Família e aconselhamento genético: o caso dos cancros hereditários

Os desenvolvimentos associados à medicina genómica e biologia molecular representam novas possibilidades no diagnóstico, tratamento e prevenção de doenças comuns, confrontando indivíduos e famílias com complexos desafios à integração da informação genética na gestão da saúde e nas suas vidas. Este estudo centra-se em famílias com suscetibilidade genética acrescida a cancros hereditários e pretende contribuir para o conhecimento da experiência individual e familiar do aconselhamento oncogenético, incluindo como pode ser contemplada no desenvolvimento de intervenções de apoio psicossocial e na organização dos cuidados de saúde na era (pós)genómica. O processo de investigação incorpora perspetivas da genética psicossocial e da teoria dos sistemas familiares. Engloba metodologias qualitativas de recolha e análise de dados, envolvendo indivíduos, famílias e profissionais de saúde num formato de investigação-ação participativa. Os principais resultados permitem: i) conceptualizar a experiência do aconselhamento oncogenético, através da caracterização das suas implicações instrumentais, emocionais, relacionais e desenvolvimentais para o indivíduo e sistema familiar; ii) conhecer o desenvolvimento, implementação e avaliação de um programa psicoeducativo multifamiliar, enquanto intervenção de apoio psicossocial a indivíduos com suscetibilidade acrescida a cancros hereditários e suas famílias; e iii) integrar a perspetiva dos profissionais de saúde quanto à incorporação de apoio psicossocial na provisão dos serviços oncogenéticos. As conclusões gerais sustentam a importância do aprofundamento da pesquisa sobre o funcionamento familiar face ao aconselhamento e risco oncogenético, e a incorporação de uma orientação familiar nesses serviços. As implicações decorrentes da suscetibilidade acrescida a doenças genéticas impõem uma discussão alargada aos vários agentes envolvidos no planeamento, provisão e utilização dos cuidados de saúde, no sentido do desenvolvimento de serviços atuantes no continuum biopsicossocial indivíduofamília- sistema de saúde-comunidade.

Aplicação de cortiça em dois tipos de reatores para tratamento de água

A qualidade da água degradou-se de forma relevante nas últimas décadas e os processos de sorção têm vindo a ser investigados como métodos promissores para o tratamento de águas contaminadas. Neste trabalho avaliou-se a capacidade de dois tipos de cortiça para a remoção de diversos contaminantes, em reatores de vaso fechado e de leito fixo. Os ensaios realizados em reatores de vaso fechado permitiram (i) avaliar o efeito do pH e da granulometria na eficiência dos sorventes na remoção de mercúrio e (ii) avaliar a afinidade dos sorventes para outros contaminantes, nomeadamente arsénio, cádmio, níquel e chumbo. Estruturalmente as duas cortiças estudadas aparentam ser semelhantes, com uma pequena diferença de comportamento ácido-base e não apresentam diferenças estatisticamente significativas na remoção de mercúrio. Os resultados obtidos permitiram constatar que o processo de remoção é independente do pH, tendo-se obtido percentagens de remoção da ordem dos 80% e de concentrações de mercúrio na cortiça na ordem dos 117 μg/g. As cortiças estudadas revelaram-se menos eficazes no tratamento de água com os restantes contaminantes, atingindo percentagens de remoção máximas de 0% para As, 11% para Cd, 35% para Ni e 69% para Pb. Os ensaios em leito fixo, mesmo sem terem sido otimizados, revelam que é possível obter uma eficácia de remoção de mercúrio superior a 90% nas primeiras 40 horas de trabalho, sendo a concentração de mercúrio no leito de 680 μg/g. Relativamente aos mecanismos de sorção, os resultados experimentais indicam que estes são possivelmente de natureza química e que as interações eletrostáticas têm pouca importância.

