Escola Superior de Saúde Egas Moniz

ABSTRACT This study presents an integrative approach to chronic disease and disability in a Portuguese nun who died in 1779. The aim is to interpret her condition by combining osteopathological and burial context evidence with written sources. It offers a concise example of how bringing these sources together can enhance pathological interpretation and support the reconstruction of soft tissue disease, disability, and the lived experience of disease in past populations. This older woman was exhumed from the Convent of Jesus in Setúbal, Portugal. Her atypical burial position, also noted in the convent chronicles, indicates the remains likely belong to Michaela Archangela do Ceo. Osteopathological analysis revealed several changes, including atheromas, while the burial showed a crouched position, presumably related to stroke sequelae. The chronicles describe lifelong frailty and disease, followed in later life by a stroke with right‐sided hemiplegia, pressure ulcers, and myiasis. Apart from the atheromas, which may be associated with the stroke, the skeletal changes show no correspondence with the signs reported in the account. The chronicles further document the attentive care she received, reflecting communal support within the convent, and the religious meaning of suffering. In conclusion, this case demonstrates the value of integrating multiple sources to interpret pathological conditions and the lived experience of disease, while emphasizing the relevance of soft tissue disease that leaves no skeletal trace. It also illustrates the careful application of retrospective diagnosis as an interpretive tool for historical documentation. Altogether, it highlights key methodological considerations for interpreting disease in osteoarchaeological contexts.

Introdução: A Perturbação Obsessivo-Compulsiva (POC) é uma condição psiquiátrica crónica e incapacitante (Singh et al., 2023), com elevado impacto funcional, mas cujo conhecimento público continua associado a algum estigma social, perpetuando conceções erradas (Alves et al., 2025; Chaves et al., 2022). Objetivos: Este estudo transversal teve como objetivo avaliar a perceção da população sobre a POC, nomeadamente a sua origem, manifestações clínicas e abordagens terapêuticas. Material e Métodos: Foi elaborado e aplicado um questionário anónimo online, obtendo-se uma amostra de 546 participantes, maioritariamente do sexo feminino (79,1%), com idade média de 35 anos e diferentes níveis de escolaridade. O estudo respeitou a Declaração de Helsínquia, com garantia de consentimento informado e confidencialidade, tendo obtido aprovação pela Comissão de Ética da Egas Moniz. Resultados: A maioria dos participantes (90,3%) declarou estar familiarizada com a POC e 58% identificaram-na corretamente como uma perturbação de ansiedade. Do total, 4,7% reportaram diagnóstico pessoal e 32,9% conheciam alguém próximo com POC. Os sintomas mais associados à doença foram comportamentos repetitivos (92,7%) e pensamentos intrusivos (83,2%). As causas da doença mais referidas incluíram experiências traumáticas ou stressantes (76,5%), perturbações mentais concomitantes (75,3%) e fatores genéticos (53,1%). Contudo, foram também atribuídas causas incorretas, como o perfecionismo, fraqueza emocional e falta de autocontrolo, refletindo a persistência de estigma social. Quanto ao tratamento, 77,9% reconheceram a psicoterapia e 58% a medicação como opções terapêuticas. No âmbito do tratamento farmacológico, 47,2% identificaram corretamente os Inibidores Seletivos da Recaptação de Serotonina como fármacos de primeira linha. Os efeitos adversos mais mencionados foram a sonolência (67,8%), o aumento de peso (60,5%) e a disfunção sexual (53,1%). Conclusões: Os resultados evidenciam a existência de lacunas na perceção da POC, sobretudo quanto à origem da perturbação e tratamento farmacológico. As conceções baseadas no estigma evidenciam a necessidade de programas educativos que promovam a literacia em saúde mental, essenciais para ampliar o conhecimento, favorecer o diagnóstico precoce e reduzir o estigma associado à POC.

