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- Improving influenza surveillance in Portuguese preschool children by parents' reportPublication . Paixão, P.; Piedade, C.; Papoila, A.; Caires, I.; Pedro, C.; Santos, M.; Silvestre, M.J.; Brum, L.; Nunes, Baltazar; Guiomar, R.; Curran, M.D.; Carvalho, A.; Marques, T.; Neuparth, N.Influenza surveillance is usually based on nationally organized sentinel networks of physicians and on hospital reports. This study aimed to test a different report system, based on parents’ phone contact to the research team and in home collection of samples by a dedicated team. The identification of influenza and other respiratory viruses in children who attended a Hospital Emergency Department was also recorded. Real-time PCR and reverse transcription PCR were performed for influenza A and B, parainfluenza 1-4, adenovirus, human metapneumovirus, respiratory syncytial virus A and B, rhinovirus, enterovirus, group 1 coronaviruses, group 2 coronaviruses, and human bocavirus. One hundred children were included, 64 from the day care centers and 36 from the Hospital. Overall, 79 samples were positive for at least one respiratory virus. Influenza A (H3) was the virus most frequently detected: 25 cases, 20 of these in children under 5 years of age (ten from day care centers and ten who went to the hospital) which was higher than those reported by the National Influenza Surveillance Programme for this age. Conclusion: The results obtained in this study suggest that a surveillance system based on parents’ reports could complement the implanted system of the National Influenza Surveillance Programme.
- Cellular adhesion gene SELP is associated with rheumatoid arthritis and displays differential allelic expressionPublication . Burkhardt, J.; Blume, M.; Petit-Teixeira, E.; Hugo Teixeira, V.; Steiner, A.; Quente, E.; Wolfram, G.; Scholz, M.; Pierlot, C.; Migliorini, P.; Bombardieri, S.; Balsa, A.; Westhovens, R.; Barrera, P.; Radstake, T.R.; Alves, H.; Bardin, T.; Prum, B.; Emmrich, F.; Cornelis, F.; Ahnert, P.; Kirsten, H.In rheumatoid arthritis (RA), a key event is infiltration of inflammatory immune cells into the synovial lining, possibly aggravated by dysregulation of cellular adhesion molecules. Therefore, single nucleotide polymorphisms of 14 genes involved in cellular adhesion processes (CAST, ITGA4, ITGB1, ITGB2, PECAM1, PTEN, PTPN11, PTPRC, PXN, SELE, SELP, SRC, TYK2, and VCAM1) were analyzed for association with RA. Association analysis was performed consecutively in three European RA family sample groups (Nfamilies = 407). Additionally, we investigated differential allelic expression, a possible functional consequence of genetic variants. SELP (selectin P, CD62P) SNP-allele rs6136-T was associated with risk for RA in two RA family sample groups as well as in global analysis of all three groups (ptotal = 0.003). This allele was also expressed preferentially (p<10-6) with a two- fold average increase in regulated samples. Differential expression is supported by data from Genevar MuTHER (p1 = 0.004; p2 = 0.0177). Evidence for influence of rs6136 on transcription factor binding was also found in silico and in public datasets reporting in vitro data. In summary, we found SELP rs6136-T to be associated with RA and with increased expression of SELP mRNA. SELP is located on the surface of endothelial cells and crucial for recruitment, adhesion, and migration of inflammatory cells into the joint. Genetically determined increased SELP expression levels might thus be a novel additional risk factor for RA.
