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- Fate of microbial contamination in a South European Coastal Lagoon (Ria Formosa) under the influence of treated effluents dispersalPublication . Caetano, Sandra; Correia, Cátia; Torres, Ana Flor; Matos, André Filipe; Ferreira, Cristina; Cravo, AlexandraAim: Assessment of the fate of microbial contamination driven from treated wastewater disposal at a highly productive zone on a South European coastal lagoon (Ria Formosa). Methods and results: Microbial indicators of contamination (Total coliforms, Escherichia coli and Enterococci) were evaluated monthly during September 2018-September 2020, at three study areas (Faro, Olhão, Tavira) under different wastewater discharge flows and hydrodynamic conditions. Additional data on E. coli monitoring in bivalves, available from the national institution responsible for their surveillance was also considered. The maximum microbial contamination was found at Faro, the highest-load and less-flushed study area, contrasting the lowest contamination at Olhão, a lower-load and strongly flushed area. The wastewater impact decreased along the spatial dispersal gradients and during high water, particularly at Faro and Tavira study areas, due to a considerable dilution effect. Microbial contamination at Olhão increased during the summer while at the other study areas seasonal evidence was not clear. Data also indicate that E. coli in bivalves from BPZ next to the three study areas reflected the differentiated impact of the wastewater treatment plants effluents on the water quality of those areas. Conclusions: Effluent loads together with local hydrodynamics, water temperature, solar radiation, precipitation and land runoff as well as seabirds populations and environmentally adapted faecal or renaturelized bacterial communities, contributed to microbial contamination of the study areas.
- + Equilíbrio 65 - risco de queda em idosos na comunidade da região do algarvePublication . Tome, Ana Maria; Rosa, Marlene Cristina Neves; Pais, Sandra Cristina Cozinheiro Fidalgo Rafael Gamboa; Tomás, Maria Teresa Barreiros Caetano; de Almeida Fontes, Ana PaulaIntrodução - As quedas constituem uma das principais causas de morbilidade na população sénior. A identificação e caracterização dos fatores causais é basilar na intervenção. Objetivo - Caracterizar a população de indivíduos com 65 anos ou mais de idade, da comunidade, inscritos em universidades sénior, do ponto de vista sociodemográfico e dos fatores de risco e risco de queda. Metodologia –Estudo transversal observacional. Incluídos indivíduos com 65 ou mais anos de idade. Dados recolhidos por questionário de autopreenchimento e avaliação de risco de queda e capacidade funcional e cognitiva com instrumentos específicos: FES-I TUG-C, FRT e FAB. Resultados – Avaliados 128 participantes dos 65-92 anos de idade (74.95±6.13), 74.2% mulheres. 31,3% tem história de queda no último ano; 75% toma mais de um medicamento por dia; 97,7% refere comorbilidades crónicas; 14.8% e 13.3% apresentam TUG-C e FRT, respetivamente, compatíveis com risco muito elevado de queda. 74,2% tem medo de cair moderado ou elevado e 49,2% tem disfunção marcada das funções executivas Discussão – A elevada percentagem de fatores de risco, a prevalência de quedas anteriores, polimedicação, comorbilidades crónicas e baixo nível de atividade física, risco psicossocial e baixos níveis de escolaridade são sinais de risco. O elevado medo de cair, desempenho reduzido nos testes de equilíbrio estático e dinâmico e o declínio cognitivo evidenciam a importância de uma avaliação multidimensional do risco de queda. Conclusão – Este estudo permitiu um olhar mais consistente sobre a problemática do equilíbrio e risco de queda e possibilitou sinalizar e analisar os principais fatores de risco de queda, em idosos na comunidade numa região do Algarve.
- Physiotherapy management following surgical neurolysis for a peroneal nerve injury: A case reportPublication . Almeida, Pedro Sérgio Costa da Silva; Tome, Ana Maria; Felicio, João Carlos Martins; de Almeida Fontes, Ana PaulaThe peroneal nerve becomes superficial near the head of the fibula, increasing its exposure to injury mechanisms. There is a need to improve knowledge on the influence of physiotherapy on peripheral nerve injury rehabilitation. The case involves a woman with 47 years who suffered a cut in the region of distal third of right common peroneal nerve. This injury resulted in the loss of sensitivity, strength, foot drop, and neuropathic pain after suturing. These symptoms persisted for six weeks, and she had to undergo surgery six weeks after the accident. Physiotherapy was initiated 1 month after the surgical intervention, incorporating manual therapy, electrical stimulation, functional and aerobic exercise, and patient education. The patient experienced sensory alterations, pain was eliminated, and functional recovery of gait and running was achieved. However, there were residual weaknesses in hallux extensor and dorsiflexors. This case study contributes to the development of peroneal nerve rehabilitation interventions.
