Browsing by Author "Ramos, C"
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- Changes of Soluble CD40 Ligand in the Progression of Acute Myocardial Infarction Associate to Endothelial Nitric Oxide Synthase Polymorphisms and Vascular Endothelial Growth Factor But Not to Platelet CD62P ExpressionPublication . Napoleão, P; Monteiro, MC; Cabral, L; Criado, MB; Ramos, C; Selas, M; Viegas-Crespo, AM; Saldanha, C; Mota Carmo, M; Cruz Ferreira, R; Pinheiro, TReported in vitro data implicated soluble CD40 ligand (sCD40L) in endothelial dysfunction and angiogenesis. However, whether sCD40L could exert that influence in endothelial dysfunction and angiogenesis after injury in acute myocardial infarction (AMI) patients remains unclear. In the present study, we evaluated the association of sCD40L with markers of platelet activation, endothelial, and vascular function during a recovery period early after AMI. To achieve this goal, the time changes of soluble, platelet-bound, and microparticle-bound CD40L levels over 1 month were assessed in AMI patients and correlated with endothelial nitric oxide synthase (eNOS) polymorphisms, vascular endothelial growth factor (VEGF) concentrations, and platelet expression of P-selectin (CD62P). The association of soluble form, platelet-bound, and microparticle-bound CD40L with CD62P expression on platelets, a marker of platelet activation, was also assessed to evaluate the role of CD40L in the thrombosis, whereas the association with eNOS and VEGF was to evaluate the role of CD40L in vascular dysfunction. This work shows for the first time that time changes of sCD40L over 1 month after myocardial infarct onset were associated with G894T eNOS polymorphism and with the VEGF concentrations, but not to the platelet CD62P expression. These results indicate that, in terms of AMI pathophysiology, the sCD40L cannot be consider just as being involved in thrombosis and inflammation but also as having a relevant role in vascular and endothelial dysfunction.
- Cytotoxic and Genotoxic Effects of Environmental Relevant Concentrations of Bisphenol A and Interactions with DoxorubicinPublication . Ramos, C; Ladeira, C; Zeferino, S; Dias, A; Faria, I; Cristovam, E; Gomes, M; Ribeiro, EBisphenol A (BPA) is one of the most widely utilized endocrine disruptors to which humans are exposed, particularity through ingestion. BPA is an aneugenic compound with a putative association to tumorigenesis. Although extensively studied in estrogen responsive cells, information regarding its effects on cells from the upper gastrointestinal tract exposed to free/active forms of BPA is still scarce. Similarly, BPA interactions with other drugs have been neglected, although it has been suggested to have a potential role in doxorubicin (DOX) chemoresistance. This study is intended to assess potential cytotoxic and genotoxic effects of BPA, as well as its interactions with DOX, in Human epithelial type 2 cells (Hep-2) originated from a human laryngeal carcinoma and in a DNA damage responsive cell line, the human lung fibroblasts (MRC-5). Cell viability was analyzed through the resazurin assay. The G protein-coupled estrogen receptor 1 (GPER) expression was visualized by immunodetection. Genotoxicity, namely DNA damage and oxidative DNA damage, were assessed by comet assay and micronuclei induction, and mitotic disruption was evaluated cytologically by fluorescent microscopy with DAPI staining. Cytotoxicity analysis showed that exposure to BPA per se does not affect cellular viability. Nevertheless, the genotoxic analysis showed that BPA induced an increase of DNA damage in the Hep-2 cell line and in oxidative damage in the MRC-5 cell line. An increase of micronuclei was also observed in both cell lines following BPA exposure. BPA and DOX co-exposures suggested that BPA acts as an antagonist of DOX effects in both cell lines. The interaction with DOX appears to be cell type dependent, exhibiting a non-monotonic response curve in MRC-5 cells, a GPER expressing cell line. Our study emphasizes the need for a deeper knowledge of BPA interactions, particularly with chemotherapeutic agents, in the context of risk assessment and public health.
