Publications by authors named "Raquel Fernandes"

42 Publications

Kinematic and Clinical Outcomes to Evaluate the Efficacy of a Multidisciplinary Intervention on Functional Mobility in Parkinson's Disease.

Front Neurol 2021 23;12:637620. Epub 2021 Mar 23.

Instituto de Medicina Molecular João Lobo Antunes, Lisbon, Portugal.

Functional mobility (FM) is a concept that incorporates the capacity of a person to move independently and safely to accomplish tasks. It has been proposed as a Parkinson's disease (PD) functional and global health outcome. In this study, we aimed to identify which kinematic and clinical outcomes changes better predict FM changes when PD patients are submitted to a specialized multidisciplinary program. PD patients engaged in a pre-defined specialized multidisciplinary program were assessed at admission and discharge. Change from baseline was calculated for all kinematic and clinical outcomes, and Timed Up and Go (TUG) was defined as the primary outcome for FM. A stepwise multivariate linear regression was performed to identify which outcome measures better predict TUG changes. Twenty-four patients were included in the study. The changes in TUG Cognitive test, supervised step length, and free-living (FL) step time asymmetry were identified as the best predictors of TUG changes. The supervised step length and FL step time asymmetry were able to detect a small to moderate effect of the intervention ( values ranging from -0.26 to 0.42). Our results support the use of kinematic outcome measures to evaluate the efficacy of multidisciplinary interventions on PD FM. The TUG Cognitive, step length, and FL step time asymmetry were identified as having the ability to predict TUG changes. More studies are needed to identify the minimal clinically important difference for step length and FL step time asymmetry in response to a multidisciplinary intervention for PD FM.
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http://dx.doi.org/10.3389/fneur.2021.637620DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8021905PMC
March 2021

Health care providers and people with mental illness: An integrative review on anti-stigma interventions.

Int J Soc Psychiatry 2020 Dec 30:20764020985891. Epub 2020 Dec 30.

PAHO/WHO Collaborating Center for Nursing Research Development, University of Sao Paulo at Ribeirao Preto College Nursing, Brazil.

Background: Health care providers are an important target group for anti-stigma interventions because they have the potential to convey stigmatizing attitudes towards people with mental illness. This can have a detrimental impact on the quality and effectiveness of care provided to those affected by mental illness.

Aims And Methods: Whittemore & Knafl's integrative review method (2005) was used to analyze 16 studies investigating anti-stigma interventions targeting health care providers.

Results: The interventions predominantly involved contact-based educational approaches which ranged from training on mental health (typically short-term), showing videos or films (indirect social contact) to involving people with lived experiences of mental illness (direct social contact). A few studies focused on interventions involving educational strategies without social contact, such as mental health training (courses/modules), distance learning via the Internet, lectures, discussion groups, and simulations. One study investigated an online anti-stigma awareness-raising campaign that aimed to reduce stigmatizing attitudes among health care providers.

Conclusion: Anti-stigma interventions that involve social contact between health care providers and people with mental illness, target specific mental illnesses and include long-term follow-up strategies seem to be the most promising at reducing stigma towards mental illness among health care providers.
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http://dx.doi.org/10.1177/0020764020985891DOI Listing
December 2020

Factitious disorder with psychotic symptoms: A case report.

Asian J Psychiatr 2020 Dec 5;54:102383. Epub 2020 Sep 5.

Psychiatry Department, Centro Hospitalar Psiquiátrico de Lisboa, Avenida do Brasil, 53 1749-002 Lisboa, Portugal. Electronic address:

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http://dx.doi.org/10.1016/j.ajp.2020.102383DOI Listing
December 2020

[Lost in Transition: From Child and Adolescent Psychiatry to Adult Mental Health Care].

Acta Med Port 2020 Nov 2;33(11):777. Epub 2020 Nov 2.

Clínica Psiquiátrica 1. Centro Hospitalar Psiquiátrico de Lisboa. Lisboa. Portugal.

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http://dx.doi.org/10.20344/amp.14802DOI Listing
November 2020

[Lost in Transition: From Child and Adolescent Psychiatry to Adult Mental Health Care].

Acta Med Port 2020 Nov 2;33(11):777. Epub 2020 Nov 2.

Clínica Psiquiátrica 1. Centro Hospitalar Psiquiátrico de Lisboa. Lisboa. Portugal.

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http://dx.doi.org/10.20344/amp.14802DOI Listing
November 2020

Alignment and contribution of nursing doctoral programs to achieve the sustainable development goals.

Hum Resour Health 2020 11 7;18(1):86. Epub 2020 Nov 7.

Ribeirão Preto College of Nursing, WHO Collaborating Centre for Nursing Research Development, University of São Paulo, Avenida dos Bandeirantes, 3900, Campus Universitário, Bairro Monte Alegre, Ribeirão Preto, SP, 14040-902, Brazil.

Background: Different social segments from several regions of the world face challenges in order to achieve the sustainable development goals (SDGs). Nursing represents the greatest number of health workforce in the globe, dealing with these challenges in different paths, among them the training of human resources. In this context, the goal of this study was to compare the relationship between the objectives and research areas underlying nursing doctoral programs in Latin America and the SDGs.

Method: Documental research comparing data of all Latin American nursing doctoral programs and the SDGs, conducted between January and March 2020.

Results: From the total of 56 existing programs in Latin America, this study analyzed 52 of them, representing 92.8% of the total. Most nursing doctoral programs have contributed to SDG 3, in addition to goals 1, 2, 4, 5, 6, 8, 9, 10, 12 and 16. The SDGs 11, 13, 14, 15 and 17 were not related to any of the analyzed programs. Data reveal that the training of nursing PhDs is essential to fulfilling these goals. Results also indicate a need of programs to remain committed to relationships that enhance nursing skills to cope with the current challenges in terms of global health, such as investments for the reduction of social and gender inequities.