- Point-of-care ultrasound for the early detection of intrahepatic biliary tract dilatation: a local study in a basic emergency servicePublication . Miravent, Sérgio; Vaz, Bruna; Lobo, Manuel Duarte; Jimenez, Cármen; Pablo, Pedro; Figueiredo, Teresa; Barbancho, Narciso; Ventura, Miguel; Almeida, RuiBackground/Objectives: Ultrasonography is a diagnostic modality characterized by high sensitivity in detecting hepato-biliary pathology, particularly intrahepatic biliary duct dilation. This study compares the sonographic findings obtained by a radiographer/sonographer in a Basic Emergency Service (BES) using Point-of-Care Ultrasonography (POCUS) in Portugal with the sonographic findings from the same patients acquired by radiologists at a referral hospital (RH) for suspected intrahepatic biliary dilatation. Methods: Nineteen patients presenting with right upper quadrant (RUQ) pain and suspected abdominal pathology underwent sonographic screening using POCUS in the BES. Subsequently, the same patients were referred to the RH, where a radiologist performed a comprehensive ultrasound. Both examinations were compared to determine whether the findings obtained in the BES were confirmed by radiologists in the RH. Results: Cholestasis, cholangitis, lithiasis, pancreatitis, peri-ampullary lithiasis, and neoplasms were observed in association with intrahepatic biliary dilation in this study sample. All six variables showed a strong association between the BES and RH findings (Cramer’s V > 0.6; p < 0.006). A strong kappa measure of agreement between the radiographer and radiologist findings was obtained in “cholelithiasis/sludge/gallbladder acute sonographic changes” (k = 0.802; p = 0.000). A moderate kappa value was obtained for the variable “abdominal free fluid”, (k = 0.706; p = 0.001). Conclusions: In this study, all patients referred from the BES to the RH required hospitalization for treatment and additional imaging exams. Although prehospital screening ultrasound is not intended for definitive diagnoses, the early detection of intrahepatic biliary tract dilatation through screening sonography played a significant role in the clinical referral of patients, with a sensitivity of 94% and specificity of 75%.
- Comparing the diagnostic performance of ultrasound elastography and magnetic resonance imaging to differentiate benign and malignant breast lesions: a systematic review and meta-analysisPublication . Gomes, Ana Filipa; Justino, David; Tomás, Carina; Jesus, Diogo; Macedo, Ana; Pinto, Ezequiel; Leitao, HelenaObjective: The purpose of this systematic review and meta-analysis was comparing diagnostic performance of ultrasound elastography (UE), strain UE and shear wave elastography (SWE), with magnetic resonance imaging (MRI) in differentiating benign and malignant breast lesions. Methods: Literature search of MEDLINE, Web of Science, SCOPUS and Google Scholar was performed in June 2023. Included studies used Breast Imaging Reporting and Data System (BI-RADS) and histopathology as reference standard. A bivariate random-effects model was used to calculate sensitivity, specificity, diagnostic odds ratio (DOR), positive and negative likelihood ratios and area under the curve (AUC). Meta-regression subgroup analysis was performed. Results: Nine studies and 536 lesions were included. Pooled sensitivity was not different between MRI vs UE [MRI: 94% (95% CI: 88.2%-96.9%) vs UE: 90% (95% CI: 84.7%-93.1%); P=0.153] but a difference was found for specificity [UE: 78% (95% CI: 66.3%-86.4%) vs MRI: 71.3% (95% CI: 52.1%-85%); P=0.0065]. Strain UE showed higher specificity and similar sensitivity to SWE [strain UE: 0.85 (95% CI: 0.71-0.93) vs SWE: 0.72 (95% 0.58-0.83); P=0.017 and strain UE: 0.87 (95% CI 0.79-0.93) vs SWE: 0.91 (95% CI 0.85-0.95); P=0.311, respectively]. AUC was similar between MRI vs UE [0.91 (95% CI 0.87-0.95) vs 0.92 (95% CI 0.88-0.95); P=0.452, respectively] as was DOR [MRI: 38.083 (95% CI: 12.401-116.957) vs UE: 30.395 (95% CI: 16.572-55.75); P > 0.05]. Meta-regression analysis found no significant differences in the diagnostic accuracy between MRI, strain UE and SWE. Conclusion: Our results show that UE when compared to MRI has adequate performance in differentiating benign and malignant breast lesions.