- Innate immune response during NTM infectionsPublication . Sousa, Sara; Martins, Fatima; Jordão, LuísaBackground As tuberculosis incidence declines in industrialized countries, nontuberculous mycobacteria (NTM) infections gained relevance. Human infection with NTM became relevant with AIDS pandemic, being currently recognized as a cause of pulmonary infection in humans. Despite this fact little is known about NTM pathogenesis. In the present work the role of innate immune response during NTM infection using THP-1 cells as a model of alveolar macrophages was evaluated. Methods M.smegmatis mc2 155, 2 reference strains (M.avium ATCC25291; M.fortuitum ATCC6841) and 2 clinical isolates (M.avium 60/08;M. fortuitum 747/08) were used. Bacteria were grown until mid-exponential phase and stored at -80°C. Before each experiment analiquot was thawed and diluted in RPMI with 10% HI- FCS in order to reach an OD600nm of 0.1. The inoculums were titrated by CFU enumeration on 7H10 medium supplemented with 10% OADC. Briefly, 4x104 THP-1 cells were platted/well and incubated for 72h with 100nM PMA (37°C/5% CO2) then fresh medium without PMA was added being the cells incubated for further 24h. The cells were infected for 1 or 3h for fast or slow growers, respectively. The intracellular persistence was evaluated by CFU enumeration at different time points from 1 to 24h or 3 to 168h for fast and slow growers, respectively. Phagosome acidification was followed using confocal microscopy. The secretion of pro-inflammatory cytokines was assayed by ELISA, NO production using the Griess reagent and apoptosis was followed by flow cytometry and confocal microscopy. The ability of mycobacteria to persist at different pHs was evaluated using BACTEC-MGIT960. Results The mycobacteria experienced different fates within THP-1 macrophages. M.smegmatis and M.fortuitum ATCC6841 were cleared within 24h, whereas 747/08 and the two M.avium strains were able to replicate. Despite this fact for the latest mycobacteria more than 50% of acidified phagosomes were present during the experience. Mycobacteria survival at acidic pHs (6.6; 5.4 and 4.6) was then evaluated. With the exception of M.smegmatis all strains grew at acidic pH showing that other factors than phagosome acidification were involved in mycobacteria killing. Next, other components of the inflammatory response were evaluated. Measurable values of NO were present in supernatants of THP-1 infected for 3 days with 60/08 being this bacterium susceptible, to high concentrations of NO in vitro. Il-10 secretion was also assayed. For both fast growing NTM and M.avium ATCC25291 the production of IL-10 was not detectable. For 60/08 IL-10 production peaked at 3 days, decreasing afterwards until undetectable levels at 7 days. Another factor being explored is apoptosis induction by NTM. Our preliminary results point to differential induction of apoptosis by different NTM.
- Reticulócitos − Relatório Avaliação Final (2.2014)Publication . Faria, Ana Paula; Cardoso, Ana; Correia, Helena; Brito, CristinaElaborado no âmbito do Programa Nacional de Avaliação Externa da Qualidade (PNAEQ), o relatório de avaliação final contém: a Avaliação individual e o Relatório de desempenho geral.
- Indoor air quality and thermal comfort in elderly care centersPublication . Mendes, A.; Bonassi, S.; Aguiar, L.; Pereira, C.; Neves, P.; Silva, S.; Mendes, D.; Guimarães, L.; Moroni, R.; Teixeira, João PauloThis study explored environmental variables and buildings characteristics in 22 elderly care centers (ECCs) in Portugal. Indoor environmental parameters were measured twice for a total of 141 sampling sites. Each site was assessed for PM10, PM2.5, total volatile organic compounds (TVOC), formaldehyde, CO, CO2, total bacteria and fungi. Thermal comfort (TC) parameters were measured according to ISO 7730:2005 and a building characterization was performed. The overall PM2.5 mean concentration of the 22 ECC was above international reference levels in summer and winter seasons. TVOC, bacteria, CO and CO2 showed significantly higher indoor levels compared to outdoor, in both seasons. Indoor PM10, TVOC, bacteria and CO2 present significant differences between seasons. TVOC, bacteria and CO2 show significant variation between ECC rooms and 4% of fungi samples were positive for pathogenic Aspergillus species. The winter predicted mean vote (PMV) index showed a ‘slightly cool’ thermal sensation scale which may potentiate respiratory tract infections. The predicted percent of dissatisfied people (PPD) and PMV indices show significant differences by season. The building variables ‘Insulation’, ‘Heating Ventilation’ and ‘Windows frames’ were significantly associated to chemical, biological and TC parameters. ‘Bacteria’, ‘Fungi’, ‘Temperature’, Relative Humidity’, and ‘PPD index’ are the mostly affected by building characteristics. Insulating ceilings, walls, and windows could improve winter season TC, providing health benefits to ECC residents.