Introdução: A Síndrome de Ressaca Alcoólica (SRA) corresponde a um conjunto de sintomas físicos e psicológicos adversos que surgem após um único episódio de consumo de álcool. Apresenta elevada prevalência entre jovens adultos, permanecendo pouco estudada e sem terapêuticas validadas (Verster et al., 2020). O seu potencial impacto académico e social justifica a análise de padrões de ocorrência e estratégias de mitigação. Objetivos: Avaliar a prevalência, os padrões da SRA e as estratégias utilizadas para o alívio dos seus sintomas por estudantes do primeiro ano Ensino Superior (ES). Metodologia: Foi elaborado e aplicado um inquérito online, anónimo e confidencial. Foram critérios de inclusão ter 18 anos ou mais e frequentar o primeiro ano do ES em Portugal no ano letivo 2023/24. A análise estatística incluiu procedimentos descritivos e inferenciais, realizados no software SPSS v.29. O protocolo obteve aprovação da Comissão de Ética da Egas Moniz (PT-223/24), com garantia de consentimento informado. Responderam ao questionário 563 participantes, dos quais 92 cumpriram os critérios de inclusão. Resultados: Os resultados revelaram que 93,5% dos estudantes consumia álcool, com 7,0% a referir uma frequência de ingestão de três ou mais vezes por semana. De salientar que 41,9% referiu que aumentou o consumo com a entrada no ES. Uma percentagem preocupante (41,9%) assumiu binge drinking, consumindo cinco ou mais bebidas por ocasião. 72,1% dos estudantes referiu já ter sentido ressaca, com 40,3% a mencionar sintomas ligeiros e 9,7% ressacas graves ou muito graves. O recurso a medicamentos para aliviar a SRA foi referido por 41,9%, metade dos quais indicou consumir paracetamol e 38,5% ibuprofeno. As medidas não farmacológicas foram utilizadas por 41,9% dos estudantes. Questionados sobre a alteração do padrão de consumo de álcool caso existisse medicação eficaz contra a SRA, apenas 16,3% admitiu que aumentaria o consumo. Conclusões: A elevada prevalência de SRA entre estudantes do primeiro ano enfatiza a necessidade de aumentar a literacia em saúde, programas de educação em saúde e políticas para reduzir consumos excessivos. A eficácia limitada das abordagens atuais da SRA sugere a necessidade de intervenções farmacológicas inovadoras, eficazes e seguras.

To clinically evaluate dermal thickness, pores, and wrinkles after using Profhilo® in perioral regions. This split-face study included 12 female participants aged 45 to 65 with visible signs of perioral aging. After selection, a blinded operator randomly allocated the right and left sides to receive either treatment (experimental group-Profhilo®) or placebo (control group-saline solution). Treatment consisted of two sessions spaced 30days apart. For the first session, 3 points were marked on the cutaneous portion of the upper lip and 2 points on the lower lip, at 5mm from the beginning of the mucosa, for each side of the face. The amount of product injected in each session was 1 ml of Profhilo®. The same proportion of saline solution was used on the opposite side of the upper and lower lips, following the same application points. After 30days, a local evaluation and application of the second session were performed, following the same protocol as the first. At 60days, digital stereophotogrammetry, ultrasound of the perioral region, and standardized photographic images were performed. In addition, the volunteers answered the Face-Q questionnaire to assess satisfaction with the treatment, signs of aging, post-procedure recovery, and psychological factors. Subsequently, the data collected were tabulated and analyzed using paired t-test and Wilcoxon test, with a significance level of 5%. Stereophotogrammetry revealed visual improvements in wrinkles and pores after the application of Profhilo®. Ultrasonography indicated an increase in dermal thickness for both Profhilo® (p = 0.016) and placebo (p < 0.001). A substantial proportion