National Institute of Health Dr. Ricardo Jorge
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Avaliação da exposição da população portuguesa a substâncias químicas: resultados de um estudo de âmbito nacional
No full textIntrodução: Tem sido amplamente reconhecido que a exposição humana a determinados químicos tem um impacto negativo na saúde humana. Importa, pois, caracterizar e monitorização a exposição da população por forma a, se necessário, suportar o desenvolvimento de medidas que levem à redução dessa exposição.
Objetivo: Caracterizar a exposição da população adulta portuguesa a um conjunto de substâncias químicas consideradas prioritárias no âmbito da Iniciativa Europeia de Biomonitorização Humana (HBM4EU).
Metodologia: Em 2019-2020 realizou-se um estudo epidemiológico transversal (INSEF-ExpoQuim) numa subamostra dos participantes do Inquérito Nacional de Saúde com Exame Físico (INSEF 2015). Para tal, selecionaram-se indivíduos de ambos os sexos e entre os 28 e 39 anos que foram recontactados. Cada participante respondeu a um questionário para recolha de dados socio-demográficos e estilos de vida e cedeu uma amostra de primeira urina da manhã. As amostras foram analisadas em laboratórios previamente qualificados para determinação de cádmio (Cd), bisfenóis (BPA, BPF e BPS), hidrocarbonetos aromáticos policíclicos (PAHs), acrilamidas e micotoxinas (desoxinivalenol – DON). Foi realizada uma análise descritiva das concentrações dos biomarcadores e uma avaliação do risco para a saúde utilizando a proporção de participantes com valores acima dos valores de referência disponíveis.
Resultados: Observaram-se, na população portuguesa (n=296), valores médios das concentrações urinárias de BPA, BPS, acrilamidas e de alguns PAHs, entre os quais o 1-hidroxipireno, superiores aos valores médios observados para a população europeia, enquanto que a média das concentrações de cádmio era inferior. Comparando as concentrações dos biomarcadores analisados com os valores de referência disponíveis observou-se que 1,4%, 0%, 19,3%, 13,7% e 1,0% das concentrações de Cd, BPA, BPS, DON, e 1-hidroxipireno, respetivamente, se encontravam acima dos valores de referência.
Conclusões: O INSEF-ExpoQuim produziu pela primeira vez dados de exposição a várias substâncias químicas na população adulta portuguesa harmonizados e diretamente comparáveis com valores de exposição da população Europeia. Os resultados mostraram que a população portuguesa está exposta aos químicos analisados e considerados prioritários no âmbito do HBM4EU, com uma proporção significativa de indivíduos a apresentar valores de exposição a BPS e DON, que poderão ser preocupantes, em termos de saúde pública. Os presentes resultados poderão contribuir para a definição de prioridades nacionais num futuro programa de monitorização e apoiar o desenvolvimento de políticas que visem a redução da exposição a estes químicos.Grant Agreement number: 733032 — European Human Biomonitoring Initiative (HBM4EU)N/
Effectiveness of the adapted bivalent mRNA COVID-19 vaccines against hospitalisation in individuals aged ≥ 60 years during the Omicron XBB lineage-predominant period: VEBIS SARI VE network, Europe, February to August, 2023
Get PDFMembers of the European Hospital Vaccine Effectiveness Group: Portugal: Ana Paula Rodrigues, Débora Pereira, Susana Costa Maia e Silva, Paula Pinto, Cristina Bárbara, António Pais de Lacerda, Raquel Guiomar and Camila Henriques.The European Medicines Agency (EMA) authorised four adapted bivalent mRNA COVID-19 vaccines for use against COVID-19 in September/October 2022: Comirnaty (BNT162b2; Pfizer-BioNTech) and Spikevax (mRNA-1273; Moderna) Original/Omicron BA.1 and Original/Omicron BA.4–5 [1]. During autumn 2022, all European Union/European Economic Area (EU/EEA) countries had vaccination campaigns in place to administer a booster dose, with several countries using the adapted bivalent vaccines [2]. The Omicron-descendent XBB lineage and XBB.1.5 sub-lineage became variants of interest in March 2023 [3]. We estimated the effectiveness of the COVID-19 bivalent vaccines against hospitalisation with PCR-confirmed SARS-CoV-2 infection among patients aged ≥ 60 years with severe acute respiratory infection (SARI) during the XBB lineage-predominant period.The ‘Vaccine Effectiveness, Burden and Impact Studies studies’ (VEBIS) is a project of the European Centre for Disease Prevention and Control (ECDC) run under the framework con tract No. ECDC/2021/016.info:eu-repo/semantics/publishedVersio
Toxocariasis: laboratory confirmation of clinical cases suspected of infection by Toxocara spp. between 2018-2022
Get PDFA toxocaríase é uma infeção parasitária zoonótica com distribuição mundial,
considerada pelo Centre for Disease Control and Prevention (CDC) uma das
doenças parasitárias mais negligenciadas e que apresenta uma taxa de prevalência
subestimada, sendo raros os estudos sobre a seroprevalência para
Toxocara spp. em Portugal. A infeção no Homem pode ocorrer de várias formas,
sendo predominante a infeção através da ingestão de ovos infetados
existentes no meio ambiente.
