Browsing by Author "Cunha, Maria"
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- Epidemiological and clinical aspects of Cutaneous and Mucosal Leishmaniases in Portugal: retrospective analysis of cases diagnosed in public hospitals and reported in the literature between 2010 and 2020Publication . Rocha, Rafael; Conceição, Cláudia; Gonçalves, Luzia; Carvalho, Ana Cláudia; Maia, André; Martins, André; Carujo, António; Maio, António; Forra, Catarina; Melita, Catarina; Couto, Daniela; Fernandes, Diana; Pereira, Dulce; Leal, Ema; Sarmento, Helena; Sousa, Inês; Gonçalves, Jean-Pierre; Marinho, Joana; Vasconcelos, Joana; Cunha, João; Rodrigues, João; Silva, José Miguel; Caley, Lídia; Malheiro, Luís; Santos, Luís; Garcia, Margarida; Cunha, Maria; Lima, Maria; Andrade, Maria Margarida; Marques, Marta; Alpalhão, Miguel; Silva, Mónica; Ferraz, Rita; Soares, Rui; Fernandes, Salomão; Llobet, Samuel; Cruz, Sofia; Guimarães, Teresa; Branco, Tiago; Nunes, Tomás Robalo; Almeida, Vasco; Maia, CarlaLeishmania infantum, a zoonotic vector-born parasite, is endemic in the Mediterranean region, presenting mostly as visceral (VL), but also as cutaneous (CL) and mucosal leishmaniasis (ML). This study aimed to describe the epidemiological and clinical aspects of the CL and ML cases diagnosed in mainland Portugal between 2010 and 2020. Collaboration was requested from every hospital of the Portuguese National Health System. Cases were screened through a search of diagnostic discharge codes or positive laboratory results for Leishmania infection. Simultaneously, a comprehensive literature search was performed. Descriptive statistics and hypothesis testing were performed using IBM (R) SPSS (R) Statistics. A total of 43 CL and 7 ML cases were identified, with a predominance of autochthonous cases (86%). In CL, immunosuppressed individuals constituted a significant proportion of patients (48%), and in this group, disseminated CL (22%) and simultaneous VL (54%) were common. In autochthonous cases, lesions, mostly papules/nodules (62%), were frequently observed on the head (48%). The approach to treatment was very heterogeneous. ML cases were all autochthonous, were diagnosed primarily in older immunosuppressed individuals, and were generally treated with liposomal amphotericin B. The findings suggest a need for enhanced surveillance and reporting, clinical awareness, and diagnostic capacity of these forms of leishmaniasis to mitigate underdiagnosis and improve patient outcomes. A holistic One Health approach is advocated to address the multifaceted challenges posed by leishmaniases in Portugal and beyond.
- Impact of elexacaftor/tezacaftor/ivacaftor on the small airways in cystic fibrosisPublication . Silva, Sofia Campos; Barroso, Andreia; Cunha, Maria; Fragoso, Elsa; Azevedo, PilarObjective: To evaluate the impact of the elexacaftor/tezacaftor/ivacaftor (ELX/TEZ/IVA) combination on the small airways in adults with cystic fibrosis (CF), a genetic disorder that primarily affects the respiratory system, leading to progressive lung disease. In CF, the small airways play a critical role, contributing to chronic symptoms such as cough, sputum production, and dyspnea. Methods: This was a single-center, retrospective observational study of adults with CF treated with ELX/TEZ/IVA for 12 months. We compared the patients who were homozygous for the F508del mutation of the CF transmembrane conductance regulator (CFTR) gene with those who were heterozygous for that mutation, in terms of lung function outcomes (FEV1, FEF25-75%, and the RV/TLC ratio) and the extent of non-homogeneous ground-glass opacity. Among the patients within the cohort, the same parameters were evaluated separately in those who had advanced lung disease and in those who had previously undergone CFTR modulator therapy. Results: There was a significant post-treatment improvement in lung function, with a median increase of 0.42 L/s in the FEF25-75% (p < 0.001) and a 5% reduction in the mean RV/TLC ratio (p < 0.001). There was a trend toward a higher improvement the F508del homozygous patients. A significant reduction in non-homogeneous ground-glass opacity was observed in 79.5% of the patients. Among the patients with advanced lung disease, there were notable post-treatment improvements in all of the parameters assessed. Conclusions: Our results highlight the positive impact that ELX/TEZ/IVA treatment can have on small airway function in patients with CF, with potential benefits even for those with advanced lung disease. Further research is needed in order to evaluate the long-term effects of this treatment and its relationship with patient-reported outcomes.
- Life cycle assessment of integrated multi-trophic aquaculture: a review on methodology and challenges for its sustainability evaluationPublication . Hala, Ahmad Furqan; Chougule, Komal; Cunha, Maria; Caria Mendes, Madalena; Oliveira, Inês; Bradley, Tom; Forbes, Jonathan; Galileu Speranza, LaisThe increase in aquaculture activity is inevitable to fulfil global food provisioning for a growing population. Therefore, it is most recommendable to develop a sustainable approach for aquaculture practice. Integrated Multi-Trophic Aquaculture (IMTA) is proposed as one solution taking advantage of circular uptake of nutrients within the system. IMTA practice has been conducted for a thousand years despite only gaining recognition in recent decades. It is suggested to have lower environmental impact while promoting more advantages in the social and economic aspect of the industry. Therefore, multi aspects perspective of Life Cycle Assessment (LCA) is valuable to demonstrate the benefits of the system compared to the others. This review analyses 29 LCA studies on IMTA systems from 2009 to 2022 to understand the results, challenges, limitations, and benefits of LCA methodologies on IMTA systems. The studies followed the ISO 14040/44 guideline and were selected using the Google Scholar research tool. The four stages of the LCA were evaluated and it was concluded that there are several challenges in the Goal and Scope definition phase to determine the functional unit and methods that will be utilized. Hence, it is valuable to evaluate more options and, whenever possible, to conduct sensitivity analysis to help determine the proper methodology. The development of a specific database for the aquaculture sector is also strongly recommended, together with a standardized methodology for Data Collection and definition of impact categories to improve the consistency and comparability of the studies. Feed, fish effluents, and energy use are the impact hotspots and improving these factors might decrease the total impacts of the system as well. From this review, the potential of IMTA systems compared to monoculture systems and the potential of applying a tool such as LCA to measure it is highlighted. Therefore, more studies need to be conducted to improve the LCA methodology's consistency and reliability for IMTA system assessment.