Departamento de Promoção da Saúde e Prevenção de Doenças Não Transmissíveis
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- Alle Frequency Distribution Of Clinicaly Relevant Pharmacogenetic Variants In Genes With CPIC Guidelines Across European Populations: A Scoping ReviewPublication . Simões, Raquel; Cardoso, Maria Luis; Martiniano, Hugo F. M. C.; Vicente, Astrid MouraIntroduction: Pharmacogenetics (PGx) is the study of how genetic variants affect drug response. PGx variants can affect either pharmacokinetics – the processes of drug absorption, distribution, metabolism, and elimination – or pharmacodynamics – the biochemical and physiological effects of drugs and their mechanisms of action. Pharmacokinetics gene variants often define haplotypes, which are described using the star (*) allele nomenclature for genes such as those in the Cytochrome P450 (CYP450) family. This results in phenotypes of normal, rapid, ultrarapid, or poor metabolisers, leading to various drug responses (1). In recognition of the importance of understanding the clinical impact of PGx variants, the Clinical Pharmacogenetics Implementation Consortium (CPIC) has developed guidelines that translate PGx test results into clinical recommendations for drug selection and dosing (2). Reports in the literature on ancestry‑related differences in drug response highlight the need for a broader investigation of PGx variants, namely in CYP450 genes, across diverse groups(3).
- Allele frequency distribution of clinically relevant pharmacogenetic variants across European populations: A Scoping ReviewPublication . Simões, Raquel D.; Cardoso, Maria L.; Martiniano, Hugo F. M. C.; Vicente, Astrid M.Review of the literature on the distribution of pharmacogenetic variants in European populations.. Pharmacogenetics (PGx) is the study of how genetic variants affect drug metabolism, transport and target interactions, impacting efficacy and risk of adverse reactions. PGx variants can affect either pharmacokinetics – the processes of drug absorption, distribution, metabolism and elimination of drugs -or pharmacodynamics - the biochemical and physiological effects of drugs and their mechanisms of action. Pharmacokinetics gene variants often define haplotypes, which are described using the star (*) allele nomenclature for genes such as those in the Cytochrome P450 (CYP450) family. This results in phenotypes of normal, rapid, ultrarapid or poor metabolisers, leading to various drug responses 1. In recognition of the importance of understanding the clinical impact of PGx variants, the Clinical Pharmacogenetics Implementation Consortium (CPIC) has developed guidelines that translate PGx test results into clinical recommendations for drug dosing 2. Reports in the literature of ancestrality differences in drug response highlight the need for a broader investigation of PGx variants, namely in CYP450 genes, across diverse groups.
- Application of a Pilot Screening Program for Familial Hypercholesterolemia in a High-Complexity Hospital CenterPublication . Radojkovic, Claudia; Honorato, Paula; Portiño, René; Martínez, Catalina; Saez, Katia; Bourbon, Mafalda; Muñoz, Isabel; Alvarado, Cristóbal; Guzmán, Enrique; Bustos, Paulina; Alonso, Rodrigo; Sánchez, AndreaOne of the current challenges is the early identification of patients with Familial Hypercholesterolemia (FH) through clinical diagnosis and genetic analysis to initiate treatment and prevent the development of atherosclerotic disease. Aim: To describe the results of a pilot program for opportunistic screening of Familial Hypercholesterolemia index cases in a highly complex hospital laboratory. Materials and methods: Retrospective cross-sectional convenience recruitment study. Search for patients with clinical suspicion of FH was conducted by analyzing the lipid profile of users from the Las Higueras Hospital of Talcahuano, between 2019 and 2021. Patients were selected and stratified according to LDL-C concentrations using the Dutch Lipid Clinic Network (DLCN) Criteria. Patients with a DLCN score >6 were selected as candidates for genetic diagnosis. Results: 36,804 lipid profiles were obtained, of which 19,021 corresponded to a unique lipid profile per patient. After applying the exclusion criteria, 98 patients suspected of FH. According to the DLCN criteria, 5 patients were stratified with a definitive clinical diagnosis (DLCN ≥8) and 4 with a probable diagnosis of FH (DLCN 6-7). In 4 of the 6 patients who were contacted, 3 genetic variants associated with FH were identified. Conclusion: This work corresponds to the first report on the application of an FH screening program in a highly complex hospital center in Chile and allowed the definitive diagnosis of pediatric and adult patients with FH. These results demonstrate the importance of implementing an opportunistic screening program and performing genetic analysis for FH variants to a definitive diagnosis.
- Bridging Genetic Insights with Neuroimaging in Autism Spectrum Disorder - A Systematic ReviewPublication . Vilela, Joana; Rasga, Célia; Santos, João Xavier; Martiniano, Hugo; Marques, Ana Rita; Oliveira, Guiomar; Vicente, Astrid Moura; MDPIAutism Spectrum Disorder (ASD) is an early onset neurodevelopmental disorder characterized by impaired social interaction and communication, and repetitive patterns of behavior. Family studies show that ASD is highly heritable, and hundreds of genes have previously been implicated in the disorder; however, the etiology is still not fully clear. Brain imaging and electroencephalography (EEG) are key techniques that study alterations in brain structure and function. Combined with genetic analysis, these techniques have the potential to help in the clarification of the neurobiological mechanisms contributing to ASD and help in defining novel therapeutic targets. To further understand what is known today regarding the impact of genetic variants in the brain alterations observed in individuals with ASD, a systematic review was carried out using Pubmed and EBSCO databases and following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. This review shows that specific genetic variants and altered patterns of gene expression in individuals with ASD may have an effect on brain circuits associated with face processing and social cognition, and contribute to excitation–inhibition imbalances and to anomalies in brain volumes.