Qualidade de vida e doença mental

Atendendo à conjuntura nacional e internacional que norteia a saúde mental e psiquiatria, a Qualidade de Vida (QDV) das pessoas com doença mental torna-se uma área fundamental de investigação, tendo em conta a sua inquestionável importância na aferição de medidas de intervenção. Um facto observável relaciona-se com um interesse crescente nos últimos anos na QDV da pessoa com doença mental como objeto de investigação. Estudos apontam para que as pessoas com doença mental percecionem a sua QDV inferior às pessoas sem doença mental e/ou com doenças físicas. Esta investigação foi realizada com base em três estudos. O Estudo I pretendeu estudar relações entre variáveis sociodemográficas e clínicas e a QDV de pessoas (n = 39) com doenças do humor (Depressão Major, Distimia, Doença Bipolar e Perturbações Depressivas Sem Outra Especificação). Para isso, foram utilizados o WHOQOL-Bref, o Índice de Graffar, um Questionário de Dados Sociodemográficos e Clínicos e um Guia de Observação. Os dados foram recolhidos no domicílio dos sujeitos. No Estudo II compararam-se diferenças de QDV em duas amostras independentes: sujeitos com doenças do humor (n = 39) e sujeitos sem doença mental diagnosticada (n = 39). Utilizaram-se os mesmos instrumentos do Estudo I exceto o Guia de Observação. Nestes dois estudos os dados foram tratados recorrendo ao IBM SPSS Statistics, versão 19.0. O Estudo III teve como objetivo recolher dados sobre as narrativas dos sujeitos com doença mental e sobre o conhecimento sobre a Rede Nacional de Cuidados Continuados e Integrados de Saúde Mental (RNCCISM). Para esta segunda parte do objetivo foi utilizada uma amostra de profissionais de saúde mental (n = 42) que respondeu a um Questionário sobre a RNCCISM construído para o efeito. Este Instrumento foi validado e do qual resultou uma variável final: “avaliação do conhecimento sobre a RNCCISM”. Os resultados desta pesquisa sugeriram, pelo Estudo I, que a QDV difere em função da doença apresentada pelos sujeitos; encontraram-se também diferenças em relação à idade, sexo, escolaridade, classe social, estado civil e transportes utilizados para a consulta de especialidade. Pelo Estudo II, os resultados indicaram-nos diferenças entre a QDV nos dois grupos, sendo que, o Grupo com doença do humor apresenta scores mas baixos em todos os domínios do WHOOL-Bref que o Grupo sem doença mental diagnosticada. Os dados do EstudoIII sugeriram-nos: i) no primeiro momento, uma reflexão que girou em torno de cinco eixos: o sofrimento; a estigmatização; os eventos de vida perturbadores; o modelo de tratamento adotado pelos profissionais; e o acompanhamento das pessoas com doença mental; ii) no segundo momento, que os enfermeiros são os que, em média, possuíam um score de conhecimento sobre a RNCCISM mais baixo. Esta investigação sugeriu que a QDV das pessoas com doença mental é baixa, indicando algumas relações entre algumas variáveis. Durante o seu desenvolvimento, pretendemos também reforçar a necessidade do envolvimento de todos os profissionais da saúde nas alterações preconizadas, o que permite intervir de forma mais informada. Porque, durante este percurso surgiram dificuldades sérias de acesso à amostra clínica, esta tese chama ainda a atenção para a importância da investigação em saúde mental e psiquiatria e para as formalidades de acesso aos dados que a podem condicionar. De facto, ao assumirmos a QDV como uma medida de resultado em saúde, torna-se importante, por um lado, aprofundar a investigação neste domínio e, por outro, e pelo conhecimento de que já dispomos, equacionar de forma efetiva novas modalidades de intervenção, contribuindo para um plano terapêutico mais amplo, pondo em prática uma filosofia de cuidados mais abrangente e de continuidade, implementando as politicas comunitárias e globais preconizadas para a prestação de cuidados em saúde mental e psiquiatria.

