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- Adherence to pharmacological therapy for hypertension in Portugal: insights from patients’ focus groupsPublication . Silva, Beatriz Rosendo; Vieira, Diogo; Ferreira, Ana Sofia Fernandes; Santos, Bárbara; Pratas, Carolina; Soares, Carolina A.; Coito, Catarina; Santeiro, Catarina; Gomes, Hugo Amorim; Pereira, João Pedro; Gato, Maria Martins; Martins, Susana Patrícia; Sousa, Tânia; Prazeres, Filipe; Santiago, Luiz Miguel; Rosendo, InêsPurpose: Medication adherence is crucial for blood pressure control. Knowledge of medication adherence and its influencing factors, particularly within cultural and healthcare contexts, is essential for developing effective strategies to enhance medication adherence. Qualitative studies have explored patients' perspectives globally. Few have focused on strategies to improve adherence, and such research is lacking in Portugal. This study aimed to gather the perspectives of Portuguese patients with Arterial Hypertension (HTN) concerning the most effective strategies to enhance adherence to antihypertensive medication and to understand its contributing factors. Methods: We conducted qualitative research through online focus groups of four to ten participants each. Participants were adult patients with HTN taking at least one antihypertensive drug from the primary care setting. The number of focus groups was achieved through theoretical saturation. Purposive sampling was used, with patients recruited through their family doctors. Participants were recruited from all seven Portuguese regions, representing both sexes, controlled and uncontrolled HTN, and a diverse range of educational levels, employment statuses, living arrangements, and socioeconomic statuses. Meetings were audio-recorded and transcribed. Two researchers conducted content analyses using MAXQDA 2023 through comparative analyses and consensus. Results are presented narratively. Results: Four focus groups were conducted. Findings reported patients' strategies to improve adherence to pharmacological therapy for HTN. These included changes to medication and blister packs, such as a color-coded system. Other strategies involved reducing medication costs and making specific suggestions for primary healthcare. Patients additionally proposed psychological support and technological aids. Barriers such as difficulties in accepting medication and facilitators, such as fears of complications associated with HTN, were also identified. Conclusion: These results highlight the multifaceted perspectives of Portuguese patients with HTN and emphasise the role of technology, family support, and primary health services in promoting adherence. Such insights should be incorporated when addressing medication adherence in HTN.
- Mismatch repair deficiency or microsatellite instability in locally advanced rectal cancer patients treated with total neoadjuvant therapyPublication . Benhima, Nada; Audisio, Alessandro; Gallio, Chiara; Ricco, Gianluca; Meillat, Hélène; Velenik, Vaneja; Carmen Riesco, Maria; Suárez Alecha, Javier; Rasschaert, Gertjan; López-Bravo, David Páez; Tougeron, David; Carvalho, Carlos; Borelli, Beatrice; Famiglietti, Federico; De la Pinta, Carolina; Manuel O’Connor, Juan; Artaç, Mehmet; Braam, Pètra M.; Puccini, Alberto; Waldhorn, Ithai; Vanden Bulcke, Alexander; Loi, Mauro; De Felice, Francesca; Eid, Michal; Deleporte, Amélie; Rossini, Chiara; Montenegro, Paola; Fiore, Michele; Van Den Eynde, Marc; Shamseddine, Ali; Geboes, Karen P.; Messina, Marco; Mulet Margalef, Núria; Houlzé-Laroye, Constance; Kirac, Iva; Pastorino, Alessandro; Salati, Massimiliano; Argalácsová, Soňa; Morano, Federica; Capdevila, Jaume; Garajovà, Ingrid; Antoun, Claire; Pinto, Cidália Maria Sousa; Lutz, Manfred P.; Adams, Richard