ABC2-Artigos (em revistas ou actas indexadas)
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- An integrative review of potential diagnostic biomarkers for complex regional pain syndromePublication . Lopes, Revelino; Santos, André; Gomes, Teresa; Ribeiro, Júlia; Rodrigues, Ivone; Paiva, Bruno; Nzwalo, Isa; Catamo Vaz, Deise Haua da Silva; Baco, Jamal; Buque, Helena Agostinho; Botelho, Marta; Pais, Sandra; Nzwalo, HipólitoBackground: Complex regional pain syndrome (CRPS) is a rare, chronic, painful, neurological, debilitating disorder. Despite the substantial impact on quality of life, diagnosis remains challenging due to its complex pathophysiology and subjective clinical criteria. This integrative review aims to synthesize current research on potential diagnostic biomarkers for CRPS. Methods: A systematic search was conducted using the PubMed and Scopus databases to identify relevant studies published until January 2025. Inclusion criteria focused on adult CRPS patients, with studies examining diagnostic or predictive biomarkers. Results: Key findings highlight the role of inflammatory and immune-related biomarkers, such as elevated levels of cytokines (IL-6, TNF-alpha), immune cell infiltration, and specific autoantibodies. Neuropeptides, including substance P and calcitonin gene-related peptide, were associated with pain sensitization in acute phases, though their levels normalized in chronic stages. Additionally, genetic and epigenetic markers, brain imaging, and neurophysiological alterations provided insights into CRPS pathogenesis, emphasizing the dynamic nature of these biomarkers across disease stages. Conclusions: This review underscores the need for further research to integrate these biomarkers into diagnostic frameworks, which could enhance early diagnosis and treatment strategies for CRPS.
- Advanced therapy medicinal products development - from guidelines to medicines in the marketPublication . Frederico, Catarina; Vieira da Conceição, André Filipe; Nóbrega, Clévio; Mendonça, Liliana S.In Europe, Advanced Therapy Medicinal Products (ATMPs) include medicines based on gene therapy, somaticcell therapy, tissue-engineered products, and combined ATMPs. ATMPs constitute an emerging and innovative class of medicines used to treat multiple pathologies and are particularly relevant in pathologies where therapeutic options are limited and require high medical needs. These therapies act, among others, through the insertion of recombinant nucleic acids, including genes, to promote a therapeutic effect and through the restoration of cell functions, and repairing or replacing damaged cells and tissues impaired in pathological conditions. Despite their unique potential, these therapies face challenges related to scientific complexity, production processes, regulatory approval, and market access that hinder their development and availability. Based on official European guidelines, the present review explores the current regulatory framework for the non-clinical and clinical development of advanced therapies. We aimed to discuss the regulations applied to the different types of ATMPs, as well as the challenges associated with their development until these therapies reach the market. Accordingly, topics such as the implementation of proof-of-concept studies to provide evidence supporting the potential clinical effect; biodistribution studies to evaluate tissue distribution and persistence; and toxicology studies to assess potential undesirable effects, integration potential of viral vectors, tumorigenicity, and germline transmission, are discussed. This work also covers some of the ATMPs available to patients on the EU market.
- Green surgery: a systematic review of the environmental impact of laparotomy, laparoscopy, and roboticsPublication . Cunha, Miguel F.; Neves, João Cunha; Roseira, Joana; Pellino, Gianluca; Castelo-Branco, PedroSurgery is the most energy-intensive healthcare sector, but data on the environmental impact of abdominal surgical techniques are limited. This systematic review aims to identify the most sustainable approach among open, laparoscopic, and robotic surgeries. We searched MEDLINE, Cochrane, and Web of Science databases (inception to March 2024) for studies on the carbon footprint of abdominal surgery, focusing on carbon dioxide equivalents (CO2e) or CO2 emissions. The Joanna Briggs Institute checklist was used to assess bias. (PROSPERO: 298486). Of 2155 records, eight cohort studies were included, showing low to moderate risk of bias but high heterogeneity. Two studies on hysterectomy found robotic surgery had the highest carbon footprint (12.0-40.3 kgCO2e) compared to laparoscopic (10.7-29.2 kgCO2e) and open surgery (7.1-22.7 kgCO2e). Another study found laparoscopic prostatectomy produced more emissions than robotic surgery (59.7 vs. 47.3 kgCO2e) due to higher disposable devices, surgery time and length of stay. Single-use devices in laparoscopic cholecystectomy emitted more CO2e than hybrid devices (7.194 vs. 1.756 kgCO2e). CO2 used in minimally invasive surgery had negligible environmental effects (0.9 kgCO2e). Qualitative subgroup analyses revealed significant differences between surgery types and measurement methodologies, contributing to data heterogeneity. Minimally invasive surgeries often have higher carbon footprints due to disposable tools and waste. However, one study showed robotic surgery may reduce the overall environmental impact by shortening hospital stays. Due to methodological heterogeneity across studies, definitive conclusions remain limited. Standardized life-cycle assessment methodologies and inclusion of clinical outcomes in future studies are urgently needed to clarify the environmental sustainability of surgical practices.
