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  • Estudo da qualidade microbiológica de queijos da Beira Baixa fabricados com leite cru
    Publication . Mendonça, Rita; Batista, Rita; Chambel, Lénia
    Os queijos fabricados com leite cru fazem parte da cultura gastronómica portuguesa, sendo valorizados produtos de elevada qualidade microbiológica para garantir a segurança dos consumidores. Neste estudo avaliou-se a deteção e/ou contagem de Escherichia coli patogénica, Staphylococcus spp. coagulase positiva (CP), Salmonella spp. e Listeria monocytogenes, e de microrganismos indicadores de higiene (E. coli não patogénica e outras Listeria spp.) em 98 queijos da Beira Baixa fabricados com leite cru, e realizou-se a caracterização fenotípica e genotípica de isolados. Foram utilizados métodos baseados nas normas ISO e métodos para quantificação, deteção e identificação de bactérias (TEMPO®, VIDAS® e VITEK®, respetivamente). Fenotipicamente foram efetuados testes de suscetibilidade a antimicrobianos (E. coli e Salmonella spp.), testes da atividade hemolítica (E. coli) e teste de serotipagem por aglutinação (Salmonella spp.). Genotipicamente realizaram-se ensaios de PCR multiplex (pesquisa de genes específicos de E. coli patogénica intestinal) e sequenciação total do genoma (E. coli, Listeria spp. e Salmonella spp.), com deteção de genes de virulência e de resistência a antimicrobianos (E. coli e Salmonella spp.), bem como análise de clusters (E. coli e Listeria spp.). Detetou-se a presença de E. coli, Staphylococcus spp. CP, L. monocytogenes, Listeria innocua e Salmonella spp. em 73,5%, 63,3%, 4,1%, 4,1% e 1,0% das amostras, respetivamente. Não foram detetadas enterotoxinas estafilocócicas. Foram detetados três isolados de E. coli patogénica extraintestinal (ExPEC), um hemolítico e dois resistentes a múltiplos antimicrobianos (Ampicilina, Cloranfenicol, Sulfametoxazol, Tetraciclina), ST (sequence type) 14755, ST155 e ST362, respetivamente; um isolado de Salmonella Duisburg (ST4046) suscetível aos antimicrobianos testados e com dois genes associados a resistências; quatro isolados de L. monocytogenes (ST1, ST5, ST7) e quatro isolados de L. innocua (ST492, ST603). A contaminação encontrada poderá estar relacionada com a não adesão às boas práticas de higiene e segurança dos alimentos ao longo do processo de fabrico.
    2023-12-05Master thesis Restricted access Show more
  • Investigating the role of symptom valorisation in tuberculosis patient delay in urban areas in Portugal
    Publication . de Morais, Margarida; Sousa, Sofia; Marques, Jéssica; Moniz, Marta; Duarte, Raquel; Leite, Andreia; Soares, Patricia; Carreira, Mário; Pereira, Sofia; Alves, Catarina; Alves, Filipe; Rodrigues, Ana; Moreira, Ana; Cardoso, Márcia; Mota, Sandra; Gomes, Ana; Ferreira, Liliana; Lopes, Marta; Correia, Isabel; Rachadell, Juan; Gameiro, Maria; Dias, Ângela; Pereira, Manuel; Gonçalves, Jorge; Gonçalves, Maria; Taveira, Adriana; Neves, Celene; Silva, Lucinda; Mendes, Maria; Teixeira, Maria; Pereira, Maria; Piedade, Milena; Teixeira, Antónia; Carvalho, Carlos
    Background: Diagnosis delay contributes to increased tuberculosis (TB) transmission and morbimortality. TB incidence has been decreasing in Portugal, but median patient delay (PD) has risen. Symptom valorisation may determine PD by influencing help-seeking behaviour. We aimed to analyse the association between symptom valorisation and PD, while characterising individuals who disregarded their symptoms. Methods: A cross-sectional study was conducted among TB patients in Lisbon and Oporto in 2019 - 2021. Subjects who delayed seeking care because they did not value their symptoms or thought these would go away on their own were considered to have disregarded their symptoms. PD was categorised using a 21-day cut-off, and a 30-day cut-off for sensitivity analysis. We