Conclusion: The doctoral training of nurses in Latin America needs to be better aligned with the sustainable development goals (SDGs), since there is a high concentration in SDG 3. We believe that nursing will bring a greater contribution to the movement to protect planetary health as the principles governing nursing practices are better aligned with international health demands and agendas.
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http://dx.doi.org/10.1186/s12960-020-00530-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7648269PMC
November 2020

Pedicle Screws and Facet Violation - The importance of the Angle between the Facet and the Screw.

Rev Bras Ortop (Sao Paulo) 2020 Oct 8;55(5):642-648. Epub 2020 Jun 8.

Instituto de Patologia da Coluna (IPC), São Paulo, SP, Brasil.

 To verify whether, regardless of the screw placement technique, there is a safe distance or angle in relation to the facets that can prevent violation of the facet joint when the screws are placed.  Retrospective, single, comparative, non-randomized center. We evaluated by axial computed tomography: the angle of the screw/rod in relation to the midline, the angle of the center of the facets in relation to the midline, the distance between the head of the screw/rod to the midline, and the distance from the center of the facets to the midline; the violation of the facet joint will be evaluated in a gradation of 0 to 2. Also will be measured the difference between the angle os the facets and the angle of the screws (Δ Angle) and, the difference between the facet distance and the screw distance (Δ Distance).  A total of 212 patients and 397 facets were analyzed (196 on the left and 201 on the right). Of these, 303 were not violated (grade 0), corresponding to 76,32%, and 94 suffered some type of violation (grade 1 and 2), corresponding to 23,68%. The mean of Δ angle was 9.87° +/- 4.66° (grade 0), and of 3.77° +/- 4.93° in facets (grade 1 and 2) (  < 0.001), and the Δ mean distance in cases in which there was no violation was 0.94 arbitrary units (a.u.) +/- 0.39 a.u., while the Δ distance in G1 and G2 cases was 0.56 a.u. +/- 0.25 a.u. (  < 0.001).  The measurements of angle and distance between facet and screw can help in the placement of screws. These parameters can be used as safety measures with the most frequent use of surgical navigation techniques.
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http://dx.doi.org/10.1055/s-0040-1709200DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7575402PMC
October 2020

Babassu ( Zona) Nut Oil Is More Effective than Olive Oil for Treating Ischemia-Reperfusion Injury.

Evid Based Complement Alternat Med 2020 21;2020:2525871. Epub 2020 Sep 21.

Postgraduate Program in Adult Health (PPGSAD), Biological and Health Sciences Center, Federal University of Maranhão, Bacanga University Campus, Avenida dos Portugueses s/n, Block 3, Room 3A, 65085-580 São Luís, MA, Brazil.

Background: Cardiovascular disease (CVD) is the leading cause of death in Western civilizations. The type of fatty acid which makes up the diet is related to the cardiovascular morbimortality and the formation of atheromas. Populations with high consumption of oils and fats have a higher number of deaths from CVD.

Purpose: In the present study, the objective was to comparatively analyze the microcirculatory effects of unrefined babassu oil with olive oil in microcirculation and liver of male hamsters of the species , checking the permeability to macromolecules after ischemia-reperfusion (I/R) without and with topical application of histamine 5 × 10 M. This is an experimental study, using as model the hamster's cheek pouch, which was prepared for intravital microscopy. The hamsters were divided into seven groups and orally treated for 14 days, twice a day (at 8 AM and 4 PM), orally received treatments in the following doses: unrefined babassu oil (BO) 0.02 mL/dose (group BO-2), 0.06 mL/dose (group BO-6), and 0.18 mL/dose (BO-18 group); extra virgin olive oil (OI) 0.02 mL/dose (group OI-2), 0.06 mL/dose (group OI-6), and 0.18 mL/dose (OI-18 group); and mineral oil (MO) 0.18 mL/dose (MO-18 group). The observations were made on the 15th day on the hamsters' cheek pouch; the increase of vascular permeability induced by I/R with and without histamine application was evaluated, and in the liver the biological material was collected aseptically then fixed in 10% buffered formalin.

Results: Microcirculatory analyses showed a significant reduction in the number of leaks after I/R with and without the topical use of histamine in animals treated with unrefined BO 0.06 mL/dose (BO-6) and 0.18 mL/dose (BO-18) compared to animals treated with OI. The BO group ( < 0.001) presented a dose-response relationship for decreasing leaks after I/R with and without topical use of histamine. Histological liver analyses showed no fat deposition changes in any of the treatment groups. Phytochemical analyses evidenced a chemical compound (CHNO) in unrefined BO but not in OI.

Conclusions: This experiment demonstrates the protective effect of unrefined BO on the microcirculatory system and its greater dose effect than that of OI. Finding a chemical compound (CHNO) that is present in BO but not in OI opens the possibility of investigating whether this chemical compound was responsible for the protective effect on membrane permeability.
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http://dx.doi.org/10.1155/2020/2525871DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7528137PMC
September 2020

P2Y inhibitor loading dose before catheterization in ST-segment elevation myocardial infarction: Is this the best strategy?

Rev Port Cardiol 2020 Oct 3. Epub 2020 Oct 3.

Centro Hospitalar Universitário do Algarve, Faro, Portugal; Algarve Biomedical Center, Faro, Portugal.

Introduction And Objectives: In ST-segment elevation myocardial infarction (STEMI) the benefit of dual antiplatelet therapy is unequivocal, but the optimal time to administer the loading dose (LD) of a P2Y inhibitor is the subject of debate and disagreement. The main aim of this study was characterize current practice in Portugal and to assess the prognostic impact of P2Y inhibitor LD administration strategy, before versus during or after primary percutaneous coronary intervention (PCI).