Volatile terpenoids and C13 norisoprenoids in wines: development of rapid methods of analysis and evaluation of the sesquiterpenoids biological potential

Vitis vinifera L., the most widely cultivated fruit crop in the world, was the starting point for the development of this PhD thesis. This subject was exploited following on two actual trends: i) the development of rapid, simple, and high sensitive methodologies with minimal sample handling; and ii) the valuation of natural products as a source of compounds with potential health benefits. The target group of compounds under study were the volatile terpenoids (mono and sesquiterpenoids) and C13 norisoprenoids, since they may present biological impact, either from the sensorial point of view, as regards to the wine aroma, or by the beneficial properties for the human health. Two novel methodologies for quantification of C13 norisoprenoids in wines were developed. The first methodology, a rapid method, was based on the headspace solid-phase microextraction combined with gas chromatography-quadrupole mass spectrometry operating at selected ion monitoring mode (HS-SPME/GC-qMS-SIM), using GC conditions that allowed obtaining a C13 norisoprenoid volatile signature. It does not require any pre-treatment of the sample, and the C13 norisoprenoid composition of the wine was evaluated based on the chromatographic profile and specific m/z fragments, without complete chromatographic separation of its components. The second methodology, used as reference method, was based on the HS-SPME/GC-qMS-SIM, allowing the GC conditions for an adequate chromatographic resolution of wine components. For quantification purposes, external calibration curves were constructed with β-ionone, with regression coefficient (r2) of 0.9968 (RSD 12.51 %) and 0.9940 (RSD of 1.08 %) for the rapid method and for the reference method, respectively. Low detection limits (1.57 and 1.10 μg L-1) were observed. These methodologies were applied to seventeen white and red table wines. Two vitispirane isomers (158-1529 L-1) and 1,1,6-trimethyl-1,2-dihydronaphthalene (TDN) (6.42-39.45 μg L-1) were quantified. The data obtained for vitispirane isomers and TDN using the two methods were highly correlated (r2 of 0.9756 and 0.9630, respectively). A rapid methodology for the establishment of the varietal volatile profile of Vitis vinifera L. cv. 'Fernão-Pires' (FP) white wines by headspace solid-phase microextraction combined with comprehensive two-dimensional gas chromatography with time-of-flight mass spectrometry (HS-SPME/GCxGC-TOFMS) was developed. Monovarietal wines from different harvests, Appellations, and producers were analysed. The study was focused on the volatiles that seem to be significant to the varietal character, such as mono and sesquiterpenic compounds, and C13 norisoprenoids. Two-dimensional chromatographic spaces containing the varietal compounds using the m/z fragments 93, 121, 161, 175 and 204 were established as follows: 1tR = 255-575 s, 2tR = 0,424-1,840 s, for monoterpenoids, 1tR = 555-685 s, 2tR = 0,528-0,856 s, for C13 norisoprenoids, and 1tR = 695-950 s, 2tR = 0,520-0,960 s, for sesquiterpenic compounds. For the three chemical groups under study, from a total of 170 compounds, 45 were determined in all wines, allowing defining the "varietal volatile profile" of FP wine. Among these compounds, 15 were detected for the first time in FP wines. This study proposes a HS-SPME/GCxGC-TOFMS based methodology combined with classification-reference sample to be used for rapid assessment of varietal volatile profile of wines. This approach is very useful to eliminate the majority of the non-terpenic and non-C13 norisoprenic compounds, allowing the definition of a two-dimensional chromatographic space containing these compounds, simplifying the data compared to the original data, and reducing the time of analysis. The presence of sesquiterpenic compounds in Vitis vinifera L. related products, to which are assigned several biological properties, prompted us to investigate the antioxidant, antiproliferative and hepatoprotective activities of some sesquiterpenic compounds. Firstly, the antiradical capacity of trans,trans-farnesol, cis-nerolidol, α-humulene and guaiazulene was evaluated using chemical (DPPH• and hydroxyl radicals) and biological (Caco-2 cells) models. Guaiazulene (IC50= 0.73 mM) was the sesquiterpene with higher scavenger capacity against DPPH•, while trans,trans-farnesol (IC50= 1.81 mM) and cis-nerolidol (IC50= 1.48 mM) were more active towards hydroxyl radicals. All compounds, with the exception of α-humulene, at non-cytotoxic levels (≤ 1 mM), were able to protect Caco-2 cells from oxidative stress induced by tert-butyl hydroperoxide. The activity of the compounds under study was also evaluated as antiproliferative agents. Guaiazulene and cis-nerolidol were able to more effectively arrest the cell cycle in the S-phase than trans,trans-farnesol and α-humulene, being the last almost inactive. The relative hepatoprotection effect of fifteen sesquiterpenic compounds, presenting different chemical structures and commonly found in plants and plant-derived foods and beverages, was assessed. Endogenous lipid peroxidation and induced lipid peroxidation with tert-butyl hydroperoxide were evaluated in liver homogenates from Wistar rats. With the exception of α-humulene, all the sesquiterpenic compounds under study (1 mM) were effective in reducing the malonaldehyde levels in both endogenous and induced lipid peroxidation up to 35% and 70%, respectively. The developed 3D-QSAR models, relating the hepatoprotection activity with molecular properties, showed good fit (R2LOO > 0.819) with good prediction power (Q2 > 0.950 and SDEP < 2%) for both models. A network of effects associated with structural and chemical features of sesquiterpenic compounds such as shape, branching, symmetry, and presence of electronegative fragments, can modulate the hepatoprotective activity observed for these compounds. In conclusion, this study allowed the development of rapid and in-depth methods for the assessment of varietal volatile compounds that might have a positive impact on sensorial and health attributes related to Vitis vinifera L. These approaches can be extended to the analysis of other related food matrices, including grapes and musts, among others. In addition, the results of in vitro assays open a perspective for the promising use of the sesquiterpenic compounds, with similar chemical structures such as those studied in the present work, as antioxidants, hepatoprotective and antiproliferative agents, which meets the current challenges related to diseases of modern civilization.

