Since I started the Integrated Master Degree in Medicine at the Faculty of Medicine of the University of Lisbon I realized that my future medical career could focus on three major areas: clinical practice, teaching and research. Clinical practice was my main goal and the reason for choosing this degree, but I soon realized that other activities also aroused by curiosity and interest. When I was still in the “basic years” I carried out pedagogical initiation traineeships, and when I reached the “clinical years” I lacked the experience to participate in a research project. This was an experience that I postponed mainly because I had in mind the possibility of being involved in a clinical or translational project not so focused on basic science, and this only made sense when I had obtained some experience of clinical practice.

The opportunity to work with the Rheumatology Research Unit (UIR) came when I studied the Rheumatology subject, part of the group of elective subjects. Professor João Eurico Fonseca and Professor Helena Canhão indicated that the UIR was willing to receive students who wanted to work at the unit. I was immediately interested in the structure of the UIR, whose projects combine basic science with clinical practice and are jointly conducted by researchers and physicians who do their best to attain common goals. The major research areas are inflammation, bones and vessels. After having been told about the ongoing projects in each area, I chose to work on the project linking atherogenesis and the bone, combining rheumatology with vascular medicine, which is another area I find particularly interesting.

I started to work on the inclusion and clinical evaluation of patients before I defined my application to the 16th Programme “Education through Science”, but when that opportunity came it was the ideal time to shape what would become my research question and my own project, which will also lead to my Master Degree final project. Under the supervision of Professor Maria José Santos and of Diana Carmona-Fernandes (MSc.), I developed the project “Osteoporosis in Patients with Carotid Atherosclerosis”, which was accepted without funding by the 16th Programme “Education through Science”, and which I have been working on over the last year.

The work is based on some already known epidemiological elements, such as the fact of risk of osteoporotic fracture being increased in individuals with cardiovascular disease (CV) and the fact that there may be an excess of CV episodes and deaths in individuals with bone mass loss. Although osteoporosis (OP) and atherosclerosis share several risk factors, some studies suggest there is an independent association between these two entities. Chronic inflammation, oxidative stress, vitamin D, and homocysteine are some potential connection mechanisms between the two pathologies. Accordingly, the main objectives of this project are to determine if bone mineral density (BMD) in patients with advanced carotid atherosclerosis is different from what can be expected taking into account gender and age, as well as the risk factors for OP. Secondly, I intend to establish a connection between atherosclerosis and BMD regardless of common factors, namely age, diabetes mellitus, smoking and physical activity, and establish the relationship between changes in homocysteine levels and vitamin D and BMD.
Up to this point we have included in this study 45 patients who underwent carotid endarterectomy at the Vascular Surgery Department of Santa Maria Hospital (HSM). They were given a clinical protocol to evaluate the risk factors for atherosclerosis and OP, had a blood sample taken while fasting for purposes of establishing the doses of homocysteine and vitamin D, and had a bone densitometry performed on them.
I wrote a summary of the evaluation of the first 32 patients and sent it to the Symposium “Inflammation and Pain” organized by the Portuguese Society of Rheumatology. It was accepted for presentation in the form of a poster. I will present the final results of this part of the project at the Workshop of the 16th Programme “Education through Science”.

I think that all medical students should go through a similar experience, obviously according to their own interest areas, since I find the contact with the specific methodology of scientific research and the opportunity to acquire skills such as teamwork, communication with patients, problem solving, time management, and working methods are paramount for our own professional and personal advancement. In addition, I have had the opportunity to advance knowledge on the topic of the project and on statistical concepts and tools, which are transversal to any work that we may perform in the future.

I cannot write about this experience without thanking the 16th Programme “Education through Science”, all the members of the UIR who welcomed me without reservation, inviting me to participate in their various activities and meetings, making me feel part of the group, and in particular my supervisors, Professor Maria José Santos and Diana Carmona-Fernandes, MSc, for their suggestions, comments, advice, and support.

Sofia Carvalho Fernandes Barreira
Year 5 student of the MIM MIM
Institute of Molecular Medicine – Rheumatology Research Unit
Supervisors: Professor Maria José Santos and Diana Carmona-Fernandes, MSc.