ABC2-Artigos (em revistas ou actas indexadas)
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- Biological therapies for metastatic colorectal cancer: literature reviewPublication . Almeida, Maria Patricia; Condinho, MónicaColorectal cancer is among the most prevalent and lethal malignancies worldwide. Its initially asymptomatic nature contributes to a high incidence of metastatic cases. Although predominantly diagnosed in older adults, the incidence among younger populations is rising at an alarming rate. Historically, treatment has relied on antineoplastic agents such as 5-fluorouracil, irinotecan, and oxaliplatin. While these agents remain in use, their effectiveness is limited, particularly in metastatic disease, with modest improvements in overall survival and progressionfree survival. Moreover, their low target specificity results in significant systemic toxicity. This underscores the urgent need formore selective and less toxic therapeutic strategies, such as monoclonal antibodies. Monoclonal antibodies targeting Vascular Endothelial Growth Factor (VEGF), Epidermal Growth Factor Receptor (EGFR), and immune checkpoints have become integral to the management of metastatic colorectal cancer. Notable examples include bevacizumab (anti-VEGF), cetuximab and panitumumab (anti-EGFR), and the immune checkpoint inhibitors pembrolizumab, nivolumab, and ipilimumab. Their clinical success especially when guided by molecular tumour profiling highlights their contribution to improved patient outcomes. In addition, other targeted therapies distinct from monoclonal antibodies are currently under investigation.
- The burden of COVID-19 care in community and academic intensive care units in Ontario, Canada: a retrospective cohort studyPublication . Pestana, Daniel; Joshi, Divya; Duan, Erick; Fowler, Robert; Tsang, Jennifer; Binnie, AlexandraDuring the COVID-19 pandemic, neighbourhoods with high material deprivation and high proportions of racialized Canadians were disproportionately affected by COVID-19. Many of these neighbourhoods were served by community hospitals. We sought to compare the burden of COVID-19 care in community and academic intensive care units (ICUs) in Ontario, Canada. We included all adult patients admitted to Ontario ICUs with COVID-19 between 1 March 2020 and 31 July 2021 in a retrospective cohort study. We compared patient volumes, demographics, interventions, and outcomes between community hospital corporations (CHCs) and academic hospital corporations (AHCs). During the first three waves of the pandemic, 9,651 adult ICU admissions for COVID-19 were reported across 72 hospital corporations in Ontario: 6,902 (71.5%) in CHCs and 2,749 (28.5%) in AHCs. Days of ICU care per baseline ICU bed were highest in large CHCs ([ 10 baseline ICU beds) relative to AHCs and small CHCs (median [interquartile range], 73.7 [53.8–110.6] vs 42.2 [32.7–71.8] vs 21.4 [7.2–40.3]; Kruskal–Wallis test, P \ 0.001). Among direct ICU admissions, CHC patients had greater severity of illness whereas among transfer ICU admissions, AHC patients were more severely ill. In a multivariable logistic regression model, mortality was similar among patients with index admission to a CHC or AHC; however, patients with index admission to an AHC were more likely to receive extracorporeal membrane oxygenation (adjusted odds ratio, 6.16; 95% confidence interval, 4.72 to 8.11). During the pandemic, Ontario’s large CHCs provided significantly more days of ICU COVID-19 care per baseline ICU bed compared with AHCs and small CHCs. Equipping large CHCs to handle ICU surges during future emerging disease outbreaks should be a priority for pandemic preparedness.
