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- Gender-based violence against women and girls aged ≥15 years presenting to European emergency departments: a multinational, cross-sectional analysisPublication . Carannante, Anna; Pitidis, Alessio; Fondi, Gianni; Fian, Tabea; Alves, Tatiana; Valkenberg, Huib; Nijman, Susanne; Giustini, Marco; IDB groupBackground: Gender-based violence (GBV) is an important public health issue in Europe, yet standardised cross-national data remain scarce. Emergency departments (EDs) are often the first point of contact for an individual who has been assaulted. This study aimed to analyse GBV-related ED presentations using data from the European Injury Database (IDB). Methods: This cross-sectional study analysed IDB data from 16 European countries (Jan 1, 2008, to Dec 14, 2023), defining GBV as intentional injuries inflicted by male perpetrators, involving female individuals aged ≥15 years. Descriptive analyses compared GBV with other female injuries (female victims in whom the perpetrator was recorded as female or was not specified). Multivariable logistic regression assessed GBV-associated injury severity compared with other violence against girls and women, adjusting for age, period, and country. Findings: Of 5 643 295 injury-related ED attendances, 1 960 096 were other female injuries and 21 048 were violence cases, of which 10 315 were GBV. Mean age was 38·2 years (SD 15·7) for individuals subjected to GBV and 55·3 years (41·5) for those with other female injuries. There were higher rates of head and face injuries, contusions, and asphyxiation-related injuries in cases of GBV than other female injuries, but there were lower rates of fractures. Most GBV events occurred in domestic settings (5802 [56·3%] of 10 315 GBV cases) and during night-time hours (3931 [41·9%]), involving physical force (7340 [73·1%]); perpetrators were most commonly intimate partners (4906 [47·6%]) or strangers (1546 [15·0%]). Hospital admission was more frequent in GBV than in other female injuries (2210 [21·4%] of 10 315 vs 366 765 [18·7%] of 1 960 096; p<0·0001). GBV was associated with higher injury severity compared with other female injuries after adjustment (odds ratio 1·22, 95% CI 1·12-1·34; p<0·0001). Interpretation: GBV-related ED cases show distinct features that characterise the visible spectrum of violence against girls and women in emergency settings. These patterns highlight the need for improved documentation and greater awareness of less visible presentations. Cross-national variability underscores the need for harmonised surveillance protocols to capture the true burden of GBV in Europe.
- Predicted no effect concentrations of antifungals for wastewater management and agricultural usePublication . Gil, D.; José, S.; Ascenso, A.; Babič, M. Novak; Segal, E.; Meletiadis, J.; Gangneux, J.P.; Weiskerger, C.J.; Solo-Gabriele, H.M.; Valério, E.; Brandão, J.Antifungal resistance is an on-growing public health concern due to the difficulty in managing or treating medical conditions that often favour fatal fungal infections. The changing climate and globalisation, which increase fungal persistence and propagation, adds to that concern. Wastewater disposal is one potential source to the environment as antifungals are released into it. Considering that most fungal infections originate from the environment and considering the One Health principle, introducing antifungals through wastewater effluents has the potential to promote the emergence and dissemination of antifungal resistance. The objective of this study was to generate knowledge that can assist regulating the release of antifungals in the environment by quantifying predicted no-effect concentrations (PNECs) that would not promote antifungal resistance. For this purpose, a systematic review was performed to consolidate information on antifungals released to the environment and respective concentrations. The systematic literature review followed Preferred Reporting Items for Systematic literature reviews and Meta Analyses extension for Scoping Reviews (PRISMA-SLR). The analysis of 122 reviewed articles using this approach showed high concentrations and dispersion of antifungals in water, wastewater or soil. This highlights their potential dispersion in the environment, thus increasing the potential of fungal antimicrobial resistance. Due to the lack of PNEC values using fungi as model organisms in this review, PNECs for 17 antifungals were calculated using as model, as it is done for clinical purposes. We consider that the antifungal PNECs calculated and consolidated from the literature can be used to prioritise them for regulation and to determine acceptable levels in wastewater effluents.
