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- CBmeter study: Protocol for assessing the predictive value of peripheral chemoreceptor overactivation for metabolic diseasesPublication . Lages, Marlene; Carvalho, Lucinda; Feijó, Salvato; Vieira, Alexandra; Fonseca-Pinto, Rui; Guarino, Maria PedroEarly screening of metabolic diseases is crucial since continued undiagnostic places an ever-increasing burden on healthcare systems. Recent studies suggest a link between overactivated carotid bodies (CB) and the genesis of type 2 diabetes mellitus. The non-invasive assessment of CB activity by measuring ventilatory, cardiac and metabolic responses to challenge tests may have predictive value for metabolic diseases; however, there are no commercially available devices that assess CB activity. The findings of the CBmeter study will clarify the role of the CBs in the genesis of—metabolic diseases and guide the development of new therapeutic approaches for early intervention in metabolic disturbances. Results may also contribute to patient classification and stratification for future CB modulatory interventions.
- mHealth Applications to Monitor Lifestyle Behaviors and Circadian Rhythm in Clinical Settings: Current Perspective and Future DirectionsPublication . Rosa, Iolanda; Lages, Marlene; Grilo, Carlos; Barros, Renata; Guarino, Maria P.Metabolic diseases are a global rising health burden, mainly due to the deleterious interaction of current lifestyles with the underlying biology of these diseases. Daily habits and behaviors, such as diet, sleep, and physical exercise impact the whole-body circadian system through the synchronization of the peripheral body clocks that contribute to metabolic homeostasis. The disruption of this system may promote the development of metabolic diseases, including obesity and diabetes, emphasizing the importance of assessing and monitoring variables that affect circadian rhythms. Advances in technology are generating innovative resources and tools for health care management and patient monitoring, particularly important for chronic conditions. The use of mobile health technologies, known as mHealth, is increasing and these approaches are contributing to aiding both patients and healthcare professionals in disease management and education. The mHealth solutions allow continuous monitoring of patients, sharing relevant information and data with physicians and other healthcare professionals and accessing education resources to support informed decisions. Thus, if properly used, these tools empower patients and help them to adopt healthier lifestyles. This article aims to give an overview of the influence of circadian rhythms disruption and lifestyle habits in the progression of metabolic diseases while also reviewing some of the mobile applications available to monitor lifestyle behaviors and individual chronobiology. Herein is also described the design and development of the NutriClock system, an mHealth solution developed by our team to monitor these variables.
- Aceitação de um programa mHealth para prevenção da obesidade em adolescentes: estudo misto sequencialPublication . Sousa, Pedro Miguel Lopes; Ferreira, Inês; Filipe, Maria; Guerra, Patrick; Ferreira, Raquel; Lages, Marlene; Dixe, Maria dos AnjosA área da saúde tem-se adaptado ao uso de tecnologia, recorrendo a esta como um aliado relevante em programas de monitorização e prevenção da obesidade e problemas associados. Objetivo: Avaliar a aceitação do programa e-terapêutico TeenPower em adolescentes
- Usefulness of serum C-reactive protein and calprotectin for the early detection of colorectal anastomotic leakage: A prospective observational studyPublication . Rama, Nuno J G; Lages, Marlene C C; Guarino, Maria Pedro S; Lourenço, Óscar; Motta Lima, Patrícia C; Parente, Diana; Silva, Cândida S G; Castro, Ricardo; Bento, Ana; Rocha, Anabela; Castro-Pocas, Fernando; Pimentel, JoãoBACKGROUND: Colorectal anastomotic leakage (CAL) is one of the most dreaded complications after colorectal surgery, with an incidence that can be as high as 27%. This event is associated with increased morbidity and mortality; therefore, its early diagnosis is crucial to reduce clinical consequences and costs. Some biomarkers have been suggested as laboratory tools for the diagnosis of CAL. AIM: To