- Comparing the outcomes of digital and traditional cardiac rehabilitation practices: a systematic review and meta-analysisPublication . Ansari, Sumbul; Nadar, Bhuvaneshwari G; Estêvão, Maria Dulce da Mota Antunes de Oliveira ; Aguiar, Débora R.; Ejeh, Jude; Khan, ZahidThis systematic review and meta-analysis aimed to evaluate the effects of digital cardiac rehabilitation (DCR) encompassing application-based telehealth compared to traditional cardiac rehabilitation on major adverse cardiovascular events (MACE), rehospitalisation, costs, quality of life (QoL), and physical activity levels in patients with coronary artery disease (CAD). From 2014 to May 2024, a systematic search of the MEDLINE, PubMed, Web of Science, and Scopus databases was conducted using relevant keywords to identify randomised controlled trials (RCTs) or randomised cross-over trials. The methodological quality of the included studies was assessed using the Physiotherapy Evidence Database (PEDro) scale and risk of bias tool. The included articles were then subjected to qualitative synthesis and meta-analysis. Thirteen studies involving 1850 participants were included in the study. Meta-analysis revealed statistically significant improvements in QoL (mean deviation (MD) = 0.10, 95% CI: 0.05-0.15, p = 0.0002). DCR compared with centre-based rehabilitation (CBR). These improvements in QoL likely translated to enhanced daily functioning, such as the increased ability to perform activities of daily living. However, no significant differences were found for physical activity levels (MD = 1.69, 95% CI: 1.49-4.87, p = 0.30), rehospitalisation (relative risk (RR) = 0.86, 95% CI: 0.66-1.11, p = 0.25) or MACE (RR = 0.67, 95% CI: 0.42-1.07, p = 0.09). High heterogeneity was observed in QoL, likely due to variations in DCR modalities, study populations, and intervention content. The results of this study, therefore, must be interpreted with caution. DCR may offer significant benefits in terms of improving the QoL in patients with CAD. While promising trends were observed for rehospitalisation and MACE, further research is needed to confirm these findings. Potential reasons for the observed benefits of DCR over centre-based rehabilitation plausibly include improved accessibility, enhanced patient engagement, and greater flexibility. However, it is important to acknowledge the presence of heterogeneity among the included studies and potential gender imbalances within the study populations, which may have influenced the results. Future research should prioritize long-term outcomes, cost-effectiveness, real-world effectiveness in diverse populations, and the development of standardized DCR protocols.
- Editorial: Endocrine disruption in marine species: unraveling pollution and climate change effectsPublication . Bertucci, Juan Ignacio; Blanco, Ayelén Melisa; Estêvão, Maria Dulce da Mota Antunes de OliveiraEndocrine disruption in marine species has emerged as a significant concern in environmental endocrinology, particularly in the context of escalating anthropogenic pressures. Persistent pollutants, including microplastics, heavy metals, and agrochemical residues, alongside climate-induced stressors like ocean warming and acidification, are now recognized as potent modulators of endocrine function in aquatic organisms. These stressors compromise critical physiological and behavioral processes, with potential implications for individual fitness, population viability, and ecosystem stability. The Research Topic Endocrine disruption in marine species: unraveling pollution and climate change effects brings together a multidisciplinary set of contributions that examine the mechanistic underpinnings, organismal impacts, and ecological implications of endocrine disruption across marine taxa. This editorial synthesizes the key findings, contextualizes them within the broader scientific discourse, and highlights knowledge gaps and future research directions.
