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  • Unraveling Mycobacterium tuberculosis genomic diversity and evolution in Lisbon, Portugal, a highly drug resistant setting
    Publication . Perdigão, João; Silva, Hugo; Machado, Diana; Macedo, Rita; Maltez, Fernando; Silva, Carla; Jordão, Luísa; Couto, Isabel; Mallard, Kim; Coli, Francesc; Hill-Cawthorne, Grant A.; McNerney, Ruth; Pain, Arnab; Clark, Taane G.; Viveiros, Miguel; Portugal, Isabel
    BACKGROUND: Multidrug- (MDR) and extensively drug resistant (XDR) tuberculosis (TB) presents a challenge to disease control and elimination goals. In Lisbon, Portugal, specific and successful XDR-TB strains have been found in circulation for almost two decades. RESULTS: In the present study we have genotyped and sequenced the genomes of 56 Mycobacterium tuberculosis isolates recovered mostly from Lisbon. The genotyping data revealed three major clusters associated with MDR-TB, two of which are associated with XDR-TB. Whilst the genomic data contributed to elucidate the phylogenetic positioning of circulating MDR-TB strains, showing a high predominance of a single SNP cluster group 5. Furthermore, a genome-wide phylogeny analysis from these strains, together with 19 publicly available genomes of Mycobacterium tuberculosis clinical isolates, revealed two major clades responsible for M/XDR-TB in the region: Lisboa3 and Q1 (LAM).The data presented by this study yielded insights on microevolution and identification of novel compensatory mutations associated with rifampicin resistance in rpoB and rpoC. The screening for other structural variations revealed putative clade-defining variants. One deletion in PPE41, found among Lisboa3 isolates, is proposed to contribute to immune evasion and as a selective advantage. Insertion sequence (IS) mapping has also demonstrated the role of IS6110 as a major driver in mycobacterial evolution by affecting gene integrity and regulation. CONCLUSIONS: Globally, this study contributes with novel genome-wide phylogenetic data and has led to the identification of new genomic variants that support the notion of a growing genomic diversity facing both setting and host adaptation.
    2014-11-18Journal article Open access Show more
  • Positive Self Rated Health in a Portuguese Population with Diabetes: Association with Socio-Demographic Characteristics and Behaviour Risk Factors Patterns
    Publication . Costa, Elsa; Gonçalves, Luzia; Oliveira, Luisa; Dias, Carlos Matias
    Introduction: Self-rated health (SRH) is a health measure related to mortality, healthcare services utilization and quality of life. Given that behaviour related risk factors do not occur in isolation, rather they cluster together it is important to examine their patterns in a population with diabetes to inform a more holistic approach in both health promotion and illness prevention strategies. This study explores the association between the patterns of behaviour risk factors in a Portuguese population aged 15 years and over with diabetes and their SRH. Methods: The study sample was derived from 2005/2006 Portuguese National Health Interview Survey. Associations with SHR were assessed using binary logistic regression model. SRH was categorized as positive (very good or good) and negative (fair, bad or very bad). Latent Class Analysis (LCA) was used to classify individuals in groups of behavioural risk factors patterns. Results: Among the population with diabetes aged ≥ 15 years (226,068 valid cases), 11% reports positive SRH and 89% reports negative SRH. Men gender, younger age, higher level of education in contrast with lower education level´s, divorced and widower marital statuses in contrast with married were associated with positive SRH in the multiple logistic regression model. Physical activity and healthy diet were associated with positive SRH, after adjusting for socio demographics characteristics. Three behavioural risk factors patterns were identified: Physically inactive (83.3%), Smokers (11.2%) and Heavy drinkers (5.5%). Conclusion: The perception of health status is essential for better planning in health, thus these findings have implications for policy makers to develop specific programmes aimed at improving public health.
    2014-11-18Journal article Open access Show more