Methods: This multicenter retrospective study based on the Portuguese National Registry on Acute Coronary Syndromes included patients with STEMI and PCI performed between October 1, 2010 and September 19, 2017. Two groups were established: LD before PCI (LD-PRE) and LD during or after PCI (LD-CATH).

Results: A total of 4123 patients were included, 66.3% in the LD-PRE group and 32.4% in the LD-CATH group. Prehospital use of a P2Y inhibitor was a predictor of the composite bleeding endpoint (major bleeding, need for transfusion or hemoglobin [Hb] drop >2g/dl), Hb drop >2g/dl and reinfarction. There were no differences between groups in major adverse events (MAE) (in-hospital mortality, reinfarction and stroke) or in-hospital mortality.

Conclusions: Prehospital use of a P2Y inhibitor was associated with an increased risk of bleeding, predicting the composite bleeding outcome and Hb drop >2g/dl, with no differences in mortality or MAE, calling into question the benefit of this strategy.
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http://dx.doi.org/10.1016/j.repc.2020.09.001DOI Listing
October 2020

Assessment of the proposed pseudo-potential theoretical model for the static and dynamic Raman scattering intensities: Multivariate statistical approach to quantum-chemistry protocols.

Spectrochim Acta A Mol Biomol Spectrosc 2021 Jan 28;245:118891. Epub 2020 Aug 28.

Departamento de Química, Centro de Educação, Ciências Exatas e Naturais - CECEN, Universidade Estadual do Maranhão - UEMA, Cidade Universitária Paulo VI, Campus São Luís/MA, CEP 65000-00, Brazil. Electronic address:

Accurate calculation of molecular polarizabilities and Raman intensities required high-level correlated wave functions (CCSD) and large basis set with the inclusion of electronic correlation within experimental precision. These requirements, in terms of time and computation, are economically costly. Polarized Gaussian basis sets adapted to effective core potentials (ECPs) for the static and frequency dependent Raman intensities is presented. The results of the proposed basis sets at CCSD and DFT levels in comparison with Sadlej-pVTZ, as reference basis set, show quite a good quantitative agreement in the properties with a valuable reduction in the computational time and resources. Multivariate principal component analysis (PCA) was performed to study the assessment of the efficiency of proposed methodology and diagnose the inherent information related to the kind of normal vibrational mode of each molecule, based on the variations in the computed Raman intensities. The results, in the form of score-plots, explored a clear segregation and classification among the Raman intensities data, revealing its dependence on the excitation frequencies of laser and nature of the vibrational mode of each molecule of interest. Moreover, the projection of the loadings-plots of the PCs successfully enabled to classify the most correlated computational methods in to the same groups, and made isolations of the less efficient basis functions at the corresponding theoretical method.
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http://dx.doi.org/10.1016/j.saa.2020.118891DOI Listing
January 2021

Aging-related mitochondrial alterations in bovine oocytes.

Theriogenology 2020 Nov 1;157:218-225. Epub 2020 Aug 1.

CNC - Center for Neuroscience and Cell Biology, CIBB, Azinhaga de Santa Comba, Celas, 3004-504, University of Coimbra, Portugal; University of Coimbra, Department of Life Sciences, Calçada Martim de Freitas, 3000-456, Coimbra, Portugal. Electronic address:

Advanced maternal age is an emerging health problem which involves many functional and structural alterations in oocytes, and its study is relevant to design better approaches to improve the reproductive function in women of advanced age. A constraint to this type of studies is the limited amount of samples and the ethical problems of working with human gametes. This study aims to characterize the in vitro-induced age-related modifications in a bovine model, as well as to determine if this model is a reliable approach to study human aging. For this purpose, we have focused on aging-related alterations related to oocyte mitochondrial dysfunction, a key hallmark in aging. Morphological and bioenergetic in vitro-induced alterations in bovine oocytes were compared to an in vivo aged group and to the already reported information regarding humans and other animal models. Parameters monitored included ooplasmic volume; mitochondrial mass, distribution and aggregation, assessed by MitoTracker Green; mitochondrial activity, monitored by JC-1; and the mitochondrial levels of hydrogen peroxide (HO), quantified using MitoPY. Results show a significant decrease in oocyte cytoplasmic volume after both in vitro and in vivo aging (p < 0.001). Additionally, the levels of HO increased significantly after in vitro and in vivo aging (p < 0.001) and mitochondrial aggregation patterns were significantly different after 30 h of in vitro maturation, with MII oocytes presenting small aggregates inside the cytoplasm, whereas aged oocytes had a lack of granularity (p < 0.001). In contrast, there were no differences between the different aging groups in terms of mitochondrial mass, distribution and activity. In conclusion, this in vitro approach of inducing aging-related alterations may be considered as a reliable approach to study the aging process in human female gametes, since it causes the same types of alterations in both species.
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http://dx.doi.org/10.1016/j.theriogenology.2020.07.036DOI Listing
November 2020

[Electroconvulsive Therapy: A Health Literacy Problem].

Acta Med Port 2020 Jul 1;33(7-8):529. Epub 2020 Jul 1.

Serviço de Psiquiatria. Centro Hospitalar Psiquiátrico de Lisboa. Lisboa. Portugal.

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http://dx.doi.org/10.20344/amp.13865DOI Listing
July 2020

EGSYS score for the prediction of cardiac etiology in syncope: Is it useful in an outpatient setting?

Rev Port Cardiol 2020 May 10;39(5):255-261. Epub 2020 Jun 10.

Serviço de Cardiologia, Hospital de Faro, Centro Hospitalar Universitário do Algarve, EPE, Faro, Portugal.

Introduction: The EGSYS score uses clinical variables to predict which patients may have cardiac (CS) or non-cardiac syncope (NCS) and has been validated in the emergency department setting. This study aims to determine whether the score has the same applicability in an outpatient setting.

