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- Detection of mpox using polymerase chain reaction from the skin and oropharynx over the course of infection: A prospective studyPublication . Correia, Catarina; Alpalhão, M,; de Sousa, D,; Vieitez-Frade, J.; Pelerito, Ana; Cordeiro, Rita; Lopes de Carvalho, Isabel; Núncio, MS; Ferreira, J,; Filipe, P.To the Editor: Since early May 2022, 86,746 mpox virus (MPV) infections have been reported worldwide.1,2 However, its in vivo viral kinetics and infectivity remain unclear.3 We conducted a prospective observational study to determine how long MPV remains detectable in skin lesions and the oropharynx. (...)
- e_LIPID–Characterization of hypercholesterolemia and association with cardiovascular disease in the Portuguese populationPublication . Chora, Joana Rita; Alves, Ana Catarina; Mariano, Cibelle; Antunes, Marília; Rato, Quitéria; Bourbon, MafaldaThe e_LIPID study aimed to characterise the lipid profile of the Portuguese population and study its association with cardiovascular disease (CV D) events. Demographic, clinical, and biochemical data derived from the e_COR Study, a cross-sectional epidemiological study with 1688 adults (18-79 years old) from five Portuguese continental regions. Population specific percentiles for lipid and lipoprotein biomarkers were esmated stratified by sex and age. All calculations were weighted by sex, age, and geographic region to be representative of the mainland Portuguese population. Odds ratio was calculated to study association of biochemical profile with CV D. Associations of total cholesterol (TC), LDL, ApoB and non-HDL were performed only on individuals under no lipid-lowering therapy. Individuals with LDL above the 9th5 percentile and fulfilling Simon-Broome criteria of Familial Hypercholesterolemia (FH) were sequenced for LDLR, APOB and PCSK9. National prevalence of individuals with TC≥190mg/dl were 52.4%, with LDL≥116mg/dl were 53.9%, with ApoB≥90mg/dl were 53.8%, with non- HDL≥146mg/dl were 38.9%, and with Lp(a)≥125nmol/L were 21.1%. The 90th percentile for lipid and lipoprotein biomarkers for the Portuguese population are TC of 244mg/dl, LDL of 169mg/dl, ApoB of 128mg/dl, non-HDL of 193mg/dl, and Lp(a) of 223nmol/L. The 10th percentile for HDL is 38mg/dl. Individuals with LDL≥116mg/dl presented 2.50 [1.13-6.07] higher odds of having had CV D events (p=0.018), with non-HDL≥146mg/dl had 2.06 [1.01-4.31] higher odds (p=0.041), and with high Lp(a)≥125nmol/L had 1.77 [1.13-2.72] higher odds (p=0.008) than their respective counterparts. From the 33 individuals sequenced 3 individuals were found to have heterozygous FH. Population age and sex specific values are important for dyslipidaemia assessment. Having LDL≥116mg/dl, non-HDL≥146mg/dl or Lp(a) ≥125nmol/L can double the odds of CV D. Our results highlight that hypercholesterolemia is a neglected cardiovascular risk factor with more than 50% of the population with TC≥190mg/dl, LDL≥116mg/dl, or ApoB≥90mg/dl. Since hypercholesterolemia is a modifiable risk factor in the majority of cases, strategies to increase adherence to changes in lifestyle habits need to be urgently discussed.