- Editorial: advancing cancer therapy: innovative strategies targeting immune evasion and metabolic modulationPublication . Teotónio Fernandes, Mónica Alexandra; De Sousa-Coelho, Ana Luísa; Méndez-Lucas, AndrésCancer remains one of the leading causes of death worldwide, with both incidence and mortality continuing to rise despite advances in diagnosis and treatment (1). While early-stage cancers often respond to conventional therapies, advanced and recurrent tumors frequently develop resistance, limiting long-term therapeutic efficacy (2).Two fundamental hallmarks of cancer, immune evasion and metabolic reprogramming, enable tumors to thrive in hostile microenvironments (3, 4). Although immunotherapies have revolutionized cancer care, a significant proportion of patients either fail to respond or acquire resistance over time (5). In parallel, altered tumor metabolism is increasingly recognized as a promising therapeutic target, particularly for enhancing responses to immunotherapy (7).This Research Topic highlights recent advances that move beyond traditional treatment. Collectively, the nine featured articles provide valuable insights into the interplay between immunity and metabolism in cancer, exploring strategies to overcome therapeutic resistance and improve clinical outcomes across diverse cancer types.
- Impact of yoga training on heart rate variability and pilot performance: a randomized controlled trialPublication . Santos, Sara; Melo, Filipe; Fernandes, Orlando; Parraca, José AlbertoBackground Piloting military aircraft demands precise execution of maneuvers under high-stress conditions. Yoga has been proposed as a potential intervention to enhance stress management, operational performance, and flight safety in pilots. However, its effects on stress resilience and performance metrics need further investigation. Methods In this randomized controlled trial, 18 pilots were randomly assigned to either a Yoga intervention group (n=10) or a control group (n=8). Heart rate variability (HRV) measures were analyzed to evaluate physiological stress responses. Performance variables, including completion times for flight maneuvers and number of errors during emergency protocol, were also assessed before and after a 12-week intervention period. Results HRV analysis showed improvements in stress resilience, indicated by changes in heart rate variability (HRV) parameters such as standard deviation of NN intervals (SDNN), root mean square of successive differences (RMSSD), low frequency (LF), and high frequency (HF). The Wilcoxon rank test revealed significant results regarding performance variables within the Yoga group, particularly for the Touch & Go maneuver (p=0.016) and the emergency maneuver (p=0.039), with large effect sizes (0.9444 and 0.8333, respectively). While completion times were longer for the Yoga group, indicating a more careful approach, the number of errors significantly decreased (p=0.025, effect size=0.917), with a notable reduction observed in the Yoga group compared to controls. Conclusion Incorporating yoga into pilot training protocols holds promise for better executive/cognitive functions, enhancing stress management and operational performance, reducing the number of errors, and leading to increased flight safety. While yoga may lead to longer completion times for maneuvers, the significant reduction in errors and improvements in stress resilience highlight its potential benefits. However, careful consideration is needed to balance improved precision with operational efficiency.
- Skeletal age assessed by Greulich-Pyle: intra-observer and inter-observer agreement among male pubertal tennis playersPublication . Celis-Moreno, Jorge M.; Martinho, Diogo V.; Coelho-e-Silva, Manuel J.; Fragoso, Isabel; Ribeiro, Luís Pedro; Gouveia, Élvio R.; Oliveira, Tomas; Gonçalves-Santos, João; Tavares, Oscar M.; Cayolla, Ricardo R.; Duarte-Mendes, Pedro; Konarski, Jan M.; Malina, Robert M.; Myburgh, Gillian K.; Cumming, Sean P.; Sherar, Lauren B.; Roberto ScendoniThe assessment of biological maturation is a central topic in pediatric exercise sciences. Skeletal age (SA) reflects changes in each bone of the hand and wrist from initial ossification to the adult state. This study examined intra-observer and inter-examiner agreement is Greulich-Pyle (GP) assessments of SA in 97 male tennis players 8.6–16.8 years of age. Two observers independently examined all films on two occasions using the GP method. The SA of each bone was evaluated. The mean and median of SAs assigned for each bone was the individual SA for each participant. The calculation was exclusively based on the bones that were not skeletally mature. Intra-observer mean differences were significant for several bones with better results by the experienced examiner (observer B). Comparisons between SA values of the two independent observers indicated significant differences for the ulna, metacarpals II and III, and distal phalanx V. Nevertheless, the magnitude of the bone-specific differences was small, perhaps trivial. Differences in individual SA values of the tennis players based on the non-mature bones of the hand-wrist were negligible based on the mean (0.04±0.39, t = 0.321, p = 0.749) or the median (0.05±0.58, t = 0.007, p = 0.994). Nevertheless, the current study confirmed examiners as a source of error in the estimation of SA using the Greulich-Pyle method and highlighted the importance of calculating SAs based on non-mature bones among adolescent players.
