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- Brucellosis: the evolution of the disease in Portugal over two decadesPublication . Aires, Joana; Martins, Carla; Almeida Santos, JoãoBackground: Human and animal health are closely linked, with this relationship being a potential source of diseases to humans, with brucellosis being a classic example. Several prevention strategies have been successfully implemented to control brucellosis, but monitoring the disease is an essential instrument for early implementation of prevention measures, in order to mitigate any damage that an increase in cases may have on the human and animal population. Therefore, the aim of this study was to characterize the evolution of notified cases of human brucellosis in Portugal between 1998-2018. Methods: Retrospective observational study that included all reported cases of human brucellosis in Portugal, between 1998 and 2018 (last official public data available). Data was collected from reports made available by the Directorate-General for Health (DGS). Descriptive statistics (frequencies mean, median, proportions) by sex, age and geographic location were performed using Microsoft Excel® software. Results: Between 1998 and 2018, 3752 cases of brucellosis were reported in Portugal, the majority of which were male (n=2298, 61.2%), aged between 15 and 54 years (n=1870; 49.8%). With the exception of 2011, the number of cases reported in males was systematically higher than in females. The regions with the most reported cases are the North (n=1298; 34.6%) and Center (n=1323; 35.3%) of Portugal. The highest number of reported cases were recorded in North region (13 of the 21 years studied). The highest number of reported cases was observed in 1998 (n=817), while the lowest was observed in 2017 (n=16). The number of cases decreased substantially between 1998 and 2004 (variation of -82.6%), with this decline being interrupted by a small increase in cases in 2005. From 2005 onwards, the number of cases resumed its downward trend, although with some fluctuations and in a less pronounced way until 2018. Conclusion: In the last two decades, the number of reported cases of human brucellosis has decreased significantly. The improvement of the notification system, socioeconomic changes and animal brucellosis eradication programs are determining factors for this decrease. However, brucellosis is not eradicated in Portugal; therefore, the surveillance of human cases is essential to develop timely strategies for controlling brucellosis, not only at human level but also at animal and environmental levels.
- APOBEC3 deaminase editing in mpox virus as evidence for sustained human transmission since at least 2016Publication . O’Toole, Áine; Neher, Richard A.; Ndodo, Nnaemeka; Borges, Vitor; Gannon, Ben; Gomes, João Paulo; Groves, Natalie; King, David J.; Maloney, Daniel; Lemey, Philippe; Lewandowski, Kuiama; Loman, Nicholas; Myers, Richard; Omah, Ifeanyi F.; Suchard, Marc A.; Worobey, Michael; Chand, Meera; Ihekweazu, Chikwe; Ulaeto, David; Adetifa, Ifedayo; Rambaut, AndrewHistorically, mpox has been characterized as an endemic zoonotic disease that transmits through contact with the reservoir rodent host in West and Central Africa. However, in May 2022, human cases of mpox were detected spreading internationally beyond countries with known endemic reservoirs. When the first cases from 2022 were sequenced, they shared 42 nucleotide differences from the closest mpox virus (MPXV) previously sampled. Nearly all these mutations are characteristic of the action of APOBEC3 deaminases, host enzymes with antiviral function. Assuming APOBEC3 editing is characteristic of human MPXV infection, we developed a dual-process phylogenetic molecular clock that-inferring a rate of ~6 APOBEC3 mutations per year-estimates that MPXV has been circulating in humans since 2016. These observations of sustained MPXV transmission present a fundamental shift to the perceived paradigm of MPXV epidemiology as a zoonosis and highlight the need for revising public health messaging around MPXV as well as outbreak management and control.
