ULS_10.1-MED-Artigos
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- Old habits die hard: Can AI help bring coronary angiography Into the 21st Century?Publication . Menezes, Miguel Nobre; Oliveira, Catarina Simões; Silva, João Lourenço; Silva, Beatriz Valente; Marques, João Silva; Guerreiro, Cláudio; Guedes, João Pedro; Oliveira-Santos, Manuel; Oliveira, Arlindo L.; Pinto, Fausto J.Coronary angiography (CAG) was pioneered in the 1950s by Eduardo Coelho (who performed the first nonselective in vivo CAG in 1952 at the Santa Marta Hospital in Lisbon, Portugal) and Frank Mason Sones Jr (who performed the first selective CAG in vivo in 1958 at the Cleveland Clinic in Ohio, USA). Sones further developed the technique by contributing to the development of the C-arm, enabling multiangular views and a comprehensive assessment of coronary artery anatomy and disease. This approach remains essentially the same today. When interpreting CAG images, an essential step is the assessment of the severity/significance of coronary lesions, paramount for considering revascularization. Furthermore, the presence of significant lesions increases the risk of cardiovascular events and symptoms, rendering optimal medical therapy mandatory for addressing both.
- 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.
- Pregnancy outcomes in systemic sclerosis: experience of a rheumatology-obstetric multidisciplinary clinicPublication . Chícharo, Ana Teodósio; Lopes, Ana Rita; Barreira, Sofia; Martins, Patrícia; Machado, Ana Rita Cruz; Pinto, Luísa; Capela, SusanaSystemic sclerosis (SSc) is a rare multisystemic connective tissue disease (CTD). It is mainly characterized by progressive fibrosis and non-inflammatory vasculopathy. Women diagnosed with SSc seem to be at increased risk of developing adverse pregnancy outcomes (APO), but maternal and perinatal outcomes remain poorly understood in these patients, with no data yet available from Portuguese centers.
- Biologic disease-modifying antirheumatic drugs survival in late-onset axial spondyloarthritis — data from a Portuguese registryPublication . Silva, Susana P.; Monteiro, Beatriz; Oliveira, Cláudia Pinto; Costa, Roberto Pereira da; Matos, Carolina Ochôa; Lopes, Mariana Diz; Gomes, Carlos Marques; Bernardes, Miguel; Santos, Mariana Emília; Gago, Laura; Abreu, Catarina; Fraga, Vanessa; Mendes, Beatriz; Rocha, Margarida Lucas; Soares, Catarina Dantas; Silva, Cândida; Santos, Helena; Valente, Paula; Silva, Lígia; Eugénio, Gisela; Barcelos, AnabelaObjectives Although axial spondyloarthritis (axSpA) typically begins before age 45, late-onset axSpA (lo-axSpA) has been widely recognized. While existing literature describes this subgroup, data on therapeutic approaches remain limited. Therefore, we aimed to evaluate the efficacy and safety of biologic DMARDs in patients with lo-axSpA.Methods We conducted a retrospective, multicentre, national cohort study using data from the Rheumatic Diseases Portuguese Register. A cut-off age of 45 years was applied to define lo-axSpA. Group differences between early- and late-onset disease activity scores were evaluated, and drug survival was assessed over 12 months. Predictors of drug discontinuation were identified using a Cox proportional hazards model.Results In total, 2256 patients were included, of whom 260 (11.5%) had lo-axSpA. Patients with late-onset disease exhibited significantly higher scores in the Ankylosing Spondylitis Disease Activity Score, Bath Ankylosing Spondylitis Disease Activity Index and Bath Ankylosing Spondylitis Functional Index at baseline, 3, 6 and 12 months. Despite these differences, both groups showed proportional reductions in disease activity scores, indicating a continuous decrease in disease activity over time. Although the late-onset group had a higher discontinuation rate during the first 12 months of treatment, lo-axSpA was not associated with an increased risk of therapy discontinuation. The primary reason for treatment discontinuation in both groups was inefficacy, with low rates of infections and other adverse events observed across the cohort.Conclusion Our study demonstrated that lo-axSpA is not associated with reduced treatment efficacy or compromised safety.