Pregnancy and newborns disorders followed by urine metabolomics

Chapter 1 introduces the scope of the work by identifying the clinically relevant prenatal disorders and presently available diagnostic methods. The methodology followed in this work is presented, along with a brief account of the principles of the analytical and statistical tools employed. A thorough description of the state of the art of metabolomics in prenatal research concludes the chapter, highlighting the merit of this novel strategy to identify robust disease biomarkers. The scarce use of maternal and newborn urine in previous reports enlightens the relevance of this work. Chapter 2 presents a description of all the experimental details involved in the work performed, comprising sampling, sample collection and preparation issues, data acquisition protocols and data analysis procedures. The proton Nuclear Magnetic Resonance (NMR) characterization of maternal urine composition in healthy pregnancies is presented in Chapter 3. The urinary metabolic profile characteristic of each pregnancy trimester was defined and a 21-metabolite signature found descriptive of the metabolic adaptations occurring throughout pregnancy. 8 metabolites were found, for the first time to our knowledge, to vary in connection to pregnancy, while known metabolic effects were confirmed. This chapter includes a study of the effects of non-fasting (used in this work) as a possible confounder. Chapter 4 describes the metabolomic study of 2nd trimester maternal urine for the diagnosis of fetal disorders and prediction of later-developing complications. This was achieved by applying a novel variable selection method developed in the context of this work. It was found that fetal malformations (FM) (and, specifically those of the central nervous system, CNS) and chromosomal disorders (CD) (and, specifically, trisomy 21, T21) are accompanied by changes in energy, amino acids, lipids and nucleotides metabolic pathways, with CD causing a further deregulation in sugars metabolism, urea cycle and/or creatinine biosynthesis. Multivariate analysis models´ validation revealed classification rates (CR) of 84% for FM (87%, CNS) and 85% for CD (94%, T21). For later-diagnosed preterm delivery (PTD), preeclampsia (PE) and intrauterine growth restriction (IUGR), it is found that urinary NMR profiles have early predictive value, with CRs ranging from 84% for PTD (11-20 gestational weeks, g.w., prior to diagnosis), 94% for PE (18-24 g.w. pre-diagnosis) and 94% for IUGR (2-22 g.w. pre-diagnosis). This chapter includes results obtained for an ultraperformance liquid chromatography-mass spectrometry (UPLC-MS) study of pre-PTD samples and correlation with NMR data. One possible marker was detected, although its identification was not possible. Chapter 5 relates to the NMR metabolomic study of gestational diabetes mellitus (GDM), establishing a potentially predictive urinary metabolic profile for GDM, 2-21 g.w. prior to diagnosis (CR 83%). Furthermore, the NMR spectrum was shown to carry information on individual phenotypes, able to predict future insulin treatment requirement (CR 94%). Chapter 6 describes results that demonstrate the impact of delivery mode (CR 88%) and gender (CR 76%) on newborn urinary profile. It was also found that newborn prematurity, respiratory depression, large for gestational age growth and malformations induce relevant metabolic perturbations (CR 82-92%), as well as maternal conditions, namely GDM (CR 82%) and maternal psychiatric disorders (CR 91%). Finally, the main conclusions of this thesis are presented in Chapter 7, highlighting the value of maternal or newborn urine metabolomics for pregnancy monitoring and disease prediction, towards the development of new early and non-invasive diagnostic methods.