- Hepatitis A in Portugal – epidemiological overview of incidence in the last decadePublication . Fonseca, Yasmin; Almeida, Ana; Almeida Santos, JoãoBackground. Hepatitis A is an acute liver disease with faecal-oral transmission caused by a hepatotrophic picornavírus - Hepatitis A Virus (HAV). Food contamination with HAV can occur at any time: cultivation, harvesting, processing, handling and even after cooking.1,2 Food and water contamination happens more frequently in developing countries where the disease is common but can also happen in developed countries. Although uncommon, foodborne outbreaks have occurred due to people consuming contaminated fresh and frozen imported food products. Therefore, monitoring the disease is an essential tool for the early implementation of preventive measures, applying the One Health approach to both the human and environmental dimensions to mitigate the impact that an outbreak may have on the population.3 Methods. Retrospective observational study, which analyses the incidence of reported cases of Hepatitis A in Portugal between 2012 and 2022. Data presented were collected from the Directorate-General for Health (DGS) and the European Center for Disease Prevention and Control (ECDC). Descriptive statistics were performed using Microsoft Excel® software. Results. Portugal had 806 cases of Hepatitis A between 2012 and 2022, the majority of which were male (n=597, 74.1%), aged between 25 and 44 years (n=397; 49.3%). Between 2012 and 2016, there was a gradual increase in incidence, from 0.1 in 2012 to 0.5 per 100 000 population in 2016. In 2017, there was a peak in incidence (4.7 per 100 000 population), corresponding to an outbreak of Hepatitis A that year. After 2017, the incidence gradually decreased. However, it never reached values lower than those of 2012, even during the years of the COVID-19 pandemic. During the study period, the incidence in men and women was similar, except between 2016 and 2019, where the incidence in men was higher. In terms of age, the incidence of Hepatitis A by age group showed high heterogeneity over the years, without a predominance. Conclusions. In Portugal, the incidence, except for 2017, was relatively low. However, most diagnoses occur in adults when the disease can present greater severity, with consequences in terms of morbidity and mortality. The decrease in incidence is a good indicator of improved hygiene and sanitary conditions, but it increases the possibility of outbreaks since the population tends to see its natural immunity against the disease reduced. It is essential to monitor the incidence of the disease in the population of Portugal to develop timely public health strategies to control potential outbreaks of Hepatitis A. Strategies to be implemented must take into account not only the human dimension in terms of prevention with vaccination, diagnosis and treatment of the disease but also measures in the environmental dimension, since transmission of the disease occurs via the faecal-oral route, it is essential to implement legislation and measures that promote food and water safety and alert the population to risk behaviours. References. 1Hofmeister MG, Foster MA, Teshale EH. Epidemiology and Transmission of Hepatitis A Virus and Hepatitis E Virus Infections in the United States. 2019. 2Castaneda D, Gonzalez AJ, Alomari M, et al. From hepatitis A to E: A critical review of viral hepatitis. World J Gastroenterol 2021; 27: 1691–1715. 3Jefferies M, Rauff B, Rashid H, et al. Update on global epidemiology of viral hepatitis and preventive strategies. Australia World J Clin Cases 2018; 6:589–599.
- Fermented melon by-products: can they contribute to the One Health approach?Publication . Domingues, M.S.; Silva, M.A.; Costa, H.S.; Albuquerque, T.G.One Health concept can be employed to implement an approach that contributes to increasing the use of sustainable practices and improving the overall health, as well as the well-being of humans, animals and the environment. About 42% of total food waste comes from fruits and vegetables. The application of fermentative processes can be an alternative to the valorization of fruit by-products, which can extend the shelf life of the product, as well as add economic and nutritional value, and create a more sustainable way of exploitation. The objective of this work was to subject melon by-products to two fermentation processes (lactic and alcoholic), to obtain flours that can be used by the food industry. Samples of melon by-products were collected in a hotel in the centre of Lisbon and fermented in sealed vacuum bags at 99%, with the following formulations: addition of 2% of table salt of the total weight of melon by-products (lactic fermentation) and addition of 2% of granulated white sugar from the total weight of melon by-products (alcoholic fermentation) – the ratio of peel and seeds was equal to that present in a fresh melon (38% and 8%, respectively). Fermentation was monitored for 7 days at an average temperature of 27 ºC ± 1 ºC. After, samples were dehydrated, homogenized and sieved to obtain a product with a flour texture. The nutritional composition of the flours was analytically determined, while the energy value and carbohydrates were calculated. Melon peel flour subjected to alcoholic fermentation had a dietary fibre content approximately 1.2 times higher than flour subjected to lactic fermentation (36 g and 29 g/100 g, respectively). On the other hand, the total ash content of the flour sample that underwent lactic fermentation was approximately 3 times higher than the alcoholic fermentation flour (20 g and 7 g/100 g, respectively). In terms of salt content, lactic fermentation flour had a content 4 times higher than alcoholic fermentation flour (4.7 and 1.0 g/100 g, respectively). Regarding the carbohydrate content, the difference between the samples was only 1.4 g/100 g. The fermentation of melon by-products, regardless of the selected fermentation process, makes it possible to obtain products with an enhanced nutritional profile, namely due to the high dietary fibre content. High dietary food intake has been shown to reduce the risk of several chronic diseases. Moreover, the approach applied in this study, revealed that the valorization of such products can be performed by a sustainable process (fermentation), contributing to a decrease in the amount of food waste, as well as reducing the social and environmental impacts of these products.
