ESS - FAR - Artigos
Permanent URI for this collection
Browse
Recent Submissions
- Medication review improves pain management and quality of life in chronic pain: a pilot randomized controlled studyPublication . Duarte, Nuno; Martins, João Paulo; García-Domingo, Mónica; A. García-Pedraza, Jose; Santos, Marlene; Santos, Marlene; Oliveira Martins, João Paulo; Duarte, NunoChronic pain is a complex condition that benefits from a multidisciplinary approach. This pilot parallel-group single-blinded randomized controlled study evaluated the feasibility, acceptability and adherence by patients and physicians of pharmacist-led medication review on chronic pain patients. Trends in pain intensity, quality of life and patient satisfaction were examined. Twenty adults were recruited from two primary care units in Porto, Portugal, and randomly assigned to either the medication review (MR) group, (n=10) using the Dader method, or the usual care (UC) group, (n=10) and given general advice, for 16-weeks. Pain intensity decreased by 2.07 (MR group) and increased by 0.52 (UC group), yielding an adjusted mean difference of 2.77 (95% CI, -4.93 to -0.62; p=0.008). Pain relief was reported by 62.5% in the MR group versus 37.5% in UC (p=0.357). The MR group showed significant improvement in physical functioning (p=0.019) and higher treatment satisfaction (p=0.029). The acceptance rate of MR interventions was 71%, which resolved 63% of negative medication outcomes. Acceptability was high (>90% of planned interviews). Conducting pharmacist led MR for chronic pain management in primary care is feasible and well accepted by patients and physicians. Observed trends toward improved pain and QoL warrant confirmation in a larger trial. This pilot trial was registered in clinicaltrials.gov (NCT06997861).
- Exploring methodologies from Isolation to excystation for Giardia lamblia: A systematic reviewPublication . Sequeira, Susie; Sousa, Mariana; Cruz, Agostinho; Cruz, AgostinhoGiardia lamblia is a flagellated protozoan and the etiological agent of giardiasis, a leading cause of epidemic and sporadic diarrhoea globally. The clinical and public health relevance of giardiasis underscores the need for robust methodologies to investigate and manage this pathogen. This study reviews the main methodologies described in the literature for studying the life cycle of G. lamblia, focusing on isolation, purification, axenization, excystation, and encystation. A systematic literature review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2020) statement. Searches were performed in MEDLINE, ScienceDirect, and Web of Science Core Collection databases. A total of 43 studies were included, revealing 58 methods for isolation and purification, 7 for excystation, 2 for axenization, and 5 for encystation. Isolation and purification methods exhibited significant variability, often involving two phases: an initial separation (e.g., filtration and centrifugation) followed by purification using a density gradient for faecal samples or immunomagnetic separation for water samples. Method effectiveness differed depending on the sample source and type, limiting comparability across studies. In contrast, methods used for other life cycle stages were more consistent. These findings underscore the need for standardised methodologies to enhance the reproducibility and reliability of research outcomes in this field.
- Identification of barriers that can influence older adults in community pharmacies: A systematic reviewPublication . Pedro, Rita; Mateos-Campos, Ramona; Cruz, Agostinho; Cruz, AgostinhoThis systematic review examines the barriers that may influence the proper care and counseling for people who are 65 years or older, in community pharmacies. Also, we attempt to identify potential strategies to mitigate these barriers. The research question addressed is “What kind of barriers influence older people in community pharmacies?”. Five electronic databases were used: Medline from Pubmed, Core collection of Web of Science, Science direct, Cumulative Index to Nursing and Allied Health Literature (CINAHL) through EBSCO and RCAAP (Repositório Científico de Acesso Aberto de Portugal). This systematic review followed the PRISMA guidelines. The protocol was prospectively published in PROSPERO (International Prospective Register of Systematic Review) having the following identification number: ID CRD42024516422. The original articles about individuals over 65 years of age and about barriers to counseling in community pharmacies were included. The Critical Appraisal tool made by Joanna Briggs Institute was chosen. From a total of 919 articles identified, 9 were included in this systematic review. The identified barriers were categorized into four typologies: centered on the pharmacy profession, centered on older adults, centered on the pharmacy layout and infrastructure, and centered on society. Other than this, some facilitators were identified during the research and were also categorized into the same four typologies. The classification of the identified barriers and facilitators has significant importance as it provides essential insights for responsible bodies of community pharmacies. Comprehending these barriers and facilitators is crucial to transforming community pharmacies into a more accessible and supportive environment for older patients.