Methods: In this retrospective study of all patients observed in the outpatient setting of a hospital with a syncope unit between January 2015 and December 2016, the EGSYS score was calculated for each patient, and its sensitivity and specificity were determined for the prediction of CS in patients with score ≥3.

Results: A total of 224 patients, mean age 64.3±21.7 years, 116 (51.8%) male, were analyzed. In the 163 (72.7%) patients with confirmed syncope, CS was diagnosed in 27 (16.6%) and NCS in 136 (83.4%). The EGSYS score was ≥3 in 40 (20.0%) patients with NCS and in 13 (48.1%) with CS. A positive score had a sensitivity of 48.2% (95% CI: 28.7-68.1), a specificity of 77.9% (95% CI: 70.0-84.6), and a positive and negative predictive value of 30.2% (95% CI: 20.8-41.8) and 88.3% (95% CI: 83.9-91.7), respectively.

Conclusion: The EGSYS score has limited usefulness in an outpatient setting, where observed patients have already been been medically assessed. Given its high specificity and negative predictive value, it may be useful to reassure low-risk patients and family members.
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http://dx.doi.org/10.1016/j.repc.2019.09.009DOI Listing
May 2020

Clinical implications of using non-invasive haemoglobin monitoring for red blood cell transfusion decision in hip arthroplasty.

Transfus Apher Sci 2020 Aug 26;59(4):102770. Epub 2020 Apr 26.

Department of Anesthesia, Unidade Local de Saúde de Matosinhos - Hospital Pedro Hispano, Matosinhos, Portugal. Electronic address:

Introduction: The decision to transfuse red blood cells requires accurate haemoglobin concentration values. In this study, we evaluated if continuous non-invasive haemoglobin (SpHb) measurement could substitute laboratory determined haemoglobin (LabHb) in patients undergoing elective hip replacement. As secondary objective, we analyzed the trend of the difference between techniques.

Materials/methods: LabHb measurements were done using an automated analyser and SpHb measurements were acquired using Radical-7®. In randomly selected patients undergoing hip replacement, whenever blood was collected for LabHb, concomitant SpHb was recorded. Correlation, bias and accuracy of SpHb were calculated in comparison with LabHb.

Results: 108 paired measurements were obtained from 43 patients. The Pearson R of the correlation between SpHb and LabHb was 0.7 (p < 0.001). Bland-Altman test revealed a bias of 1 ± 1.4 g dL, meaning Lab Hb was recurrently higher than SpHb. Limits of agreement were [-1.7; 3.8]. Considering RBC transfusion threshold of 8 g dL, we found that in two situations transfusion decision would differ based on the measurement considered. Trending ability of SpHb study showed a significant difference between preoperative and postoperative LabHb-SpHb.

Discussion: There was a good correlation between SpHb and LabHb, while bias and limits of agreement were higher than those in literature. There was a limited trending ability of SpHb during the perioperative period. Despite this, using SpHb instead of LabHb for decision making regarding transfusion would only change the decision in 1.9 % of our cases. Our findings suggest that this device could be used as a reference but cannot replace venous puncture as gold standard.
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http://dx.doi.org/10.1016/j.transci.2020.102770DOI Listing
August 2020

Efficient removal of parabens from real water matrices by a metal-free carbon nitride photocatalyst.

Sci Total Environ 2020 May 21;716:135346. Epub 2019 Nov 21.

Laboratory of Separation and Reaction Engineering - Laboratory of Catalysis and Materials (LSRE-LCM), Faculdade de Engenharia, Universidade do Porto, Rua Dr. Roberto Frias s/n, 4200-465 Porto, Portugal. Electronic address:

Metal-free graphite-like carbon nitride (GCN-500) was obtained by thermal post-treatment of bulk polymeric carbon nitride at 500 °C. The catalyst was thoroughly characterized by morphological, optical and textural analysis techniques. The efficiency of GCN-500 was evaluated under visible (λ = 417 nm) LED excitation for the photocatalytic degradation of methyl-, ethyl- and propyl-paraben in different water matrices either isolated or in a mixture of the three compounds. The GCN-500 proved to be more efficient than the benchmark TiO P25, with complete conversion of the individual parabens within 20 min of irradiation, contrasting with 120 min needed for total degradation using TiO. Experiments in the presence of selected scavengers confirmed the high importance of superoxide radicals in the photocatalytic oxidation of parabens using GCN-500. The effect of the nature of the aqueous matrix in the kinetics of the photocatalytic process was assessed using ultrapure, tap and river waters spiked with a mixture of the three parabens. Although still very efficient, the complexity of the real water samples turned the degradation process slower due to the presence of other components such as ions and dissolved organic matter. GCN-500 proved to be stable in a continuous-flow system using GCN-500 coated glass rings (GCN-500-GR) to remove MP, EP and PP from real water matrices.
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http://dx.doi.org/10.1016/j.scitotenv.2019.135346DOI Listing
May 2020

Perspectives of remedial teaching for students with language disorders in Portugal.

Codas 2019 31;31(5):e20180074. Epub 2019 Oct 31.

Centro de Investigação em Educação - CIEd, Instituto de Educação, Universidade do Minho - UMinho - Braga, Portugal.

Purpose: To analyze how students with Language Disorders receive remedial teaching in inclusive settings in Portugal.

Methods: We developed a questionnaire based on the literature review, and applied it to 123 elementary teachers in Portugal. We performed a descriptive and inferential statistical analysis of the dependent variables using parametric tests.

Results: Descriptive analysis revealed that most teachers know the concept of language disorders and consider it important to the development of language when supporting students with this problem. However, over half of the respondents answered that they have no training and enough information about the acquisition and development of language, and don´t consider having sufficient knowledge to contribute to the identification of students with language disorders. Results for inferential statistics showed statistically significant differences regarding gender; length of service and district, as well as a good internal consistency in relation to the questionnaire.

