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- A wearable IoT-based system for gait cycle duration and symmetry assessment in lower-limb amputeesPublication . Alves, Bruna; Fantoni, Alessandro; Matos, José Pedro; Costa, JoãoThis study presents the development of a wearable sensor designed to assess gait asymmetry. The device uses the TF mini-S LiDAR sensor to detect mid-stance and calculates the gait cycle duration to assess symmetry. The Arduino Nano RP2040 Connect microcontroller was chosen for its compact size, real-time data processing capabilities, and seamless integration with the Arduino Cloud, facilitating remote monitoring and data storage. The TF mini-S LiDAR was found to be the most suitable sensor due to its field of view and high frame rate, allowing accurate mid-stance detection. The final device combines portability, high data update rates, and precise detection, making it an effective tool for monitoring gait rehabilitation, including LLA. This wearable sensor contributes to improving prosthetic adaptation and offers healthcare systems a reliable means of monitoring patient progress.
- Gonad dose assessment of patients undergoing pelvic radiotherapyPublication . Ribeiro, Daniela; Sá, Ana Cravo; Carolino, Elisabete; Martins, Leonor Santos; Borrego, MargaridaIntroduction: Radiotherapy can impact patients’ reproductive organs and fertility. This study aims (i) to assess whether the doses to the gonads of 70 patients met the tolerance doses used in radiotherapy planning; (ii) to compare Three-Dimensional Conformal Radiotherapy (3DCRT) with Volumetric Modulated Arc Therapy (VMAT) techniques; and (iii) to verify if ovarian transposition reduces the dose to the ovaries. Methods: A retrospective analysis of 70 patients aged 45 or under who underwent pelvic radiotherapy between 2014 and 2023 in a radiotherapy department was carried out. The dose constraints considered were derived from the Dose-Volume Constraints for Organs at Risk in Radiotherapy project. Results: The average number of children of all the patients in the study was 1.25, and the standard deviation was 1.40. No statistically significant differences were detected regarding the doses to the left and right gonads between 3DCRT and VMAT (p > 0.05). There were statistically significant differences between female patients who underwent ovarian transposition and those who did not undergo ovarian transposition regarding the maximum and median doses in both right and left ovaries (p < 0.05), with a dose reduction that could reduce doses by an average of up to 39 Gy. Conclusions: In the total sample, 58.6% of patients were treated with VMAT, only 18.6% met the maximum dose limits, and 22.9% met the average dose constraints. Only five women underwent ovarian transposition, which proved effective in meeting dose constraints and significantly reducing the dose to the ovaries.
- Concordance between FVC and FEV6 for identifying chronic airflow obstruction and spirometric restriction in the Burden of Obstructive Lung Disease (BOLD) studyPublication . Knox-Brown, Ben; Potts, James; Franssen, Frits M. E.; Nielsen, Rune; Denguezli, Meriem; Rotevatn, Anders Ørskov; Juvekar, Sanjay K.; Cherkaski, Hamid Hacene; Studnicka, Michael; Sylvester, Karl Peter; Mortimer, Kevin; Bateman, Eric D.; Janson, Christer; Malinovschi, Andrei; Seemungal, Terence; Koul, Parvaiz; Mannino, David; Mahesh, Padukudru Anand; Jogi, Rain; Mejza, Filip; Al Ghobain, Mohammed; Paraguas, Stefanni Nonna M.; Welte, Tobias; Wouters, Eliel; Gislason, Thorarinn; Harrabi, Imed; Dias, Maria Hermínia Monteiro Brites; Obaseki, Daniel O.; Kocabas, Ali; Barbara, Cristina; Cardoso, João; Agarwal, Dhiraj; Nafees, Asaad Ahmed; Rodrigues, Fatima; Garcia-Larsen, Vanessa; Erhabor, Gregory E.; Loh, Li-Cher; Amaral, Andre F. S.Introduction: We investigated whether the forced expiratory volume in 6 s (FEV6) can be used as a surrogate for the forced vital capacity (FVC). Methods: The Burden of Obstructive