estimated the effect of symptom valorisation on PD through a directed acyclic graph. Then, a multivariable regression analysis characterised patients that disregarded their symptoms, adjusting for relevant variables. We fitted Poisson regression models to estimate crude and adjusted prevalence ratios (PR). Results: The study included 75 patients. Median PD was 25 days (IQR 11.5-63.5), and 56.0% of participants had PD exceeding 21 days. Symptom disregard was reported by 38.7% of patients. Patients who did not value their symptoms had higher prevalence of PD exceeding 21 days compared to those who valued their symptoms [PR 1.59 (95% CI 1.05-2.42)]. The sensitivity analysis showed consistent point estimates but wider confidence intervals [PR 1.39 (95% CI 0.77-2.55)]. Being a smoker was a risk factor for symptom disregard [PR 2.35 (95% CI 1.14-4.82)], while living in Oporto [PR 0.35 (95% CI 0.16-0.75)] and having higher household incomes [PR 0.39 (95% CI 0.17-0.94)] were protective factors. Conclusions: These findings emphasise the importance of symptom valorisation in timely TB diagnosis. Patients who did not value their symptoms had longer PD, indicating a need for interventions to improve symptom recognition. Our findings also corroborate the importance of the socioeconomic determinants of health, highlighting tobacco as a risk factor both for TB and for PD.
    2023-12-05Journal article Open access Show more
  • Surveillance of multiple congenital anomalies; searching for new associations
    Publication . Morris, Joan K.; Bergman, Jorieke E.H.; Barisic, Ingeborg; Wellesley, Diana; Tucker, David; Limb, Elizabeth; Addor, Marie-Claude; Cavero-Carbonell, Clara; Matias Dias, Carlos; Draper, Elisabeth S.; Echevarría-González-de-Garibay, Luis Javier; Gatt, Miriam; Klungsøyr, Kari; Lelong, Nathalie; Luyt, Karen; Materna-Kiryluk, Anna; Nelen, Vera; Neville, Amanda; Perthus, Isabelle; Pierini, Anna; Randrianaivo-Ranjatoelina, Hanitra; Rankin, Judith; Rissmann, Anke; Rouget, Florence; Sayers, Geraldine; Wertelecki, Wladimir; Kinsner-Ovaskainen, Agnieszka; Garne, Ester
    Many human teratogens are associated with a spectrum of congenital anomalies rather than a single defect, and therefore the identification of congenital anomalies occurring together more frequently than expected may improve the detection of teratogens. Thirty-two EUROCAT congenital anomaly registries covering 6,599,765 births provided 123,566 cases with one or more major congenital anomalies (excluding chromosomal and genetic syndromes) for the birth years 2008–2016. The EUROCAT multiple congenital anomaly algorithm identified 8804 cases with two or more major congenital anomalies in different organ systems, that were not recognized as part of a syndrome or sequence. For each pair of anomalies, the odds of a case having both anomalies relative to having only one anomaly was calculated and the p value was estimated using a two-sided Fisher’s exact test. The Benjamini–Hochberg procedure adjusted p values to control the false discovery rate and pairs of anomalies with adjusted p values < 0.05 were identified. A total of 1386 combinations of two anomalies were analyzed. Out of the 31 statistically significant positive associations identified, 20 were found to be known associations or sequences already described in the literature and 11 were considered “potential new associations” by the EUROCAT Coding and Classification Committee. After a review of the literature and a detailed examination of the individual cases with the anomaly pairs, six pairs remained classified as new associations. In summary, systematically searching for congenital anomalies occurring together more frequently than expected using the EUROCAT database is worthwhile and has identified six new associations that merit further investigation.
    2023-12-05Journal article Open access Show more