of participants expressed dissatisfaction with the decision to undergo treatment (36.4%) and the treatment outcomes (54.5%). Most participants reported mild recovery symptoms, with only one noting extreme sensitivity, discomfort, and itching. The intervention evaluated psychological function, appearance, and aging, which resulted in statistically significant improvements in psychological scores (p = 0.014) and aging assessment (p = 0.008). Profhilo® reduced wrinkles and pore size; however, its impact on dermal thickness did not exceed the placebo effect, and patients were not fully satisfied with outcomes. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Exercise medicine has gained significant recognition owing to its demonstrated benefits throughout the breast cancer treatment continuum. While resistance exercise (RE) promotes improvements in lean mass and muscle strength, aerobic exercise (AE) enhances cardiorespiratory fitness, with several studies investigating both exercise modes in patients with breast cancer. However, because of an effect often referred to as interference effect, it is hypothesised that combining resistance and aerobic exercise (COMB) may compromise gains in lean mass and muscle strength and other outcomes in cancer populations. This study aims to investigate the presence of an interference effect from prescribing COMB compared with RE on fatigue, lean mass, physical function and muscle strength in women with breast cancer. In addition, it examines a range of demographic, clinical and exercise prescription moderators within this population. We searched seven databases from inception to January 2024 (PROSPERO CRD42023491118), with an updated search in April 2025. Eligible trials examined the effects of RE, AE and/or COMB in women diagnosed with breast cancer. The primary outcomes for this review were cancer-related fatigue, lean mass, physical function and/or lower-limb muscle strength. A random-effects network meta-analysis was undertaken to examine the effect of different exercise programs and controls, with specific focus on the comparisons between RE and COMB. Differences between RE and COMB above 0.20 standardised mean difference (SMD) were an indicative of a potential interference effect. We included a total of 131 articles describing 116 randomised trials (n = 9206). Both RE (SMD - 0.52, 95% CI - 0.83 to - 0.21, p = 0.001) and COMB (SMD - 0.47, 95% CI - 0.65 to - 0.29, p < 0.001) similarly reduced fatigue compared with controls. However, a potential interference effect was observed on fatigue during surgery (SMD - 0.23, 95% CI - 0.58 to 0.12, p = 0.191) and chemotherapy (SMD - 0.22, 95% CI - 0.59 to 0.16, p = 0.257), with RE showing greater benefits than COMB. For physical function, both RE (SMD 0.86, 95% CI 0.41-1.30, p < 0.001) and COMB (SMD 0.90, 95% CI 0.58-1.22, p < 0.001) improved outcomes compared with controls, though RE was superior to COMB in patients receiving hormone therapy (SMD 0.62, 95% CI - 0.56 to 1.81, p = 0.303). Differences between RE and COMB in lean mass (MD 0.18kg, 95% CI - 0.17-0.53kg, p = 0.303) and muscle strength (SMD 0.43, 95% CI - 0.01-0.86, p = 0.056) were not significant in the main analyses; however, sensitivity analyses omitting the outliers indicated significant differences favouring RE for lean mass (MD 0.36kg, 95% CI 0.15-0.57kg, p < 0.001) and muscle strength (SMD 0.40, 95% CI 0.08-0.71, p = 0.014). Our findings emphasise the importance of personalised exercise medicine targeted to treatment characteristics in women with breast cancer. While COMB may offer benefits across the outcomes investigated, prescribing RE alone may be preferable to minimize potential interference effects on lean mass and muscle strength, regardless of demographic, clinical and exercise prescription characteristics, as well as fatigue and physical function tests, particularly during adjuvant and hormonal therapies.