- Delphi consensus statement for the management of delayed post-polypectomy bleedingPublication . Rodríguez de Santiago, Enrique; de la Iglesia, Sandra Pérez; de Frutos, Diego; Marín-Gabriel, José Carlos; Mangas-SanJuan, Carolina; Honrubia López, Raúl; Uchima, Hugo; Aicart-Ramos, Marta; Rodríguez Gandía, Miguel Ángel; Valdivielso Cortázar, Eduardo; Zabala, Felipe Ramos; Álvarez, Marco Antonio; Solano Sánchez, Marina; González Santiago, Jesús Manuel; Albéniz, Eduardo; Hijos-Mallada, Gonzalo; Quismondo, Nerea Castro; Fraile-López, Miguel; Martínez Ares, David; Tejedor-Tejada, Javier; Hernández, Luis; Gornals, Joan B.; Quintana-Carbo, Sergi; Ocaña, Juan; Neves, João A. Cunha; Martínez Martínez, Juan; Pinilla, María López-Cerón; Abadía, Carlos Dolz; Pellisé, MaríaBackground: Delayed post-polypectomy bleeding (DPPB) is the most common adverse event following colonic polypectomy, yet its management remains highly heterogeneous and lacks standardization. A considerable number of colonoscopies performed for DPPB may be unnecessary and do not result in hemostatic intervention.Objectives: To develop evidence-based statements to guide clinical decision-making in DPPB.Design: Multidisciplinary Delphi consensus statement.Methods: A panel of 29 experts in gastroenterology, hematology, radiology, and surgery was assembled. Through a systematic review of the literature and a modified Delphi process, consensus statements were developed through iterative rounds of anonymous voting. Statements were revised following anonymous voting and feedback at each round. Those achieving 80% agreement were accepted.Results: The expert panel reached a consensus on 36 statements, covering areas such as antithrombotic management, bowel preparation, colonoscopy indications, and therapeutic hemostatic modalities. Key recommendations include guidance for managing self-limited bleeding and risk stratification to reduce the rate of unnecessary colonoscopies, as well as recommendations for hemodynamically unstable patients who may require primary angioembolization. A practical clinical algorithm is proposed.Conclusion: This document provides a consensus-based framework for managing DPPB. These recommendations aim to improve patient outcomes and optimize healthcare resources while fostering a standardized approach to this common adverse event.
- 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
- Custos e consequências da doença renal crónica em pessoas com diabetes em Portugal: um estudo de modelaçãoPublication . Borges, Margarida; Almeida, Edgar; Alves, Rui; Ascenção, Raquel; Vieira, Miguel Bigotte; Bulhosa, Carolina; Costa, João; Duarte, Gonçalo S.; Falcão, Luís; Pestana, Manuel; Raposo, João; Sampaio, Filipa; Santos, Josefina; Silva, Ana Paula; Miguel, Luís SilvaIntrodução: A doença renal crónica é a doença crónica com maior crescimento de prevalência, e uma das maiores causas de mortalidade global de acordo com o Global Burden of Disease Collaboration. O presente estudo teve como objetivo projetar a evolução desta doença em pessoas com diabetes, de modo a quantificar os custos e consequências no contexto português. Tal foi conseguido através do desenvolvimento e parametrização de um modelo analítico refletindo a epidemiologia da doença renal crónica e integrando os vários estádios de progressão da doença.Métodos: Foi utilizado um modelo populacional de coorte com uma mecânica de Markov, onde pessoas com diabetes e doença renal crónica foram seguidas ao longo de 50 anos, em ciclos anuais, sendo registada a sua progressão através das diferentes categorias de risco da doença renal crónica. O modelo considerou a progressão natural da doença renal crónica através de 18 categorias de risco baseados na matriz de estadiamento de KDIGO, bem como a probabilidade de os doentes receberem terapêutica de substituição renal, designadamente, diálise e transplantação renal e a probabilidade de morte. A cada estádio estão associados um custo anual e um ponderador de incapacidade, pelo que o modelo permitiu estimar a sobrevivência, os anos de vida perdidos por incapacidade (years lived with disability), e os custos incorridos ao longo da vida, para a totalidade da população e para doentes em diferentes categorias de risco.Resultados: Durante o tempo total de evolução da coorte, o modelo estimou, para a população total com doença renal crónica e diabetes, uma sobrevivência média de 8,62 anos, com 0,59 anos perdidos por incapacidade, e um custo médio lifetime de €24 613. Estes valores correspondem a mais de 410 mil anos de vida perdidos por incapacidade e um custo total, ao longo da vida, de 17,0 mil milhões de euros. A análise por nível de risco demonstra que a progressão da doença renal crónica está associada a menor sobrevivência, mais anos perdidos por incapacidade e maiores custos. Conclusão: Os resultados deste estudo caracterizam a progressão natural da doença renal crónica em pessoas com diabetes mellitus tipo 2 bem como os custos e consequências associados no contexto nacional. Sendo a diabetes mellitus tipo 2 um fator de risco da doença renal crónica, é expectável que nas próximas décadas o impacto real seja maior do que o estimado. A análise por nível de risco permite verificar que a progressão da doença está associada a piores resultados.
