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- A scoping review of person-centred care strategies used in diagnostic Nuclear MedicinePublication . Champendal, M.; Grima, K. Borg; Costa, Pedro; Andersson, C.; Baun, C.; Gorga, R.G.; Murphy, S.; Kedves, A.; Santos, A.; Geao, A.Person-centred care (PCC) emphasises the need for the health care professional to prioritise individual patient needs, thereby fostering a collaborative and emphatic environment that empowers patients to actively participate in their own care. This article will explore the purpose of PCC in Nuclear Medicine (NM), while discussing strategies that may be used to implement PCC during diagnostic NM examinations performed on adult patients. The scoping review was conducted in accordance with the Joanna Briggs Institute methodology. The search was performed on PubMed, Embase and Cinhal in June 2023 and included studies in English, Spanish, Portuguese and Italian. The research equation combined keywords and Medical Subject Heading terms (MeSH) related to person-centred care (PCC), for all types of nuclear medicine diagnostic examinations performed. Three independent review authors screened all abstracts and titles, and all eligible full-text publications were included in this scoping review. Fifty-three articles, published between 1993 and 2022, met the inclusion criteria for this scoping review. Seven articles were published in 2015 while 56.6 % of all included studies were performed in Europe. Most studies (n = 39/53) focused on the patients only, with the identified patient benefits being: improve patient experience (67.9 %), increase patient comfort (13.2 %), increase patient knowledge (5.7 %), reduction of patient anxiety (9.4 %) and reduction of waiting/scan time (3.8 %). The scoping review identified a lack of research investigating the use of person-centred care strategies in NM. Future research will focus on using an international survey to explore this topic in nuclear medicine departments overseas.
- Computacional pathology: What’s newPublication . Coelho, Daniel; Assunção, Teresa; Borrecho, Gonçalo; Geraldes, Mariana; Vinagre, Tiago; Ferreira, Inês; Ferreira, Ana; Fernandes, Ana Isabel; França, Amélia; Vale, João; Curado, Mónica; Mendes, Fernando; Martins, DianaThe term computacional pathology (CPath) has become a buzz-word among the digital pathology community. Adances in scanning systems, imaging technologies and storage devices are generating an ever-increasing volume of whole-slide images (WSI) acquired in clinical settings, which can be computacionally analyzed using artificial intelligence (AI), such as deep learning technologies, in a new área of development called CPath. The purpose of the review is to disseminate the latest news and futures perspectives by CPath. Deep learning in the context of CPath has methodological contributions that can be distinguished into approaches based on the final purpose of the analysis: predicting clinical endpoints such as cancer subtype, patient survival or genetic mutations from WSI and AI-based assistive tools, such as segmentation methods for WSI or virtual staining. The emergence of multipex imaging, spatially resolver genomic assays and 3D pathology, among other methodologies, will accelerate this trend, providing new opportunities for multimodal integration and discovering new biomarkers. Additionally, these developments will help automating labor-intensive manual work and reducing inter-observer variability diagnosis between pathologists, contributing to a better patient care. CPath will underpin the development of the next generation of cancer therapies and diagnostics, changing the clinical research and ultimately leading towards new cures or improved patient outcomes.
- Biomarkers in whole slide images stained by: Hemtoxylin-Eosin: A groundbreaking application using artificial intelligencePublication . Borrecho, Gonçalo; Curado, Mónica; Vale, João; Vinagre, Tiago; Geraldes, Mariana; Assunção, Teresa; Coelho, Daniel; Ferreira, Inês; Ferreira, Ana; Fernandes, Ana Isabel; França, Amélia; Mendes, Fernando; Martins, DianaBiomarkers play a fundamental role in the diagnosis, prognosis and prediction of diseases. The study of biomarkers requires the performance of complementary diagnostic tests, which entails high costs and inevitably leads to an increase in response time, which could have a severe impact on the patient’s outcome. The digital transformation in Pathology Laboratories, accompanied by the wide implementation of slide digitalization, has been decisive for the development and application of digital intelligence algorithms in a diagnostic context. The aim of this review is to assess artificial intelligence algorithms for evaluating biomarkers that can be applied to whole slide images stained by hemtoxylin-eosin (WSI-HE) and to understand their advantages and limitations. There are several types of algorithms, some established on the identification and quantification of morphological biomarkers, such as nuclear density, celular heterogeneity, the presence of certain cellular structures, tissue organization and other features. The usage of WSI-HE is enormously promising, as it reveals additional information that is not visually observable but can help or even expand to pathologists capabilities. The identification and validation of morphological biomarkers in WSI-HE still presents challenges, such as the need for large data sets annotated using multimodal data (information from diferente sources, such as histopathological images, clinical data, radiologial information, genomic data, among others), the interpretability of deep learning models, the integration of these biomarkers into clinical practice, among others. The application of algorithms in WSI-HE could represente na importante change in patient management, contributing to timely precision medicine.