Lung Disease is a multinational cohort study. At baseline, data were collected from adults aged 40 years or older, from 41 sites across 34 countries. Participants from 18 sites were followed up after a median of 8.3 years. Participants who completed the study core questionnaire and had acceptable post-bronchodilator spirometry were included. We performed receiver operating characteristic analyses to measure the ability of FEV1/FEV6 less than the lower limit of normal (LLN) to correctly classify FEV1/FVC less than the LLN, and FEV6 less than the LLN to correctly classify FVC less than the LLN. We used multilevel regression analyses to assess the association of discordant measurements with respiratory symptoms, quality of life, and lung function decline. Results: At baseline, 28,604 participants were included. 53% were female (15,060). 10% (2876) had chronic airflow obstruction for FEV1/FVC, compared with 9% (2704) for FEV1/FEV6. 37% (10,637) had spirometric restriction for FVC, compared with 35% (9978) for FEV6. The FEV1/FEV6 had excellent accuracy in identifying FEV1/FVC less than the LLN (area under the curve (AUC): 0.90, 95% CI, 0.89 to 0.91, κ coefficient 0.82). The FEV6 also had excellent agreement in identifying FVC less than the LLN (AUC: 0.95, 95% CI, 0.94 to 0.95, κ coefficient 0.90). Discordant reductions in FEV1/FEV6 (1%, 345) and FEV6 (1%, 309) were associated with greater odds of having respiratory symptoms and a lower physical quality of life. 3870 participants were followed up with. Those with discordant reductions in FEV1/FEV6 and FEV6 were more likely to have chronic airflow obstruction and spirometric restriction at follow-up. Conclusions: There is strong agreement between the FVC and FEV6 in the identification of chronic airflow obstruction and spirometric restriction.
- Characterization of physical activity levels in female breast cancer survivors: relationship with lymphedema (AtiLinf)Publication . Duarte, Alice Ralheta; Neto, Carla Martinho; Prates, Leonor; Lobo, Pablo; Tomás, Maria TeresaThe development of lymphedema (LE) is a major concern in breast cancer treatment, and it is crucial to understand the best ways to prevent and treat it. Physical activity is effective, safe, and feasible in controlling complications arising from treatments, as well as improving function and quality of life in breast cancer survivors. This study aimed to investigate the relationship between physical activity and grip strength, as well as LE development, in breast cancer survivors. A cross-sectional analytical study was conducted, and women who had survived breast cancer between 1 and 5 years after surgery were selected. Participants completed the International Physical Activity Questionnaire Short Form. The volume of the upper limb (UL) was measured using perimetry, handgrip strength was assessed with the JAMAR dynamometer, and the Actigraph accelerometer was placed on the waist. It was found that 50% of the sample was overweight, 28.3% were obese, and 52% of the participants had grip strength below the recommended level. They had an average energy expenditure of 1.2 (0.1) metabolic equivalents, 8.3 (1.8) hours/day of sedentary activity, and spent an average of 61% of their awake time in sedentary activity per day. Significant correlations were found between grip strength on the affected side and the difference in volume between the UL (rp = -.303, P = .041), as well as between body mass index (BMI) and the difference in volume between the UL (rp = .341; P = .020). Moreover, a significant correlation between BMI and the volume of the affected UL was found (rp = .848, P = .000). BMI and grip strength of the affected side were identified as significant predictors of LE, both with P values less than .05. Although physical activity cannot directly prevent LE, it may contribute by helping to control BMI and promote higher levels of grip strength, both of which are important factors in the prediction of LE.