- Exploring alternative potentialities of portuguese and spanish craft beers: antioxidant and photoprotective activitiesPublication . Pereira, Maria João; Santos, Diana; Cruz, Agostinho; Jesus, Ângelo; Martins, João P.; Moreira, Fernando; Santos, Marlene; Pinho, Cláudia; Oliveira, Ana Isabel; Cruz, Agostinho; Santos, Diana; Pereira, Maria João; Pinho, CláudiaCraft beer has gained popularity due to its unique sensory characteristics and complex matrix with nutritional and potential health benefits. Studies linking beer consumption to skin conditions are limited, however, the high content of bioactive compounds is related to biological activities such as antibacterial, anti-inflammatory, anti-oxidative, and anti-carcinogenic. This study aims to evaluate the antioxidant, photoprotective and metabolic activity in human keratinocytes (HaCaT). Eighteen craft and four industrial beers were analyzed after dealcoholizing, degassing and freeze-drying. Total phenolic content (TPC) and antioxidant activity were determined. The most promising craft beer was studied for its photoprotective and metabolic activity. An India Pale Ale beer (ALM-IPA) presented the second best TPC (8.96 ± 0.64 mg of GAE/g) and promising antioxidant activity by ABTS (IC50 = 55.21 ± 4.68 µg/mL), H2O2 (IC50 = 23.54 ± 1.53 µg/mL) and FRAP (53.74 ± 1.27 µmol TE/g) assays. Regarding photoprotective activity, a solar photoprotection factor of 48.85 ± 0.39 was obtained. ALM-IPA showed no cytotoxicity up to a concentration of 250 µg/mL after 24 and 48 h of incubation. The potential benefits of beer extracts on skin can be seen, but further studies are essential to corroborate the findings and guarantee the safety of the extracts.
- Knowledge of vulvovaginal candidiasis characteristics, signs, symptoms, and appropriate treatment among portuguese pharmacy professionalsPublication . Oliveira, Tiago; Jesus, Ângelo; Martins, João P.; Correia, Patrícia; Moreira, Fernando; Moreira, Fernando; Oliveira Martins, João Paulo; Correia, Patrícia Carla dos Santos CorreiaVulvovaginal candidiasis (VVC) is a common cause of vaginitis. Over-the-counter drugs are usually dispensed by pharmacy professionals to treat this condition without prior medical consultation. This study aimed at assessing the knowledge of Portuguese pharmacy professionals regarding VVC. An online questionnaire including questions about the symptoms and treatment of VVC was distributed between March and April of 2024. A total of 376 professionals participated in this study. There was a significantly lower proportion of men (p = 0.007) and pharmacy technicians (p = 0.005) who correctly identified the main causative agent of VVC when compared to women and pharmacists. Only 30% of women correctly identified the number of VVC episodes in the same year they classified as complicated, but this was significantly higher (p = 0.038) than the proportion of men who identified complicated VVC (20%). Topical clotrimazole preparations were the more frequently identified medicines for the treatment of uncomplicated VVC, and fluconazole-containing medicines were the preferred choice for the treatment of complicated VVC. This study highlights the need to improve education and training for pharmacy professionals. By addressing these knowledge gaps, pharmacists and pharmacy technicians can provide more accurate and effective advice to patients.