Our research topic brings together four studies that explore different aspects of this challenge by adopting a comprehensive approach to companion animal behavioral management. In this collection, Sonowal et al. (2025) compared scented and non-scented chew toys to evaluate their effect on chewing and mouthing behaviors in puppies, which are among the most common developmental issues faced by caregivers during critical bonding periods. Although these behaviors are largely normal communicatory and exploratory behaviors, they are frequently reported as problematic and can strain the human-animal bond at a sensitive stage of development. Authors showed that sensory enhanced toys significantly increased puppy engagement and reduced the need for caregiver prompting during observed sessions. Interestingly, while the frequency of unwanted chewing did not change over the course of the intervention, caregivers reported perceiving mouthing as less problematic. This finding highlights the importance of how caregivers experience and interpret behavior when managing behavioral problems in companion animals and offers a valuable insight for veterinary behavioral medicine regarding the key role of caregiver perspectives.Distinguishing primary behavioral disorders from those arising secondary to medical conditions such as pain is one of the most challenging areas in behavioral medicine and was addressed by Kwik et al. (2025) within our research topic. Their case series revealed that maladaptive pain was present in 70% of dogs referred for behavioral complaints when assessed using a multimodal approach. This finding carries important implications for clinical practice and raises important questions such as: "How often are animals diagnosed with behavioral problems before pain is thoroughly investigated?" and "How frequently do behavior modification efforts fail because an underlying pain remains untreated?". Their study demonstrates that multimodal treatment addressing both pain and behavior led to recovery in most cases, which highlights the inseparable relationship between medical and behavioral assessment. It further underscores the significant welfare consequences of diagnostic delay, resulting in unnecessary animal suffering and caregiver distress.Feline behavioral management is the focus of two interesting studies in this collection. In order to better understand undesired scratching in domestic cats, Salgirli Demirbas et al. (2024) employed a multifactorial approach and identified the risk factors that contribute to this behavior. Their findings provide valuable insight into the environmental, social and individual factors that influence when normal feline behavior becomes problematic in the domestic setting. They identified stress as a leading contributor to undesired scratching, with specific risk factors including the presence of children in the household, high levels of play and nocturnal activity as well as personality traits such as aggression or disruptiveness. The authors emphasize that scratching, while a normal species-typical behavior, becomes problematic when underlying stressors are not adequately addressed. This etiological perspective is complemented by the Endersby et al. (2024), who present a largescale, controlled evaluation of a pheromone-impregnated collar for the management of multiple feline behavioral problems. With nearly 500 cats included, the findings provide robust evidence that continuous pheromone delivery can significantly reduce behavioral problems such as inappropriate urination, destructive scratching and inter-cat conflict, with trends toward improvement in fear-related behaviors. These results are particularly important, as these behaviors are among the most commonly reported problems in the companion cat population and represent predominant reasons for relinquishment and, in some cases, euthanasia. Their study highlights the value of pheromonal signals in reducing stress by promoting emotional stability in cats and demonstrates how effective pheromone messaging can be in managing a range of behavioral problems.Collectively, the studies in this Research Topic highlight a number of fundamental concepts that deserve to be included into standard clinical practice. These include the critical importance of systematic pain assessment in cases presenting with behavioral change; recognition that caregiver perceptions and expectations may be influential determinants of treatment success and must be addressed; the value of identifying risk factors to inform management strategies and the role of sensory modulation as a foundational strategy for supporting emotional well-being of companion animals. This collection supports the view that advancing the field requires moving beyond simplistic approaches toward integrative frameworks and adaptive expectations, with evidencebased strategies that enhance quality of life and strengthen the human-animal bond.

In forensic toxicology, the rapid and reliable detection of emerging synthetic opioids and hallucinogens is crucial for case investigations and public health monitoring. This work describes the development, optimization and validation of a simple, fast and sensitive methodology for the simultaneous analysis of 6 new synthetic opioids (carfentanil, fentanyl, isotonitazene, metonitazene, norfentanyl, and sufentanil) and 2 hallucinogens (lysergide [LSD] and mescaline), together with the main LSD metabolite 2-oxo-3-hydroxy-lysergide [LSD-OH], in whole blood samples by liquid chromatography coupled to tandem mass spectrometry. Under optimized experimental conditions, linearity was verified between 0.1 and 20 ng/mL for all analytes except mescaline (2.5-500 ng/mL), with r2 > 0.99 for 1/x weighting, and no significant carryover or matrix effects were observed. Good precision (% RSD < 13 %) and trueness (% Bias within ± 20 %) values were achieved. The estimated limit of quantification (LOQ) was 0.1 ng/mL for all compounds except mescaline (2.5 ng/mL). Authentic forensic samples were also analyzed, and positive samples for fentanyl, norfentanyl, and sufentanil were identified. The proposed methodology allows the simultaneous analysis of compounds from different families of psychoactive substances, in both postmortem and in vivo samples, using only 50 µL of whole blood. The demonstrated speed, simplicity, and effectiveness make it particularly advantageous for routine implementation in forensic toxicology laboratories.