- Medication adherence and glycemic control in older adults with type 2 diabetes: a cross-sectional study in a community settingPublication . Nascimento, Tânia; Andrade, Amanda de Oliveira; Pinto, Ezequiel; Cabrita, Catarina; Pais, Sandra; Puerta, Rocío de laBackground/Objectives: Glycemic control is essential for preventing both short- and long-term complications of type 2 diabetes (T2D), requiring strict adherence to pharmacological therapy. Medication adherence directly influences therapeutic effectiveness, making its assessment in clinical practice crucial. This study aimed to evaluate medication adherence in elderly patients with T2D and its association with glycemic control. Methods: A descriptive cross-sectional study was conducted in the Algarve, Portugal, involving 133 elderly patients (≥60 years) with T2D. Cardiometabolic parameters and medication adherence (global, intentional, and unintentional) were assessed. Statistical analyses were performed using IBM SPSS Statistics 28.0. Results: The study population had a mean age of 71.7 ± 5.7 years, with a predominance of male participants (57.9%) and a high prevalence of dyslipidemia and/or hypertension. Cardiometabolic control was generally poor, with only 26.3% achieving blood pressure targets (≤140/90 mmHg), 8.5% maintaining fasting glycemia within the recommended range (70–110 mg/dL), and 13.6% attaining glycated hemoglobin (HbA1c) values ≤ 7%. Despite this, medication adherence was notably high (97.7%), with no significant association with cardiometabolic control (p > 0.05). Unintentional non-adherence behaviors, such as forgetfulness and inconsistent medication schedules, were the most frequently reported. Conclusions: Although elderly patients with T2D demonstrated high medication adherence rates, their cardiometabolic control remained suboptimal. Unintentional non-adherence behaviors may contribute to poor glycemic control. However, medication adherence alone does not fully explain these outcomes, highlighting the need to assess adherence to other self-care behaviors, particularly dietary and physical activity patterns. Future interventions should integrate comprehensive lifestyle modifications alongside pharmacological management to enhance overall disease control.
- Skeletal age assessed by Greulich-Pyle: intra-observer and inter-observer agreement among male pubertal tennis playersPublication . Celis-Moreno, Jorge M.; Martinho, Diogo V.; Coelho-e-Silva, Manuel J.; Fragoso, Isabel; Ribeiro, Luís Pedro; Gouveia, Élvio R.; Oliveira, Tomas; Gonçalves-Santos, João; Tavares, Oscar M.; Cayolla, Ricardo R.; Duarte-Mendes, Pedro; Konarski, Jan M.; Malina, Robert M.; Myburgh, Gillian K.; Cumming, Sean P.; Sherar, Lauren B.; Roberto ScendoniThe assessment of biological maturation is a central topic in pediatric exercise sciences. Skeletal age (SA) reflects changes in each bone of the hand and wrist from initial ossification to the adult state. This study examined intra-observer and inter-examiner agreement is Greulich-Pyle (GP) assessments of SA in 97 male tennis players 8.6–16.8 years of age. Two observers independently examined all films on two occasions using the GP method. The SA of each bone was evaluated. The mean and median of SAs assigned for each bone was the individual SA for each participant. The calculation was exclusively based on the bones that were not skeletally mature. Intra-observer mean differences were significant for several bones with better results by the experienced examiner (observer B). Comparisons between SA values of the two independent observers indicated significant differences for the ulna, metacarpals II and III, and distal phalanx V. Nevertheless, the magnitude of the bone-specific differences was small, perhaps trivial. Differences in individual SA values of the tennis players based on the non-mature bones of the hand-wrist were negligible based on the mean (0.04±0.39, t = 0.321, p = 0.749) or the median (0.05±0.58, t = 0.007, p = 0.994). Nevertheless, the current study confirmed examiners as a source of error in the estimation of SA using the Greulich-Pyle method and highlighted the importance of calculating SAs based on non-mature bones among adolescent players.