- Evolução do diagnóstico pré-natal em Portugal: dados do Registo Nacional de Anomalias CongénitasPublication . Braz, Paula; Machado, Ausenda; Aniceto, Carlos; Matias Dias, CarlosIntrodução: O diagnóstico pré-natal (DPN), permite: o diagnóstico de patologia para programar tratamento, preparar pais para o nascimento de uma criança com anomalias e optar pela continuidade da gravidez. É objetivo deste estudo avaliar a evolução do DPN nas gravidezes com anomalia congénita (AC) ao longo do tempo e nas diferentes regiões do país. Métodos: Realizou-se um estudo transversal, descritivo, usando dados do Registo Nacional de Anomalias Congénitas (RENAC. A análise contemplou dois resultados de interesse: i) quando foi detetada a primeira AC e respetivo primeiro exame alterado, (dados de 2000-2019); ii) quais as AC mais diagnosticadas ecograficamente, tanto a nível nacional como por região NUTS II de residência da grávida (dados de 2011-2019). Resultados: Nos 23745 casos notificados ao RENAC, observou-se um aumento de casos diagnosticados na fase pré-natal (42,3% em 2000 e 62,9% em 2019) e uma redução ao nascer (40,2% em 2000 e 23,7% em 2019). O primeiro exame alterado foi a ecografia em 89,6% dos casos, e os exames invasivos reduziram de 6,4% em 2000 para 1,9% em 2019. Nos 11931 casos notificados entre 2011-2019, observou-se uma maior frequência de diagnóstico em algumas AC do Sistema Nervoso Central (89% a 93%), Aparelho Renal (93% a 96%), AC da Parede Abdominal (85% e 92%), Anomalias dos Cromossomas (85% a 98%) e coração esquerdo hipoplásico (95,1%). São também estes os grupos mais diagnosticados por NUTS II, registando-se na Região Norte frequências quase sempre superiores às nacionais. Conclusões: Nos anos em estudo, ao observou-se um impacto do diagnóstico pré-natal, com aumento de diagnósticos na fase pré-natal e redução ao nascer, sendo a ecografia o exame que mais frequentemente diagnostica ou suspeita da presença de uma AC. Nas AC potencialmente detetáveis por ecografia, observou-se variação na frequência de diagnostico de acordo com a região de residência da gravida.
- Demographic and Clinical Characteristics of Mpox Patients Attending an STD Clinic in LisbonPublication . Cid Brito, Margarida; Nuncio, M.S.; Lopes de Carvalho, Isabel; Cordeiro, Rita; Pelerito, AnaMpox is a viral disease caused by the monkeypox virus, which marked the year of 2022 with a global outbreak. While previously considered to be a zoonosis of almost exclusive animal-to-human transmission, the current outbreak has been attributed to human-to-human transmission, particularly sexual transmission. As a new sexually transmissible disease, we studied the epidemiological and clinical features, as well as the concomitant occurrence of other sexually transmissible diseases, treatment approach, and outcome of our 291 patients, in the current outbreak. We found a total of 169 concomitant sexually transmissible infections of bacterial and viral origins, corresponding to 107 patients. Neisseria gonorrhoeae was the most common agent, particularly in the anal location. With this work, we emphasize the need for a thorough epidemiological and medical history, as well as a concomitant complete laboratorial screening for other STIs in patients with confirmed or suspected mpox.
- Poluição atmosférica exterior e saúde mental um estudo representativo a nível nacionalPublication . Pinheiro-Guedes, Lara; Sousa Uva, Mafalda; Gusmão, Ricardo; Martinho, Clarisse; Matias Dias, Carlos; da Conceição, Virgínia; Gomes Quelhas, Carlos; Saldanha Resendes, Daniel; Gaio, VâniaIntrodução: A poluição atmosférica exterior constitui um grave problema de saúde global. As doenças mentais comuns (DMC), nomeadamente as perturbações depressivas e ansiosas, são uma das principais causas de carga de doença, a nível mundial. A exposição de longo-prazo a partículas inaláveis parece associar-se à redução do bem-estar mental (BEM) e ao diagnóstico de DMC, mas a evidência é inconsistente. Procurámos estimar a associação entre a exposição de longo-prazo a partículas inaláveis com um diâmetro inferior a 10μm (PM10), o BEM e a frequência de diagnóstico provável de DMC. Métodos: Realizou-se um estudo transversal, de base populacional, em Portugal Continental. A exposição de longo-prazo foi estimada através das concentrações médias anuais de PM10, calculadas com dados provenientes das estações de monitorização da qualidade do ar da Agência Portuguesa do Ambiente e individualizadas para cada um dos participantes do Inquérito Nacional de Saúde com Exame Físico que residissem até 30km de pelo menos uma dessas estações, de acordo com o seu código-postal de residência. O BEM e a frequência de DMC foram estimados através da pontuação obtida na escala Mental Health Inventory-5. Utilizaram-se modelos lineares generalizados para estimar percentagens de mudança e razões de prevalências (RP), ajustadas para um potenciais confundidores, e seus intervalos de confiança a 95% (IC95%). Realizaram-se ainda análises de sensibilidade para avaliar eventuais vieses. Resultados: A mediana (intervalo interquartílico) de BEM foi de 72 (56-84) pontos, numa escala de 0 a 100. Verificou-se a ocorrência de diagnóstico provável de DMC em 22,7% (IC95%: 20,0-25,6) dos residentes em Portugal Continental com 25 a 75 anos. A exposição de longo-prazo a PM10 não se associou a uma diminuição estatisticamente significativa da pontuação de BEM [por cada aumento de 10 μg/m³ na concentração média anual de PM10, verificou-se uma diminuição de 2% (IC95%:-8,4) na pontuação]. Esta exposição também não se associou a um aumento estatisticamente significativo da frequência de diagnóstico provável de DMC (RP=1,012; IC95%:0,979-1,045). Discussão e conclusão: A ausência de associações estatisticamente significativas pode ter-se devido à reduzida variabilidade dos níveis de PM10 observados a nível nacional. Alguns estudos de características semelhantes e que reportaram associações estatisticamente significativas foram conduzidos em países asiáticos ou europeus (Alemanha, Bélgica, Espanha e Países Baixos) onde as medianas de concentração e os intervalos de variação observados foram superiores aos nacionais. A atual rede de monitorização da qualidade do ar apresenta limitações funcionais, cobrindo essencialmente a zona litoral do país. A manutenção de uma rede funcionante e de cobertura alargada é essencial para a obtenção de dados de qualidade, que permitam alavancar futuros estudos nesta temática e compreender os reais impactos da poluição atmosférica exterior, no nosso país.