- Cold agglutinin syndrome in a patient with metastatic breast cancer: a Case reportPublication . Bandarra, Daniel; Rochate, Dina; Gosalbez, Beatriz; Ferreira, José; Cunha, Nidia Maltez; Carvalhal, SaraBackground: Cold agglutinin syndrome (CAS) is a form of autoimmune hemolytic anemia (AIHA), most often associated with lymphoproliferative disorders or infections. Its occurrence in breast cancer is rare and may be triggered by systemic treatment. Case presentation: We report the case of a woman in their fifties diagnosed with breast cancer in 2019. She underwent surgery followed by adjuvant chemotherapy and radiotherapy and subsequently received 3 years of endocrine therapy before developing bone and hepatic metastases. First-line treatment with ribociclib plus letrozole achieved partial response, and fulvestrant was administered at progression. Following further progression, paclitaxel was introduced as third-line metastatic therapy. After four weekly administrations, the patient was admitted to our hospital with severe anemia and diagnosed with CAS. Prompt management and a multidisciplinary approach resulted in partial hematological recovery. Nevertheless, paclitaxel was permanently discontinued, and subsequent therapies provided only transient benefit. The disease continued to progress, her performance status declined, and she ultimately transitioned to exclusive palliative care until death. Conclusion: This case illustrates a rare and severe immune complication of paclitaxel in metastatic breast cancer. The emergence of CAS not only limited systemic options but also reshaped the therapeutic trajectory, highlighting the need for close monitoring during cancer treatments. Early recognition, multidisciplinary approach, and prompt management can provide some improvement, although overall prognosis remains determined by the underlying malignancy.
- Delays in the stroke care pathway in a low-income setting: an audit study from MozambiquePublication . Buque, Helena Agostinho; Smith, Lee; Lopes, Dino; Pizzol, Damiano; Lorenzo, Elder; Arroz, Nachan; Bacallau, Lazara; Sidat, Mohsin; Bauaze, Evangelina Namburete; Nzwalo, HipólitoBackground: The burden of stroke is on the rise in low-income countries (LICs). Organized stroke care (OSC) is crucial for improving outcomes in LICs and is the very first step to reducing delays in diagnosis and treatment. We aim to evaluate delay times (DT) in accessing OSC at the national reference hospital of Mozambique, a LIC from southern Africa. Methods: An observational study based on consecutive case series of 59 stroke patients confirmed by computed tomography (CT) scans over a period of 3 months (May–July 2023). The total DT (from stroke onset to inward hospitalization) was the main outcome. Other specific DTs were analyzed including initial symptoms to arrival and admission (DT0), arrival to CT scans (DT1), arrival of laboratory results (DT2), and arrival to inward hospitalization (DT3). Results: The mean age was 61.9 (min 30–max 90) and 45.8% were female. The median total DT was 20 h. The median time DT0 was 10.6 h (interquartile range (IQR): 16.48). The median DT1 and DT2 were 4 h (IQR: 3.5) and 5 h (IQR: 2.6), respectively. The median DT3 was 10 h (IQR: 4). None of the patients were treated under a stroke code. Conclusions: This study reveals an unacceptable prehospital and in-hospital DT. Waiting for the CT scan contributed to a large proportion of the total DT, which among other factors can be explained by the absence of a stroke code and limited imaging capacity. These findings mirror disparities in stroke care seen in other LICs, where late presentation, scarce imaging, and limited specialized protocols are common. The urgent implementation of organized prehospital and in-hospital stroke pathways is needed in Maputo to improve outcomes.
- Description of the Hamburg Alexander Leukodystrophy Cohort—Insights into Practical Classification and the Care SituationPublication . Kokaly, Nadia; Guerreiro, Helena; Bredow, Janna; Dreha-Kulaczewski, Steffi; Ohlenbusch, Andreas; Köhler, Wolfgang; Reinhardt, Tabea; Schön, Gerhard; Volk, Alexander E.; Sigel, Helen; Bley, AnnetteBackground: Alexander disease (AxD) is a rare severe leukodystrophy that has no cure to date. A pathogenic gain-of-function variant in the GFAP gene affects the astrocytes and subsequently the function of the white matter in the CNS. Methods: We retrospectively analyzed the most frequent symptoms of nine AxD cases, classified them according to published classifications, and described the need of care and support. Results: The description of the courses of disease of nine cases with AxD reflects the broad spectrum of different phenotypes of AxD, with often occurring apnoea. Data about care and support for AxD patients indicate a high and heterogeneous need of support. Treatment with steroids reduced symptoms in two patients. Some patients showed lasting improvement during their course of disease. Conclusions: The course of AxD is very heterogeneous. Thus, we extracted relevant key features to describe the severity of the disease, namely feeding problems, epilepsy, age-appropriate motor function, failure to thrive, age-appropriate language and apnoea. We recommend early evaluation for clinical care and support. For some AxD patients, treatment with steroids may alleviate symptoms. Further development of efficient treatments is necessary
- Food insecurity in higher education studentsPublication . Paula, Aline de; Carneiro, Beatriz; Mendes, Inês; Pacheco, Mariana; Gonçalves, Marta; Pinto, Ezequiel; Palma Mateus, MariaFood insecurity (FI) indicates a situation in which there is no regular access to food in satisfactory quantity and quality. To characterize FI in students from Portuguese higher education institutions, a study was conducted in a non-random sample of students, with an online questionnaire consisting of sociodemographic questions and the Portuguese version of the IF scale. There were 200 valid questionnaires and 27.5% of the participants were classified as having some degree of FI. Participants with FI reported fewer visits to the family’s home (p = 0.024) and less financial resources (p < 0.001). The results indicate that interventions are needed in this area.