- Developing and Validating High-Value Patient Digital Follow-Up Services: a Pilot Study in Cardiac SurgeryPublication . Londral, A; Azevedo, S; Dias, P; Ramos, C; Santos, J; Martins, F; Silva, R; Semedo, H; Vital, C; Gualdino, A; Falcão, J; Lapão, LV; Coelho, P; Fragata, JBackground: The existing digital healthcare solutions demand a service development approach that assesses needs, experience, and outcomes, to develop high-value digital healthcare services. The objective of this study was to develop a digital transformation of the patients' follow-up service after cardiac surgery, based on a remote patient monitoring service that would respond to the real context challenges. Methods: The study followed the Design Science Research methodology framework and incorporated concepts from the Lean startup method to start designing a minimal viable product (MVP) from the available resources. The service was implemented in a pilot study with 29 patients in 4 iterative develop-test-learn cycles, with the engagement of developers, researchers, clinical teams, and patients. Results: Patients reported outcomes daily for 30 days after surgery through Internet-of-Things (IoT) devices and a mobile app. The service's evaluation considered experience, feasibility, and effectiveness. It generated high satisfaction and high adherence among users, fewer readmissions, with an average of 7 ± 4.5 clinical actions per patient, primarily due to abnormal systolic blood pressure or wound-related issues. Conclusions: We propose a 6-step methodology to design and validate a high-value digital health care service based on collaborative learning, real-time development, iterative testing, and value assessment.
- Hemotórax Maciço em Doente com Dupla Antiagregação PlaquetáriaPublication . Rubackova, K; Ramos, C; Canavilhas, M; Martelo, FOs autores descrevem o caso clínico de uma doente que se encontrava sob dupla antiagregação plaquetária com hemotórax traumático maciço e choque hemorrágico, no Serviço de Urgência do nosso hospital. Foi submetida a uma toracotomia de emergência, durante a qual se verificou instabilidade hemodinâmica grave. No pós-operatório, observou-se boa evolução clínica com alta para o domicílio.
- Implementação de uma Unidade de Dor VascularPublication . Ramos, C; Vasconcelos, L; Mota Capitão, L; Fragata, IA preocupação em tratar adequadamente a dor dos doentes do Serviço de Angiologia e Cirurgia Vascular (SACV) do Hospital de Santa Marta levou ao desenvolvimento de uma estrutura organizada, destinada à optimização da analgesia peri-operatória. Pretendemos descrever neste artigo o processo de implementação da Unidade de Dor Vascular (UDV) do Hospital de Santa Marta, cujo projecto se iniciou em 2003 e que viria a culminar na sua inauguração em Janeiro de 2005.
- Pré-Eclâmpsia Grave. Gravidade Relacionada com Idade GestacionalPublication . Ribeiro, F; Júlio, C; Lermann, R; Reis, J; Bettencourt, B; Ramos, C; Tomé, T; Dias, E; Campos, AA pré-eclâmpsia (PE) complica 3% das gestações. Nas suas formas mais graves é responsável por importante morbilidade e mortalidade materna e fetal. Neste estudo de 126 gravidezes com PE grave após as 24 semanas, pretendeu-se avaliar se a precocidade da instalação do quadro clínico esteve associada a maior morbilidade materna e perinatal. Formaram-se dois grupos de acordo com a idade gestacional no parto - antes e após as 32 semanas (Grupo 1 e 2, respectivamente). Foram avaliadas 49 gravidezes no grupo 1 e 77 gravidezes no grupo 2. Verificou-se maior incidência de sintomatologia clínica, alterações laboratoriais indicadoras de gravidade clínica, dados ecográficos sugestivos de compromisso fetal e risco relativo para recém-nascido leve para idade gestacional, asfixia neonatal e síndrome de dificuldade respiratória no grupo 1. Não se encontraram diferenças na mortalidade materna. A PE grave com parto antes das 32 semanas de gestação associou-se a maior deterioração da condição clínica materna, restrição de crescimento intra-uterino, fluxometria doppler fetal patológica e asfixia neonatal.
- Prognostic Value of VEGF in Patients Submitted to Percutaneous Coronary InterventionPublication . Ramos, C; Napoleão, P; Selas, M; Freixo, C; Viegas Crespo, AM; Mota Carmo, M; Cruz Ferreira, R; Pinheiro, TWe examined the longitudinal changes of VEGF levels after percutaneous coronary intervention for predicting major adverse cardiac events (MACE) in coronary artery disease (CAD) patients. VEGF was measured in 94 CAD patients' serum before revascularization, 1-month and 1-year after. Independently of clinical presentation, patients had lower VEGF concentration than a cohort of healthy subjects (median, IQ: 15.9, 9.0-264 pg/mL versus 419, 212-758 pg/mL; P < 0.001) at baseline. VEGF increased to 1-month (median, IQ: 276, 167-498 pg/mL; P < 0.001) and remained steady to 1-year (median, IQ: 320, 173-497 pg/mL; P < 0.001) approaching control levels. Drug eluting stent apposition and previous medication intake produced a less steep VEGF evolution after intervention (P < 0.05). Baseline VEGF concentration <40.8 pg/mL conveyed increased risk for MACE in a 5-year follow-up. Results reflect a positive role of VEGF in recovery and support its importance in CAD prognosis.