- Trends in delivery hospitalizations and the impact of ICD-9-CM to ICD-10-CM-PCS transition in Portugal between 2010 and 2018Publication . Camarinha, Catarina de Paraíso; Oliveira, Maria Miguel Gomes; Elias, Cecília; Nobre, Miguel de Araújo; Nicolau, Leonor Bacelar Costa; Furtado, Cristina; Costa, Andreia Silva da; Nogueira, Paulo Jorge da SilvaBackground: Hospital discharge data are essential for maternal health surveillance, clinical research, and healthcare resource allocation. In 2017, Portuguese hospitals transitioned from the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) to the International Classification of Diseases, 10th edition, Clinical Modification and Procedure Coding System (ICD-10-CM/PCS), impacting the recording of delivery hospitalizations. This study examines trends in delivery hospitalizations from 2010 to 2018 and assesses the impact of the ICD-10-CM/PCS transition. Methods: We conducted a register-based observational cross-sectional analysis using data from the National Hospital Discharge Database, covering delivery hospitalizations in public hospitals from January 1, 2010, to December 31, 2018. Delivery episodes were identified using diagnosis codes, normal delivery codes, diagnosis-related group (DRG) codes, and procedure codes. Statistical analyses included descriptive statistics, interrupted time series with segmented regression, and Prophet forecasting models to evaluate trends and the impact of the coding transition. Results: A total of 673,978 delivery hospitalizations were recorded. The transition from ICD-9-CM to ICD-10-CM/PCS in 2017 had minimal overall impact on delivery trends. DRG codes consistently identified the majority of delivery episodes, with outcome of delivery codes and selected procedure codes showing varying trends. An increase in episodes identified by normal delivery codes and a significant decrease in episodes identified by procedure codes was observed immediately after the ICD-10 transition (p < 0.001). The Prophet model indicated improved forecast accuracy for procedure codes when including the ICD-10 transition variable. Conclusion: The transition to ICD-10-CM/PCS had a limited impact on overall delivery hospitalization trends but significantly affected procedure coding. These findings underscore the importance of considering coding system changes in healthcare data analyses. Further research should incorporate private hospital data and continuously monitor coding practices to ensure reliable health data for research and policy-making.
- Late HIV diagnosis: trends, risk factors, and progress toward the 2025 target of <20% late diagnosis in 23 EU/EEA countries, 2022 to 2024Publication . Reyes-Urueña, Juliana; Stoppa, Giorgia; Pizzolato, Federica; Marrone, Gaetano; Hansson, Disa; EU/EEA HIV networkIn 2022-2024, 14,153 of 28,521 (49.6%) new HIV diagnoses in 23 European Union and Economic Area (EU/EEA) countries were late. In adjusted analyses, older age and migrant status increased late diagnosis risk. The proportion of late diagnoses was 2.6-fold higher among migrants with pre-migration HIV acquisition than post-migration. Late-diagnosed migrants with likely post-migration HIV acquisition were often women, ≥ 50-year-olds, heterosexuals, people who inject drugs, or from South and South-East Asia. The 2025 target of < 20% late diagnosis was unachieved.
- First occurrence records and molecular identification of Sergentomyia spp. (Diptera: Psychodidae) sand flies in Praia, Santiago Island, Cabo Verde (2024)Publication . Pires, Hélida; Amaro, Fátima; Sousa, Celivianne; de Sousa, Rita; Leal, Silvânia da VeigaPhlebotomine sand flies are important vectors of pathogens affecting both humans and animals and are widely distributed geographically. In Cabo Verde, research on vector-borne diseases has focused primarily on mosquitoes, leaving other potential vectors understudied. As part of the ONESVEC surveillance project, we conducted a preliminary assessment to determine the presence of sand flies in Cabo Verde. From February to December 2024, entomological surveys using BioGents-Sentinel traps were carried out in five neighborhoods of Praia, Santiago Island: Achada Eugénio de Lima, Ponta de Água, Taiti, Vale do Palmarejo, and Vila Nova. Male specimens were slide-mounted for morphological identification, and randomly selected individuals underwent mitochondrial cytochrome c oxidase subunit I (COI) gene sequencing. Haplotype diversity and species delimitation (DnaSP, ASAP) were also assessed. A total of 367 sand flies (184 males, 173 females) were collected, of which 168 males were successfully identified. Most specimens were Sergentomyia fallax, found in all neighborhoods, while S. squamipleuris was identified in Taiti and Vale do Palmarejo. Phylogenetic analysis showed Cabo Verde S. fallax forming a well-supported monophyletic group, distinct from North African and Cyprus-Saudi Arabian lineages. Haplotype analysis revealed high haplotype but low nucleotide diversity, suggesting a genetically diverse yet stable or expanding population. In contrast, S. squamipleuris sequences clustered with Kenyan isolates in separate subclades, consistent with higher nucleotide diversity. ASAP species delimitation supported the phylogenetic analysis. This study provides the first confirmed record of phlebotomine sand flies in Cabo Verde and highlights the need for expanded surveillance and pathogen screening across the archipelago.