- Gamification on mathematics engagement and motivation in secondary school and higher education: a systematic review and meta-analysisPublication . Ratinho, Elias; Figueiredo, Mauro; Estêvão, Maria Dulce da Mota Antunes de Oliveira ; Faísca, Luís; Martins, CátiaThis systematic review and meta-analysis examined the effects of gamification on students’ motivation and engagement in mathematics at the secondary and higher education levels. A literature search (April 2025) followed by an updated search (November 2025) across ten databases identified 45 studies for qualitative synthesis and 11 for meta-analysis. The review followed PRISMA 2020 guidelines with a pre-registered protocol, and study quality was appraised with the Mixed Methods Appraisal Tool. Meta-analytic results using a three-level Correlated and Hierarchical Effects model with robust variance estimation showed a significant small-to-moderate positive effect on motivation (g = .383, 95% CI [.11, .66], p = .0218). Motivation was assessed more consistently than engagement that could not be included in the meta-analysis due to the lack of validated measures. The systematic review indicates that gamification supports motivation and engagement, with only four studies reporting negative effects. Most interventions used digital platforms (e.g., Kahoot!; Classcraft) and common game elements such as points, leaderboards and instant feedback. Overall, gamification appears promising for enhancing motivation and engagement in mathematics when designs are aligned with students’ needs, balancing competition with mastery and cooperation. Therefore, educators should limit excessive competition and prioritize personal progress and cooperative tasks that foster social interaction. Future studies should employ validated measures, larger samples, and examine both motivation and engagement to strengthen the evidence base and guide effective implementation in education.
- P0397 Soluble transferrin receptor as a reliable inflammation-independent marker of iron deficiency in crohn’s disease and ulcerative colitisPublication . Portela, F.; Santos, M. P. Ministro dos; Sousa, Helena Tavares; Roseira, Joana; Fernandes, S. R.; Crespo, R.; Domingues, B.; Santiago, M.; Miranda, R.; Dias, S.; Dias, C. C.; Magro, F.Background: Iron deficiency is a common complication in inflammatory bowel disease (IBD), including ulcerative colitis (UC) and Crohn’s disease (CD).1 However, standard iron markers are influenced by inflammation, complicating the diagnosis of true iron deficiency.1,2 Soluble transferrin receptor (sTfR) has been proposed as a more reliable, inflammation-independent marker of iron demand.3 This study aimed to assess the utility of sTfR in identifying iron deficiency without anaemia (IDWA). Methods: The ID_IBD study was a multicentre, cross-sectional study. Iron status was classified using two approaches: the ECCO consensus definition, focusing on ferritin thresholds adjusted for inflammatory markers (C-reactive protein [CRP] and faecal calprotectin [FCAL]), and a stricter definition that adds transferrin saturation to the ECCO criteria. sTfR levels were compared across groups, and ROC curve analysis was used to identify optimal diagnostic cut-offs. Results: This analysis included 411 IBD patients (130 UC, 281CD) and 178 controls. sTfR showed no correlation with CRP or FCAL. In UC, patients with IDWA had significantly higher sTfR levels (median 1.20mg/L, IQR 1.02-1.42) compared to non-IDWA patients (median 1.05mg/L, IQR 0.92-1.22; p=0.013). Anaemic UC patients also showed elevated sTfR levels (median 1.27mg/L, IQR 1.14-1.59) compared to non-IDWA individuals (patients but was significantly higher in anaemic patients (p=0.003). Conclusion: sTfR appears to be an inflammation-independent marker of iron status in IBD. It showed potential for identifying IDWA in UC, while in CD it mainly reflected increased iron demand in anaemia. Further longitudinal studies are warranted to validate its role and assess its clinical utility in IBD.