- Endoscopy‐related musculoskeletal injuries: a systematic review and meta‐analysis on prevalence, risk factors and preventionPublication . de Oliveira, Raquel; Roseira, Joana; Estevinho, Maria Manuela; Sousa, Helena Tavares; Rolanda, Carla; Meining, Alexander; Walter, BenjaminBackgroundEndoscopy-related musculoskeletal injuries (ERIs) are a major occupational hazard, impacting career longevity and personal well-being.ObjectiveThis systematic review and meta-analysis aimed to update and expand on previous findings by assessing prevalence, risk factors and management of ERIs among endoscopists.MethodsFollowing PRISMA guidelines, we systematically searched MEDLINE, Web of Science and Scopus for relevant studies published since the last comprehensive review. A manual search of the references of relevant manuscripts was also performed. Outcomes of interest included the prevalence of ERIs, common pain syndromes, risk factors, and preventive or treatment strategies. Studies' quality was assessed using the National Institutes of Health (NIH) Quality Assessment Tool.ResultsThirty studies were included, incorporating data from 7646 gastrointestinal endoscopists. The pooled career-long prevalence of overall ERI was 62.5% (CI 52.6-71.8, I2 = 98%), including pain (67.5%; CI 46.4%-85.6%; I2 = 98%) and numbness (12.4%; 95% CI 6.6%-19.7%; I2 = 98%) syndromes. Among pain syndromes, the most affected areas were the hand (28.2%; CI 19.2%-38.2%; I2 = 99%), lower back (27.3%; CI 20.1%-35.2%; I2 = 97%), thumb (27.1%; CI 18.9%-37.7%; I2 = 99%) and neck (25.7%; CI 19.3%-32.7%; I2 = 98%). Higher procedural volume, years in practice and female gender were consistently reported as risk factors for ERIs. Concerning therapy, 41.8% of endoscopists used medications (CI 31.2%-52.8%; I2 = 94%), while 28.2% engaged in physical therapy (CI 18.2%-39.5%; I2 = 96%). Sick leave was reported by 13.8% of endoscopists (CI 7.9%-20.9%; I2 = 94%). Practice modifications to manage ERIs included adjusting monitor (45.5%, CI 22.2%-69.9%; I2 = 96%) and table (32.4%, CI 14.5%-53.5%; I2 = 97%) height, but also reducing the number of cases per endoscopy session (14.6%; CI 10.4%-19.4%; I2 = 72%).ResultsThirty studies were included, incorporating data from 7646 gastrointestinal endoscopists. The pooled career-long prevalence of overall ERI was 62.5% (CI 52.6-71.8, I2 = 98%), including pain (67.5%; CI 46.4%-85.6%; I2 = 98%) and numbness (12.4%; 95% CI 6.6%-19.7%; I2 = 98%) syndromes. Among pain syndromes, the most affected areas were the hand (28.2%; CI 19.2%-38.2%; I2 = 99%), lower back (27.3%; CI 20.1%-35.2%; I2 = 97%), thumb (27.1%; CI 18.9%-37.7%; I2 = 99%) and neck (25.7%; CI 19.3%-32.7%; I2 = 98%). Higher procedural volume, years in practice and female gender were consistently reported as risk factors for ERIs. Concerning therapy, 41.8% of endoscopists used medications (CI 31.2%-52.8%; I2 = 94%), while 28.2% engaged in physical therapy (CI 18.2%-39.5%; I2 = 96%). Sick leave was reported by 13.8% of endoscopists (CI 7.9%-20.9%; I2 = 94%). Practice modifications to manage ERIs included adjusting monitor (45.5%, CI 22.2%-69.9%; I2 = 96%) and table (32.4%, CI 14.5%-53.5%; I2 = 97%) height, but also reducing the number of cases per endoscopy session (14.6%; CI 10.4%-19.4%; I2 = 72%).ConclusionERIs are highly prevalent among international gastrointestinal endoscopists, and are linked to procedural volume, years in practice, and gender. Ergonomic training and workplace adaptations are essential to mitigate risks and support career sustainability.Trial RegistrationPROSPERO Registration: CRD42024534349
