Ana Rita Gaio

Behaviour and biomarkers of oxidative stress in Gambusia holbrooki after acute exposure to widely used pharmaceuticals and a detergent

Pharmaceuticals are continuously dispersed into the environment, as a result of human and veterinary use, and have become a relevant environmental concern. In the present study, the acute toxicity of three therapeutic agents (diazepam, clofibrate, and clofibric acid) and a detergent, sodium dodecylsulphate (SDS), to the euryhaline fish Gambusia holbrooki was evaluated. Special attention was devoted to oxidative stress parameters. G. holbrooki males, captured in the estuary of the Minho River (NW Portugal), were exposed for 96 h to the selected compounds. The following oxidative stress biomarkers were evaluated in gills and liver tissues: reduced and oxidised glutathione, lipid peroxidation, and several antioxidant enzymes, namely (1) total and selenium-dependent glutathione peroxidase (GPx), (2) glutathione reductase (GRed), (3) copper-zinc superoxide dismutase (Cu-ZnSOD) and manganese superoxide dismutase (MnSOD), and (4) glutathione-S-transferases (GSTs). In the particular case of diazepam, swimming behaviour was also evaluated. The obtained results indicate an overall diminished oxidative stress response caused by SDS and diazepam. Oxidative-based alterations were observed after exposure to clofibrate and clofibric acid, with modifications of several enzymatic activities. Diazepam caused evident behavioural changes: animals showed dark pigmentation and also abnormal postures, namely lethargy and anomalous movement.

Diagnostic value of patterns of symptoms and signs of heart failure: application of latent class analysis with concomitant variables in a cross-sectional study

Objective The diagnosis of heart failure (HF) requires a compatible clinical syndrome and demonstration of cardiac dysfunction by imaging or functional tests. Since individual symptoms and signs are generally unreliable and have limited value for diagnosing HF, the authors aimed to identify patterns of symptoms and signs, based on findings routinely collected in current clinical practice, and to evaluate their diagnostic value, taking into account the a priori likelihood of HF. Design Cross-sectional evaluation. Participants 1115 community participants aged ≥45 years from Porto, Portugal, in 2006–2008. Main outcomes measures Patterns were identified by latent class analysis, using concomitant variables to predict class membership. Patterns used 11 symptoms/signs, covering dimensions of congestion and hypoperfusion. Sex, age, education, obesity, diabetes and history of myocardial infarction or HF were included as concomitants. Results Bayesian information criteria supported a solution with three patterns: 10.1% of participants followed a pattern with symptoms of troubled breathing and signs of congestion (pattern 1), 27.8% a pattern characterised mainly by signs of congestion (pattern 2) and 62.1% were essentially asymptomatic (pattern 3); model fit was best when including concomitant variables. The likelihood ratio of patterns 1, 2 and 3 for left ventricular systolic dysfunction was 3.4, 1.1 and 0.6, and for left ventricular diastolic dysfunction 3.5, 1.4 and 0.5, respectively. Conclusions The use of concomitant variables can improve the diagnostic value of the symptoms and signs patterns and, consequently, improve the usefulness of the symptoms and signs for diagnosis and as an outcome measure. The potential for application in other settings of complex diagnoses is very high. These models were shown to be useful to standardise and quantify the probabilistic reasoning in clinical diagnosis, upon which decisions of further investigation and even treatment need to be made.

Tuberculosis in native- and foreign-born populations in Portugal.

BACKGROUND Tuberculosis (TB) is a major global health problem, and during the last 20 years, industrialised countries have shown similar patterns in TB notifications: decreasing TB incidence in native populations and increasing incidence in foreign-born populations. OBJECTIVES To characterise risk factors associated with TB among native- and foreign-born TB patients in Portugal and identify barriers to the management of foreign cases. METHODS Analysis of the data from the national tuberculosis surveillance system and data from an online survey of physicians managing TB cases in the country. RESULTS Risk factors in the two populations differed. Foreign-born patients were younger, less likely to use drugs or alcohol and had fewer comorbidities. They were also more likely to be human immunodeficiency virus positive, to be employed and to be homeless/living in shelters. The outcome of the disease and the time to diagnosis were not significantly different between the two populations. The most important barriers to the management of foreign-born TB cases were language and fear of deportation. CONCLUSIONS As there are significant differences between the two populations, different TB control strategies should be implemented in the two populations.