Conclusion: Results highlight the need for training and information about acquisition and development of language, and more specifically in relation to language disorders. It also showed that elementary teachers may find difficulties in intervention with students with language disorders, and particularly, to adequate strategies to their needs, particularly when developing Individualized Educational Programs for their students in a team.
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http://dx.doi.org/10.1590/2317-1782/20192018074DOI Listing
December 2019

p.G360R Is a Pathogenic GLA Gene Mutation Responsible for a Classic Phenotype of Fabry Disease.

Cardiology 2019;144(3-4):125-130. Epub 2019 Oct 21.

Cardiology Department, Centro Hospitalar e Universitário do Algarve, Faro, Portugal.

The authors report the case of a classic phenotype of Fabry disease in a 60-year-old male patient presenting with left ventricular hypertrophy and stroke. Genetic analysis revealed 2 GLA-gene variants, i.e., p.R356Q and p.G360R. This clinical case highlights that the finding of 2 or more GLA gene variants in a Fabry patient should lead to a careful evaluation in order to determine their exact role in the condition. This case also provides the first clinical evidence that the p.G360R mutation is pathogenic and responsible for a classic phenotype of Fabry disease. The clinical improvement following the initiation of enzyme replacement therapy reinforces the importance of Fabry disease awareness and diagnosis in patients exhibiting red flags, such as left ventricular hypertrophy and stroke.
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http://dx.doi.org/10.1159/000502437DOI Listing
April 2020

Photodynamic therapy in vulvar lymphangioma: Case report.

Photodiagnosis Photodyn Ther 2019 Mar 16;25:84-86. Epub 2018 Oct 16.

Medical School of University Nove de Julho, Brazil. Electronic address:

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http://dx.doi.org/10.1016/j.pdpdt.2018.09.001DOI Listing
March 2019

Intravascular imaging, histopathological analysis, and catecholamine quantification following catheter-based renal denervation in a swine model: the impact of prebifurcation energy delivery.

Hypertens Res 2018 Sep 13;41(9):708-717. Epub 2018 Jul 13.

Cardiology Department, Coimbra's Hospital and University Centre - General Hospital, Coimbra, Portugal.

The purpose of this study was to evaluate the impact of prebifurcation renal denervation in a swine model and assess its safety through optical coherence tomography (OCT). Prebifurcation renal denervation with a multi-electrode catheter was performed in one renal artery of 12 healthy pigs, with the contralateral artery and kidney being used as controls. Angiograms and OCT pullbacks were obtained peri-procedurally and 1 month post procedure. Renal tissue catecholamines were quantified, and the arterial wall and peri-adventitial tissue were analyzed histologically. Intraluminal changes (endothelial swelling, spasm, and thrombus formation) were observed acutely by OCT in most of the treated arteries and were no longer visible at follow-up. Histology revealed a statistically significant accumulation of collagen (fibrosis) and a near absence of tyrosine hydroxylase labeling in the denervated artery, suggesting a clear reduction in nervous terminals. Renal tissue catecholamine levels were similar between both sides, probably due to the low number of ablation points and the renorenal reflex. The present study demonstrates that renal denervation is associated with acute intimal disruptions, areas of fibrosis, and a reduction in nervous terminals. The lack of difference in renal tissue catecholamine levels is indicative of the need to perform the highest and safest number of ablation points in both renal arteries. These findings are important because they demonstrate the histological consequences of radiofrequency energy application and its medium-term safety.
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http://dx.doi.org/10.1038/s41440-018-0072-yDOI Listing
September 2018

Effects of resistance exercise on endothelial progenitor cell mobilization in women.

Sci Rep 2017 12 19;7(1):17880. Epub 2017 Dec 19.

Research Center in Physical Activity, Health and Leisure, CIAFEL, Faculty of Sport, University of Porto, Porto, Portugal.

This study aimed to determine the effect of a single bout of resistance exercise at different intensities on the mobilization of circulating EPCs over 24 hours in women. In addition, the angiogenic factors stromal cell-derived factor 1 (SDF-1α), vascular endothelial growth factor (VEGF), hypoxia-inducible factor 1-alpha (HIF-1α) and erythropoietin (EPO) were measured as potential mechanisms for exercise-induced EPCs mobilization. Thirty-eight women performed a resistance exercise session at an intensity of 60% (n = 13), 70% (n = 12) or 80% (n = 13) of one repetition maximum. Each session was comprised of three sets of 12 repetitions of four exercises: bench press, dumbbell curl, dumbbell squat, and standing dumbbell upright row. Blood was sampled at baseline and immediately, 6 hours, and 24 hours post-exercise. Circulating EPC and levels of VEGF, HIF-1α and EPO were significantly higher after exercise (P < 0.05). The change in EPCs from baseline was greatest in the 80% group (P < 0.05), reaching the highest at 6 hours post-exercise. The change in EPCs from baseline to 6 hours post-exercise was correlated with the change in VEGF (r = 0.492, P = 0.002) and HIF-1α (r = 0.388, P = 0.016). In general, a dose-response relationship was observed, with the highest exercise intensities promoting the highest increases in EPCs and angiogenic factors.
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http://dx.doi.org/10.1038/s41598-017-18156-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5736626PMC
December 2017

Therapeutic comparison between treatments for Vulvar Lichen Sclerosus: study protocol of a randomized prospective and controlled trial.

BMC Womens Health 2017 08 10;17(1):61. Epub 2017 Aug 10.

Postgraduate Program in Biophotonics Applied to Health Sciences, Nove de Julho University/UNINOVE, 249 Vergueiro Street, Liberdade, São Paulo, SP, 01504-001, Brazil.