- Síndrome de VEXAS: Rastreio e determinação de Mosaicismos no gene Uba1 por Pcr DigitalPublication . Novais, Gonçalo; Gonçalves, Ana; Mota, Sandra Marlene; Amorim, Maria Manuela; Mota, SandraA síndrome de VEXAS (Vacuoles, E1, X-linked; autoinflammatory, somatic) é uma doença autoinflamatória com maior incidência a partir de 4ª década de vida, causada por variantes somáticas no gene UBAI1 (cromossoma X), que codifica a enzima E1 responsável pela ativação da ubiquitina na via metabólica ubiquitina proteossoma. Esta patologia apresenta um quadro clínico muito variável, associado a sintomas reumatológicos e hematológicos, tendo como principal achado a presença de vacúolos nas células precursoras das linhas eritróides e mielóides. Das 10 variantes patogénicas e provavelmente patogénicas atualmente descritas no gene UBAI1, três (p.Met41Leu; p.Met41Val; p.Met41Thr) têm elevada incidência na população mundial. Uma das metodologias mais utilizadas para o diagnóstico desta patologia é a sequenciação de Sanger que, no entanto, tem capacidade limitada para deteção e mosaicimos de frequência reduzida. O PCR digital (dPCR), devido à sua elevada sensibilidade e capacidade de quantificar de forma absoluta as sequências de interesse, revela-se uma alternativa capaz de colmatar estas dificuldades. Este trabalho teve como objetivo avaliar a capacidade de diagnóstico do dPCR na síndrome de VEXAS. Após desenho e otimização, foi efetuado o rastreio das três variantes patogénicas mais frequentes em 51 amostras de doentes com suspeita de VEXAS. Foram utilizadas como controlos positivos sete amostras com diagnóstico prévio para as três variantes. Resultados preliminares deste trabalho não revelaram a presença de mosaicismos de baixa frequência para as variantes estudadas. O estudo das amostras positivas permitiu confirmar a especificidade das sondas na deteção das três variantes e ainda determinar com maior exatidão a sua percentagem de mosaicismos. O dPCR demonstrou ser uma ferramenta viável e útil como primeira abordagem no diagnóstico da síndrome de VEXAS devido à sua sensibilidade e rapidez, e com potencial de monitorização da eficácia terapêutica.
- Uso de filtros no processamento de Citologia de base líquida: Importante discriminar?Publication . Monteiro, Tiago; Fernandes, Sílvia; Silva, Regina; Silva, ReginaRegularmente em todo o mundo, sendo a filtração com recurso a filtros descartáveis a metodologia mais utilizada. Apesar de existirem filtros específicos para diversos tipos de processamento, pouco se sabe acerca das suas características, da forma como são empregues e do impacto da sua utilização no processamento de citologia de base líquida e consequente diagnóstico citológico. O estudo teve como principal objetivo avaliar e registar as características dos filtros usados em citologia de base líquida, e avaliar o impacto do seu uso indiscriminado, em Portugal. Para tal, estudou-se microscopicamente os poros de uma área de 7500µm2 de membrana de policarbonato de filtros de citologia de base líquida, indicados para processamento de amostras ginecológicas (Gyn) e não ginecológicas (Não Gyn), de três marcas diferentes. Procedeu-se à sua caracterização quanto ao número, diâmetro e distribuição dos poros. Foi ainda administrado um questionário a laboratórios de citologia em Portugal, e os dados recolhidos foram analisados com o intuito de caracterizar o uso das metodologias, os resultados obtidos permitem concluir que existem diferenças entre os filtros destinados aos vários tipos de processamento e entre filtros de diferentes marcas. Os filtros destinados ao processamento de amostras Gyn, para além de poros de maiores dimensões (7.2-7.5 µm), apresentam um menor número de poros (92-98) e respetiva sobreposição em 55 a 58% da área em análise. Por sua vez, os filtros recomendados para amostras Não Gyn apresentam menor diâmetro (5.7-6.1 µm), maior número de poros (107-122) e respetiva sobreposição numa maior área (60 a 83%).Considerados globalmente, os resultados revelam que as diferenças verificadas entre os filtros podem resultar na alteração ao nível da representação de estruturas celulares e de microrganismos, e o seu uso indiscriminado a nível laboratorial pode comprometer a avaliação citopatológica.
