Instituto Politécnico de Lisboa

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    Characterization of a cohort of Angolan children with sickle cell anemia treated with hydroxyurea

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    This research was funded by Fundação para a Ciência e Tecnologia, Ministério da Ciência, Tecnologia e Ensino Superior (FCT-MCTES) and Aga Khan Foundation (FCT/MCTES/Aga Khan, project n◦ 330842553), by FCT/MCTES funding to H&TRC (UIDB/05608/2020, UIDP/05608/2020) and to GHTM IHMT NOVA (UID/04413/2020) and LA-REAL – LA/P/0117/2020.Background: Sickle Cell Anemia (SCA) is a monogenic disease, although its severity and response to treatment are very heterogeneous. Objectives: This study aims to characterize a cohort of Angolan children with SCA and evaluate their response to hydroxyurea (HU) treatment and the potential side effects and toxicity. Methods: The study enrolled 215 patients between 3 and 12 years old before and after the administration of HU, at a fixed dose of 20 mg/kg/day for 12 months. Results: A total of 157 patients started HU medication and 141 of them completed the 12-month treatment. After initiating HU treatment, the frequency of clinical events decreased (transfusions 53.4%, hospitalizations 47.1%). The response to HU medication varied among patients, with some experiencing an increase in fetal hemoglobin (HbF) of <5%. The mean increase in HbF was 11.9%, ranging from 1.8% to 31%. Responders to HU treatment were 57%, inadequate responders 38.7%, and non-adherent 4.2%. No clinical side effects related to HU were reported. Hematological toxicities were transient and reversible. Children naïve to HU and with lower HbF reported a higher number of hospitalizations caused by malaria infection. During HU treatment, the frequency of malaria episodes did not appear to be affected by HbF levels. Conclusions: the present study provided a valuable contribution to the understanding of the clinical and laboratory profiles of Angolan children with SCA. These findings support the evidence that the implementation of prophylactic measures and treatment with HU is associated with increased survival in children with

    Organs at risk delineation

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    Delineation of organs at risk and volumes of interest plays a crucial role in the radiation therapy chain. The process should be aligned with technological and clinical treatment approaches for optimal personalized care. Organs at risk contouring is part of the planning stage, after the initial simulation process, where volumetric CT imaging takes place to generate optimal 3D image set reconstruction for structure delineation and dose planning calculation. Relevant organs at risk for breast cancer radiation therapy have been described and contoured for global quality improvement and better communication between professionals. This chapter supports the evidence-based consensus from recently published literature, which served as the basis for the harmonization and standardization of practices in this planning radiation therapy stage. Electronic supplement material includes axial, sagittal, and coronal views of delineation on planning CT of relevant organs at

    Effects of apigenin on gastric cancer cells

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    The H&TRC authors gratefully acknowledge the FCT/MCTES national support through the UIDB/05608/2020 and UIDP/05608/2020. This work was part of the IPL/2021/GATumor_ESTeSL project.Gastric Cancer (GC) is one of the most prevalent cancers worldwide. As the currently available therapeutic options are invasive, new and more benign options are being explored. One of which is Apigenin (Api), a natural flavonoid found in fruits and vegetables, such as celery, parsley, garlic, bell pepper, and chamomile tea. Api has known anti-inflammatory, -oxidant, and -proliferative properties in several diseases, and its potential as an anticancer compound has been explored. Here we systematize the available data regarding the effects of Api on GC cells, in terms of cell proliferation, apoptosis, Helicobacter pylori (H. pylori) infection, and molecular targets. From the literature, it is possible to conclude that Api inhibits cell growth in a dose- and time-dependent manner, which is accompanied by the reduction of clone formation and induction of apoptosis. This occurs through the Akt/Bad/Bcl2/Bax axis that activates the mitochondrial pathway of apoptosis, resulting in the restriction of cell proliferation. Additionally, it seems that the anti-proliferative potential of Api on GC cells is particularly relevant in a more aggressive GC phenotype but can also affect normal gastric cells. This indicates that this flavonoid must be used in low-to-moderate doses to avoid side effects induced by disturbance of the normal epithelium. In H. Pylori-infected cells, the literature demonstrates that Api reduces inflammation by diminishing the levels of H. pylori colonization, preventing NF-kB activation, and diminishing the production of reactive oxygen specimens (ROS). Accordingly, GC Api seems to regulate different hallmarks of cancer, such as cell proliferation, apoptosis, cell migration, inflammation, and oxidative stress, demonstrating its potential as an anti-GC

    Prevenção do COVID-19 nos websites institucionais: que papel desempenharam os cuidados de saúde primários?