Background: Vulvar lichen sclerosus (VLS) is a lymphocyte-mediated disease of unknown etiology that can cause intense itching as well stenosis, hindering the evacuation and urination. It can also limit the sex life due to severe local pruritus, pain and dyspareunia (pain during sexual intercourse). The standard treatment for this disease is the use of topical corticosteroids to reduce the clinical symptoms and to try to increase disease-free intervals. Photodynamic therapy (PDT), a treatment that associates a light radiation with a photosensitizing agent and photobiomodulation (PBM) are therapies that can promote effective immunomodulatory responses at the application site by means of photophysical and photochemical phenomena from the molecular to the systemic level, which promote their use in chronic dermatoses. The aim is to compare the effects of PDT, PBM, and topical corticosteroid in VLS evaluating clinical, histological, immunohistochemical and spectroscopic responses.

Methods: The study is prospective, randomized and controlled, in a population of 60 women with histological diagnoses of VLS. There will be 3 treatments groups: PDT, PBM and topical corticosteroid (control group), where will be allocated by randomization 20 patients in each one. The clinical course will be monitored by measuring local temperature, itching, atrophy, and the area of the lesion. Histologically, the slides will be classified and will have the ordering of collagen fibers quantified. Immunohistochemical analysis will be done using the markers IFN-γ, TGF-β, CD4, CD8, IL-1, p53 and Ki-67. Finally, the spectroscopic evaluation will be done by reflectance. Descriptive and inferential statistical analyses will be conducted to compare the groups and make associations between different responses. The study is an open-label for patients with active symptomatic disease with a period of 1 year follow-up to determine the rate of recurrence in each groups.

Discussion: The immunological effects of PDT and PBM are described by several authors in inflammatory skin diseases, stimulating the production and organization of the associated collagen. Thus, it is reasonable to determine the efficacy and safety of these new treatments in VLS, in comparison to the control group, analyzing the recurrence time, the impact on the optical properties of the skin, and the benefit to patients.

Trial Registration: ClinicalTrials.gov: NCT02416531 .
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http://dx.doi.org/10.1186/s12905-017-0414-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5550930PMC
August 2017

Trial of Electrical Direct-Current Therapy versus Escitalopram for Depression.

N Engl J Med 2017 06;376(26):2523-2533

From the Service of Interdisciplinary Neuromodulation, Department and Institute of Psychiatry, Laboratory of Neurosciences (LIM-27) (A.R.B., B.S.-J., L.B., L.V.M.A., R.F., W.F.G.), and the Interdisciplinary Center for Applied Neuromodulation, University Hospital (A.R.B., A.H.M., B.S.-J., L.B., M.L.M., R.A.F., B.P.V., B.S.N., L.V.M.A., L.B.R., R.C., L.C.T., R.F., P.A.L., I.M.B.), University of São Paulo, São Paulo; and the Spaulding Neuromodulation Center, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston (F.F.).

Background: We compared transcranial direct-current stimulation (tDCS) with a selective serotonin-reuptake inhibitor for the treatment of depression.

Methods: In a single-center, double-blind, noninferiority trial involving adults with unipolar depression, we randomly assigned patients to receive tDCS plus oral placebo, sham tDCS plus escitalopram, or sham tDCS plus oral placebo. The tDCS was administered in 30-minute, 2-mA prefrontal stimulation sessions for 15 consecutive weekdays, followed by 7 weekly treatments. Escitalopram was given at a dose of 10 mg per day for 3 weeks and 20 mg per day thereafter. The primary outcome measure was the change in the 17-item Hamilton Depression Rating Scale (HDRS-17) score (range, 0 to 52, with higher scores indicating more depression). Noninferiority of tDCS versus escitalopram was defined by a lower boundary of the confidence interval for the difference in the decreased score that was at least 50% of the difference in the scores with placebo versus escitalopram.

Results: A total of 245 patients underwent randomization, with 91 being assigned to escitalopram, 94 to tDCS, and 60 to placebo. In the intention-to-treat analysis, the mean (±SD) decrease in the score from baseline was 11.3±6.5 points in the escitalopram group, 9.0±7.1 points in the tDCS group, and 5.8±7.9 points in the placebo group. The lower boundary of the confidence interval for the difference in the decrease for tDCS versus escitalopram (difference, -2.3 points; 95% confidence interval [CI], -4.3 to -0.4; P=0.69) was lower than the noninferiority margin of -2.75 (50% of placebo minus escitalopram), so noninferiority could not be claimed. Escitalopram and tDCS were both superior to placebo (difference vs. placebo, 5.5 points [95% CI, 3.1 to 7.8; P<0.001] and 3.2 points [95% CI, 0.7 to 5.5; P=0.01], respectively). Patients receiving tDCS had higher rates of skin redness, tinnitus, and nervousness than did those in the other two groups, and new-onset mania developed in 2 patients in the tDCS group. Patients receiving escitalopram had more frequent sleepiness and obstipation than did those in the other two groups.

Conclusions: In a single-center trial, tDCS for the treatment of depression did not show noninferiority to escitalopram over a 10-week period and was associated with more adverse events. (Funded by Fundação de Amparo à Pesquisa do Estado de São Paulo and others; ELECT-TDCS ClinicalTrials.gov number, NCT01894815 .).
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http://dx.doi.org/10.1056/NEJMoa1612999DOI Listing
June 2017

Calpastatin Overexpression Preserves Cognitive Function Following Seizures, While Maintaining Post-Injury Neurogenesis.

Front Mol Neurosci 2017 23;10:60. Epub 2017 Mar 23.

Center for Biomedical Research, CBMR, University of AlgarveFaro, Portugal; Regenerative Medicine Program, Department of Biomedical Sciences and Medicine, University of AlgarveFaro, Portugal; Algarve Biomedical Center, University of AlgarveFaro, Portugal.