The professionalization of electronic sports (Esports) and streaming has introduced new challenges to players' physical and mental health, including chronic stress, sleep disruption and pain-related dysfunction. These factors are linked to bruxism and temporomandibular disorders (TMD), yet their prevalence and psychosomatic correlations within this community remain unknown. This study aimed to investigate the occurrence of bruxism and TMD among Esports players and streamers as well as their associations with psychosomatic and gaming-related variables. This cross-sectional study included 97 Esports players and streamers that completed validated self-report instruments screening for TMD (TMD pain-screener), bruxism, sociodemographic data, oral behaviors, sleep quality, perceived stress, anxiety, somatic symptoms, pain vigilance, and gaming/streaming habits. In addition to standard statistical tests, orthogonal partial least squares-discriminant analysis (OPLS-DA) were applied to identify group differences and multivariate associations. Nearly half of the participants screened positive for TMD (49.5%) and 78.4% reported possible bruxism. Increased daily gaming hours correlated significantly with higher perceived stress and oral parafunctions. Multivariate analyses further showed that anxiety, somatic symptoms, poor sleep and perceived stress were key factors distinguishing participants with TMD from those without, and those with combined sleep and awake bruxism from those with only awake bruxism. TMD and bruxism are highly prevalent among Esports players and streamers, with greater daily gaming exposure linked to psychosomatic stress and oral parafunctions. Digital athletes with combined sleep and awake bruxism and/or TMD experience greater psychosocial distress, indicating a subgroup that needs closer attention through early screening and targeted preventive strategies. • First study to assess bruxism and TMD prevalence and psychosocial ties in Esports. • This population is vulnerable to the development of painful TMD and bruxism. • Longer daily gaming hours were linked to higher stress and oral parafunctions.

Long COVID (LC) is a post-infectious condition affecting millions worldwide, characterized by persistent multisystem symptoms. Females are disproportionately affected, reporting higher symptom burden, particularly neurocognitive and neurosensory complaints. While short-term immunopathology has been described, the long-term clinical course, immune dysregulation, and sex-specific underpinnings remain poorly understood. We analyzed 34 participants experiencing persisting symptoms from 9months to 5years post-SARS-CoV-2 infection, alongside 26 SARS-CoV-2-infected controls without symptoms. Clinical assessments, symptom inventories, comorbidity analysis, and work capacity evaluation were performed. Immune profiling included flow cytometry of CD4⁺ and CD8⁺ T cells, NK cells, and B cells, as well as quantification of plasma cytokines, soluble factors, and cytotoxic molecules, analyzed in a sex-disaggregated manner. Females with LC exhibited higher symptom burden, particularly persistent fatigue, neurocognitive and neurosensory complaints, which increased with age and tended to increase with disease duration, whereas males showed no clear age- or duration-related patterns. Comorbidities, especially affecting endocrine, metabolic, and circulatory systems, were more frequent in females and aligned with symptom severity. Immune profiling revealed subtle but sex-specific differences: females had reduced CD8⁺ T cell cytotoxic profile, lower NKG2D and granzyme K expression, increased sCD40L and sFAS, and decreased perforin, whereas males displayed elevated TNF-α. NK cell function, B cells, and humoral immunity remained largely intact. Over half of participants reported functional impairments affecting work capacity. Even though our cohort is small it suggests that prolonged LC is characterized by sex-specific differences in symptom burden and immune profiles. Reduced cytotoxic CD8⁺ T cell profile in females may contribute to viral persistence and neurological symptoms, whereas elevated inflammatory markers in males suggest distinct immune pathways. These findings highlight the need for sex- and duration-specific management strategies, the identification of biomarkers, and the development of personalized therapies targeting specific LC endotypes.