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    Os Agrupamentos de Centros de Saúde (ACeS) têm como responsabilidade a prestação de cuidados de saúde primários, a nível nacional. No ato da sua criação, em 2008, ficou expresso que para cumprir a sua missão, desenvolvem, entre outras medidas, iniciativas de promoção da saúde e de prevenção da doença (Decreto-Lei n.º 28/2008). O objetivo principal deste estudo foi identificar, na perspetiva dos utentes, se os websites institucionais dos ACeS apresentaram conteúdos relacionados com a infeção por Sars-CoV-2 e a sua prevenção. Os resultados obtidos indicam que os recursos online utilizados pelos ACeS apresentam várias falhas que precisam de ser colmatadas, tais como a atualização dos conteúdos. Entendemos, assim, em linha com estudos anteriores (Garcia & Eiró-Gomes, 2020), que a comunicação desenvolvida pelos ACeS, em Portugal, está longe de uma perspetiva estratégica, que possa contribuir para uma redução dos comportamentos de risco relacionados com a pandemia de covid-19.N/

    Exploring the cancer patients' experiences during external radiotherapy: a systematic review and thematic synthesis of qualitative and quantitative evidence

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    Purpose: To investigate the subjective experience of adult cancer patients undergoing external radiotherapy and provide evidence for better practices in radiotherapy services. Methods: A systematic review was performed according to the PRISMA Statement Guidelines. Qualitative and mixed studies were identified through five electronic databases (CINAHL, PsychINFO, MEDLINE, Scopus, and Web of Science), between March and April 2020, using defined criteria. Methodological quality assessment was conducted, and the data integrated into a thematic synthesis. Results: Of the 886 studies identified, 13 met our inclusion criteria. Patients' experiences were described into four main themes: (1) Time, (2) Physical Environment, (3) Treatment Concerns, and (4) Radiotherapy Team. Time refers to waiting time and treatment time; Physical Environment states temperature in the treatment room and equipment; Treatment Concerns included side effects, daily activities, positioning and immobilization and treatment preparation (e.g., bladder filling); radiotherapy team comprised patients support; response to patients needs and recognized team. The generating analytical phase of thematic analysis allowed us to recognize that the effectiveness of the radiotherapy team operates as a facilitator of the patients' experience. In contrast, time in the waiting room, the treatment preparation when is required, and the positioning and immobilization, specifically for the neck and head patients, act as barriers. Conclusion: Four distinct themes were identified to be positively and negatively associated with patients' experience during external radiotherapy. The evidence provides valuable recommendations to improved radiotherapy services organization, as well as to the delivery of more patient-centered care adjusted to the concerns and needs of

    Topical review: studies on management of myopia progression from 2019 to 2021

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    Myopia is a common eye condition that increases the risk of sight-threatening complications. Each additional diopter increases the chance of complications. The purpose of this review is to make an overview of myopia control treatment options for children with myopia progression. In this non-systematic review, we searched PubMed and Cochrane databases for English-language studies published from 2019 through September 2021. Emphasis was given to a selection of randomized controlled trials. Nineteen randomized controlled trials and two retrospective studies were included. Topical atropine and orthokeratology remain the most used treatments, while lenses with novel designs are emerging treatments. Overall myopia progression in the treatment groups for low-dose atropine and orthokeratology were lower than in the control groups and their efficacy was reported in several randomized controlled trials and confirmed by various systematic reviews and meta-analysis. The findings of myopia progression and axial elongation for the MiSight, defocus incorporated multiple segments spectacle lens, highly aspherical lenslets and diffusion optics technology spectacle lens was comparable. Public health interventions to optimize environmental influences may also be important strategies to control myopia. The optimal choice of management of myopia depends on treatment availability, acceptability to the child and parents, and specific patient features such as age, baseline myopia, and lifestyle. Eye care providers need to understand the advantages and disadvantages of each therapy to best counsel parents of children with

    Drug resistance and epigenetic modulatory potential of epigallocatechin-3-gallate against Staphylococcus aureus

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    Project “Resistance modulation and epigenetic divergence in resistant phenotypic profiles of Staphylococcus aureus” (IPL/2020/ EpiResistanceSA _ESTeSL).FCT_UIDB/05608/2020. FCT_UIDP/05608/2020.Antimicrobial resistance of human pathogens, such as methicillin-resistant Staphylococcus aureus, is described by the World Health Organization as a health global challenge and efforts must be made for the discovery of new effective and safe compounds. This work aims to evaluate epigallocatechin-3-gallate (EGCG) epigenetic and modulatory drug potential against S. aureus in vitro and in vivo. S. aureus strains were isolated from the commensal flora of healthy volunteers. Antibiotic susceptibility and synergistic assay were assessed through disk diffusion accordingly to EUCAST guidelines with and without co-exposure to EGCG at final concentrations of 250 µg/ml, 100 µg/ml, 50 µg/ml, and 25 µg/ml. Transcriptional expression of orfx, spdC, and WalKR was performed through qRT-PCR. A 90-day interventional study was performed with daily consumption of 225 mg of EGCG. Obtained data revealed a high prevalence of S. aureus colonization in healthcare workers and clearly demonstrated the antimicrobial and synergistic potential of EGCG as well as divergent resistant phenotypes associated with altered transcriptional expression of epigenetic and drug response modulators genes. Here, we demonstrate the potential of EGCG for antimicrobial treatment and/or therapeutic adjuvant against antibiotic-resistant microorganisms and report divergent patterns of epigenetic modulators expression associated with phenotypic resistance

    Influence of indoor air quality on sleep quality of university students in Lisbon