In the adult mammalian brain, new neurons continue to be produced throughout life in two main regions in the brain, the subgranular zone (SGZ) in the hippocampus and the subventricular zone in the walls of the lateral ventricles. Neural stem cells (NSCs) proliferate in these niches, and migrate as neuroblasts, to further differentiate in locations where new neurons are needed, either in normal or pathological conditions. However, the endogenous attempt of brain repair is not very efficient. Calpains are proteases known to be involved in neuronal damage and in cell proliferation, migration and differentiation of several cell types, though their effects on neurogenesis are not well known. Previous work by our group has shown that the absence of calpastatin (CAST), the endogenous inhibitor of calpains, impairs early stages of neurogenesis. Since the hippocampus is highly associated with learning and memory, we aimed to evaluate whether calpain inhibition would help improve cognitive recovery after lesion and efficiency of post-injury neurogenesis in this region. For that purpose, we used the kainic acid (KA) model of seizure-induced hippocampal lesion and mice overexpressing CAST. Selected cognitive tests were performed on the 3rd and 8th week after KA-induced lesion, and cell proliferation, migration and differentiation in the dentate gyrus (DG) of the hippocampus of adult mice were analyzed using specific markers. Cognitive recovery was evaluated by testing the animals for recognition, spatial and associative learning and memory. Cognitive function was preserved by CAST overexpression following seizures, while modulation of post-injury neurogenesis was similar to wild type (WT) mice. Calpain inhibition could still be potentially able to prevent the impairment in the formation of new neurons, given that the levels of calpain activity could be reduced under a certain threshold and other harmful effects from the pathological environment could also be controlled.
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http://dx.doi.org/10.3389/fnmol.2017.00060DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5362605PMC
March 2017

Autism spectrum disorders and the amplitude of auditory brainstem response wave I.

Autism Res 2017 Jul 1;10(7):1300-1305. Epub 2017 Apr 1.

Centro Hospitalar do Porto, Portugal, Largo do Prof. Albel Salazar, 4099-001, Porto, Portugal.

To determine whether children with autism spectrum disorders (ASDs) have an increased number of wave I abnormal amplitudes in auditory brainstem responses (ABRs) than age- and sex-matched typically developing children. This analytical case-control study compared patients with ASDs between the ages of 2 and 6 years and children who had a language delay not associated with any other pathology. Amplitudes of ABR waves I and V; absolute latencies (ALs) of waves I, III, and V; and interpeak latencies (IPLs) I-III, III-IV, and I-V at 90 dB were compared between ASD patients and normally developing children. The study enrolled 40 children with documented ASDs and 40 age- and sex-matched control subjects. Analyses of the ABR showed that children with ASDs exhibited higher amplitudes of wave 1 than wave V (35%) more frequently than the control group (10%), and this difference between groups reached statistical significance by Chi-squared analysis. There were no significant differences in ALs and IPLs between ASD children and matched controls. To the best of our knowledge, this is the first case-control study testing the amplitudes of ABR wave I in ASD children. The reported results suggest a potential for the use of ABR recordings in children, not only for the clinical assessment of hearing status, but also for the possibility of using amplitude of ABR wave I as an early marker of ASDs allowing earlier diagnosis and intervention. Autism Res 2017. © 2017 International Society for Autism Research, Wiley Periodicals, Inc. Autism Res 2017, 10: 1300-1305. © 2017 International Society for Autism Research, Wiley Periodicals, Inc.
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http://dx.doi.org/10.1002/aur.1771DOI Listing
July 2017

Interviews of Children in a Portuguese Special Judicial Procedure.

Behav Sci Law 2017 May 29;35(3):189-203. Epub 2017 Mar 29.

University of Cambridge, Cambridge, UK.

Since 2007, alleged victims of child sexual abuse in Portugal have provided evidence in a mandatory "Declarações para Memória Futura" (DMF; English transl. 'Statement for future use') proceeding. In order to protect children from having to testify in court, interviews conducted at the DMF can be used later as trial evidence because the hearings are conducted by judges. The present study examined 137 interviews with 3- to 17-year-olds conducted in several Portuguese criminal courts. Detailed examination of interview transcripts showed that 69% of all questions asked were option-posing questions, 16% were directive questions, 11% were suggestive questions, and only 3% were open-ended prompts. The vast majority of details provided by children were thus obtained using the risky recognition-based prompts (i.e., option posing and suggestive questions) associated with the risks of contaminating and limiting children's informativeness, both potential threats to the credibility of their testimony. There is an urgent need to address this issue and consider the implementation of a scientifically validated structured interview protocol in Portugal. Copyright © 2017 John Wiley & Sons, Ltd.
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http://dx.doi.org/10.1002/bsl.2284DOI Listing
May 2017

Cytotoxic analysis and chemical characterization of fractions of the hydroalcoholic extract of the Euterpe oleracea Mart. seed in the MCF-7 cell line.

J Pharm Pharmacol 2017 Jun 17;69(6):714-721. Epub 2017 Feb 17.

Post-Graduation Program in Adult and Children Health, Research Center of CCBS, Federal University of Maranhão, São Luís, Maranhão, Brazil.

Objectives: To analyse the antineoplastic activity of fractions derived from the hydroalcoholic extract of Euterpe oleracea Mart. seed in the MCF-7 cell line and to identify the compounds responsible for the antineoplastic action.

Methods: Cells were treated with 10, 20, 40 and 60 μg/ml with the hexane, chloroform and ethyl acetate fraction (EAF) of the hydroalcoholic extract of açaí seed, for 24 and 48 h. After treatment, cell viability was measured using MTT assay and cell death was assessed using the Annexin-Pi assay. The most cytotoxic fraction under study was analysed by mass spectrometry using an electrospray ionization source and a cyclotron analyser coupled to a Fourier transform. Data were analysed statistically by analysis of variance (ANOVA) or by Student's t-test, where appropriate.

