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- Non-pharmacological interventions modulating immune response in Parkinson's disease : where do we stand for future preventive approachesPublication . Pirovano, Elenamaria; Silva, Inês P.; Camacho, Marta; Çanak, Asuman; Aktas, Busra; Crompton, David; Gökçe, Evrim; Tan, Fu-Miao; Marino, Franca; Domingos, Josefa; Almeida, Mafalda F.; Comi, Cristoforo; Dragic, Milorad; Figueira, InêsParkinson's disease (PD) imposes a growing socioeconomic burden due to its increasing prevalence and lack of a cure. Existing treatment options primarily manage motor and nonmotor symptoms but do not halt or slow disease progression, underscoring the urgent need for more effective and preventative strategies. Growing evidence suggests a strong link between immune system dysfunction, chronic inflammation, and the early pathogenesis of Parkinson's disease, often occurring years before the onset of motor symptoms, thereby indicating a critical window for early intervention. In this review, we examine current evidence on non-pharmacological approaches such as dietary changes, physical activity, and gut microbiome regulation, focusing on their potential to modulate both peripheral and central immune responses, thereby influencing the progression of PD. Besides being complementary to standard pharmacological treatments, these approaches not only reduce systemic inflammation but may also help delay, prevent, or improve clinical management of PD by targeting and modulating its immunological foundations.
- European Society of Clinical Pharmacy : bridging gaps—clinical pharmacy in the digital transition of carePublication . Guerreiro, Mara Pereira; Paulino, Ema
- Age-related differences in the presentation, management, and outcomes of lower gastrointestinal bleeding : a retrospective multinational cohort studyPublication . Vara-Luiz, Francisco; Palma, Carolina; Mascarenhas, Paulo; Tham, Tony C.; Arvanitakis, Marianna; Rodriguez-de-Santiago, Enrique; Pedroto, Isabel; Simas, Diogo; Radaelli, Franco; Camus, Marine; Gkolfakis, Paraskevas; Triantafyllou, Konstantinos; Fabbri, Carlo; Patita, Marta; Tan, Erica; Campbell, Ellen; Smyth, Michael; Beattie, Hannah; Seeruthun, Ravish; Hadefi, Alia; Rodríguez-Francisco, Gabriela; Paulo, João Pedro; Gonçalves, Luísa; Caetano, Isabel; Savino, Alberto; Goudot, Marie; Panagaki, Antonia; Koukoulioti, Eleni; Nikolaki, Maroulla; Gibiino, Giulia; Gattuso, Alberto; Mendes, Ivo; Piçarra, Francisco; Fonseca, JorgeBackground: Population ageing in Europe is reshaping the clinical profile and outcomes of lower gastrointestinal bleeding (LGIB), but age-related comparative data remain scarce. We aimed to compare clinical presentation, management and 30-day outcomes between older and younger adults with LGIB. Methods: This retrospective, multinational, cohort study included consecutive adults presenting to emergency departments with LGIB between January 1 and December 31 in 2024. European hospitals routinely managing LGIB were eligible to participate. Ethical approval was obtained at hospital level. Patients were categorised in two age groups (≥65 and <65 years). The primary outcome was 30-day mortality. Findings: Overall, 1058 patients from 11 centres in seven European countries were included. Of these, 77.3% (818/1058) were aged ≥65 years and demonstrated a higher Oakland (21.0 ± 7.15), ABC (4.0 ± 2.9), and ALIBI (8.94 ± 3.7) scores, and a higher transfusion rate (50.9%, 416/818). Aetiology differed by age, with anorectal and inflammatory bowel diseases more common in younger adults and diverticular bleeding predominating in older patients. Endoscopy was performed in most patients (84.9%, 899/1058) and the rates of endoscopic therapy, interventional radiology, and surgery were similar across groups. Overall, 30-day mortality was 11.7% (124/1058) and was higher in older adults (13.7%, 112/818 versus 5.0%, 12/240), mainly due to non-bleeding-related causes (89.3%, 100/112). In multivariable analyses, ALIBI score (OR = 1.26 per-point, 95% CI 1.14–1.39), ABC score (OR = 1.25 per-point, 95% CI 1.15–1.36), and Charlson Comorbidity Index (OR = 1.25 per-point, 95% CI 1.14–1.37) were independently associated with 30-day mortality (p < 0.001). Age was inversely associated with intensive care unit admission (OR = 0.95 per-year, 95% CI 0.92–0.98; p = 0.0028). Interpretation: LGIB in older adults presents distinct clinical features with more severe bleeding. Higher baseline vulnerability might explain the age-related differences in escalation of care and worse outcomes. This supports the need for better integrated pathways of care in ageing European populations.