Development of infrared spectroscopy for assessing bacterial quality in foods

Rapid and specific detection of foodborne bacteria that can cause food spoilage or illness associated to its consumption is an increasingly important task in food industry. Bacterial detection, identification, and classification are generally performed using traditional methods based on biochemical or serological tests and the molecular methods based on DNA or RNA fingerprints. However, these methodologies are expensive, time consuming and laborious. Infrared spectroscopy is a reliable, rapid, and economic technique which could be explored as a tool for bacterial analysis in the food industry. In this thesis it was evaluated the potential of IR spectroscopy to study the bacterial quality of foods. In Chapter 2, it was developed a calibration model that successfully allowed to predict the bacterial concentration of naturally contaminated cooked ham samples kept at refrigeration temperature during 8 days. In this part, it was developed the methodology that allowed the best reproducibility of spectra from bacteria colonies with minimal sample preparation, which was used in the subsequent work. Several attempts trying different resolutions and number of scans in the IR were made. A spectral resolution of 4 cm-1, with 32 scans were the settings that allowed the best results. Subsequently, in Chapter 3, it was made an attempt to identify 22 different foodborne bacterial genera/species using IR spectroscopy coupled with multivariate analysis. The principal component analysis, used as an exploratory technique, allowed to form distinct groups, each one corresponding to a different genus, in most of the cases. Then, a hierarchical cluster analysis was performed to further analyse the group formation and the possibility of distinction between species of the same bacterial genus. It was observed that IR spectroscopy not only is suitable to the distinction of the different genera, but also to differentiate species of the same genus, with the simultaneous use of principal component analysis and cluster analysis techniques. The utilization of IR spectroscopy and multivariate statistical analysis were also investigated in Chapter 4, in order to confirm the presence of Listeria monocytogenes and Salmonella spp. isolated from contaminated foods, after growth in selective medium. This would allow to substitute the traditional biochemical and serological methods that are used to confirm these pathogens and that delay the obtainment of the results up to 2 days. The obtained results allowed the distinction of 3 different Listeria species and the distinction of Salmonella spp. from other bacteria that can be mistaken with them. Finally, in chapter 5, high pressure processing, an emerging methodology that permits to produce microbiologically safe foods and extend their shelf-life, was applied to 12 foodborne bacteria to determine their resistance and the effects of pressure in cells. A treatment of 300 MPa, during 15 minutes at room temperature was applied. Gram-negative bacteria were inactivated to undetectable levels and Gram-positive showed different resistances. Bacillus cereus and Staphylococcus aureus decreased only 2 logs and Listeria innocua decreased about 5 logs. IR spectroscopy was performed in bacterial colonies before and after HPP in order to investigate the alterations of the cellular compounds. It was found that high pressure alters bands assigned to some cellular components as proteins, lipids, oligopolysaccharides, phosphate groups from the cell wall and nucleic acids, suggesting disruption of the cell envelopes. In this work, bacterial quantification and classification, as well as assessment of cellular compounds modification with high pressure processing were successfully performed. Taking this into account, it was showed that IR spectroscopy is a very promising technique to analyse bacteria in a simple and inexpensive manner.