O objetivo deste estudo foi efetuar uma análise dos resultados laboratoriais
de todos os casos com suspeita clínica de toxocaríase estudados no Laboratório
Nacional de Referência de Infeções Parasitárias e Fúngicas do Instituto
Nacional de Saúde Doutor Ricardo Jorge (INSA) entre 2018 e 2022, tal
como descrever as características demográficas dos casos confirmados.
As metodologias laboratoriais usadas foram métodos serológicos: determinação
qualitativa de anticorpos IgG para Toxocara canis – ELISA (TECAN)
e Imunoblot comercial (Ldbio Iberlab) para confirmação dos casos positivos.
Durante o período de estudo de 5 anos foram analisadas amostras de
soro de 542 casos suspeitos de infeção por Toxocara spp., dos quais 160
(29,5%) apresentaram serologia positiva, tendo 19% (30/160) ocorrido em
crianças entre os 5 e os 14 anos de idade, sendo este o grupo etário com
maior número de infeções causadas por este agente etiológico.
Estes resultados mostram uma seroprevalência muito superior aos 10,5%
encontrados na Região europeia sendo associada principalmente a fatores
socioeconómicos e ambientais, destacando-se a necessidade de uma compreensão
mais aprofundada da biologia molecular, bioquímica, genética,
epidemiologia e ecologia de Toxocara spp. que possam levar a novas e melhores
estratégias para o tratamento, diagnóstico e controlo desta parasitose,
tais como o desenvolvimento de uma vacina e/ou de um agente ovicida
eficaz, com vista a um melhor controlo deste problema de saúde pública.Toxocar iasis is a zoonotic parasi tic infection wi th wor ldwide distr ibution,
considered by the Center for Disease Control and Prevention to be
one of the most neglected parasi tic diseases and which has an underestimated
prevalence rate, wi th studies on seroprevalence for Toxocara
spp being rare in Por tugal. It is a disease caused by the lar val forms
of Toxocara spp., nematodes belonging to the order Ascar idiodea,
fami ly Toxocar idae, wi th the species Toxocara canis, whose def ini tive
hosts are canids, responsible for the major i ty of infections in humans.
Infection in humans can occur in several ways, wi th the predominant
mode of infection being through the ingestion of infected lar val eggs existing in the envi ronment, and presenting four main cl inical forms.
The aim of the study was to per form an analysis of the laborator y resul ts
of al l cases wi th cl inical suspicion of toxocar iasis studied at the Nat ional
Reference Laborator y for Parasi t ic and Fungal Infect ions of the Nat ional
Inst i tute of Heal th Dr Ricardo Jorge (Por tugal ) between 2018 and 2022,
as descr ibe the demographic character ist ics in conf i rmed cases.
The laborator y methodologies used were serological methods: qual i tative
determination of IgG antibodies to Toxocara canis – ELISA (TECAN) and
commercial Immunoblot (Ldbio Iber lab) to conf i rm posi tive cases. Dur ing
the 5-year study per iod, serum samples f rom 542 suspected cases of
Toxocara spp. infection were analyzed, of which 160 (29.5%) presented
posi tive serology, 19% (30/160) of which occur red in chi ldren aged 5
and 14 years of age, this being the age group wi th the highest number of
infections caused by this etiological agent.
