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- A narrative review on breast cancer treatment supported by focused and systemic phytotherapyPublication . Machado, Helena; Machado, Jorge; Alves, Christian; Monteiro, Maria do Céu; Cruz, Agostinho; Pinho, Cláudia; Soares, Cristina; Grosso, Clara; Rodrigues, Jorge Magalhães; Criado, Maria Begoña; Pinho, Cláudia; Cruz, AgostinhoCancer remains a persistent global health challenge, continuously driving the search for novel and effective therapeutic strategies. In the case of breast cancer, treatment decisions are primarily guided by factors such as the disease stage, histological grade, molecular receptor status, and the presence of genetic mutations. Understanding these parameters is crucial for tailoring interventions and improving clinical outcomes. To enhance prognostic and diagnostic accuracy, attention has increasingly turned to identifying molecular targets that play key roles in breast cancer development. Currently, standard treatments include surgery, chemotherapy, and radiotherapy. However, these approaches are often associated with significant side effects and a diminished quality of life. As a result, many breast cancer patients are turning to complementary therapies—including phytotherapy, nutritional interventions, and dietary supplements—to support conventional treatment, alleviate adverse effects, and improve overall well-being. Within the vast realm of medicinal flora, anticancer plants represent a compelling area of study, serving as a rich reservoir of bioactive compounds. These compounds have demonstrated significant promise in the ongoing battle against cancer. Often highlighted in traditional medicinal practices, these plants harbor a wide array of phytochemicals, such as alkaloids, flavonoids, polyphenols, and terpenoids. These phytochemicals manifest diverse biological activities, notably exhibiting pronounced anticancer properties. The exploration of these natural compounds has opened new avenues for developing innovative and targeted therapeutic strategies in cancer treatment. They achieve definitive chemotherapeutic and chemopreventive roles by integrating with specific molecular signals. Their multiple biological functions include antimutagenic, antiproliferative, antimetastatic, anti-angiogenesis, anti-inflammatory, antioxidant, and immunomodulatory properties, which collectively enable them to control cancer progression and intervene at various stages of cancer cell development. Moreover, these compounds are involved in regulating the cell cycle and microRNA, ultimately leading to cancer cell death by promoting apoptosis and autophagy, often mediated through ROS signaling. Thus, based on a large theoretical revision, we conclude that high-quality evidence is necessary in order to advise these products concerning their efficacy and safety. Also, clinical evidence should be supported by a comprehensive individual diagnosis and adequate research protocols in order to evaluate whether the benefits of these plant-produced interventions can outweigh their harms.
- A comprehensive analysis of viability assays for Giardia lamblia and Trichomonas vaginalis trophozoites: a systematic reviewPublication . Sequeira, Susie; Sousa, Mariana; Cruz, AgostinhoGiardia lamblia and Trichomonas vaginalis are flagellated protozoan parasites that often cause asymptomatic infections but may lead to gastrointestinal or genitourinary symptoms. Improved treatment options are needed due to emerging resistance. However, selecting an appropriate method for assessing the in vitro susceptibility of G. lamblia and T. vaginalis in the presence of potential therapeutic compounds remains challenging due to the variability in these methods. This study aimed to provide an overview of commonly employed methods for determining trophozoite viability in the presence of potential therapeutic compounds and to propose a standardized viability assay for susceptibility testing for G. lamblia and T. vaginalis. A systematic literature review was conducted according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) 2020 statement, using databases including MEDLINE, ScienceDirect, and Web of Science, with the following search equation: “in vitro” AND “method” AND (“susceptibility” OR “viability” OR “sensitivity”) AND (“giardia” OR “trichomonas”). The search identified 32 experimental studies with diverse viability assays. The 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay, adherence inhibition assay, and [3H]-thymidine incorporation assay were prominent for G. lamblia. The trypan blue assay, motility assessment, and resazurin assay were frequently used for T. vaginalis. These findings underscore the diversity in viability assessment methods, highlighting the importance of standardizing viability assays to ensure accurate and reproducible results in drug susceptibility studies. The fluorometric resazurin assay has emerged as a suitable choice for standardization in both parasites, offering cost-effectiveness, reliability, and ease of use.
- Comparative effectiveness of different probiotic delivery methods in oral Candidiasis: A Systematic ReviewPublication . Ashouritoustani, Reihaneh; Pinho, Cláudia; Oliveira, Ana Isabel; Barros, Piedade; Cruz, Agostinho; Cruz, Agostinho; Gonçalves de Barros, Piedade AuroraOral candidiasis, mainly from Candida albicans, affects immunocompromised individuals, the elderly, and denture wearers. Probiotics offer immunomodulatory and microbiota-balancing benefits as potential antifungal alternatives. However, the comparative impact of different probiotic delivery methods remains inadequately explored. This systematic review evaluated the effectiveness of various probiotic delivery methods in reducing Candida colonization and clinical symptoms in oral candidiasis. Following PRISMA 2020 guidelines, a systematic review search across multiple databases included human clinical studies based (Medline, Web of Science, ScienceDirect, and ProQuest) on PICO criteria across all age groups. Outcomes assessed included Candida load, oral microbiota changes, symptom improvement, and disease recurrence. Of 297 articles screened, 10 met inclusion criteria. Delivery methods investigated included lozenges, capsules, yogurt, and cheese. Most studies reported reductions in Candida colony-forming units (CFUs) or prevalence, mainly for C. albicans and for non-albicans species, with probiotics such as Lactobacillus reuteri, L. rhamnosus, L. acidophilus, and Bifidobacterium strains. Some studies reported improved immunological markers, while symptom relief, especially when probiotics were combined with antifungals. Probiotics reduce Candida colonization and symptoms, with potential prolonged effects. They show promise as adjunctive therapies, but standardized, large-scale trials are needed for optimization.
- Dose-dependent pharmacological mechanisms within the Neuroscience-based Nomenclature: a new concept to facilitate neuroscience-based prescribingPublication . Zemach, Sasson; Zohar, Joseph; Correll, Christoph U.; Stahl, Stephen M.; Drago, Filippo; Goodwin, Guy M.; Moller, Hans-Jurgen; Uchida, Hiroyuki; Siafis, Spyridon; Santos, Marlene; Blier, Pierre; Santos, MarleneIn this Personal View, we introduce the concept of different dosage different pharmacology (DDDP), which describes how certain psychotropic medications have distinct therapeutic effects at low and high doses due to differing neurobiological mechanisms. Using the Neuroscience-based Nomenclature (NbN) framework, which classifies drugs by pharmacology and modes of action, we identified ten agents demonstrating DDDP in a comprehensive expert-based consensus process: amisulpride, amitriptyline, aripiprazole, brexpiprazole, cariprazine, doxepin, mirtazapine, quetiapine, risperidone, and trazodone. These medications show clearly demarcated dose-dependent effects, with changes in pharmacological action. For example, some drugs show anxiolytic or hypnotic effects at low doses (via histamine H1 or noradrenergic α1 antagonism) and antidepressant effects at high doses (via reuptake inhibition of serotonin or norepinephrine). Understanding these differences supports more rational prescribing (eg, increasing dopamine partial agonist doses beyond the optimal range might reduce efficacy). DDDP, within the NbN framework, offers a neuroscience-based approach to more precise psychopharmacology.
- 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.