A.; Chau, Amélie; Siebenhuener, Alexander; Dermine, Alexandre; Ghidini, Michele; Dulskas, Audrius; Papamichael, Demetris; Javed, Muhammad Ahsan; Ruiz-Garcia, Erika; Tomášek, Jiří; Petrillo, Angelica; Baratelli, Chiara; Vandamme, Timon; Spolverato, Gaya; Bock, Felix; Diaz, Marie; Campana, Luca Giovanni; Sur, Daniel; Karampeazis, Athanasios; Patsko, Veronika; Puleo, Francesco; Bounedjar, Adda; Fiorica, Francesco; Gilliaux, Quentin; Bernardini, Ilaria; De Stefano, Alfonso; Guren, Marianne Grønlie; Jakubauskas, Matas; Sert, Fatma; Gomez Galdon, Maria; Veron Sanchez, Ana; Vierasu, Ortansa-Irina; Assaf, Irene; Moretti, Luigi; Martinive, Philippe; Liberale, Gabriel; Van Laethem, Jean-Luc; Sclafani, FrancescoBackground: Data on the prognostic value of dMMR/MSI-H in locally advancer rectal cancer (LARC) are inconsistent and mostly from patients treated with conventional neoadjuvant therapy. We sought to evaluate oncological outcomes by mismatch repair/microsatellite (MMR/MS) status in LARC patients treated with total neoadjuvant therapy (TNT). Methods: Patients from the International Real-World Study of TNT in Rectal Cancer tested for dMMR/MSI-H by immunohistochemistry and/or molecular testing were included. Pathological complete response (pCR), complete response (CR, pCR + clinical complete response), event-free survival (EFS) and overall survival (OS) were assessed by MMR/MS status in the overall and matched populations. For the latter, variable-ratio matching according to nine variables (age, year of diagnosis, tumour location, staging modality, cT stage, cN stage, presence of lateropelvic lymphadenopathy, distance from the mesorectal fascia, TNT regimen) was applied. Results: Of 1911 patients, 1320 (69.1%) (09/2012-09/2025) had information on the MMR/MS status, 46 (3.5%) having dMMR/MSI-H tumours. No outcome differences were found by MMR/MS status in the overall population. In the matched population (n = 372), pCR was 14.2% among patients with pMMR/MSS tumours versus 12.5% among those with dMMR/MSI-H tumours (adjusted OR 1.07, 95%CI 0.39-2.91, p = 0.899), while CR was 18.9% and 16.7%, respectively (adjusted OR 0.95, 95%CI 0.35-2.58, p = 0.917). 3-year EFS and 5-year OS were 65.8% and 79.2%, and 67.6% and 93.5% in patients with pMMR/MSS and in those with dMMR/MSI-H tumours, respectively (adjusted HR EFS 1.30, 95%CI 0.57-2.89, p = 0.527; adjusted HR OS 2.52, 95%CI 0.67-9.42, p = 0.171). Conclusions: In this study, the dMMR/MSI-H phenotype did not hold prognostic value in LARC patients treated with TNT.
- Verrucous carcinoma of the esophagus: a deceiving entity with an uncertain etiology – case reportPublication . Carvalho, Isabel Malta; Gago, Tânia; Relvas, Luís; Portugal, Margarida; Cadilla, Jesus; Peixe, BrunoVerrucous carcinoma of the esophagus is an extremely rare malignancy, described as a well-differentiated variant of esophageal squamous cell carcinoma, typically exhibiting exophytic/verrucous growth and intraluminal involvement that is often rich in inflammation and hyperkeratosis, which hampers histologic diagnosis and consequently delays treatment. We report the case of a 58-year-old woman with progressive dysphagia and a circumferential, verrucous esophageal lesion, without histologic confirmation despite multiple biopsies and endoscopic resections, showing only focal p16 positivity. After further evaluation with CT, endoscopic ultrasound, and FDG-PET/CT, a presumptive diagnosis of locally advanced verrucous carcinoma of the esophagus was assumed, and palliative chemotherapy was initiated, followed by a sustained endoscopic and radiologic response. This case highlights the importance of multidisciplinary discussion when verrucous carcinoma of the esophagus is suspected and the unexpected, sustained response despite unresectability.