- The International Collaboration of Pharmacy Journal Editors (ICPJE) formally constituted to foster quality around clinical and social pharmacy practice research publicationsPublication . Alves da Costa, Filipa; Fernandez-Llimos, Fernando; Desselle, Shane; Arnet, Isabelle; Babar, Zaheer; Bond, Christine; Cordina, Maria; Garcia Cardenas, Victoria; El Hajj, Maguy S.; Jacobsen, Ramune; Law, Anandi V.; Nørgaard, Lotte S.; Polidori, Carlo; Shcherbakova, Natalia; Stewart, Derek; Tonin, Fernanda; Weidmann, Anita E.The Granada statements were a result of the need to strengthen clinical, social, and administrative pharmacy practice as an area of knowledge that translates into practice, research and policy. As a response, a group of clinical and social pharmacy practice journal editors launched an initiative in Granada in 2022 to discuss ways to improve the quality of publications in this area, which culminated in the Granada statements. Eighteen statements were developed, clustered into six main domains: (1) the appropriate use of terminology; (2) developing impactful abstracts; (3) having the required peer reviews; (4) preventing journal scattering; (5) more effective and wiser use of journal and article performance metrics; and (6) authors' selection of the most appropriate pharmacy practice journal to submit their work. The full Granada statements have been published in 14 journals. These pioneering statements are rooted in similar endeavors undertaken by scholars in other health professions groups, fostering the concept of interdisciplinary consensus and advancing the scientific paradigm.
- Functional asymmetries after 6 months of ACL reconstruction: a cross‐sectional studyPublication . Nuno, Sérgio Loureiro; Romero‐Morales, Carlos; López‐López, Daniel; Losa‐Iglesias, Marta Elena; Becerro‐de‐Bengoa‐Vallejo, Ricardo; Gómez‐Salgado, Juan; Guerra, João; Saavedra‐García, Miguel ÁngelFunctional tests commonly assess athletes' readiness to return to sports after knee surgery. Despite this, there are still more studies on clinical and patient-reported outcomes. The purpose of this study was to determine differences and combinations of various functional performances within and between athletes 6 months after anterior cruciate ligament (ACL) reconstruction (ACLR) for the first time (ACLR-I group), versus second ACL injury on the same knee (ACLR-II group), versus ACLR procedures on both legs (ACLR-III group). A total of 88 patients with ACLR performed single-leg hop (maximum forward distance hop, SLH; side hop > 40 cm in 30 s, SH), Functional Movement Screen (FMS), and dynamic postural balance (Y Balance Test - YBT). Data were recorded during return-to-sport testing (6 months post-surgery). For each variable, a mixed-model analysis of variance, with a between-subjects factor of group (primary ACL injury, recurrent ACL injury, and bilateral ACL injury) and a within-subjects factor of limb (involved, uninvolved), was conducted. Differences between the groups were found in different degrees of inter-limb asymmetry in the single-leg hop (p < 0.001) and side hop test (p < 0.02). There was a main effect of limb for the anterior and posteromedial YBT distances, and the single-leg hop and side hop test distances (p ≤ 0.04). For each variable, performance was worse for the involved limb compared to the uninvolved limb. Individuals after recurrent ACLR showed greater functional asymmetries at 6 months of treatment. Jumping tests detected greater performance deficits compared to YBT and FMS.
- 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.
- Carcinoma da glândula de Bartholin: estudo de caso de uma metástase à distânciaPublication . Silva, I.; Santos, I.; Tavares, V.; Roque, Ruben; André, S.; Mendonça, PaulaO carcinoma adenoide quístico da glândula de Bartholin é um tumor maligno ginecológico muito raro que se manifesta como lesão sólida, móvel e dolorosa, com crescimento lento. É um tumor associado a recorrência local e metastização, que pode ocorrer vários anos depois da lesão primária. O diagnóstico clínico inclui lesão quística ou abcesso. No entanto, apresenta características morfológicas específicas, que permitem o diagnóstico citológico e histológico. O presente caso clínico refere-se a uma mulher de 48 anos diagnosticada em 2015 com carcinoma adenoide quístico da glândula de Bartholin que foi submetida a uma vulvectomia radical modificada com linfadenectomia esquerda e alargamento da margem cirúrgica. Em outubro de 2021 foram detetados dois novos nódulos vaginais, cuja biópsia confirmou tratar-se de recidiva e a avaliação citológica confirmou a metastização paratraqueal e pulmonar. Nesta apresentação de caso salientamos a pertinência da realização do Rapid On-Site Evaluation durante a colheita de amostras citológicas.