- Potential impact of metabolic syndrome control on cardiovascular risk in elderly patients with diabetes: a cross-sectional studyPublication . Nascimento, Tânia; Estêvão, Maria Dulce da Mota Antunes de Oliveira ; Gonçalves, Adriana; Pinto, Ezequiel; De Sousa-Coelho, Ana Luísa; Neto Espírito-Santo, Margarida de FátimaMetabolic syndrome (MS), a complex pathology with features like abnormal body fat distribution, insulin resistance, and dyslipidaemia, contributes to higher cardiovascular (CV) risk. A cross-sectional study including 87 individuals assessed CV risk score in elderly patients with type 2 diabetes and MS in Algarve, Portugal. The 10-year CV risk score was estimated using the ADVANCE risk score calculator. The reductions in CV risk score were estimated by adjusting the data inputted on the online tool to achieve systolic blood pressure (SBP) <130 or <120 mmHg, and LDL cholesterol <70 mg/dL Beyond waist circumference, the mean number of clinical features of MS was 3.14 ± 0.84, without significant sex differences. The mean CV risk score was 22.5% (CI: 20.3–24.7). Sex-specific analysis showed higher risk score in males (24.2%, CI: 21.3–27.0) vs. females (19.7%, CI: 16.2–23.3; p = 0.028). Hypothetical risk score reductions show that lowering SBP to <130 mmHg could significantly lower the risk score by an average of 9.2% (CI: 7.7–10.7), whereas 34.5% of the participants would be out of the diagnostic criteria for MS. When comparing each potential intervention with current risk score, all interventions significantly reduce the 10-year CV risk score. The study highlights the potential of blood pressure control in reducing CV risk score and the importance of multifaceted risk score reduction strategies.
- Preface: VII Poster Sunset Session—ESSUAlg 2024Publication . De Sousa-Coelho, Ana Luísa; Teotónio Fernandes, Mónica Alexandra; Estêvão, Maria Dulce da Mota Antunes de Oliveira ; Braz, Luis; Nascimento, TâniaThe event “Poster Sunset Session” began in 2017 at the School of Health of the University of Algarve (ESSUAlg), bringing the premise that scientific knowledge depends on research and critical analysis and that the exchange of ideas and information is an essential part of the continuous development process. This event was conceptualized and prepared by professors of the Pharmacy Department at ESSUAlg. The idea of “sunset” was based on the beautiful view over Ria Formosa (Faro, Portugal) that the previous building of ESSUAlg offered at dusk.
- Statement of Peer ReviewPublication . De Sousa-Coelho, Ana Luísa; Teotónio Fernandes, Mónica Alexandra; Estêvão, Maria Dulce da Mota Antunes de Oliveira ; Neto Espírito-Santo, Margarida de Fátima; Braz, Luis; Nascimento, TâniaIn submitting conference proceedings to Proceedings, the volume editors of the proceedings certify to the publisher that all papers published in this volume have been subjected to peer review administered by the volume editors. The reviews were conducted by expert referees, and to the professional and scientific standards expected of a proceedings journal.
- Common mechanistic pathways in rare congenital syndromes with primary microcephalyPublication . Jorge, Xavier; Milagre, Ines; Ferreira, Anita; Calado, Sofia; Oliveira, Raquel; Carvalhal, SaraPrimary microcephaly is an often-seen phenotype in several rare congenital syndromes. It is characterised by a smaller brain size at birth compared to the norm. The causes of this malformation are not fully understood, but genetic testing suggests a connection with defective genes involved in mitotic regulation and proteins related to DNA repair and replication pathways. Cohesinopathies represent a group of rare syndromes, where several subtypes exhibit spontaneous railroad chromosomes and primary microcephaly. This includes Roberts Syndrome, Warsaw Breakage Syndrome and a recently characterised syndrome caused by mutations in the BUB1 gene. Currently, we are examining fibroblast cells from patients with these syndromes to identify common mechanistic pathways. In this context, we have identified a new promising candidate: Topoisomerase II alpha, a protein responsible for resolving of the DNA catenation both in the DNA replication and mitosis. Defective localisation of Topoisomerase II alpha may contribute to the observed mitotic defects in these cells. We are currently exploring the impact of these defects on brain development using reprogramming techniques to assess proper neuronal differentiation.