- A New World disease: Dual diagnostic challenges in travelers returning from Costa RicaPublication . Brazão, Cláudia; Borges-Costa, João; Antunes-Duarte, Sofia; Mancha, Dora; Sun, Lanyu; Marques, Tiago; Gargaté, Maria João; Vilares, Anabela; Reis, Tânia; de Vasconcelos, Pedro; Soares-de-Almeida, Luís; Filipe, PauloCutaneous diseases in returning travelers encompass a wide spectrum of etiologies and often pose diagnostic challenges. We present the cases of a 50-year-old man and a 57-year-old woman who presented with a 3-month history of erythematous, ulcerated plaques with well-defined elevated borders and a necrotic center on the lower limbs that began 3 weeks after returning from vacation in Costa Rica. Cutaneous biopsy revealed epidermal ulceration and extensive caseating granulomas throughout the full thickness of the dermis. Giemsa staining revealed no amastigotes. Microbiological examinations identified Leishmania braziliensis and excluded mycobacteria and fungi. The diagnosis of cutaneous Leishmaniasis was established. Owing to clinical severity and antimonial unavailability, the man was treated with liposomal amphotericin B. The woman underwent surgical excision of the single lesion, along with oral fluconazole. Complete resolution was documented in both patients. These cases, which posed diagnostic and therapeutic challenges, highlight that cutaneous leishmaniasis, in all its versatile and often perplexing presentations, is a parasitic infection that should always be considered in dermatologic patients returning from vacation in endemic countries.
- The Role of Immunogenetics in the Host-Parasite Interaction of Chagas Disease: Implications for Personalized MedicinePublication . Hassnain, Muhammad; Bukhari, Syeda Mahnoor; Bibi, Tahira; Waheed, Syeda Fakhra; Botelho, Monica C.; Ahmad, WaqasChagas disease, caused by the protozoan parasite Trypanosoma cruzi, continues to be a significant global health issue, especially in Latin America, with increasing international prevalence due to migration. Despite advancements in diagnosis and treatment, it remains a neglected tropical disease characterized by significant morbidity and mortality, mainly influenced by the complex interaction between parasite diversity and host immune responses. Importantly, the remarkable genetic diversity of T. cruzi lineages also contributes to clinical heterogeneity, influencing immune evasion, therapeutic responses, and vaccine feasibility. This review analyzes the impact of immunogenetics on host-parasite interactions in Chagas disease and explores its implications for personalized therapy approaches. Recent research, particularly over the last decade, has indicated that processes including antigenic variation, extracellular vesicle-mediated regulation, and disruption of host signaling pathways facilitate parasite persistence. Host genetic variables significantly influence susceptibility, disease development, and treatment outcomes, including changes in Human Leukocyte Antigen (HLA) genes, cytokine gene polymorphisms, and immunogenetic determinants of cardiac pathology. These findings underscore the potential of immunogenetic markers as tools for prognosis and as targets for personalized therapies. However, there are still considerable research deficiencies. Inadequate comprehension of gene-environment interactions, lack of representation of varied populations, and inconsistencies in study design limit the use of immunogenetic findings in therapeutic settings. At present, the concept of personalized medicine in Chagas disease remains largely aspirational, better understood as a framework for precision public health or stratified interventions guided by host immunogenetic and parasite lineage data. Addressing these issues necessitates comprehensive genomic research, mechanistic investigations of host-parasite interactions, and clinical validation of genetic markers. This study emphasizes the necessity of incorporating immunogenetics into personalized patient management strategies based on existing evidence. This integration has the potential to improve diagnosis, enhance treatment efficacy, and inform preventive interventions, thereby advancing personalized therapy for Chagas disease.