Key Findings: All fractions caused significant reduction in the cell viability, but the EAF was the most cytotoxic (P < 0.001). It was observed the absence of significant annexin staining but increase Pi staining (P < 0.001). The EAF is composed of epicatechin, proanthocyanidin A and trimeric and tetrameric procyanidins.

Conclusions: In this study, we demonstrated that EAF was the most effective fraction in reducing cell viability and causing necroptosis in the MCF-7 cell.
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http://dx.doi.org/10.1111/jphp.12679DOI Listing
June 2017

Nonverbal behaviors are associated with increased vagal activity in major depressive disorder: Implications for the polyvagal theory.

J Affect Disord 2017 Feb 16;209:18-22. Epub 2016 Nov 16.

University Hospital, University of São Paulo, São Paulo, Brazil; Department and Institute of Psychiatry, University of São Paulo, São Paulo, Brazil; Service of Interdisciplinary Neuromodulation, Laboratory of Neurosciences (LIM-27), Institute of Psychiatry, São Paulo, Brazil. Electronic address:

Background: Major depressive disorder (MDD) is associated with impairments in nonverbal behaviors (NVBs) and vagal activity. The polyvagal theory proposes that vagal activity regulates heart rate and NVBs by modulating a common anatomically and neurophysiologically discrete social engagement system. However, the association between these putative endophenotypes has not yet been explored. We hypothesize that in MDD, NVBs indicating positive affects and social interest and those indicating negative feelings and social disinterest could be associated with different patterns of vagal activity.

Methods: For this cross-sectional study we recruited 50 antidepressant-free participants with moderate-to-severe MDD. Vagal activity was indexed by heart rate variability (HRV) measures, and positive and negative nonverbal behaviors (NVBs) by a validated ethogram. Associations between NVBs and HRV were explored by bivariate analyses and multivariable models were adjusted by age, gender, depression severity, and self-reported positive and negative affects.

Results: HRV measures indicative of higher vagal activity were positively correlated with positive NVBs exhibited during the clinical interview. Conversely, NVBs related to negative affects, low energy and social disinterest were not associated with HRV.

Limitations: Absence of a control group.

Conclusions: The findings highlight that the examined depression endophenotypes (nonverbal behaviors and vagal activity) are related, shedding light on MDD pathophysiology in the context of the polyvagal theory.
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http://dx.doi.org/10.1016/j.jad.2016.11.010DOI Listing
February 2017

Application of electrochemical impedance spectroscopy: A phase behavior study of babassu biodiesel-based microemulsions.

Spectrochim Acta A Mol Biomol Spectrosc 2016 Nov 27;168:60-64. Epub 2016 May 27.

Laboratório de Pesquisa em Química Analítica, Universidade Federal do Maranhão, 65085-580 São Luís, Maranhão, Brazil.

Microemulsions are thermodynamically stable systems of two immiscible liquids, one aqueous and the other of organic nature, with a surfactant and/or co-surfactant adsorbed in the interface between the two phases. Biodiesel-based microemulsions, consisting of alkyl esters of fatty acids, open a new means of analysis for the application of electroanalytical techniques, and is advantageous as it eliminates the required pre-treatment of a sample. In this work, the phase behaviours of biodiesel-based microemulsions were investigated through the electrochemical impedance spectroscopy (EIS) technique. We observed thatan increase in the amount of biodiesel in the microemulsion formulation increases the resistance to charge transfer at the interface. Also, the electrical conductivity measurements revealed that a decrease or increase in electrical properties depends on the amount of biodiesel. EIS studies of the biodiesel-based microemulsion samples showed the presence of two capacitive arcs: one high-frequency and the other low-frequency. Thus, the formulation of microemulsions plays an important role in estimating the electrical properties through the electrochemical impedance spectroscopy technique.
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http://dx.doi.org/10.1016/j.saa.2016.05.034DOI Listing
November 2016

Lymph node micrometastases in initial stage cervical cancer and tumoral recurrence.

Int J Gynaecol Obstet 2016 Apr 19;133(1):69-75. Epub 2015 Dec 19.

Gynecology and Obstetrics Department, Faculdade de Medicina de São José do Rio Preto, Hospital de Base, São José do Rio Preto, Brazil.

Objective: To evaluate the prevalence of micrometastases in lymph node tissue of patients with stage Ib1-IIA cervical cancer, the correlation of micrometastases with tumor recurrence and survival, and the expression of D2-40 in the primary tumor of patients with recurrence and/or micrometastases and its correlation with histopathologic findings.

Methods: In a retrospective study, the medical records of all patients with cervical cancer treated at a hospital in São Paulo, Brazil, between 2001 and 2007 were reviewed. Patients with no lymph node metastases and treated with radical hysterectomy without adjuvant treatment were included. Tumor sections were reviewed and lymph nodes were analyzed with AE1/AE3. Patients with and without recurrence were compared. The presence of lymph node micrometastasis or isolated tumor cells was also evaluated.

Results: Of the 83 patients evaluated, 15 (18%) had recurrence. Significant differences between patients with and without recurrence were observed with regard to tumor greatest axis, clinical stage, number of micrometastases, and negative lymph nodes (P≤0.04). Lymph node micrometastases and isolated tumor cells were significantly different for a stromal invasion depth greater than 2/3 (P=0.046).

Conclusion: The presence of lymph node micrometastases is an important risk factor for tumor recurrence. These patients should be considered eligible for adjuvant radiochemotherapy treatment.
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http://dx.doi.org/10.1016/j.ijgo.2015.08.019DOI Listing
April 2016