- Molecular characterization of a thymic neuroblastoma in an adult associated with inappropriate antidiuretic hormone secretion syndromePublication . Lérias, Sofia; Cabrera, Rafael; Branquinho-Ruivo, Leonor; Saramago, Ana; Stoehr, Robert; Agaimy, Abbas; Martins, CarmoNeuroblastoma (NB) is extremely rare in adults, and anterior mediastinal location is even more unusual. We report a primary thymic NB in a 72-year-old male, who presented with the inappropriate antidiuretic hormone secretion (SIADH) syndrome. Molecular testing revealed copy number alterations of chromosome 3, i.e., loss of whole 3p and partial gain of distal 3q, including gain of copies of the PIK3CA gene. To the best of our knowledge, only five mediastinal NB cases in adults have been reported with genetic evaluation. One case showed loss of 3p material with SETD2 gene mutation and gain of PIK3CA gene, similar to our case. As thymic NB is extremely rare, reports of more genetically characterized cases should help to delineate their pathobiology and shed light on possible mechanisms involved in the associated SIADH syndrome.
- Treino propriocetivo como estratégia de intervenção para melhoria do equilíbrio em indivíduos pós-acidente vascular cerebral: uma revisão sistemáticaPublication . Fernandes, Ana; Fernandes, Sofia Rita; Fernandes, BeatrizIntrodução – As alterações no equilíbrio correspondem a mais de metade das consequências provocadas pelo AVC, por isso, continua a ser de extrema importância investigar qual a melhor estratégia de intervenção nestas alterações de acordo com a atual evidência. Apesar de o treino propriocetivo ser considerado um treino válido em indivíduos pós-AVC, o seu contributo para a melhoria do equilíbrio nestes indivíduos permanece por esclarecer. Objetivo – Verificar a eficácia do treino propriocetivo na melhoria do equilíbrio em indivíduos pós-AVC. Métodos – Foi efetuada uma revisão sistemática seguindo as recomendações PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis). A pesquisa foi realizada nas bases de dados PubMed, PEDro e ScienceDirect, utilizando termos de pesquisa específicos. A Escala PEDro foi utilizada para avaliar a qualidade metodológica dos estudos. Critérios de inclusão: estudos randomizados controlados (RCT) que incluíssem indivíduos com idade igual ou superior a 18 anos, com diagnóstico de AVC e alterações no equilíbrio, cuja intervenção contemplasse treino propriocetivo e a avaliação tivesse medidas objetivas do equilíbrio. Critérios de exclusão: estudos em indivíduos com outras morbilidades neurológicas, com patologia músculo-esquelética nos membros inferiores ou outro tipo de patologias suscetíveis de influenciar o sistema propriocetivo. Resultados – A pesquisa identificou um total de 855 estudos, dos quais 14 foram incluídos na revisão após a aplicação dos critérios de elegibilidade. Estes envolveram 677 indivíduos com diagnóstico de AVC crónico (sete estudos) e agudo/subagudo (sete estudos). Os tipos de treino propriocetivo utilizados nos grupos de intervenção (GI) consistiram em: equilíbrio; estimulação somatossensorial com vibração ou estimulação elétrica funcional; reposicionamento articular, combinado com fisioterapia convencional, aplicada também nos grupos de controlo (GC). As medidas de avaliação objetiva do equilíbrio utilizadas consistiram nas escalas de equilíbrio de Berg (BBS) e/ou Tinneti (TBS) e Mini-Balance Evaluation Systems Test (Mini-Best). Houve diferenças estatisticamente significativas (p<0,05) entre GI e GC em 10 dos 14 estudos. Conclusão – De acordo com a presente revisão, apesar da heterogeneidade das intervenções (tipo de exercício e duração) e os instrumentos de avaliação usados na análise dos resultados, regista-se uma tendência para a maioria dos estudos incluídos apresentarem resultados positivos nas medidas que avaliam o equilíbrio e o treino propriocetivo.