- Oral health, polypharmacy and nutritional status in institutionalized dementia patients : a multicenter cross-sectional studyPublication . Pombo-Lopes, Joana; Sousa-Catita, Diogo; Mascarenhas, Paulo; Fonseca, Jorge; Grillo-Evangelista, JoséBackground: As the population ages, dementia poses a critical public health challenge. This study examined the oral health and nutritional status of institutionalized Portuguese adults with dementia, exploring their interrelated predictors. Methods: This multicenter, cross-sectional study assessed institutionalized patients using the Decayed, Missing, and Filled Teeth (DMFT) index, posterior functional units (PFUs), plaque (PI) and gingival (GI) indices, the Short Xerostomia Inventory (SXI-5), and the Mini Nutritional Assessment (MNA). DMFT was modeled using multivariable ordinary least squares (OLS) regression for demographic and clinical predictors and separate negative binomial models for medication-related predictors. Other outcomes were analyzed using outcome-specific multivariable models. Results: The study included 71 participants (mean age: 82.5 ± 6.9 years). A high dental disease burden (mean DMFT score of 24.3 ± 7.5) was observed, independently predicted by advanced age (β = 0.48, p = 0.002) and residence in public long-term care units (LTCUs) (β = 6.65, p = 0.001). Total edentulism affected 28.2% of the sample. Polypharmacy emerged as a significant predictor of tooth loss; each additional medication was associated with an 18% decrease in the likelihood of retaining natural teeth (OR = 0.82, p = 0.008). Higher cognitive decline (GDS) was associated with increased plaque (p = 0.043), and modified-texture diets were associated with lower plaque levels (β = −0.64, p = 0.021). The mean MNA score (16.9 ± 3.8) indicated a high risk of malnutrition, with a trend toward lower gingival inflammation with better nutritional status (p = 0.061). Conclusions: Institutionalized dementia patients face severe oral and nutritional risks associated with age, polypharmacy and institutional environment. This emphasizes the need for multidisciplinary protocols and caregiver training.
- Electromyographic activity of equine abdominal muscles during single and double riding in hippotherapyPublication . Lima, Liz R. S. de; Amorim, Cesar F.; Vieira, Marcus Fraga; Arnhold, Emmanuel; Scoz, Robson D.; Brandstetter, Luciana R. G.; Costa, Lara C. S.; Barcelos, Kate M. C.Background: Hippotherapy is a therapeutic intervention that uses the horse as a biomechanical and sensorimotor agent to promote rehabilitation in individuals with physical and neurological disabilities. Depending on patient needs, riding may be performed with a single rider or with double riding, in which a therapist accompanies the practitioner on the horse. However, the effects of these riding configurations on equine trunk muscle activity remain poorly understood, despite their relevance for both horse welfare and the quality of therapeutic stimuli delivered to the patient. Methods: Nine clinically healthy adult horses (mean body mass: 388 kg) routinely employed in hippotherapy were evaluated. Two healthy female physiotherapists trained in hippotherapy (26 and 27 years; 50.9 and 51.3 kg) served as riders in all experimental conditions. Surface electromyography (sEMG) was recorded bilaterally from the Rectus Abdominis (RA) and External Oblique Abdominis (EOA) muscles during walking at a constant speed of 1.43 m/s under three randomized conditions: without rider (WR), single rider (R1), and double riding (R2). Each trial consisted of a 10-s stable walking period. Data were analyzed using randomized block ANOVA with Tukey’s post hoc tests and effect size estimates (Cohen’s d and Hedges’ g). Results: Compared with WR, double riding (R2) resulted in significantly greater activation of both RA and EOA muscles bilaterally (p < 0.05), with large effect sizes (g = 1.50–2.52). No significant differences were observed between R1 and WR when rider load did not exceed 14.75% of the horse’s body weight. Comparisons between R2 and R1 revealed asymmetric activation patterns, particularly increased activation of the left EOA and right RA muscles (p < 0.05; large effect sizes), suggesting compensatory neuromuscular strategies to maintain trunk stability under increased load and movement. Conclusions: Single riding with light loads does not substantially alter equine abdominal muscle activity during walking. In contrast, double riding increases muscular demand and induces asymmetric activation patterns, which may reflect compensatory mechanisms related to load magnitude, rider movement, and handling configuration. These findings have important implications for equine welfare and for optimizing therapeutic decision-making in hippotherapy practice.