assess the usefulness of plasma C-reactive protein (CRP) and calprotectin (CLP) as early predictors of CAL. METHODS: A prospective monocentric observational study was conducted including patients who underwent colorectal resection with anastomosis, from March 2017 to August 2019. Patients were divided into three groups: G1 – no complications; G2 – complications not related to CAL; and G3 – CAL. Five biomarkers were measured and analyzed in the first 5 postoperative days (PODs), namely white blood cell (WBC) count, eosinophil cell count (ECC), CRP, CLP, and procalcitonin (PCT). Clinical criteria, such as abdominal pain and clinical condition, were also assessed. The correlation between biomarkers and CAL was evaluated. Receiver operating characteristic (ROC) curve analysis was used to compare the accuracy of these biomarkers as predictors of CAL, and the area under the ROC curve (AUROC), specificity, sensitivity, positive predictive value, and negative predictive value (NPV) during this period were estimated. RESULTS: In total, 25 of 396 patients developed CAL (6.3%), and the mean time for this diagnosis was 9.0 ± 6.8 d. Some operative characteristics, such as surgical approach, blood loss, intraoperative complications, and duration of the procedure, were notably related to the development of CAL. The length of hospital stay was markedly higher in the group that developed CAL compared with the group with complications other than CAL and the group with no complications (median of 21 d vs 13 d and 7 d respectively; P < 0.001). For abdominal pain, the best predictive performance was on POD4 and POD5, with the largest AUROC of 0.84 on POD4. Worsening of the clinical condition was associated with the diagnosis of CAL, presenting a higher predictive effect on POD5, with an AUROC of 0.9. WBC and ECC showed better predictive effects on POD5 (AUROC = 0.62 and 0.7, respectively). Those markers also presented a high NPV (94%-98%). PCT had the best predictive effect on POD5 (AUROC = 0.61), although it presented low accuracy. However, this biomarker revealed a high NPV on POD3, POD4, and POD5 (96%, 95%, and 96%, respectively). The mean CRP value on POD5 was significantly higher in the group that developed CAL compared with the group without complications (195.5 ± 139.9 mg/L vs 59.5 ± 43.4 mg/L; P < 0.00001). On POD5, CRP had a NPV of 98%. The mean CLP value on POD3 was significantly higher in G3 compared with G1 (5.26 ± 3.58 μg/mL vs 11.52 ± 6.81 μg/mL; P < 0.00005). On POD3, the combination of CLP and CRP values showed a high diagnostic accuracy (AUROC = 0.82), providing a 5.2 d reduction in the time to CAL diagnosis. CONCLUSION: CRP and CLP are moderate predictors of CAL. However, the combination of these biomarkers presents an increased diagnostic accuracy, potentially decreasing the time to CAL diagnosis.
- Mixed meal tolerance test as a screening method for gestational diabetes: A narrative reviewPublication . Pragosa, Caroline; Lages, Marlene; Pereira, Cidália; Guarino, Maria PedroThe oral glucose tolerance test is, to this day, the gold standard method to screen for gestational diabetes mellitus, even though it can cause various side effects. To outcome this problem, a few studies have tested the use of a Mixed Meal Tolerance Test in pregnant women as an alternative to the glucose load, which are reviewed in this article. After analyzing these studies, it can be concluded that the Mixed Meal Tolerance Test could be a viable alternative to the gold standard, although further studies should be conducted.
- Veggies4myHeart— A digital game to promote vegetable consumption in preschool childrenPublication . Pereira Braga Pontes, Cátia Sofia; Dias, Sara Simões; Lages, Marlene; Guarino, Maria Pedro; Graça, AntónioVegetable consumption is particularly low in childhood and is one of the main concerns about diet in this age range. Vegetable consumption is associated with better cardiovascular health and the prevention of other chronic non-communicable diseases. Therefore, it is important to find strategies to promote vegetable consumption at early ages, since eating habits established in childhood tend to persist into adulthood. The purpose of this study is to evaluate the impact of using a digital game on knowledge about vegetables and his consumption, in preschool children.