- Safeguarding patients, relatives, and nurses: A screening approach for detecting 5-FU residues on elastomeric infusion pumps using HPLC-DADPublication . Cardoso, Andreia; Jesus, Ângelo; Barreiros, Luísa; Carvalho, Daniel; Sá, Maria dos Anjos; Carvalho, Susana; Correia, Patrícia; Moreira, Fernando; Moreira, Fernando; Correia, Patrícia Carla dos Santos ; Barreiros, Luisa; Jesus, ÂngeloThe leakage of 5-fluorouracil (5-FU) from elastomeric infusion pumps used in cancer therapy poses a potential risk of unintentional exposure to multiple individuals, including patients’ relatives and healthcare professionals, and may also compromise the accurate administration of 5-FU dosages to patients. This study aimed to develop, validate, and apply an analytical method to detect and quantify 5-FU residues on the external surfaces of infusion pumps. A high-performance liquid chromatography with diode-array detection (HPLC-DAD) method was optimized for the quantification of 5-FU contamination across different components of the infusion pump, including the hard casing, infusion tubing, and catheter connection port. A mobile phase containing 5% acetic acid was used to obtain more efficient separation of 5-FU and the detection was performed at 260 nm. The method was evaluated for linearity, sensitivity, precision, accuracy, selectivity, robustness, and stability. The method demonstrated linearity within the range of 0.150 to 3.000 µg/cm2, with limits of detection and quantification of 0.05 µg/cm2 and 0.14 µg/cm2, respectively. Relative standard deviations ranged from 1.8% to 12.7%, and accuracy exceeded 85%. In real sample analysis, detectable residues were found around the catheter connection port. This screening-oriented method addresses an existing gap, as previous contamination reports were based solely on self-reported user observations. The detection of 5-FU residues highlights the critical need for safe handling practices and the consistent use of personal protective equipment (PPE) to protect healthcare workers, especially nursing staff involved in the removal of the infusion pumps, after treatment.
- Factors influencing the prescription of first-line treatment for type 2 diabetes mellitus: a systematic reviewPublication . Moreira, Helena Silva; Moreira, Fernando; Jesus, Ângelo; Soares, Matilde Monteiro; Santos, Paulo; Moreira, FernandoUnderstanding prescribing patterns for type 2 diabetes mellitus, a complex condition affecting over 10% of the global adult population, can optimise prescribing practices, guide policymakers in promoting evidence-based medicine, and help tailor first-line treatments to individual characteristics or specific subgroups, improving patient outcomes. This study aimed to identify factors influencing the prescription and non-prescription of metformin, the recommended first-line therapy in Western guidelines, and to evaluate whether these prescribing patterns align with evidence-based recommendations. It also explores factors associated with initial combination therapy, a more recent and controversial approach compared to stepwise therapy. We conducted a systematic search in PubMed, Scopus, and Web of Science on 25 August 2023, without language or time restrictions, to identify observational analytical studies assessing factors associated with the initiation of metformin or combination therapy in adults with type 2 diabetes mellitus who were naïve to antidiabetic medications. Studies involving pregnant or breastfeeding women were excluded. A narrative synthesis was conducted. Study quality was assessed using the Joanna Briggs Institute critical appraisal checklists (PROSPERO registration number CRD42023438313). Thirty studies were included, evaluating 105 variables, most of which (62%) were assessed in one study. The 25 variables using combination therapy as the outcome were mostly (72%) evaluated also in one study. Initial metformin prescription was strongly and positively associated with younger age, lower glycated haemoglobin levels, higher body mass index, and absence of renal impairment. Initial combination therapy was associated with higher HbA1c levels and a lower burden of comorbidities. Findings also highlighted a discrepancy between clinical practice and evidence-based recommendations. However, concerns were raised regarding both the internal and external validity of the included studies. Our systematic review, which offers insights into real-world clinical practices, indicated that there is a misalignment between clinical practices and evidence-based recommendations, supporting the need for interventions in this field.