- Portuguese recommendations for the management of transthyretin amyloid cardiomyopathy (Part 1 of 2): screening, diagnosis and treatment. Developed by the task force on the management of transthyretin amyloid cardiomyopathy of the working group on myocardial and pericardial diseases of the portuguese society of cardiologyPublication . Marques, Nuno; Rosa, Sílvia Aguiar; Cordeiro, Filipa; Fernandes, Raquel Menezes; Ferreira, Catarina; Bento, Dina; Brito, Dulce; Cardim, Nuno; Lopes, Luís; Azevedo, OlgaThe Portuguese recommendations for the management of transthyretin amyloid cardiomyopathy (ATTR-CM) evaluate and summarize the available evidence and provide evidence-based recommendations on the best management of patients with ATTR-CM. These recommendations represent the official position of the Working Group on Myocardial and Pericardial Diseases (WGMPD) of the Portuguese Society of Cardiology. The Portuguese WGMPD selected the members of this Task Force as expert professionals involved in the care of patients with this disease. The Task Force performed a critical evaluation of the available evidence on the diagnostic procedures and therapeutic options for ATTR-CM, including an assessment of risk-benefit ratios. The strength of every recommendation and its level of evidence were weighed and scored according to predefined scales, usually those used by the European Society of Cardiology (ESC) in their guidelines, as outlined below in Tables 1 and 2. This Task Force followed voting procedures, and all approved recommendations were subject to a vote and achieved at least 75% agreement among voting members. The experts of the writing panels provided declaration of interest forms for all relationships that might be perceived as actual or potential sources of conflicts of interest. These recommendations were developed without any financial support or involvement of the healthcare industry. The Portuguese WGMPD supervised and coordinated the preparation of these recommendations and was responsible for the approval process. After appropriate revisions, the recommendations were signed off by all the experts involved in the Task Force. The WGMPD submitted the final document for publication in the official journal of the Portuguese Society of Cardiology, Revista Portuguesa de Cardiologia (Portuguese Journal of Cardiology). The recommendations were developed after careful consideration of the scientific knowledge and evidence available at the time of writing. Tables of recommendations are provided in this document along with the corresponding class of recommendation and level of evidence for each statement. Specific areas on which there are uncertainties concerning the existing evidence for the recommendation were also identified. The Task Force members carried out systematic reviews of the literature on these topics, which will be provided in separate publications. These recommendations do not override the individual responsibility of health professionals to make appropriate and accurate decisions in consideration of each individual patient’s health condition.
- Portuguese recommendations on transthyretin amyloid cardiomyopathy: a step toward disease awareness, prompt referral and early diagnosis and treatmentPublication . Marques, Nuno; Azevedo, OlgaTransthyretin amyloidosis (ATTR) is caused by the extracellular deposition of amyloid fibrils of wild-type (ATTRwt) or variant (ATTRv) transthyretin (TTR). While ATTRwt amyloidosis is essentially a cardiac disease, ATTRv amyloidosis may present with different phenotypes, ranging from predominantly cardiac to predominantly neurologic, or even mixed phenotypes, depending on the TTR gene variant.1---3 Transthyretin amyloid cardiomyopathy (ATTR-CM) is a progressive cardiomyopathy that causes heart failure, dysrhythmias and conduction block, which eventually lead to death.1 Median survival following diagnosis in untreated patients with ATTR-CM is 3.6---4.8 years in the wild-type form, 2.6 years in ATTR-CM due to the Val142Ile variant and 5.8 years in ATTR-CM caused by other TTR variants.4,5 To improve the prognosis of ATTR-CM, it is important to implement strategic measures that (i) increase awareness of ATTR amyloidosis, (ii) ensure early referral of cases with suspicion of ATTR-CM, (iii) promote early screening, diagnosis and treatment of ATTR-CM, and (iv) assure appropriate symptomatic management of the disease. However, some questions remain concerning who should be screened for ATTR-CM, and international recommendations differ regarding the red flags that should prompt screening for ATTR-CM.6