These results show a seroprevalence much higher than the 10.5% found
in the European region, being associated mainly with socioeconomic and
environmental factors, highlighting the need for a more in-depth understanding
of the molecular biology, biochemistry, genetics, epidemiology
and ecology of Toxocara spp. that could lead to new and bet ter strategies
for treatment, diagnosis and control of this parasitic disease, such as the
development of a vaccine and/or an ef fective ovicidal agent to control this
helminthozoonosis and promote a higher public health standard.info:eu-repo/semantics/publishedVersio
Alternaria toxins in foodstuffs: a public health concern
Get PDFAs toxinas da Alternaria são metabolitos secundários produzidos por fungos
do género Alternaria, que são agentes patogénicos e saprófitas comuns
das plantas, com a capacidade de crescer numa ampla gama de temperaturas
e níveis de humidade. Deste modo, estão amplamente distribuídos no
ambiente e são contaminantes prevalentes em produtos agrícolas a nível
mundial, causando danos pré e pós-colheita em frutas, vegetais, cereais e
grãos. Apesar de causarem perdas económicas relevantes e representarem
um risco para a saúde humana e animal, até ao momento não há uma caracterização
adequada dos perigos associados a estas micotoxinas emergentes.
Neste artigo apresenta-se um resumo da literatura referente aos efeitos
tóxicos destas micotoxinas ao nível do fígado, com ênfase nos estudos de
citotoxicidade e genotoxicidade. Estes estudos toxicológicos sugerem que
micotoxinas da Alternaria podem induzir a perda da viabilidade celular e
danos do DNA nas células hepáticas humanas.Alternaria mycotoxins are secondary metabolites produced by black moulds
of the genus Alternaria, which are common plant pathogens and saprophytes
that can grow in a wide range of temperatures and moisture levels.
Thus, they are widely distributed in the environment, and are prevalent
contaminants of food and feed worldwide, causing pre- and post-harvest
damage to agricultural products, such as fruits, vegetables, cereals and
grains. Despite causing relevant economic losses and posing a risk to the
health of humans and animals, there is a lack of proper hazard characterization
for these emergent mycotoxins. This ar ticle aims to summarize data
on these mycotoxins, focusing on hepatic cytotoxicity and genotoxicity.
These toxicological studies suggest that Alternaria mycotoxins may
induce loss of cell viability and DNA damage in human hepatocytes.Trabalho parcialmente financiado pelo Centre for Toxicogenomics and
Human Health – ToxOmics (UIDB/00009/2020; UIDP/00009/2020).info:eu-repo/semantics/publishedVersio
ReporType: A Flexible Bioinformatics Tool for Targeted Loci Screening and Typing of Infectious Agents
No full textThis article belongs to the Special Issue Machine Learning Applications in Bioinformatics and Biomedicine.In response to the pressing need for continuous monitoring of emergence and circulation of pathogens through genomics, it is imperative to keep developing bioinformatics tools that can help in their rapid characterization and classification. Here, we introduce ReporType, a versatile bioinformatics pipeline designed for targeted loci screening and typing of infectious agents. Developed using the snakemake workflow manager, ReporType integrates multiple software for read quality control and de novo assembly, and then applies ABRicate for locus screening, culminating in the production of easily interpretable reports for the identification of pathogen genotypes and/or screening of specific genomic loci. The pipeline accommodates a range of input formats, from Illumina or Oxford Nanopore Technology (ONT) reads (FASTQ) to Sanger sequencing files (AB1), or FASTA files, making it flexible for application in multiple pathogens and with different purposes. ReporType is released with pre-prepared databases for some viruses and bacteria, yet it remains easily configurable to handle custom databases. ReporType performance and functionality were validated through proof-of-concept exercises, encompassing diverse pathogenic species, including viruses such as measles, Newcastle disease virus (NDV), Dengue virus (DENV), influenza, hepatitis C virus (HCV) and Human T-Cell Lymphotropic virus type 1 (HTLV-1), as well as bacteria like and . In summary, ReporType emerges as a simple, dynamic and pan-pathogen tool, poised to evolve in tandem with the ever-changing needs of the fields of pathogen genomics, infectious disease epidemiology, and one health bioinformatics. ReporType is freely available at GitHub.V.B. work on ReporType development was co-financed through the DURABLE project. The DURABLE project has been co-funded by the European Union, under the EU4Health Programme (EU4H), Project no. 101102733. This work was also partially funded by the European Union through the project “Sustainable use and integration of enhanced infrastructure into routine genome-based surveillance and outbreak investigation activities in Portugal” on behalf of EU4H programme (EU4H-2022-DGA-MS-IBA-1)