- Effectiveness of oral feeding methods in preterm infants : a systematic review of the literaturePublication . Brantes, Ana Lúcia Gonçalves; Curado, Maria Alice dos Santos; Marôco, João; Malheiro, Maria IsabelBackground: The autonomy of the preterm infant depends not only on the total daily intake over 24 h but also on the absence of hemodynamic instability, however subtle, and on the lack of signs of neurobehavioral stress. Feeding autonomy, combined with adequate and consistent weight gain, is a criterion for hospital discharge. As a nursing intervention, oral feeding requires responsible decision-making and the selection of the most appropriate feeding method to ensure adequate nutrition. Therefore, it is essential to understand how oral feeding methods promote feeding autonomy and consistent weight gain. Objective: To analyze the effectiveness of oral feeding methods in acquiring feeding autonomy and consistent weight gain in preterm infants admitted to the neonatology unit. Methods: PRISMA-P guidelines were followed. A three-stage search strategy was carried out, supported by MEDLINE, CINAHL, Cochrane Central Register of Controlled Trials, and MedicLatina electronic databases via the EBSCO platform; electronic databases SciELO and Scopus; and platforms Wiley Online Library, ScienceDirect, and PubMed, from 2015 to 2025. Quality of the included studies was assessed using standardized critical appraisal instruments from the Joanna Briggs Institute. The inclusion criteria for this systematic literature review followed the PICO framework. Eligible studies focused on feeding method interventions in preterm infants. Data extraction was independently performed by reviewers. Results: Six articles were included, 5 were randomized trials, and 1 was a cohort study. The most frequently studied feeding method was cup feeding (n = 6), followed by finger feeding (n = 4). Conclusions: The results of the different studies were inconsistent, showing significant variations and, in some cases, contradictory conclusions about the ideal method for transitioning to full oral feeding. It is therefore essential to consider the factors that influence the effectiveness of feeding methods, namely, oral motor skills, hemodynamic stability, complications that occur during feeding, and the nurse’s own experience.
- Confirmatory factor analysis of the original posttraumatic growth inventory (PTCI) in a cardiac surgery samplePublication . Amador, Débora Grübel; Castro, Elisa Kern de; Schmidt, Marcia MouraObjective: This study aimed to evaluate the psychometric properties of the Post-Traumatic Growth Inventory (ICPT), a 21-item version adapted to Portuguese. Methods: The sample consisted of 318 patients who underwent coronary artery bypass graft surgery between October 2022 and March 2024. Participants completed a socio-demographic and clinical questionnaire, the Self-Perceived Stress Scale (EPS-10). Results: The majority were male (77%), with a mean age of 64.75 years (SD = 9.53), White (93%), and married (70%). Most participants reported experiencing stress (72%) and had an average post-traumatic growth score of 73.9. Confirmatory factor analysis (CFA) supported the original five-factor model of the 21-item scale. Internal consistency estimates ranged from 0.56 to 0.81, with an overall Cronbach’s alpha of 0.90, indicating acceptable reliability. Structural equation modeling further confirmed the factor structure, yielding RMSEA = 0.046, TLI = 0.992, CFI = 0.993, and SRMR = 0.065, demonstrating good model fit. Conclusion: Overall, the results provide empirical support for the factor structure and reliability of the 21-item version of the ICPT, indicating its suitability for research in the context of chronic diseases.
- Tuning anticancer activity and antimicrobial response of ZnO nanoparticles through halogenosilane surface modificationPublication . Bușilă, Mariana; Tăbăcaru, Aurel; Botezatu, Andreea Veronica; Ceoromila, Alina-Mihaela; Moroșanu, Ana-Maria; Muazeia, Jeremias; Leitão, Jorge Humberto Gomes; Matos, António Pedro; Marques, FernandaSurface modification of zinc oxide nanoparticles (ZnO NPs) with organosilane capping agents represents an effective strategy to control their physicochemical and biological properties. In this work, we report for the first time the use of halogenosilanes, namely (3-chloropropyl)trimethoxysilane (CPTMS), (3-bromopropyl)trimethoxysilane (BPTMS) and (3-iodopropyl)trimethoxysilane (IPTMS), for the surface functionalization of ZnO NPs obtained by chemical precipitation. Structural and morphological characterization (PXRD, TEM, SEM-EDX and FTIR) confirmed successful surface modification and revealed a significant particle size reduction from ~31 nm for unmodified ZnO to ~8 nm for BPTMS-modified ZnO (ZnO_b). The biological evaluation showed that halogenosilane-modified ZnO NPs exhibit enhanced cytotoxic activity against prostate cancer cell lines (PC3 and 22Rv1), with ZnO_b displaying the highest activity, likely associated with improved cellular uptake and increased reactive oxygen species (ROS) generation. In contrast, antimicrobial assays revealed only moderate bactericidal effects against Escherichia coli and Staphylococcus aureus at relatively high concentrations (≥1250 µg mL−1), while no significant activity was observed against Pseudomonas aeruginosa, Burkholderia contaminans or Candida spp., within the tested range. These findings suggest that halogenosilane functionalization modulates the biological profile of ZnO nanoparticles by enhancing anticancer effects while also influencing microbiocidal activity, highlighting the role of surface chemistry in tuning biological selectivity. The present study supports the concept that rational surface engineering of ZnO-based nanoplatforms can be exploited to favor tumor-targeted activity over broad-spectrum antimicrobial effects, providing new perspectives for the design of application-oriented nanomaterials.