- Cross-sectional study on protective antibodies against influenza A virus subtypes and cross-protection against influenza A(H3N2) subclade K, Portugal, August 2025Publication . Guiomar, Raquel; Henriques, Camila; Pereira da Silva, Susana; Gomes, Licínia; Dias, Daniela; Verdasca, Nuno; Portuguese Laboratory Network for the Diagnosis of Influenza and Respiratory Viruses; Nunes, Baltazar; Rodrigues, Ana PaulaThe 2025/26 season was marked by co-circulation of influenza A subtypes, with the first detection of A(H3N2) subclade K in September 2025. In August 2025 in Portugal, 14.8% (95% CI: 12.2-17.8) of 886 persons tested had cross-protective antibodies against this subclade. The overall seroprevalence against circulating A(H1N1)pdm09 strains was 28.1% (95% CI: 24.4-32.0). These data highlight the presence of previous cross-reactive antibodies and the possible advantage of vaccination in the extent of detectable antibodies against influenza viruses.
- Rapid drug resistance prediction in positive clinical samples using an extensive targeted next-generation sequencing panelPublication . Rosendal, Ebba; Isidro, Joana; Carneiro, Sofia; Gomes, João Paulo; Macedo, RitaTuberculosis (TB) remains a global health challenge, exacerbated by the emergence of drug-resistant strains. Most methods for drug susceptibility testing (DST) are culture-dependent and time consuming, possibly delaying optimal TB-treatment. This study aimed to develop an extensive targeted next-generation sequencing (tNGS) approach for rapid genotypic DST directly from clinical samples. We designed a tNGS panel comprising 30 amplicons targeting 19 genomic regions associated with resistance to 20 antibiotics. This method was applied to 71 smear-positive (0-3+) pulmonary TB clinical samples collected at the Portuguese National Reference Laboratory. DNA was extracted and amplified using multiplex PCRs, followed by sequencing on Oxford Nanopore Technologies MinION platform. Sequencing data were using TB-Profiler and the tNGS results compared to phenotypic DST and whole genome sequencing (WGS) data from corresponding isolates. The tNGS demonstrated high concordance with both phenotypic and WGS-based DST across different sample types and smear positivity levels. For first-line drugs, tNGS showed 88% categorical agreement (CA) with pDST, increasing to 97% when excluding undetermined results. Compared to WGS across all analysed antibiotics, tNGS achieved 92% CA, increasing to >99% when excluding undetermined results. Validation of the tNGS panel showed 90% (1,895/2,076) of amplicons reaching >10x coverage at all analysed positions and 43 (61%) samples with all complete amplicons above this threshold. Non-specific amplification of contaminant bacterial DNA was minimal, with most mapped off-target reads being of human origin. This method enables comprehensive resistance prediction directly from clinical samples and signifies an important development in TB diagnostics and resistance monitoring.
- In vitro and in vivo assessment of nanoceria biocompatibility for their safe use in nervous system applicationsPublication . Fernández-Bertólez, Natalia; Martínez, Luisa; Ramos-Pan, Lucía; Touzani, Assia; Costa, Carla; Laffon, Blanca; Valdiglesias, VanessaNanoceria, or cerium dioxide nanoparticles (CeO NP), are increasingly employed in a number of industrial and commercial applications. Hence, the environmental presence of these nanoparticles is growing progressively, enhancing the global concern on their potential health effects. Recent studies suggest that nanoceria may also have promising biomedical applications particularly in neurodegenerative and brain-related pathologies, but studies addressing their toxicity, and specifically on the nervous system, are still scarce, and their potential adverse effects and action mechanism are not totally understood yet. The objective of this work was to assess the biological behaviour of CeO NP in vitro in human nervous systems cells, and in vivo in Drosophila melanogaster to characterize their safety for exposed individuals and verify their suitability to be further employed in diagnosis and treatment of nervous system disorders. Cell cycle alterations, late apoptosis rate and DNA damage (comet and γH2AX assays), were determined in neuronal SH-SY5Y and glial A172 cells treated with nanoceria. Moreover, the survival rate, morphological changes and behavioural alterations were analysed in D. melanogaster individuals chronically exposed to CeO NP. The results obtained from the in vitro assessment showed that the nanoceria generally presented a good biocompatibility with scarce cyto- or genotoxic effects, essentially depending the exposure time and cell type, and being restricted to the longer exposure periods. Nevertheless, decrease in adult size and alterations observed in the larval crawling in the in vivo assays highlight the need of further investigations before establishing clinical uses of nanoceria.