- Generation and validation of a classification model to diagnose familial hypercholesterolaemia in adultsPublication . Albuquerque, João; Medeiros, Ana Margarida; Alves, Ana Catarina; Jannes, Cinthia Elim; Mancina, Rosellina M.; Pavanello, Chiara; Chora, Joana Rita; Mombelli, Giuliana; Calabresi, Laura; Pereira, Alexandre da Costa; Krieger, José Eduardo; Romeo, Stefano; Bourbon, Mafalda; Antunes, MaríliaBackground and aims: The early diagnosis of familial hypercholesterolaemia is associated with a significant reduction in cardiovascular disease (CVD) risk. While the recent use of statistical and machine learning algorithms has shown promising results in comparison with traditional clinical criteria, when applied to screening of potential FH cases in large cohorts, most studies in this field are developed using a single cohort of patients, which may hamper the application of such algorithms to other populations. In the current study, a logistic regression (LR) based algorithm was developed combining observations from three different national FH cohorts, from Portugal, Brazil and Sweden. Independent samples from these cohorts were then used to test the model, as well as an external dataset from Italy. Methods: The area under the receiver operating characteristics (AUROC) and precision-recall (AUPRC) curves was used to assess the discriminatory ability among the different samples. Comparisons between the LR model and Dutch Lipid Clinic Network (DLCN) clinical criteria were performed by means of McNemar tests, and by the calculation of several operating characteristics. Results: AUROC and AUPRC values were generally higher for all testing sets when compared to the training set. Compared with DLCN criteria, a significantly higher number of correctly classified observations were identified for the Brazilian (p < 0.01), Swedish (p < 0.01), and Italian testing sets (p < 0.01). Higher accuracy (Acc), G mean and F1 score values were also observed for all testing sets. Conclusions: Compared to DLCN criteria, the LR model revealed improved ability to correctly classify observations, and was able to retain a similar number of FH cases, with less false positive retention. Generalization of the LR model was very good across all testing samples, suggesting it can be an effective screening tool if applied to different populations.
- Nutritional evaluation of branded bakery and pastry products available in the Portuguese marketPublication . Albuquerque, T.G.; Ferreira, J.; Silva, M.A.; Costa, H.S.Branded bakery and pastry products are greatly appreciated by the population, especially by the youngest ones. However, these products are often considered poor from a nutritional quality point of view because they are a source of fat, saturated fat, sugar, and salt. A high intake of these foods is considered a major risk factor for the development of non-communicable chronic diseases, such as obesity, diabetes, hypertension, cancer, among others. This study aimed to develop a branded food database for bakery and pastry products, to assess the current situation on nutritional quality and to define further needs in terms of reformulation. Between January and March of 2023, a branded food database with data for 1062 products was developed by compiling the existing information on the websites of major supermarket chains available in Portugal and websites of manufacturers and retailers. The collected information was analysed regarding: i) evaluation of nutritional adequacy; ii) application of traffic light system; and iii) application of Nutri-score. After data cleaning and checking the absence of nutrition declaration, 966 foods were evaluated. Salt was above 0.3 g/100 g in 88.7% of the products and sugars were higher than 5 g/100 g in 79.1% of the products, which are goals of the Integrated Strategy for the Promotion of Healthy Eating, in Portugal. In the traffic light label analysis, the following percentages of foods are marked with red, meaning a high content: 53.5% for fat, 56.8% for saturated fatty acids, 53.9% for sugars and 9.4% for salt. According to Nutri-Score, 34.6% of the products are classified as “E” and 36.7% as “D”, indicating the poorest nutritional foods. It is of utmost importance to follow up this study and include other categories of foods. Moreover, strategies for the reformulation of bakery and pastry products to promote public health are still needed.