- Classification of genetic variants for clinical use – the case of Familial Hypercholesterolemia (Part 2) - How to classify LDLR variantsPublication . Chora, Joana RitaLecture on the Classification of Genetic Variants for Clinical Use – The Case of Familial Hypercholesterolemia (Part 2): How to Classify LDLR Variants, presented within the framework of Genetics and Genomics in Clinical Practice: Advanced Training. This advanced course is aimed at healthcare professionals seeking to understand, interpret, and apply genomic information in clinical practice in a critical, ethical, and effective manner, particularly physicians and professionals with a background in life sciences.
- Classification of genetic variants for clinical use – the case of Familial Hypercholesterolemia (part I)Publication . Bourbon, MafaldaLecture on the Classification of genetic variants for clinical use – the case of Familial Hypercholesterolemia (part I), presented within the framework of Genetics and Genomics in Clinical Practice: Advanced Training. This advanced course is aimed at healthcare professionals seeking to understand, interpret, and apply genomic information in clinical practice in a critical, ethical, and effective manner, particularly physicians and professionals with a background in life sciences.
- DLCN-PED – A New Proposal For Clinical Diagnosis Of Children And Young People With FHPublication . Miranda, Beatriz; Kafol, Jan; Humphries, Steve E.; Freiberger, Tomas; Medeiros, Ana Margarida; Sikonja, Jaka; Alves, Ana Catarina; Groselj, Urh; Bourbon, MafaldaFamilial hypercholesterolemia (FH) is a genetic disorder characterized by high cholesterol levels, and premature cardiovascular disease (CVD). The most used clinical diagnostic criteria to identify FH are the Dutch Lipid Clinic Network-(DLCN) and Simon Broome-(SB), being SB the only with specific criteria for children. This work aims to propose an adaptation of DLCN criteria, for children and young people (DLCN-PED) and assess the performance of this adaptation in the Portuguese and Slovenian FH registries. DLCN-PED includes data on clinical examinations, lipid profile, familial history of CVD and hypercholesterolemia. We propose that those with a DLCN-PED score3 should be referred for genetic testing. Index cases included were studied with an NGS panel including at least the three FH-causing genes prior to evaluation with DLCN-PED This work includes 1696 patients (Portugal=340, Slovenia=1356): 29% FH-positives (presenting likely pathogenic/pathogenic variants in FH genes), 71% FH-negatives (no detection of pathogenic variants). Individuals with variants of uncertain significance were not included. Scores had a range between 0-17, 58% presenting a score between 2-4. Across DLCN-PED scores, we observe a distribution overlap for both FH groups: FH-negatives from 0-8 and FH-positives from 0-17. Overall, DLCN-PED3 presents higher sensitivity compared to SB (93% vs 81%) and slightly lower specificity (55% vs 79%). DLCN-PED6 presents lower sensitivity compared to SB (67% vs 81%) but an enhanced specificity (91% vs 79%). The different analysis suggests that score cutoffs should be adapted according to the screening approach intended (sensitivity and specificity trade-off). Compared to DLCN, the DLCN-PED shows an improved performance (p-value=0.024). Given the crucial role of clinical diagnosis in FH identification, we have shown that the proposed DLCN-PED performs better than the general DLCN and is similar to SB with the advantage that is possible to personalize the cut offs and so it could improve FH assessment worldwide.
- Editorial: Empowering Early Career Researchers In Psychiatry: Advancing Autism ResearchPublication . Caruso, Angela; Rasga, Célia; Fulceri, Francesca; Scattoni, Maria Luisa; Micai, MartinaNo abstract available
- Estrogen Metabolism in Schistosomiasis-associated Cancer and InfertilityPublication . Botelho, MónicaCommunication on estrogen metabolism in cancer and schistosomiasis-associated infertility.
- Evaluating Clinical Markers To Improve Selection Of Diabetes Patients For Genetic TestingPublication . Vaz, Margarida; Gaspar, Gisela; Dario, Paulo; Bourbon, MafaldaMaturity-Onset Diabetes of the Young (MODY) is a monogenic form of diabetes caused by variants in one of 14 genes, each affecting glucose metabolism differently and leading to heterogeneous clinical presentations. Because of this variability, MODY is frequently misdiagnosed as type 1 or type 2 diabetes. In this work, the aim was to characterize patients with and without pathogenic MODY variants among participants of the Molecular Study of Monogenic Diabetes. Clinical data—age at diagnosis, blood glucose, HbA1c, and C-peptide—were analyzed using statistical tests (Shapiro and Wilcoxon). Among these parameters, only age at diagnosis differed significantly, with MODY patients being diagnosed earlier, likely due to the high prevalence of GCK-MODY in the cohort. C-peptide levels were within normal ranges in both groups. The study concludes that these common clinical markers are insufficient to reliably identify MODY cases, emphasizing the need for additional biomarkers and highlighting genetic testing as the only definitive diagnostic tool