- ‘Pela Saúde de Portugal’ – data from a screening on blood pressurePublication . Ribeiro, Heloisa; Silva, Luis Nogueira; Viana, Manuel; Assis, José Guilherme; Coelho, Telmo Borges; Patrocínio, João Pedro; Ferreira, Rogério; Ambrósio, Inês; Féria, Rita Palma; Abecasis, Francisca; Pinto, Inês; Gonçalves, Fernando Martos; Pinho, Rosa dePurpose The Portuguese Society of Hypertension is responsible for the Mission 70/26 Project, a movement that aims to achieve 70% control of hypertensive patients aged 18-65 years old, under Primary Healthcare by 2026. To reach the general population, different activities were done, in this article we will describe one in particular, the campaign called 'Pela Saude de Portugal'. Materials and methods From December 2023 to July 2024, there were nine screenings for hypertension done in eight cities in Portugal. Volunteers were asked about medical history, their weight and blood pressure were assessed and they were informed about Hypertension (HTN) and target organ damage. Results479 screenings were performed. Of the participants, 243 (51%) were female. History of hypertension was reported in 34,7% of them and 32,4% of these were taking medication. There was a significant blood pressure (BP) reduction from the first to the third measurement and both systolic and diastolic BP (mean of the second and third measurements) were higher in hypertensive patients. There were significant BP differences between the cities. Conclusion 'Pela Saude de Portugal' was not a study of the prevalence of hypertension but merely an awareness campaign with HTN screening done all around the country. This type of campaign is important to draw attention to HTN and other risk factors, improving health literacy in this field. The analysis of the volunteer's characteristics is important to design future interventions.
- DOP56 Fibrosis-related transcriptome unveils a distinctive matrix remodelling pattern in penetrating but not in stricturing ileal Crohn's DiseasePublication . Sousa, Helena Tavares; Ferreira. M.; Gullo, I.; Rocha, A. M.; Oliveira, C.; Carneiro, F.; Magro, F.Fibrosis underlies most of CD complications requiring surgery, such as intestinal strictures and penetrating events. We previously demonstrated there were no histopathological differences on transmural fibrosis and fibromuscular changesbetween penetrating and stricturing ileal CD. This study aimed to investigate and compare the fibrosis-related transcriptomic profiles of penetrating and stricturing ileal CD.
- Determinants of HIV-1 transmission clusters and transmitted drug resistance in men who have sex with men: a multicenter study in Portugal (2014-2019)Publication . Abrantes, Ricardo; Pimentel, Victor; Sebastião, Cruz; Miranda, Mafalda N. S.; Seabra, Sofia; Silva, Ana Rita; Diniz, António; Ascenção, Bianca; Piñeiro, Carmela; Koch, Carmo; Rodrigues, Catarina; Caldas, Cátia; Morais, Célia; Faria, Domitília; Silva, Elisabete Gomes da; Teófilo, Eugénio; Monteiro, Fátima; Roxo, Fausto; Maltez, Fernando; Rodrigues, Fernando; Gaião, Guilhermina; Ramos, Helena; Costa, Inês; Diogo, Isabel; Germano, Isabel; Simões, Joana; Oliveira, Joaquim; Ferreira, José; Poças, José; Cunha, José Saraiva da; Soares, Jorge; Mansinho, Kamal; Pedro, Liliana; Aleixo, Maria João; Gonçalves, Maria João; Manata, Maria José; Mouro, Margarida; Serrado, Margarida; Caixeiro, Micaela; Marques, Nuno; Costa, Olga; Pacheco, Patrícia; Proença, Paula; Rodrigues, Paulo; Pinho, Raquel; Tavares, Raquel; Abreu, Ricardo Correia de; Real, Rita Côrte; Serrão, Rosário; Castro, Rui Sarmento e; Nunes, Sofia; Faria, Telo; Baptista, Teresa; Simões, Daniel; Mendão, Luis; Martins, M. Rosário O.; Gomes, Perpétua; Pingarilho, Marta; Abecasis, Ana B.In the EU/EEA, men who have sex with men (MSM) is a priority group for the prevention and control of HIV-1 infection. In Portugal, the 2023 HIV incidence rate was 8.2 per 100,000 inhabitants, with 876 new infections, 41.7% in MSM. We aim to characterize HIV-1 transmission clusters (TC) and transmitted drug resistance (TDR) and its sociodemographic, behavioral, clinical, and viral genomic determinants in MSM newly diagnosed in Portugal between 2014 and 2019.