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- Veggies4myHeart – educational project to promote vegetable knowledge and consumption in preschoolersPublication . Novo, R; Edra, J; Vieito, L; Dias, S. Simões; Lages, M; Guarino, M P; Braga-Pontes, CVegetable consumption among children is below recommended. Given the critical role of vegetable consumption in health promotion, it is essential to identify effective strategies to promote this intake. The Veggies4myHeart project aims to increase vegetable knowledge and consumption in preschool children through nutrition education strategies (NES). Veggies4myHeart is a prospective longitudinal study with children aged 2 to 6 years who attend preschools in the Leiria district. A questionnaire was applied to the parents to characterize the sample. NES were used: children’s story, digital game, vegetable-themed sticker booklet and the food wheel. The intervention consisted of 5 food education sessions, each focusing on one selected vegetable (lettuce, carrot, red cabbage, cucumber, and tomato). Sessions to assess knowledge and consumption of vegetables were held pre-and post-intervention. Knowledge was evaluated through a taxonomic categorization questionnaire. Consumption was assessed by recording the number of portions of each vegetable consumed. Wilcoxon test was used to compare pre-and post-intervention vegetable knowledge and consumption. ANOVA test was used to compare NES. Between 2018 and 2024, 649 children (52,5% female, mean age 4,36 ± 0,942) from 17 preschools participated. After the intervention, there was a statistically significant increase in vegetable knowledge (p < 0,001) and a statistically significant increase in the consumption of vegetables (p < 0,001). There are statistically significant differences between NES, with the digital game having greater vegetable knowledge (p < 0,001) and consumption (p < 0,001) than the others. The Veggies4myHeart project effectively increased vegetable knowledge and consumption in preschoolers. It is essential to continue the intervention to promote consumption and familiarity with vegetables, as well as the involvement of parents and preschool teachers, due to their prominent role as models for acquiring healthy eating habits.
- Anastomotic Leak in Colorectal Cancer Surgery: From Diagnosis to Management or Failure - A Retrospective Cohort StudyPublication . Rama, Nuno; Parente, Diana; Silva, Cândida G.; Neves, Miguel; Figueiredo, Nuno; Alves, Paulo; Amado, Sandra; Lourenço, Óscar; Guarino, Maria Pedro; Rocha, Anabela; Castro-Poças, Fernando; Pimentel, JoãoAnastomotic leakage (AL) after colorectal resections is a common surgical experience and the most frequent major adverse outcome. Early recognition of AL is critical to reduce mortality. We aim to evaluate the incidence, diagnostic criteria, morbidity, and mortality related with AL.
- A Review of Wearable Sensor Patches for Patient MonitoringPublication . Santos, Sónia; Guarino, Maria Pedro; Neves, Sandra; Lopes, Nuno VieiraWearable sensor patches are potent tools for patient monitoring in hospital care, with a particular focus on the Emergency Department waiting areas. They can enhance patient safety by alerting healthcare professionals to abnormal changes in vital physiological signals. Wearable sensors have been shown to be useful in monitoring patients’ vital signs continuously and in real-time in emergency rooms. However, there are still some challenges that need to be addressed before they can be widely adopted in emergency rooms. Some of these challenges include sensor stability with minimized signal drift, on-body sensor reusability, and long-term continuous health monitoring. This paper reviews wearable sensor patches that have the potential for use in hospital patient monitoring, considering the key variables monitored in emergency rooms. Eligible patches must be wearable, present at least one approval (CE or FDA), and measure more than one physiological parameter.
- Bioelectronic modulation of carotid sinus nerve to treat type 2 diabetes: current knowledge and future perspectivesPublication . Conde, Silvia V.; Sacramento, Joana F.; Zinno, Ciro; Mazzoni, Alberto; Micera, Silvestro; Guarino, Maria P.Bioelectronic medicine are an emerging class of treatments aiming to modulate body nervous activity to correct pathological conditions and restore health. Recently, it was shown that the high frequency electrical neuromodulation of the carotid sinus nerve (CSN), a small branch of the glossopharyngeal nerve that connects the carotid body (CB) to the brain, restores metabolic function in type 2 diabetes (T2D) animal models highlighting its potential as a new therapeutic modality to treat metabolic diseases in humans. In this manuscript, we review the current knowledge supporting the use of neuromodulation of the CSN to treat T2D and discuss the future perspectives for its clinical application. Firstly, we review in a concise manner the role of CB chemoreceptors and of CSN in the pathogenesis of metabolic diseases. Secondly, we describe the findings supporting the potential therapeutic use of the neuromodulation of CSN to treat T2D, as well as the feasibility and reversibility of this approach. A third section is devoted to point up the advances in the neural decoding of CSN activity, in particular in metabolic disease states, that will allow the development of closed-loop approaches to deliver personalized and adjustable treatments with minimal side effects. And finally, we discuss the findings supporting the assessment of CB activity in metabolic disease patients to screen the individuals that will benefit therapeutically from this bioelectronic approach in the future.
- Descodificar sinais de sensores de oxigénio para diagnosticar...diabetesPublication . Guarino, Maria Pedro
- Co-designing a monitoring system to support patient safety in emergency carePublication . Neves, Sandra; Guarino, Maria PedroGoing to a hospital can be a stressful and anxious experience for many patients, particularly those needing emergency care. These individuals are more likely to wait long hours to be treated, admitted, or discharged. Portuguese emergency departments (EDs) are struggling to treat patients quickly and safely due to the increased number of patients going into Eds (Brazão et al. 2016). This situation highlights concerns about patients’ safety issues and their implications for timely detection of clinical deterioration in patients during their waiting times in EDs. Identifying signs of clinical deterioration at the earliest stages can allow for prompt intervention that can significantly impact on patient outcomes, especially in emergency care settings where patients’ health conditions can deteriorate quickly. However, the available resources are limited, and innovative approaches to support clinical practice are required.
- 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.
- Casos clínicosPublication . Pontes, Cátia; Guarino, Maria
- 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.