- An innovative food product based on melon by-product: mineral profilePublication . Silva, M.A.; Albuquerque, T.G.; Santo, L.E.; Alves, R.C.; Oliveira, M.B.P.P.; Costa, H.S.The demand for foods with positive health effects has increased as a result of the notable expansion in interest in health, food, and well-being in Europe and other developed countries. Fruit by-products are a good source of important nutrients like dietary fiber, fat, protein, vitamins, minerals, and other bioactive elements. In recent years, research has been conducted to determine whether these by-products may be used to enrich food products, with the goal of producing foods that are more nutritious and may have positive health effects. The objective of this study was to develop a muffin formulation based on melon peel flour and evaluate its composition regarding macroelements and trace elements (essential and non-essential). In 2021, melon peels were recovered from melon production and distribution companies, located in Torres Vedras and Rio Maior (Portugal). The melon peels were manually separated, dehydrated (50 ºC, 18h), homogenised, and sieved until a fine powder (melon peel flour) was obtained. A traditional recipe for muffins (control sample) and an innovative muffin, where the wheat flour was replaced by melon peel flour were prepared. The macroelements (Ca, Mg and P) and trace elements were analysed by inductively coupled plasma mass spectrometry and sodium and potassium were analysed by flame atomic absorption spectrometry. Regarding the results obtained, the main macroelements present in the melon peel flour were potassium (26 ± 0,7 mg/g) and calcium (8 ± 0,1 mg/g) and the most abundant essential trace elements were iron, manganese and zinc. By replacing wheat flour with melon peel flour, the magnesium, calcium and potassium contents increased. The highest increase was observed for potassium content (4 mg/g). Regarding essential trace elements, the incorporation of melon peel flour increased the content of iron, manganese and molybdenum. The melon peel flour can be considered a good source of macroelements such as potassium, calcium and phosphorus, and essential trace elements such as iron, manganese and zinc. The incorporation of melon peel flour allowed the development of a formulation rich in potassium, phosphorus and magnesium. This by-product has the potential to improve food security, nutrition, and economic well-being on a global scale, as well as the general health and well-being of people, animals, and the environment, supporting the One Health concept.
- Effects on antioxidant activity, total phenolics and flavonoids of different mixtures of red fruits and green leafy vegetablesPublication . Salgado, N.; Silva, M.A.; Costa, H.S.; Figueira, M.E.; Albuquerque, T.G.Currently, several studies have shown an inverse relationship between fruits and vegetables consumption and the appearance of noncommunicable chronic diseases, due to their richness in vitamins, minerals and antioxidants. Despite these benefits, their consumption is still lower than recommended by the World Health Organization (400 g per day). This research intends to assess the synergistic, antagonistic and additive effects of 20 mixtures (M1-M20) of red fruits (strawberry I1, raspberry I2, and blueberry I3) and green leafy vegetables (spinach I4 and lettuce I5) in different proportions, considering their in vitro antioxidant content. Analytical methods for antioxidant activity (DPPH•), total phenolics and flavonoids were carried out in ingredients and their mixtures. For each mixture, expected values were calculated by adding the results of ingredients considering their amount and, then, compared with observed values. When significant differences were found (p < 0.05), the effects were classified as synergistic (observed value > expected value) or antagonistic (observed value < expected value). When significant differences were not found (p > 0.05), the effect was considered additive. Concerning DPPH•, the majority of the effects in mixtures were synergistic. However, M15 and M16 had antagonistic effects and M13 was the only one with additive effect. M6 (34% I2 and 34% I3) had the most highlighted synergistic interaction. Regarding total flavonoids, all mixtures presented synergistic effects, with M4 (50% I4) having the highest synergy (observed value = 331.7 mg of epicatechin equivalents/100 g of sample > expected value = 137.8 mg of epicatechin equivalents /100 g of sample) and M12 (35% I5) the lowest. When considering total phenolics, synergistic effects in all mixtures were observed, with M6 and M8 (68% red fruits) being highlighted and M5 (50% I5) having the weakest interaction. In general, most of the mixtures had synergistic interactions, which means gathering ingredients in those proportions enhances antioxidant content and, therefore, can promote health benefits. In these assays, M6 is highlighted, except on total flavonoids. Also, these mixtures can be used to reduce inadequate consumption of fruits and vegetables.