, Andrei; Juvekar, Sanjay; Denguezli, Miriam; Gíslason, Thorarinn; Ahmed, Rana; Nafees, Asaad; Koul, Parvaiz A.; Obaseki, Daniel; Anand, Mahesh Padukudru; Loh, Li Cher; Hermínia Brites Dias; Rodrigues, Fátima; Mannino, David; Elbiaze, Mohammed; El Rhazi, Karima; Mejza, Filip; Devereux, Graham; Franssen, Frits; El Sony, Asma; Wouters, Emiel; Al Ghobain, Mohammed; Mortimer, Kevin; Rashid, Abdul; Osman, Rashid; Studnicka, Michael; Cardoso, João; Burney, Peter; Amaral, André; BOLD Collaborative Research GroupBackground: Bronchodilator responsiveness testing is mainly used for diagnosing asthma. We aimed to investigate whether it is associated with progression to chronic airflow obstruction over time. Methods: The multinational Burden of Obstructive Lung Disease cohort study surveyed adults, aged 40 years and above, at baseline and followed them up after a mean of 9.1 years. Recruitment took place between January 2, 2003, and December 26, 2016. Follow-up measurements were collected between January 29, 2019, and October 24, 2021. On both occasions, study participants provided information on respiratory symptoms, health status, and several environmental and lifestyle exposures. They also underwent pre- and post-bronchodilator spirometry. We defined bronchodilator responsiveness at baseline using the American Thoracic Society and European Respiratory Society (ATS/ERS) 2022 definition, and the presence of chronic airflow obstruction at follow-up as a post-bronchodilator forced expiratory volume in 1 s to forced vital capacity ratio (FEV1/FVC) less than the lower limit of normal. We used multi-level regression models to estimate the association between baseline bronchodilator responsiveness and incident chronic airflow obstruction. We stratified analyses by gender and performed a sensitivity analysis in never smokers. Findings: We analysed data from 3701 adults with 56% being women. Compared to those without bronchodilator responsiveness at baseline, those with bronchodilator responsiveness had a 36% increased risk of developing chronic airflow obstruction (RR: 1.36, 95%CI 1.04, 1.80). This effect was stronger in women (RR: 1.45, 95%CI 1.09, 1.91) than in men (RR: 1.07, 95%CI 0.51, 2.24). Never smokers with bronchodilator responsiveness also were at greater risk of incident chronic airflow obstruction (RR: 1.48, 95%CI 1.01, 2.20). Interpretation: Bronchodilator responsiveness appears to be a risk factor for incident chronic airflow obstruction. It is important that future studies in other large population-based cohorts replicate these findings.