- Molecular and computational analyses of genes involved in mannose 6-phosphate independent traffickingPublication . Coutinho, M.F.; Lacerda, L.; Pinto, E.; Ribeiro, H.; Macedo-Ribeiro, S.; Castro, L.; Prata, M.J.; Alves, S.The newly-synthesized lysosomal enzymes travel to the trans-Golgi network (TGN) and are then driven to the acidic organelle. While the best-known pathway for TGN-to-endosome transport is the delivery of soluble hydrolases by the M6P receptors (MPRs), additional pathways do exist, as showed by the identification of two alternative receptors: LIMP-2, implicated in the delivery of β-glucocerebrosidase; and sortilin, involved in the transport of the sphingolipid activator proteins prosaposin and GM2AP, acid sphingomyelinase and cathepsins D and H. Disruption of the intracellular transport and delivery pathways to the lysosomes may result in lysosomal dysfunction, predictably leading to a range of clinical manifestations of lysosomal storage diseases. However, for a great percentage of patients presenting such manifestations, no condition is successfully diagnosed. To analyse if, in this group, phenotypes could be determined by impairments in the known M6P-independent receptors, we screened the genes that encode for LIMP-2 and sortilin. No pathogenic mutations were identified. Other approaches will be needed to clarify whether sortilin dysfunction may cause disease.
- Pilot project on the implementation of SSD2 in the frame of the electronic transmission of harmonized data collection of analytical results to EFSA. Call for tenderPublication . Oliveira, LuisaDefinição de estratégia DGAV – INSA
- Deteção precoce da epidemia sazonal de gripePublication . Mexia, Ricardo; Nunes, Baltazar; Contreiras, Teresa; Matias Dias, CarlosA deteção precoce da epidemia sazonal de gripe é fundamental para o planeamento e implementação adequada de um conjunto de procedimentos nas unidades de saúde, bem como nas recomendações a dar à população. Atualmente esta deteção assenta no sistema de vigilância da gripe, que inclui a Rede Médicos- Sentinela (Rede MS), um Sistema de Observação em Saúde, constituído por médicos de família, cuja atividade profissional é desenvolvida em Centros de Saúde. A participação dos clínicos na Rede é estritamente voluntária e inclui uma notificação contínua, semanal, dos novos casos de doença ocorridos nos utentes inscritos nas listas dos médicos participantes. Além disso, o sistema assenta também numa Rede de serviços de urgência sentinela que enviam zaragatoas para a vigilância virológica. Esta Rede tem entre os seus objetivos a vigilância epidemiológica de algumas doenças que ocorrem na comunidade, de forma a permitir a identificação precoce de eventuais "surtos", nomeadamente a Gripe. A Linha Saúde 24 (Linha S24) é uma linha de atendimento telefónico gratuito, de âmbito nacional, atendida por enfermeiros qualificados, disponível 24h/dia, que recolhe dados permanentemente e visa responder às necessidades manifestadas pelos cidadãos em matéria de saúde, contribuindo para ampliar e melhorar a acessibilidade aos serviços e racionalizar a utilização dos recursos existentes através do encaminhamento dos Utentes para as instituições integradas no Serviço Nacional de Saúde mais adequadas. Através do contacto telefónico, os enfermeiros identificam qual o principal problema de saúde e através de uma aplicação informática aplicam algoritmos de decisão para determinar qual a disposição e encaminhamento clínico (que pode ser oscilar entre o aconselhamento de vigilância da situação por parte do utente ou o transporte urgente através dos meios de emergência pré-hospitalar do Instituto Nacional de Emergência Médica-INEM). Os dados de que dispõe constituem uma importante fonte de informação que pode ser utilizada para permitir uma deteção precoce de surtos nas populações. Já existe experiência internacional da utilização deste tipo de sistemas, com resultados relevantes na antecipação da deteção de surtos 1,2,3. Assim, com este trabalho pretende-se verificar se a informação colhida pela Linha S24, durante as chamadas telefónicas de apoio e encaminhamento, permite identificar um “sinal” do início da epidemia sazonal de gripe na população portuguesa. Este resultado irá permitir uma muito melhor adequação dos recursos e das recomendações dadas à população em resposta à epidemia de gripe e seus impactos.