- Is fluoroscopy necessary for oesophageal SEMS placement? A retrospective cohort studyPublication . Relvas, Luís Miguel; Gago, Tânia; Barros, Sónia; Carvalho, Isabel; Portugal, Margarida; Velasco, Francisco; Caldeira, Paulo; Peixe, BrunoIntroduction: self-expanding metal stents (SEMS) are widely used for the palliation of malignant esophageal conditions, including strictures, fistulas, and extrinsic compression. Placement may be guided by fluoroscopy, direct endoscopy, or both. However, few studies have directly compared the outcomes of these techniques. Objective: to compare the safety and efficacy of SEMS placement under endoscopic versus fluoroscopic control in a real-world clinical setting. Methods: we conducted a retrospective observational study of adult patients who underwent esophageal SEMS placement between January 2011 and December 2023. Patients were assigned to either the endoscopic control (EC) or fluoroscopic control (FC) group based on fluoroscopy availability. Outcomes included technical success, complication rates (early and late), and overall survival. Results: a total of 103 patients were included (mean age 69.4 years; 79 % male), with 43 receiving SEMS under EC and 60 under FC. The primary indication was malignant esophageal stricture (91.3 %). Technical success was achieved in 97 % of EC cases and 100 % of FC cases. Early complications occurred in 53 % of EC and 49 % of FC patients (p = 0.70), including chest pain (40.7 %), vomiting (22.3 %), and stent migration (5.8 %). Late complications occurred in 28 % of EC and 31 % of FC cases (p = 0.74), most commonly tumor overgrowth (14.6 %) and stent migration (10.7 %). Thirty-day mortality was 2.3 % in the EC group and 0 % in the FC group (p = 0.31). Median survival was 102 days (EC) versus 113 days (FC) (p = 0.44). Conclusions: SEMS placement under both endoscopic and fluoroscopic control is safe and effective, with no significant differences in complication rates, technical success, or survival. Endoscopic guidance may be a viable alternative to fluoroscopy in experienced hands, particularly in resource-limited settings.
- Assessment of European health professionals’ educational needs in basic principles of geriatric medicine: a focus group qualitative analysis from the PROGRAMMING COST Action 21122Publication . Frost, Rachael; Viegas, Ana; Tsamasiotis, Georgios-Konstantinos; Gugu, Mitilda; Mougakou, Efterpi; Savas, Sumru; Kupis, Robert; Piotrowicz, Karolina; Arranhado, Susana Ganhão; Farinha, Ana; Herghelegiu, Anna Marie; Bajenaru, Ovidiu Lucian; Nuta, Catalina Raluca; Fonseca, João; Rudzińska, Anna; Popov, Vesna; Milosavljevikj, Pavlinka; Sakellari, Vasiliki; Yilmaz, Nilufer Demiral; Przybył, Helena Lesz; Prada, Ana Gabriela; Tampaki, Maria; Pérez, Laura M.; Martín, Yolanda Barrado; Avgerinou, Christina; Hadziabdic, Maja Ortner; Christakou, Anna; Moumtzi, Eleni; Arsov, Stefan; Rodeles, Santiago Cotobal; Kravvariti, Evrydiki; Kotsani, Marina; Yellon, TamarPurposeIn many countries, geriatrics is still emerging as a speciality, with limited training options for healthcare professionals (HCPs). This international qualitative study aimed to explore the geriatric educational needs of HCPs, focussing on countries where geriatric medicine (GM) is emerging or underdeveloped.MethodsFourteen focus groups (n = 125 participants, 82% female, mean age 41.6 years) were carried out representing ten European countries and a range of HCPs and settings. Focus group discussions were recorded, transcribed verbatim, and inductively coded in the original language. Codes were aggregated into a shared English codebook applied to all transcripts. Descriptive and subsequently analytical themes were then developed.ResultsThree themes were identified. (1) Current experiences of geriatric care: participants described caring for older adults as medically and socially complex, requiring strong communication skills and interprofessional collaboration. (2) Structural and contextual challenges: limited staffing, fragmented care pathways, and GM's emerging status hindered effective care delivery. (3) Uncertainties and unmet training needs: key uncertainties included distinguishing ageing from disease, applying assessment tools, recognising red flags, and safe medication management. Participants emphasised the need for practical training during undergraduate studies, standardised interprofessional courses for non-specialists, and structural support (e.g. accessible programmes, protected time for training).ConclusionCurrently, geriatrics training is limited and there are multiple contextual challenges, especially in countries with emerging GM. There is significant unmet need for HCP basic training in GM. Our study contributes to an empirical basis for developing relevant and feasible GM training for HCPs. Structural support is needed for these initiatives.