- The cardiometabolic impact of rebaudioside a exposure during the reproductive stagePublication . Bracchi, Isabella; Morais, Juliana; Coelho, João Almeida; Ferreira, Ana Filipa; Alves, Inês; Mendes, Cláudia; Correia, Beatriz; Gonçalves, Alexandre; Guimarães, João Tiago; Falcão-Pires, Inês; Keating, Elisa; Negrão, RitaSince foods rich in refined sugars promote obesity, the use of non-caloric sweeteners has gained popularity, and their consumption by pregnant women has increased. Stevia (a non-caloric sweetener) consumption was considered safe for humans by the European Food Safety Authority in a dose of up to 4 mg/kg body weight/day. However, the World Health Organization recommended in 2023 the restraint of these sweeteners at any life stage, highlighting the need for research on pregnant women and early stages of development. So, we aimed to study the effects of chronic consumption of the main sweetener compound of stevia (Rebaudioside A) during the reproductive stage. Female rats were treated with Rebaudioside A (4 mg steviol equivalents/kg body weight/day) in the drinking water from 4 weeks before mating until weaning. Food and water consumption, blood glucose and lipids, as well as heart structure, function and mitochondrial function, were assessed. Rebaudioside A decreased heart size, cardiomyocyte area and fibrosis without repercussions on cardiac or mitochondrial function. Both fasting blood glucose and cholesterol decreased. This work suggests that stevia consumption at this dose may be safe for females during the reproductive stage. However, more studies are mandatory to explore the effects of stevia consumption on offspring’s health.
- Worker's exposure to radiation in fluoroscopy, assessing and instruments: A systematic literature reviewPublication . Videira, Sara; Rodrigues, Matilde; Silva, Manuela Vieira daThis review aims to identify and analyze the instruments employed for assessing the overall performance of workers exposed to fluoroscopy during surgical procedures and/or interventional procedures, using the PRISMA methodology. The studies were located through searches conducted on PubMed, Web of Science, Lilacs, ScienceDirect, B-ON, EBSCOhost, and EBSCO Discovery Service on March 27, 2023. Additional studies were identified using backward and forward citation techniques. The PEO strategic model was followed. The search spanned studies published between 2012 and 2022. The quality of the studies underwent assessment using the Joanna Briggs Institute checklist for analytical cross-sectional studies. Out of the 23 studies identified, encompassing 3604 individuals, 12 (52%) addressed the reliability and/or validity of the instruments, while 3 (13%) focused on the development and psychometric testing of the instruments. Only 5 instruments (23%), validated and reliable, exclusively evaluated occupational radiological protection. The predominant dimension covered was knowledge (82%, n = 19). The population was assessed in 18 studies, pre- and post-intervention in 2 studies, and 21 studies provided recommendations or tools for improvement. Individuals in the studies utilized passive dosimeters (ranging from 5% to 98%), thyroid shields (15% to 98%), and aprons or lead skirts/coats (28% to 99%). The evidence quality was moderate (6/8). This study underscores the imperative to enhance compliance with protective and monitoring equipment. Furthermore, additional information is warranted concerning the validity and reliability of the instruments used, as well as the development of instruments that are both valid and reliable.
- Glial-restricted precursors stimulate endogenous cytogenesis and effectively recover emotional deficits in a model of cytogenesis ablationPublication . Martins-Macedo, Joana; Araújo, Bruna; Anjo, Sandra I.; Silveira-Rosa, Tiago; Patrício, Patrícia; Alves, Nuno Dinis; Silva, Joana M.; Teixeira, Fábio G.; Manadas, Bruno; Rodrigues, Ana J.; Lepore, Angelo C.; Salgado, António J.; Gomes, Eduardo D.; Pinto, Luísa; Gomes, EduardoAdult cytogenesis, the continuous generation of newly-born neurons (neurogenesis) and glial cells (gliogenesis) throughout life, is highly impaired in several neuropsychiatric disorders, such as Major Depressive Disorder (MDD), impacting negatively on cognitive and emotional domains. Despite playing a critical role in brain homeostasis, the importance of gliogenesis has been overlooked, both in healthy and diseased states. To examine the role of newly formed glia, we transplanted Glial Restricted Precursors (GRPs) into the adult hippocampal dentate gyrus (DG), or injected their secreted factors (secretome), into a previously validated transgenic GFAP-tk rat line, in which cytogenesis is transiently compromised. We explored the long-term effects of both treatments on physiological and behavioral outcomes. Grafted GRPs reversed anxiety-like deficits and demonstrated an antidepressant-like effect, while the secretome promoted recovery of only anxiety-like behavior. Furthermore, GRPs elicited a recovery of neurogenic and gliogenic levels in the ventral DG, highlighting the unique involvement of these cells in the regulation of brain cytogenesis. Both GRPs and their secretome induced significant alterations in the DG proteome, directly influencing proteins and pathways related to cytogenesis, regulation of neural plasticity and neuronal development. With this work, we demonstrate a valuable and specific contribution of glial progenitors to normalizing gliogenic levels, rescuing neurogenesis and, importantly, promoting recovery of emotional deficits characteristic of disorders such as MDD.