- Altered NRF2 signalling in systemic redox imbalance: Insights from non-communicable diseasesPublication . Santos, Marlene; Morgenstern, Christina; Santos, MarleneThe balanced activity of the cytoprotective transcription factor NRF2 is central for maintaining redox, metabolic-energetics, and proteome homeostasis, as well as for regulating inflammatory responses, among other functions. Activated NRF2 regulates the expression of hundreds of genes containing antioxidant response elements (AREs) or electrophile response elements (EpRE) in their regulatory regions, often promoting cytoprotection under stress conditions and contributing to defence against various pathologies and non-communicable diseases (NCDs). The products of increased NRF2 activity, detected systemically, may originate from either the white blood cells, the cells of the vasculature or tissue-derived products that could be secreted into biological fluids. Therefore, assessing basal and inducible NRF2 activity in blood or other biofluids is crucial for inferring NRF2 responses in local and often inaccessible tissues. In previous work, we identified a panel of six biomarkers - Glutamate-cysteine ligase catalytic subunit (GCLC), Glutamate-cysteine ligase modifier subunit (GCLM), Haem oxygenase 1 (HMOX1), NAD(P)H quinone dehydrogenase 1 (NQO1), Sulfiredoxin 1 (SRXN1), and Thioredoxin reductase 1 (TXNRD1) - as indicators of NRF2 activity. In the current study, we assess their utility in a clinical setting to measure NRF2 activation in a disease context. Here we discuss findings on how NRF2 activity in accessible human samples can reveal its involvement in various NCDs and its connection to clinical aspects such as diagnosis, disease progression and response to therapy.
- A preliminary assessment of a stool-based microRNA profile for early colorectal cancer screeningPublication . Santos, Daniela A. R.; Eiras, Mariana; Gonzalez-Santos, Miguel; Santos, Marlene; Pereira, Carina; Santos, Lúcio Lara; Dinis-Ribeiro, Mário; Lima, Luís; Santos, MarleneColorectal cancer screening methods are well established worldwide as a fundamental pilar in CRC management, namely through non-invasive faecal occult blood testing. However, the limited sensitivity of faecal occult blood test for detecting precancerous lesions highlights the need to search for alternative tools, such as microRNAs (miRs). The main aim of this study was to identify stoolbased miR profiles for early colorectal cancer detection. A panel with miR-21-5p, miR-199a-5p, and age showed a moderate performance for colorectal cancer detection (sensitivity: 88%). Additionally, miR-451a, miR-21-5p, miR-199a-5p, age, and gender showed high performance for discriminating high-grade dysplasia lesions (sensitivity: 91%). Moreover, when we obtained a positive result in either panel, we achieved a sensitivity of 96% for high-grade dysplasia lesions identification. Finally, when a negative result was obtained in these panels after a positive faecal occult blood test result, we accurately identified individuals without lesions. These findings demonstrate the potential of miR panels as non-invasive biomarkers for colorectal cancer and high-grade dysplasia lesions detection and could constitute a secondary screening method following a positive faecal occult blood test.
- Immunogenicity as a predictor of Influenza vaccine efficacy: A systematic reviewPublication . Martins, André Miguel; Juan, Luis Félix Valero; Santos, Marlene; Martins, João Paulo; Santos, Marlene; Oliveira Martins, João PauloInfluenza represents a significant burden on global public health, and vaccination is the most effective strategy to reduce it. The large investment in vaccination programs and the need for adjustments in vaccine serotypes are important reasons for evaluating the influenza vaccine’s efficacy every year. Establishing a relationship between immunogenicity data and efficacy is also crucial for predicting the efficacy of a vaccine during its development. Antibody response measurement is one of the most common methods for evaluating immunogenicity, particularly in vaccines and biologics. The aim of this systematic review was to define a model that relates the immunogenicity of a given vaccine to its efficacy, based on hemagglutination inhibition titer levels. To achieve this goal, information was gathered from articles linking immunogenicity with the efficacy of the influenza vaccine in the Medline and Scopus databases. Different mathematical models were developed and applied to assess the relationship between HAI titers and the effectiveness of the flu vaccine. This analysis was conducted for the various existing vaccines, for the different influenza virus strains, and for their efficacy in paediatric populations. The r2 obtained ranged from 0.2579 to 0.966, which points to the importance of this immunological factor in the efficacy of the influenza vaccine. Conclusions: The efficacy values for titer level 40 confirm the validity of the data provided by Hobson.