- Lipid-lowering therapy and LDL cholesterol control among high- and very high-risk patients in Portugal: An analysis of the SANTORINI studyPublication . Aguiar, Carlos; Aguiar, Patrício; Duarte, João Sequeira; Gil, Victor; Mimoso, Jorge; Monteiro, Pedro; Pinto, Fausto J.; Pinto, Fernando; Raposo, João; von Hafe, Pedro; Ruivo, Jorge A.; Teixeira, Carla; Catapano, Alberico L.; Ray, Kausik K.Introduction and objectives: The SANTORINI study is the first large-scale, European observational study conducted following the release of the 2019 European Society of Cardiology/European Atherosclerosis Society ESC/EAS guidelines on dyslipidemia management. This analysis aims to assess lipid-lowering therapy (LLT) use and low-density lipoprotein cholesterol (LDL-C) goal attainment in patients at high or very high cardiovascular (CV) risk enrolled in Portugal. Methods: In Portugal, 117 patients were enrolled across 10 sites between September 2020 and February 2021. Paired LDL-C values at baseline and one-year follow-up were available for 102 patients. LDL-C levels, LLT utilization patterns, and LDL-C goal attainment (as per the 2019 ESC/EAS guidelines) were assessed at both time points and compared with the broader European cohort, excluding Portuguese participants. Results: Over the one-year follow-up, the use of statin monotherapy decreased from 49.5% to 45.2%, while combination therapy with statin and ezetimibe increased from 35.9% to 40.9%. LLT intensity was escalated in 12.8% of patients, unchanged in 79.5%, and de-escalated in 6.0%. Mean LDL-C levels were similar between baseline and one-year follow-up: corresponding values were 90.2 mg/dL and 90.1 mg/dL in high-risk patients, and 74.1 mg/dL and 75.2 mg/dL in very high-risk patients. LDL-C goal attainment declined from 34.1% to 22.7% in high-risk patients and 27.6% to 22.4% in very high-risk patients. Conclusions: The Portuguese cohort of the SANTORINI study demonstrates both encouraging developments and ongoing challenges in the real-world management of dyslipidemia following the 2019 ESC/EAS guidelines. Reasons for lack of LLT intensification and factors underlying worsening rates for LDL-C goal attainment should be explored. (c) 2025 Sociedade Portuguesa de Cardiologia. Published by Elsevier Espana, S.L.U. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
- Adjuvant ovarian function suppression and aromatase inhibitors in premenopausal patients with hormone receptor and HER2 positive breast cancer, by timing of chemotherapy and trastuzumab and response to neoadjuvant therapyPublication . Shai, Ayelet; Wildiers, Hans; Venieri, Claudio; Pogoda, Katarzyna; Linderholm, Barbro; Lambertini, Matteo; Matos, Leonor; D'Esposito, Eleonora De Maio; Hajjaji, Nawale; Matos, Erika; Cortijo, Lucía González; Fotia, Giuseppe; Fortuna, Ana; Sella, Tal; Gouveia, Helena; Rosset, Laurent; Constantinidou, Anastasia; Angeli, Eurydice; Cicin, Irfan; Tjan-Heijnen, Vivianne; Ruyssers, Natacha; Demasure, Sofie; Remilah, Areen Abu; Huygh, Greet; Shimon, Shani Paluch; Chiappe, Edoardo; Shirron, Natali; Neven, Patrick; Artac, Mehmet; Kilictas, Bilgesah; Baranseh, Jalal; Rubio, Elena Vicente; Atci, Mustafa; Amato, Ottavia; van Duijnhoven, FrederiekeBackground: The benefit of adjuvant ovarian function suppression (OFS) and aromatase inhibitors (AI) in premenopausal patients with hormone receptor positive, HER2 positive (HR+/HER2+) breast cancer (BC) is unclear. We aimed to investigate this question in a retrospective cohort, stratified by timing (adjuvant or neoadjuvant) of chemotherapy and trastuzumab and by response to neoadjuvant therapy. Methods: Patients aged <45Y at diagnosis, with stage I-III HR + HER2+ BC, treated with (neo)adjuvant chemotherapy and trastuzumab ( +/- pertuzumab) and endocrine therapy were included. LHRH-agonists and oophorectomy were considered OFS. We compared distant disease-free survival (DDFS) with tamoxifen, OFS + tamoxifen and OFS + AI in three cohorts: neoadjuvant-pathologic complete response (pCR), neoadjuvantresidual disease (RD) and adjuvant. Endocrine therapy (ET) was modeled as a time dependent covariate in cox logistic regression analyses. Results: The study included 1124 patients with median follow-up of 72.6 months (range:0-205 months). DDFS rates at 5 years were 83.9 %, 86.8 % and 92.1 % with tamoxifen, OFS + tamoxifen and OFS + AI respectively in the RD group, 94.3 %, 97.6 % and 96.5 % in the pCR group, and 94.3 %, 93.4 % and 98.6 % in the adjuvant group. OFS + AI was associated with better DDFS compared to tamoxifen in the RD group (n = 366) (multi-variable weighted HR 0.28. 95 % CI 0.11-.069, p = 0.006), but associations of ET with DDFS in the pCR (n = 307, p = 0.59) and adjuvant (n = 451, p = 0.18) cohorts were not detected. Stage III was associated with worse DDFS in all groups. Conclusion: OFS + AI were associated with better DDFS in patients with RD after neoadjuvant therapy. Our findings can assist shared decision-making on adjuvant endocrine therapy of these patients.