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    Project HypnosAir (PTDC/CTA-AMB/3263/2021)Project E2Sleep 2 (IPL/2019/E2SLEEP/ESTeSL).Sleep is a crucial aspect of human daily life since it allows us to recover from physical and psychological fatigue and its lack can bring several consequences to human health. People spend around one-third of their life sleeping but, despite that, their exposure to pollutants during sleep is often neglected. Specifically, students typically change their habits after entering university, due to the freedom that they are allowed at this stage of their lives. These habits often include their sleep patterns, which not only affects their health but their academic performance as well. This study aimed to assess the indoor air quality (IAQ) that university students are exposed to in their sleeping environment and how it affects their sleep quality. Firstly, an online survey, based on standardized questionnaires, was conducted on a sample of 1040 individuals to characterize sleep habits and, ultimately, to provide an overview of the sleep quality of the Portuguese population. Students were one of the population groups that showed worse results: only 31% had good sleep quality and only 62% showed good sleep health. Afterward, a study to assess sleep quality (by actigraphy and standardized questionnaires) and IAQ (by a monitoring unit based on low-cost sensors) during the sleeping period of two consecutive nights of 13 students in Lisbon university dorms was conducted. Mean levels of CO2 and VOCs above the established legislation were found during sleep, indicating that ventilation conditions were not sufficient to keep an acceptable IAQ. The temperature was also out of the acceptable comfort range during 44% of the sleeping time. The perceived sleep quality of students was found to be negatively associated with the number of awakenings and the mean levels of carbon dioxide and relative humidity during the sleeping period. These results confirm previous findings where some IAQ parameters may influence the sleep quality of the individuals, highlighting the importance to focus on the IAQ of sleeping environments as a strategy to improve the sleep quality of

    Systematic review with network meta-analysis on the treatments for latent tuberculosis infection in children and adolescents

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    Background: We aimed to synthesize the evidence on the efficacy and safety of different treatment regimens for latent tuberculosis infection (LTBI) in children and adolescents. Methods: A systematic review with network meta-analysis was performed (CRD142933). Searches were conducted in Pubmed and Scopus (Nov-2021). Randomized controlled trials comparing treatments for LTBI (patients up to 15 years), and reporting data on the incidence of the disease, death, or adverse events were included. Networks using the Bayesian framework were built for each outcome of interest. Results were reported as odds ratio (OR) with 95% credibility intervals (CrI). Rank probabilities were calculated via the surface under the cumulative ranking analysis (SUCRA) (Addis-v.1.16.8). GRADE approach was used to rate evidence's certainty. Results: Seven trials (n = 8696 patients) were included. Placebo was significantly associated with a higher incidence of tuberculosis compared to all active therapies. Combinations of isoniazid (15–25 mg/kg/week) plus rifapentine (300–900 mg/week), followed by isoniazid plus rifampicin (10 mg/kg/day) were ranked as best approaches with lower probabilities of disease incidence (10% and 19.5%, respectively in SUCRA) and death (20%). Higher doses of isoniazid monotherapy were significantly associated with more deaths (OR 18.28, 95% ICr [1.02, 48.60] of 4–6 mg/kg/day vs. 10 mg/kg/3x per week). Conclusions: Combined therapies of isoniazid plus rifapentine or rifampicin for short-term periods should be used as the first-line approach for treating LTBI in children and adolescents. The use of long-term isoniazid as monotherapy and at higher doses should be avoided for this

    OAGB bowel function in patients with up to 5 years follow-up: updated outcomes

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    Objective: One-anastomosis gastric bypass (OAGB) is considered an effective technique in weight reduction and remission of comorbidities. However, in common with many bariatric and metabolic/bariatric procedures, gastrointestinal side effects are frequently reported, but clinical experience varies. The objective of this study was to analyze the bowel function of patients who undergo OAGB looking at 5-year postoperative outcomes. Method: This study is cross-sectional, descriptive, and analytical, developed with individuals undergoing OAGB (n = 208) in the period between 2015 and 2020. The time periods evaluated were 1 to 6 months (T1), 6 to 12 months (T2), and 1 to 5 years (T3). Data analysis was performed using SPSS v.28.0, considering a significance level p ≤ 0.05. Results: 114 participants (54.8%), 79.8% women, mean age 47.0 ± 12.6 years, and BMI 40.1 ± 5.6 kg/m2, 51.9% dyslipidemia, 43.6% arterial hypertension, and 19.1% diabetes mellitus. The T1 group had more severe symptoms/nausea than the T2 group. The T2 group had a significantly lower defecation frequency than the T1 and T3 groups. As for the occurrence of diarrhea, associations were not found in the considered groups. The T3 group had a greater severity of constipation associated with greater difficulty in consuming red meat, white meat, rice, vegetables, and salads. Conclusions: Gastrointestinal symptoms are prevalent in the first postoperative months. However, diarrhea was not common. The patient selection policy and surgical technique were decisive in this result. Constipation was prevalent in patients between 1 and 5 postoperative years. It was also prevalent in those who had food intolerance, which from a nutritional point of view is an adverse factor for optimal bowel


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