Aplicação da terapia fotodinâmica no processo de esterilização de sangue

A importância médica do sangue associada ao risco de doenças infeciosas levou a um melhoramento das técnicas de rastreio de patogénicos no sangue doado. No entanto, devido aos períodos de "janela", durante o qual os agentes infeciosos não podem ser detetados, a desinfeção de sangue e seus derivados assume uma importância vital. Considerando que as técnicas convencionais de desinfeção (tratamento com solvente-detergente ou irradiação com UV ou radiação gama) pode ser empregue em concentrados de plasma ou de proteínas, o efeito colateral associado aos respetivos tratamentos não permite a sua utilização em frações celulares. Consequentemente, é necessário o desenvolvimento de uma nova alternativa eficaz para inativar microrganismos em sangue. Uma boa estratégia que merece ser considerada baseia-se na terapia fotodinâmica antimicrobiana (aPDT). aPDT envolve a interação entre a luz e um fotossensibilizador (PS) na presença de oxigénio molecular. Esta interação produz espécies reativas de oxigénio (ROS), que causam danos oxidativos às moléculas microbianas necessárias à sobrevivência do microrganismo. Em alguns países, esta metodologia já está aprovada para descontaminação de plasma, utilizando azul de metileno ou psoraleno como PSs. O objetivo deste estudo foi avaliar a adequação de de estrutura do tipo ftalocianina (Pc) e porfirina (Por) para desinfeção fotodinâmica de hemoderivados. Plasma e sangue total foram infetados com 108 unidades formadoras de colónias (CFU) / mL de Escherichia coli e após incubação com os derivados Pc e Por em estudo, expostos respetivamente a luz vermelha ou a luz branca com uma irradiância de 150 W/m2durante 270 min. As concentrações de E. coli viáveis foram determinadas a 0, 30, 60, 90, 180 e 270 min e comparadas com as obtidas nos controlos claro (amostras irradiadas na ausência de PS) e controlos escuro (amostras incubadas com PS mas não irradiadas). O efeito do tratamento aPDT nas células do sangue (glóbulos vermelhos e brancos) também foi avaliado. Os resultados obtidos mostram que, em todos os componentes do sangue, a Por em estudo é mais eficaz na inativação de E. coli que o derivado Pc. Após o tratamento aPDT, o número de células vermelhas e brancas no sangue é semelhante aos valores observados nas amostras de controlo. A eficiente inativação de células de E. coli e a ausência de efeito sobre as células de sangue transformam os derivados porfirínicos e ftalocianinas potenciais candidatos a serem utilizados com fotossensibilizadores na desinfeção fotodinâmica de produtos derivados do sangue.

Impact of exercise training on cancer-induced cardiac dysfunction

Cachexia is a complex syndrome characterized by severe weight loss frequently observed in cancer patients and associated with poor prognosis. Cancer cachexia is also related to modifications in cardiac muscle structure and metabolism leading to cardiac dysfunction. In order to better understand the cardiac remodeling induced by bladder cancer and the impact of exercise training after diagnosis on its regulation, we used an animal model of bladder cancer induced by exposition to N-butyl-N-(4-hydroxybutyl)-nitrosamine (BBN) in the drinking water. Healthy animals and previously BBN exposed animals were submitted to a training program in a treadmill at a speed of 20m/min, 60 min/day, 5 days/week during 13 weeks. At the end of the protocol, animals exposed to BBN presented a significant decrease of body weight, in comparison with control groups, supporting the presence of cancer cachexia. Morphological analysis of the cardiac muscle sections revealed the presence of fibrosis and a significant decrease of cardiomyocyte’s cross-sectional area, suggesting the occurrence of cardiac dysfunction associated with bladder cancer. These modifications were accompanied by heart metabolic remodeling characterized by a decreased fatty acid oxidation given by diminished levels of ETFDH and of complex II subunit  from the respiratory chain. Exercise training promoted an increment of connexin 43, a protein involved in cardioprotection, and of c-kit, a protein present in cardiac stem cells. These results suggest an improved heart regenerative capacity induced by exercise training. In conclusion, endurance training seems an attractive non-pharmacological therapeutic option for the management of cardiac dysfunction in cancer cachexia.