- Portuguese EQA Assessment in Parasite Morphology 26 years experiencePublication . Correia, Helena; Júlio, Cláudia; Baptista-Fernandes, Teresa; Faria, Ana PaulaThe Parasite Morphology Programme was implemented in 1996 by the Portuguese External Quality Assessment Programme (PNAEQ), with a pilot round the previous year, which includes the assessment of stool and blood samples, as well as other matrices. The program is supported by a group of experts for sample selection and preparation, result analysis and training. Aim: Evaluation of the performance of participants in the parasite morphology program by optical microscopy (1996-2022).
- The influence of cultivated cardoon and globe artichoke ethanolic leaf extracts on the shelf life of poultry meatPublication . Barbosa, Cássia; Vilarinho, Fernanda; Andrade, Mariana; Sanches Silva, Ana; Fernando, Ana LuisaFood additives are commonly used to prolong the shelf life of food by slowing down natural deterioration. However, synthetic additives have raised health concerns despite the European Union's strict regulations. To address this issue, researchers are exploring natural sources of compounds that can be safely used as food additives. Extracts from plants and agro-industrial by-products, such as Cynara cardunculus L. (cardoon), are being investigated for their potential as natural food preservatives. Cardoon leaves, the main by-product generated, are rich in antioxidants and antimicrobials, making them a promising candidate. The ethanolic extracts from cultivated cardoon and globe artichoke leaves were tested for their effectiveness in extending the shelf life of refrigerated poultry meat at a temperature of 5 ºC. After different storage durations (0, 4, 8, 11, and 15 days), the samples were evaluated for lipid oxidation, moisture, colour, pH, acidity, total volatile basic nitrogen, and microbial growth. It was found that the addition to poultry meat of cultivated cardoon leaf extract exhibited the most negligible malondialdehyde value, indicating significant antioxidant capacity and a significant delay in lipid oxidation. The extracts were also effective in retarding microbial growth once the counts remained at initial levels for all microorganisms studied. The results showed that both extracts effectively preserved the meat's quality for up to 15 days, making them a promising natural alternative to synthetic additives.
- Development of dietary fibre enriched bakery products by incorporating melon by-productsPublication . Silva, M.A.; Albuquerque, T.G.; Alves, R.C.; Oliveira, M.B.P.P.; Costa, H.S.Regular and sufficient intake of dietary fibre has many health benefits. One of these benefits is the ability to reduce the rate of glucose absorption after eating foods rich in carbohydrates with a high glycaemic index. Glycaemic control through dietary intervention is important for people with a high risk of Type 2 Diabetes Mellitus. According to some studies, it is recommended that the diabetic diet should provide 25-50 g/day of dietary fibre. However, the average daily intake of dietary fibre for the Portuguese population is 16.3 and 19.5 g/day, for women and men, respectively. This study aimed to develop two innovative food products based on melon peel flour and to evaluate their nutritional composition. In 2022, melon peels were recovered from melon production and distribution companies, mainly discarded fruits, which do not correspond to market needs in terms of size, and/or shape, or colour. Melon peels were dehydrated and homogenised until a fine powder (melon peel flour) was obtained. The nutritional composition was analytically determined. The energy value and available carbohydrates were calculated. The incorporation of melon peel flour allowed the development of a biscuit and a muffin with 15 and 13 g/100 g of dietary fibre, respectively. According to Regulation (EC) No 1924/2006 on nutrition and health claims, it is possible to say that the products developed can be considered high in fibre (> 6 g/100 g). Moreover, one portion of the developed biscuit (35 g) and muffin (48 g) can contribute with 21% and 25% of the recommended needs, respectively. The developed bakery products rich in dietary fibre could contribute to glycaemic control. The dietary fibre content present in the developed food products can also contribute to the valorisation of melon peel flour by reducing food waste, the environmental impact and contribute to improve public health.