- Functional respiratory re-education interventions in people with respiratory disease: a systematic literature reviewPublication . Dias, Pedro Miguel Martins; Teixeira, Helena Margarida dos Santos; Palma, Magali Cavaco; Messias, Patrícia Alexandra Lopes; Vieira, João Vítor da Silva; Ferreira, Rogério Manuel FerrinhoObjectives: to identify nursing interventions in rehabilitation, within the scope of functional respiratory reeducation, which allow a respiratory function improvement in people with respiratory disease. Methods: systematic literature review using the MEDLINE database search, adopting the PICO mnemonic and the Joanna Briggs Institute’s assessment of the level of evidence and methodological quality. The search for randomized controlled trials was carried out in June 2021 considering the period from 2015 to 2020, in English or Portuguese. Results: a sample of nine randomized controlled trials with methodological quality was obtained which highlighted the use of positive expiratory pressure devices as an important component and intervention for respiratory functional reeducation. Conclusions: nursing interventions in rehabilitation with an emphasis on functional respiratory reeducation are essential, showing improvements in people’s general health.
- The influence of subclinical active inflammation on IFX pharmacokinetic modeling and disease progression assessment: findings from a prospective real-world study in inflammatory bowel disease patientsPublication . Magro, Fernando; Fernandes, Samuel; Patita, Marta; Arroja, Bruno; Lago, Paula; Rosa, Isadora; Sousa, Helena Tavares; Ministro, Paula; Mocanu, Irina; Vieira, Ana; Castela, Joana; Moleiro, Joana; Roseira, Joana; Cancela, Eugénia; Sousa, Paula; Portela, Francisco; Correia, Luís; Moreira, Paula; Dias, Sandra; Afonso, Joana; Danese, Silvio; Peyrin-Biroulet, Laurent; Vucicevic, Katarina M; Santiago, MafaldaBackground and aims: Effective management of inflammatory bowel disease (IBD) relies on a comprehensive understanding of infliximab (IFX) pharmacokinetics (PK). This study’s primary goal was to develop a robust PK model, identifying key covariates influencing IFX clearance (CL), while concurrently evaluating the risk of disease progression during the maintenance phase of IBD treatment. Methods: The multicenter, prospective, real-world DIRECT study was conducted in several care centers, which included 369 IBD patients in the maintenance phase of IFX therapy. A two-compartment population PK model was used to determine IFX CL and covariates. Logistic and Cox regressions were applied to elucidate the associations between disease progression and covariates embedded in the PK model. Results: The PK model included the contributions of weight, albumin, antidrug antibody (ADA), and fecal calprotectin (FC). On average, higher ADA, FC concentration and weight, and lower albumin concentration resulted in higher IFX CL. In the multivariate regression analyses, FC levels influenced the odds of disease progression in the majority of its definitions, when adjusted for several confounding factors. Additionally, alongside FC, both IFX and CL demonstrated a significant impact on the temporal aspect of disease progression. Conclusion: In this 2-year real-world study, readily available clinical covariates, notably FC, significantly impacted IFX availability in IBD patients. We demonstrated that subclinical active inflammation, as mirrored by FC or CRP, substantially influenced IFX clearance. Importantly, FC emerged as a pivotal determinant, not only of IFX pharmacokinetics but also of disease progression. These findings underscore the need to integrate FC into forthcoming IFX pharmacokinetic models, amplifying its clinical significance.
- Serum biomarkers of extracellular matrix remodeling in ulcerative colitis—one step closer to fibrosis biomarkers in inflammatory bowel diseasePublication . Sousa, Helena Tavares; de Oliveira, RaquelFibrosis is a serious complication of both Crohn's disease (CD) and ulcerative colitis(UC) and is currently the major unmet need in inflammatory bowel disease (IBD) management [1]. Although much less prevalent in UC, strong evidence supports severity and chronicity of inflammation are the main drivers of excessive extracellular matrix (ECM) deposition in the submucosa and muscularis mucosae [2], leading to increased wall stiffness, and ultimately to motility and anorectal dysfunction, rectal urgency and incontinence.