- Supercritical CO₂-assisted impregnation of triamcinolone acetonide into silicone-based soft contact lenses for enhanced ocular drug deliveryPublication . Silva, Diana C.; Gonçalves, Margarida; Ekoh, Elisabeth; Salema-Oom, Madalena; Serro, Ana Paula; Nobre, Beatriz P.Soft contact lenses (SCLs) have attracted increasing attention in the field of ocular drug delivery systems, owing to their potential to improve drug bioavailability in vivo. However, the incorporation of lipophilic drugs, constitutes a significant challenge through conventional soaking methods. Supercritical carbon dioxide (scCO₂), an environmentally friend solvent, has emerged as an efficient alternative for the development of delivery systems improving the impregnation of such drugs. In this work, scCO₂ impregnation (SCI) was employed to load silicone-based hydrogels for SCLs, with triamcinolone acetonide (TA), a lipophilic corticosteroid. Design of experiments was conducted using a full factorial design to identify the most significant experimental parameters affecting TA SCI, as well as to predict the experimental conditions that maximise SCI. In vitro release assays were carried out with materials loaded by SCI and by conventional soaking. The best performing materials were subjected to an extensive characterisation (thermal behaviour, and optical, physical, chemical and mechanical properties). The results confirmed that TA-loaded SCLs can be effectively prepared using the SCI process. The highest SCI yields were obtained with materials processed at 300 bar and 60 ºC, reaching a TA amount released of 10.12 ± 0.44 µg.mg−1 dry gel, which represents a 162.2% increase compared to the conventional soaking. SCI hydrogels showed suitable properties for the intended application. Overall, the SCI process proved to be both effective, with potential for further optimisation through condition refinement.
- Preclinical evaluation of Asparagus stipularis in a rat model of metabolic syndrome and development of its nanoencapsulated formPublication . Adouni, Khaoula; Zouaoui, Olfa; Brandão, Pedro; Rijo, Patrícia; Lima, Sofia A. Costa; Reis, Salette; Achour, LotfiContext: Asparagus stipularis Forssk decoction (ASD) has shown potential metabolic and antioxidant benefits, yet its effects on pancreatic dysfunction associated with metabolic syndrome remain insufficiently explored. Objective: The aim of this work was to assess the pancreatic protective properties of ASD in high-fructose diet (HFrD)-fed rats and to characterize ASD-loaded poly(lactic-co-glycolic acid) (PLGA) nanoparticles (NPs) as a delivery system to enhance its therapeutic potential. Methods: Rats were fed an HFrD and treated with ASD at two dose levels. Serum α-amylase and lipase activities were measured to assess digestive enzyme modulation. Pancreatic lipid peroxidation was quantified using thiobarbituric acid reactive substances (TBARS), while antioxidant enzyme activities, including superoxide dismutase, catalase, and glutathione peroxidase, were determined. Histopathological examination was performed to evaluate structural alterations in pancreatic tissues. ASD was encapsulated into PLGA NPs, and particle size, polydispersity index (PdI), zeta potential (ZP), and encapsulation efficiency (EE) were analyzed. Results: ASD significantly reduced serum α-amylase activity to 2285.3 ± 256.6 U/L (low dose) and 1846.4 ± 82.8 U/L (high dose) compared to HFrD controls. Serum lipase activity decreased by 13% and 18% at the respective doses. TBARS levels were markedly reduced, and antioxidant enzyme activities were restored to near-control levels. Histological analysis revealed improved β-cell morphology and reduced acinar degeneration. ASD-loaded PLGA NPs exhibited a mean size of 248 ± 5 nm, PdI of 0.13 ± 0.01, ZP of −24.7 ± 1.3 mV, and an EE of 75.5 ± 3.2%. Conclusion: ASD demonstrates significant pancreatic protective effects, and nanoencapsulation enhances its therapeutic promise for metabolic disorders.