Ticks and Tick-Borne Pathogens Circulating in Peri-Domestic Areas in Mainland Portugal
No full text(This article belongs to the Special Issue The One Health Challenge: Zoonotic Parasites)Over the years, tick-borne pathogens (TBPs) have garnered significant interest due to their medical, veterinary and economic importance. Additionally, TBPs have drawn attention to how these microorganisms interact with their own vectors, increasing the risk to human and animal infection of emerging and reemerging zoonoses. In this sense, ticks, which are obligate hematophagous ectoparasites, have a key role in maintaining and transmitting TBPs among humans and animals. The aim of this study was to assess the prevalence of neglected TBPs in mainland Portugal, namely Anaplasma spp., Babesia spp., Ehrlichia spp. and Neoehrlichia mikurensis. DNA fragments were detected in questing ticks collected from five different ecological areas under investigation. To the best of the authors' knowledge, this study reports new worldwide findings, including B. bigemina infecting Ixodes frontalis, Ixodes ricinus and Rhipicephalus sanguineus sensu lato. Additionally, it presents new findings in Portugal of N. mikurensis infecting I. ricinus and of presumably Wolbachia endosymbionts being detected in I. ricinus. Overall, there were 208 tick samples that were negative for all screened TBPs. The results herein obtained raise concerns about the circulation of neglected TBPs in mainland Portugal, especially in anthropophilic ticks, highlighting the importance of adopting a One Health perspective.Fundação para a Ciência e a Tecnologia - GHTM-UID/04413/2020 and LA-REAL–LA/P/0117/2020.info:eu-repo/semantics/publishedVersio
Melon peel flour: utilization as a functional ingredient in bakery products
No full textFood by-products are a major concern with a direct impact on the economy, society, and environment. The valorisation of these by-products could be an advantageous approach to face the increase in food waste since it can compromise environmental health and food sustainability. On the other hand, this valorisation would allow the development of new food products with health benefits for the population. Cucumis melo L. is a highly consumed fruit all over the world since it has excellent sensory and nutritional qualities, being also a good source of bioactive compounds. However, its peel and seeds are usually discarded. The aim of this study was to evaluate the potential of melon peel flour as a functional ingredient for innovative food products. For that, two different formulations containing melon peel flour were developed (a biscuit and a muffin) by replacing a conventional flour (wheat flour) in different percentages (50% and 100%, respectively). The nutritional composition, total phenolic content, and antioxidant potential of the developed products were studied, showing a high content of fibre, high levels of phenolic compounds and good sensory acceptability. These results show that it is possible to enrich different foods with melon peel flour in order to improve their nutritional properties, contributing to improving public health, simultaneously valorising a usually rejected by-product, reducing food waste and the environmental impact.This work was financially supported by the Foundation for Science and Technology (FCT) under the projects Food4DIAB (EXPL/BAA-AGR/1382/2021) and UIDB/50006/2020 and by AgriFood XXI I&D&I project (NORTE-01-0145-FEDER-000041) co-financed by the European Regional Development Fund (ERDF), through the NORTE 2020 (Programa Operacional Regional do Norte 2014/2020). Rita C. Alves thanks FCT for the CEECIND/01120/2017 contract
Observatório Nacional de Saúde: coletânea do Boletim Observações (1998-2009)
No full textColetânea do Boletim Observações editado entre 1998-2009 pelo Observatório Nacional de Saúde fundado pelo Dr. Marinho Falcão, atual Departamento de Epidemiologia do INSA.info:eu-repo/semantics/publishedVersio
Distribution of Chlamydia trachomatis ompA-genotypes over three decades in Portugal
No full textObjectives: Chlamydia trachomatis is classified into 15 major genotypes, A to L3, based on the diversity of ompA gene. Here, we evaluated and characterised the distribution and diversity of ompA-genotypes over 32 years (1990-2021) in Portugal.
Methods: The collection of the Portuguese National Reference Laboratory for Sexually Transmitted Infections includes 5824 C. trachomatis-positive samples that were successfully ompA-genotyped between 1990 and 2021. An in-depth analysis of ompA-genotypes distribution across the years, as well as by biological sex, age and anatomical site of infection was performed.