Uterine artery impedance during the first eight postpartum weeks

The aim of this study was to construct reference ranges for the uterine artery (UtA) mean pulsatility (PI) and resistance (RI) indices from 1–8 weeks postpartum. A prospective, cross-sectional, and observational study was performed with 320 healthy women from week 1 through week 8 postpartum. UtAs were examined transvaginally using colour and pulsed Doppler imaging, and the means of the right and left values of the PI and RI, as well as the presence or absence of a bilateral protodiastolic notch, were recorded. The 5th, 50th and 95th reference percentile curves for the UtA-PI and UtA-RI were derived using regression models. The adjusted reference intervals uncovered a convergence trend at the week 8 time-point, although impedance was lower at the week 1 time-point in multiparous women compared with primiparous women. The notching prevalence was 22.5% (9/40) at week 1 and 95.0% (38/40) at week 8. The study revealed consistent evidence of a progressive increase of postpartum uterine impedance and provided new average UtA-PI and UtA-RI reference charts for weeks 1 through 8. Multiparity does not change the trend but does impart a lower rate of increase, likely as a consequence of previous vascular structural and functional differences.

Longitudinal clustering of tuberculosis incidence and predictors for the time profiles: the impact of HIV.

BACKGROUND Portugal remains the country with the highest tuberculosis (TB) incidence in Western Europe. OBJECTIVES To identify longitudinal trends in TB incidence in Portugal from 2002 to 2012 and investigate the longitudinal effect of sociodemographic and health-related predictors among the resident population on the TB incidence rate. METHODS We used data from the National Tuberculosis Surveillance System and other national institutions. K-means longitudinal clustering algorithm was performed on TB incidence time profiles from districts of Portugal. RESULTS Three longitudinal profiles for the TB incidence rate of Portugal were identified. In all of them, TB incidence decreased over time. Among all studied sociodemographic and health-related predictors, human immunodeficiency virus (HIV) notification rate and unemployment were shown to have (positive) significant effects on TB incidence. In particular, the greatest effects were found for the HIV notification rate. CONCLUSIONS Our study supports the view that combined TB-HIV strategies and the improvement of social determinants can contribute to decreases in TB incidence.

Quantitative modelling of hip fracture trends in 14 European countries: Testing variations of a shared reversal over time

Qualitative similarities between hip fracture trends in different countries suggests variations of the same epidemic. We tested a single statistical shape to describe time trends in Europe, while allowing for country-level variability. Using data from 14 countries, we modelled incidence rates over time using linear mixed-effects models, including the fixed effects of calendar year and age. Random effects were tested to quantify country-level variability in background rates, timing of trend reversal and tempo of reversal. Mixture models were applied to identify clusters of countries defined by common behavioural features. A quadratic function of time, with random effects for background rates and timing of trend reversal, adjusted well to the observed data. Predicted trend reversal occurred on average in 1999 in women (peak incidence about 600 per 100 000) and 2000 in men (about 300 per 100 000). Mixture modelling of country-level effects suggested three clusters for women and two for men. In both sexes, Scandinavia showed higher rates but earlier trend reversals, whereas later trend reversals but lower peak incidences were found in Southern Europe and most of Central Europe. Our finding of a similar overall reversal pattern suggests that different countries show variations of a shared hip fracture epidemic.

Social profile of the highest tuberculosis incidence areas in Portugal.

ith a tuberculosis (TB) prevalence of over 20 cases per 00 000 individuals, Portugal is one of the countries with he highest TB burden in the European Union.1--3 From 999 to 2011, TB incidence in Portugal showed a consisent decrease of 4.3% per year, leading to a total decline of 2.1%2 and to the disappearance of high incidence regions ≥50 cases/100 000 habitants).4 Despite this progressive ecline, the country’s heterogeneity is remarkable and the istricts of Oporto, Lisbon and Setubal still have an interediate incidence of Tuberculosis (>20 cases/100 000 and 50 cases/100 000 population). Couceiro et al.3 showed that igh risk of TB in some areas of Portugal was related to he high prevalence of HIV/AIDS, incarceration, nonstandard nd/or crowded accommodation, unemployment and immirant populations from countries with high TB incidence. A oncentration of young adults might also contribute to the ncrease of the number of TB cases since the incidence is ighest in individuals aged 25--44 years.3--5 Realizing the importance of the social determinants in he control of TB, the authors wanted to characterize the rofile of the Portuguese regions with higher incidence ates. The analyzed demographic and socio-economic facors included the population density, proportion of people t working age (15--64 years old), proportion of immigrants nd unemployment rate and the TB incidence between 2002 nd 2012 in Greater Oporto, Greater Lisbon and Setúbal eninsula. The territorial unit used was NUTS 3 (Nomenclatura das nidades Territoriais para Fins Estatísticos). New TB cases ere identified from the tuberculosis national surveillance ystem; unemployment rate values were obtained from the mployment and Vocational Training Institute reports and he remaining data were collected from National Statisics Institute database. The number of immigrants was only vailable from 2008 to 2012. Greater Oporto presented the highest incidence of B, followed by Greater Lisbon and Setúbal Peninula. Until 2008, the decline of the incidence rate was t f a t