- WHO European Childhood Obesity Surveillance Initiative: body mass index and level of overweight among 6-9-year-old children from school year 2007/2008 to school year 2009/2010Publication . Wijnhoven, TA; van Raaij, J; Spinelli A, A; Starc, G; Hassapidou, M; Spiroski, I; Rutter, H; Martos, E; Rito, AI; et, al.Background: The World Health Organization (WHO) Regional Office for Europe has established the Childhood Obesity Surveillance Initiative (COSI) to monitor changes in overweight in primary-school children. The aims of this paper are to present the anthropometric results of COSI Round 2 (2009/2010) and to explore changes in body mass index (BMI) and overweight among children within and across nine countries from school years 2007/2008 to 2009/2010. Methods: Using cross-sectional nationally representative samples of 6−9-year-olds, BMI, anthropometric Z-scores and overweight prevalence were derived from measured weight and height. Significant changes between rounds were assessed using variance and t-tests analyses. Results: At Round 2, the prevalence of overweight (including obesity; WHO definitions) ranged from 18% to 57% among boys and from 18% to 50% among girls; 6 − 31% of boys and 5 − 21% of girls were obese. Southern European countries had the highest overweight prevalence. Between rounds, the absolute change in mean BMI (range: from −0.4 to +0.3) and BMI-for-age Z-scores (range: from −0.21 to +0.14) varied statistically significantly across countries. The highest significant decrease in BMI-for-age Z-scores was found in countries with higher absolute BMI values and the highest significant increase in countries with lower BMI values. The highest significant decrease in overweight prevalence was observed in Italy, Portugal and Slovenia and the highest significant increase in Latvia and Norway. Conclusions: Changes in BMI and prevalence of overweight over a two-year period varied significantly among European countries. It may be that countries with higher prevalence of overweight in COSI Round 1 have implemented interventions to try to remedy this situation.
- Investigação epidemiológica sobre prevalência e incidência de hipertensão arterial na população portuguesa - uma revisão de âmbitoPublication . Sousa-Uva, Mafalda; Victorino, Paulo; Roquette, Rita; Machado, Ausenda; Dias, Carlos Matias[PT] Introdução e objetivos: Portugal é referido na literatura como um dos países com maiores níveis de tensão arterial média na população. O objetivo do presente estudo é realizar uma revisão estruturada da literatura acerca do âmbito (quantidade, foco e natureza) da investigação epidemiológica publicada sobre prevalência e incidência de hipertensão arterial na população portuguesa. Métodos: A revisão de âmbito foi realizada em junho de 2013. Através da consulta das fontes de informac¸ão Pubmed e B-on foram pesquisados estudos sobre prevalência e incidência de hipertensão arterial cuja recolha de dados tivesse decorrido, respetivamente, entre 2005-2013 e 1995-2013. Resultados: Obtiveram-se 527 publicações, das quais foram selecionadas 14 sobre prevalência e duas sobre incidência de hipertensão. Os resultados indicam maior número de estudos sobre populac¸ões da região Norte do país; a aparente inexistência de estudos específicos sobre as populações do Alentejo e Algarve; longos períodos de tempo entre a recolha de dados e a publicac¸ão dos resultados (até nove anos); variabilidade apreciável nos métodos utilizados para medir a tensão arterial; e a infrequente desagregação dos resultados por sexo e idade. Conclusões: Os diferentes métodos de medic¸ão da hipertensão arterial, omissos na maioria dos trabalhos analisados, a rara desagregação dos resultados por sexo e idade e a assimetria de cobertura geográfica da população dificultam a monitorização das tendências da frequência de hipertensão arterial em Portugal.