- Ictal and interictal source connectivity during gelastic seizures in a focal cortical dysplasia of the cingulate gyrusPublication . Borges, Daniel Filipe; Dias, Daniela; Cordeiro, Helena; Leal, AlbertoGelastic seizures are rare manifestations of epilepsy often associated with hypothalamic hamartomas (HH). In the absence of HH, localization of the origin is more difficult and there are several less well-established possibilities. Non-invasive assessment is often complicated by the deep localization of the epileptogenic area and the complex dynamics of spike activity. Robust neurophysiologic methods and careful validation of intrinsically epileptogenic lesions detected by RM can improve the validity of scalp EEG analysis. To analyze the dynamics of epileptic activity in gelastic seizures associated with cortical dysplasia. A 26-year-old girl with daily refractory gelastic seizures since the age of 6 underwent a neurophysiological assessment with long-term EEG recordings (24h, 31 channels) and an MRI of the brain. She had previously been rejected in an epilepsy surgery program because no structural brain lesion had been found and the EEG information was not informative enough. A recent 3T MRI showed cortical dysplasia in the cingulate gyrus, which was highly suspicious as an epileptogenic focus. We analyzed the 31-channel EEG (ictal and interictal) using source and functional connectivity methods to obtain a solid computer model of the origin and dynamics of epileptic activity and correlate it with the anatomical information of the MRI. Source analysis of interictal activity revealed multiple sources that dominated at different time points, indicating considerable dynamics that prevented clear source identification. The ictal recordings demonstrated barely late rhythmic activity over the frontal areas, but no early focalization. Connectivity analysis, which revealed the flow of information between cortical sources, showed a consistent origin of epileptic activity in the vicinity of cortical dysplasia for both interictal and ictal activity. EEG connectivity analysis significantly improves the performance of non-invasive methods for determining intracranial dynamics of epileptic activity and correlation with structural lesions.
- Knowledge about type 2 diabetes: its impact for future managementPublication . Ferreira, Pedro L. ; Morais, Carminda ; Pimenta, Rui; Ribeiro, Inês ; Amorim, Isabel ; Alves, Sandra Maria; Santiago, LuizDiabetes can cause several long-term complications. Knowledge about this disease can play an important role in reducing diabetes-related complications. In addition, the lack of awareness leads to misconceptions, which joined with inadequate knowledge, are relevant barriers to proper diabetes management. In this study, we aimed to assess the diabetes knowledge of a type 2 diabetes (T2D) population and identify major knowledge gaps, in order to prevent complications and to increase quality of life. In a cross-sectional, observational study in a convenience sample, we identified individuals diagnosed with T2D attending ambulatory visits from five health settings, older than 18 years, with a time diagnosis of at least 1 year, and attending multidisciplinary visits for at least 3 months. To assess the knowledge of T2D individuals, we applied the Portuguese version of the Diabetes Knowledge Test. The sample included a total of 1,200 persons, of whom almost half were female. The age range of the participants varied from 24 to 94 years old, and the mean age was 65.6 ± 11.4 years. Most of the sample had a level of education under secondary and lived with someone. In our sample, 479 (39.9%) were insulin-treated. The percentage of correct answers was 51.8% for non-insulin vs. 58.7% for insulin treated (p < 0.05). There were three items with a percentage of correct answers lower than 15%; the item with the lower value of correct answers was the one related to the identification of signs of ketoacidosis with only 4.4% of correct answers, the errors presented a random pattern; the item related to the identification of which food should not be used to treat low blood glucose with 11.9%, where 56.9% of the sample’s participants considered that one cup of skim milk would be the correct answer (53.1% in non-insulin patients and 62.6% in insulin treated patients; p < 0.001). The item regarding the knowledge of free food presented a 13.3% of correct answers (10.8% non-insulin group vs. 17.1% insulin group; p < 0.01). Two of the three items with lower value of correct answers were related to glycemic control and health status monitoring, the other was related to diet and food.
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