Mycobacterium avium infection in Portugal

BACKGROUND Although the incidence rates of non-tuberculous mycobacteria (NTM) have been increasing in many countries, the basic epidemiology of NTM remains to be fully understood. OBJECTIVE To assess the incidence, clinical relevance and geographical distribution of NTM disease in Portugal and to identify demographic and clinical characteristics associated with Mycobacterium avium complex (MAC) disease. METHODS Information stored in an electronic database of all NTM cases reported over an 11-year period was retrospectively reviewed. Significant demographic and clinical characteristics of MAC disease (vs. having any other NTM disease) were determined using multiple logistic regression models. RESULTS We identified 632 patients, mostly male, native Portuguese, with pulmonary disease, predominantly from Lisbon and Porto. The annual incidence of NTM disease was 0.54 per 100 000 population. The annual number of NTM cases increased throughout the study period. MAC was most frequently isolated. MAC disease was positively (and significantly) associated with being female, age >45 years and human immunodeficiency virus infection. CONCLUSIONS The increasing incidence of NTM over the study period emphasises the importance of NTM as a public health issue. This study provides important information for health care professionals and a basis for further study of NTM in Portugal.

Pneumonia pneumocócica - serão os novos scores mais precisos a prever eventos desfavoráveis?

INTRODUCTION The site-of-care decision is one of the most important factors in the management of patients with community-acquired pneumonia. The severity scores are validated prognostic tools for community-acquired pneumonia mortality and treatment site decision. The aim of this paper was to compare the discriminatory power of four scores - the classic PSI and CURB65 ant the most recent SCAP and SMART-COP - in predicting major adverse events: death, ICU admission, need for invasive mechanical ventilation or vasopressor support in patients admitted with pneumococcal pneumonia. METHODS A five year retrospective study of patients admitted for pneumococcal pneumonia. Patients were stratified based on admission data and assigned to low-, intermediate-, and high-risk classes for each score. Results were obtained comparing low versus non-low risk classes. RESULTS We studied 142 episodes of hospitalization with 2 deaths and 10 patients needing mechanical ventilation and vasopressor support. The majority of patients were classified as low risk by all scores - we found high negative predictive values for all adverse events studied, the most negative value corresponding to the SCAP score. The more recent scores showed better accuracy for predicting ICU admission and need for ventilation or vasopressor support (mostly for the SCAP score with higher AUC values for all adverse events). CONCLUSIONS The rate of all adverse outcomes increased directly with increasing risk class in all scores. The new gravity scores appear to have a higher discriminatory power in all adverse events in our study, particularly, the SCAP score.

Nosocomial tuberculosis prevention in Portuguese hospitals: a cross-sectional evaluation

SETTING Measures to control tuberculous infection are crucial to prevent nosocomial transmission and protect health care workers (HCWs). In Portugal, the extent of implementation of tuberculosis (TB) control measures in hospitals is not known. OBJECTIVE To determine the current implementation of preventive measures for tuberculous infection at administrative, environmental and personal levels in Portuguese hospitals. DESIGN A cross-sectional evaluation was performed using two anonymous questionnaires: one sent to all the hospital infection control (IC) committees and the other sent to all pulmonologists and physicians specialising in infectious disease. RESULTS Fourteen IC committees and 72 physicians responded. According to the IC committees, 92% of hospitals had a written TB control plan, but only 37% of the physicians said there was always/almost always a fast track for diagnosing suspected pulmonary TB cases. The majority of the hospitals had an isolation policy (85%) and these patients were always/almost always admitted in separate rooms, according to 70% of physicians. Both HCWs and TB patients used respiratory protection equipment (92%). CONCLUSION These findings indicate that the most basic TB IC measures had been undertaken, but some TB IC measures were not fully implemented at all hospitals. An institutional effort should be made to solve this problem and strengthen TB prevention activities.