Results: ompA-genotype E was consistently the most frequently detected across the years, with a median frequency of 34.6%, followed by D/Da (17.6%), F (14.3%) and G (10.7%). The prevalence of lymphogranuloma venereum (LGV) genotypes (mostly L2, 62.0%, followed by L2b, 32.1%) increased since 2016, reaching the highest value in 2019 (20.9%). LGV, G and Da genotypes were associated with biological sex, specifically with being male, and were the most frequent among anorectal specimens (37.7%, 19.4% and 17.7%, respectively). Notably, LGV ompA-genotypes represented 38.9% of the male anorectal specimens since 2016, and were also detected among oropharynx and urogenital samples. ompA-genotype E was the most frequently detected at the oropharynx (28.6%) and urogenital (33.9%) sites during the study period, followed by D/Da (17.4%) and F (16.0%) in the urogenital specimens, and by G (26.1%) and D/Da (25.7%) in oropharynx specimens. Our data also highlight the emergence of the recombinant L2b/D-Da strain since 2017 (representing between 2.0% and 15.5% of LGV cases per year) and the non-negligible detection of ompA-genotype B in urogenital and anorectal specimens.
Conclusions: This study provides a comprehensive landscape of C. trachomatis molecular surveillance in Portugal, highlighting the continued relevance of ompA-genotyping as a complement to rapid LGV-specific detection tests. It also contributes to a deeper understanding of C. trachomatis epidemiology, diversity and pathogenicity.The work by MA is partially financed by national funds through Fundação para a Ciência e a Tecnologia under the project UIDB/00006/2020 (https://doi.org/10.54499/UIDB/00006/2020)
Extreme Temperatures and Stroke Mortality: Evidence From a Multi-Country Analysis
No full textMulti-Country Multi-City (MCC) Network Group Members: Joana Madureira (Department of Enviromental Health, Instituto Nacional de Saúde Dr Ricardo Jorge, Porto, Portugal; Susana Pereira Silva (Department of Epidemiology, Instituto Nacional de Saúde Dr Ricardo Jorge, Lisboa, Portugal).Background: Extreme temperatures contribute significantly to global mortality. While previous studies on temperature and stroke-specific outcomes presented conflicting results, these studies were predominantly limited to single-city or single-country analyses. Their findings are difficult to synthesize due to variations in methodologies and exposure definitions.
Methods: Within the Multi-Country Multi-City Network, we built a new mortality database for ischemic and hemorrhagic stroke. Applying a unified analysis protocol, we conducted a multinational case-crossover study on the relationship between extreme temperatures and stroke. In the first stage, we fitted a conditional quasi-Poisson regression for daily mortality counts with distributed lag nonlinear models for temperature exposure separately for each city. In the second stage, the cumulative risk from each city was pooled using mixed-effect meta-analyses, accounting for clustering of cities with similar features. We compared temperature-stroke associations across country-level gross domestic product per capita. We computed excess deaths in each city that are attributable to the 2.5% hottest and coldest of days based on each city's temperature distribution.
Results: We collected data for a total of 3 443 969 ischemic strokes and 2 454 267 hemorrhagic stroke deaths from 522 cities in 25 countries. For every 1000 ischemic stroke deaths, we found that extreme cold and hot days contributed 9.1 (95% empirical CI, 8.6-9.4) and 2.2 (95% empirical CI, 1.9-2.4) excess deaths, respectively. For every 1000 hemorrhagic stroke deaths, extreme cold and hot days contributed 11.2 (95% empirical CI, 10.9-11.4) and 0.7 (95% empirical CI, 0.5-0.8) excess deaths, respectively. We found that countries with low gross domestic product per capita were at higher risk of heat-related hemorrhagic stroke mortality than countries with high gross domestic product per capita (P=0.02).
Conclusions: Both extreme cold and hot temperatures are associated with an increased risk of dying from ischemic and hemorrhagic strokes. As climate change continues to exacerbate these extreme temperatures, interventional strategies are needed to mitigate impacts on stroke mortality, particularly in low-income countries.This study was supported by the Kuwait Foundation for the Advancement of Science (Grant ID: CB21-63BO-01), the Medical Research Council-UK (Grant ID: MR/V034162/1), the European Union’s Horizon 2020 Project Exhaustion (Grant ID: 820655), the Swiss National Science Foundation (Grant ID: TMSGI3_211626), and the National Institutes of Health (Grant ID: R01ES034038)