- Development of a mixed-meal that impacts carotid-body mediated cardiorespiratory and metabolic parameters - a pilot studyPublication . Frazão, Ana; Costa, Andreia; Teixeira, Bárbara; Santo, Marisa; Brito, Gabriel; Lages, Marlene; Lopes, Nuno Vieira; Fonseca-Pinto, Rui; Pereira, Cidália; Guarino, Maria PedroThe carotid bodies (CB) have been recently implicated in the genesis of metabolic diseases in animal models. The CBs respond to circulating insulin to increase heart rate, respiratory rate and blood glucose levels. In humans, this mechanism is not well characterized.
- Assessing autonomic control of metabolic syndrome by principal component analysis: a data driven methodologyPublication . Fonseca-Pinto, Rui; Lopes, Nuno Vieira; Brito, Gabriel; Lages, Marlene; Guarino, Maria PedroMetabolic diseases are one of the leading causes of death worldwide. Due to its lack of clinical manifestations for long periods, metabolic diseases are generally detected in advanced stages, when the risk of cardiovascular, ocular and renal complications is high. Thus, early detection of these disorders is essential to design effective health promotion strategies. Herein we provide a preliminary approach for the early diagnosis of metabolic diseases based on Principal Component Analysis (PCA) of autonomic features of sympathovagal Balance (SVB) to characterize the activity of the carotid bodies (CB). CBs are small chemoreceptors located in the bifurcation of the carotid arteries whose overactivation is intimately linked to early stages of metabolic disease through asymptomatic deregulation of the sympathetic nervous system. Herein we discuss parameters that can be extracted from these recordings using a PCA approach in response to two different challenge tests: 100% oxygen and administration of a mixed meal in healthy and type 2 diabetes volunteers. This methodology may represent a paradigm shift in the diagnosis of metabolic diseases through the characterization of CB activity, and aims to bridge the existing gap in early assessment of metabolic dysfunction.
- The NutriClock Study Protocol - Assessing the Impact of a Chrononutrition Intervention in Patients With Cardiometabolic DisturbancesPublication . Lages, Marlene; Gaspar, Laetitia; Carmo-Silva, Sara; Frontini, Roberta; Álvaro, Ana; Cavadas, Cláudia; Fonseca, Rui; Barros, Renata; Guarino, Maria Pedro; Moreira, Pedro
- The Usefulness of Inflammatory Biomarkers to Predict Anastomotic Leakage after Colorectal Surgery: Systematic Review and Meta-AnalysisPublication . Rama, Nuno; Lages, Marlene C. C.; G. Silva, Cândida; Motta Lima, Patrícia; Campos Gil, Inês; Guarino, Maria; Oliveira, P.; Dixe, Maria; A, Rocha; Castro-Poças, Fernando; Pimentel, JoãoAim: Anastomotic leakage (AL) is a severe postoperative complication in colorectal surgery, but its preclinical diagnosis may improve outcomes and increase anastomotic salvage. This study aimed to assess the added value of serum biomarkers for early detection of colorectal AL. Method: We performed a comprehensive literature review, and a qualitative and quantitative analysis of papers retrieved from MEDLINE, Embase, PubMed, Web of Science, Scopus and the Cochrane Library. We included all studies published before September 2021 assessing the serum biomarkers white blood cells (WBC), C-reactive protein (CRP), procalcitonin (PCT) and calprotectin (CLP) for the early diagnosis of AL. Results: Fifteen studies that evaluated three different systemic biomarkers in the context of AL were identified, including 5150 patients. Diagnostic test accuracy was estimated for CRP and PCT. On postoperative day (POD) 5, the highest AUC (87.1%) and specificity (80.2%) values were estimated for CRP. Random-effects meta-analysis and total effect sizes estimation for the biomarkers CRP, PCT and WBC were performed according to POD. The concentration of serum biomarkers is significantly higher in patients presenting AL. Regarding the qualitative analysis, there was significant heterogeneity in the inclusion of different subcategories of the consensus definition of colorectal AL in each paper’s definition. Conclusion: The serum biomarkers CRP and PCT are moderate predictors for AL, showing a high heterogeneity among the studies. Combinations of these biomarkers might improve predictive accuracy, but more studies will be necessary to conduct a quality metaregression.