FM-IMPSP-Artigos em Revistas Internacionais
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- Unveiling the prevalence and antimicrobial resistance landscape of Pantoea genus in veterinary clinical strains: insights from a cohort studyPublication . Holy, Ondrej; Sladecek, Vladimir; Bzdil, Jaroslav; Zouharova, Monika; Parra-Flores, Julio; Caneiras, CatiaThe genus Pantoea, of which Pantoea agglomerans is the most common species, is an emerging Gram-negative facultative anaerobic bacillus that causes a wide range of opportunistic infections. To date, the prevalence, antibiotic resistance, and pathogenic potential of this bacterium in animals remains largely unexplored. The aim of this work was to describe the prevalence of microorganisms of the genus Pantoea in clinical samples obtained from animals during the period 2015–2017 and to define their susceptibility to antimicrobial agents. In the monitored period, a total of 23,739 clinical samples obtained from animals in the Czech Republic with symptoms of disease were tested, from which 151 Pantoea genus were isolated (prevalence 0.63 %). Cultivation and incubation were carried out under aerobic conditions by culture methods using massopeptone blood agar, Endo's agar and xylose lysine deoxycholate agar at 37 ± 1 °C for 24 h. Suspect strains were confirmed by matrix-assisted laser desorption/ionization coupled to time-of-flight mass spectrometry (MALDI-TOF MS). Susceptibility testing was performed by the standard disk diffusion method using Mueller-Hinton agar. Pantoea strains were recovered from domestic horses, carnivores (dogs, cats) and rodents (prevalence of 6.78, 1.64 and 1.12 % respectively). Resistance to beta-lactam antimicrobials was detected in 12 strains. In addition to beta-lactams, resistance to co-trimoxazole was detected in 1 case and to co-trimoxazole and chloramphenicol in 1 case, highlights the need to monitor the emergence of this strain in the context of the One Health approach.
- Co-creation and implementation of a healthy snacks policy in primary schools: data from Sintra Grows HealthyPublication . Nogueira, Telma; Ferreira, Raquel J.; Liñan Pinto, Mariana; Silva, Vitória Dias da; Nogueira, Paulo Jorge; Sousa, JoanaPolicy interventions in the school food environment can improve dietary behaviors. However, the literature describing its development and implementation is scarce. This manuscript aims to describe the process of co-creation, implementation, monitoring, and evaluation of a Healthy Snacks Policy, in the scope of Sintra Grows Healthy intervention. Through a community-based participatory research methodology, the co-creation of the Healthy Snacks Policy comprises six stages: snacks evaluation, feedback sessions, class assemblies, school community assemblies, school cluster policy approval, and process evaluation. Within one school year, a Healthy Snacks Policy was co-created, approved, incorporated in the school regulations, implemented, continuously monitored, and evaluated. Regarding snacks evaluation, 1900 snacks were evaluated at the beginning of the school year and 1079 at the end of the school year. There were three feedback sessions, twenty-two class assemblies, and three school community assemblies. Most teachers perceived that children began to consume healthier snacks (72%); 66% of the children were considered to have started eating healthier; and most families said "yes or sometimes" when asked whether their children started requesting healthier snacks (70%), trying new foods (63%), and noticing improvements in their eating habits (74%). The co-creation of a Healthy Snacks Policy establishes an approach to effectively implement existing guidelines for school food supplies, complying with national priority implementation recommendations.
- Global variation in lipoprotein/a levels among patients with coronary heart diseasePublication . Barkas, Fotios; Brandts, Julia; De Bacquer, Dirk; Jennings, Catriona; De Backer, Guy G.; Kotseva, Kornelia; Ryden, Lars; Lip, Gregory Y. H.; Santos, Raul D.; Libby, Peter; Erlund, Iris; Ganly, Sandra; Vihervaara, Terhi; Adamska, Agnieszka; Abreu, Ana; Almahmeed, Wael; Ambari, Ade Meidian; Ge, Junbo; Hasan-Ali, Hosam; Huo, Yong; Jankowski, Piotr; Jimenez, Rodney M.; Li, Yong; Mahmood Zuhdi, Ahmad Syadi; Makubi, Abel; Mbakwem, Amam Chinyere; Mbau, Lilian; Navarro Estrada, Jose Luis; Ogah, Okechukwu Samuel; Ogola, Elijah Nyainda; Quintero–Baiz, Adalberto; Sani, Mahmoud Umar; Sosa Liprandi, Maria Ines; Tan, Jack Wei Chieh; Urina Triana, Miguel Alberto; Yeo, Tee Joo; Wood, David; McEvoy, John William; Ray, Kausik K.; INTERASPIRE InvestigatorsBackground Lipoprotein(a) [Lp(a)] is a common risk factor for atherosclerotic cardiovascular disease, potentially more atherogenic per particle than low-density lipoprotein. An estimated 1.5 billion individuals globally have elevated levels ≥125 nmol/L, considered as a risk-enhancing threshold. Although Lp(a) levels vary by ethnicity, ongoing trials of novel therapies in predominantly secondary prevention patients use fixed Lp(a) enrollment thresholds. Objectives The purpose of this study was to assess Lp(a) levels in coronary heart disease (CHD) patients across geographical regions, providing inference on the proportions potentially eligible for future Lp(a)-lowering therapies and whether these vary by region and country. Methods INTERASPIRE (International Action on Secondary Prevention through Intervention to Reduce Events)enrolled adults hospitalized with CHD in the previous 6 to 24 months. Lp(a) levels were available in 13 countries across 6 World Health Organization (WHO) regions: Africa (Kenya, Nigeria, Tanzania), Americas (Argentina, Colombia), Eastern Mediterranean (UAE), Europe (Poland, Portugal), South-East Asia (Indonesia), and Western Pacific (China, Malaysia, Philippines, Singapore). Lp(a) measurements were performed once and centrally in Helsinki using an isoform-independent assay for 11 countries, and locally in Indonesia and China with standardization to the core laboratory. Lp(a) levels are reported as median (Q1-Q3) and proportions above different thresholds. Results Lp(a) results were available for 3,928 patients from 13 countries (mean age: 60.2 ± 10.2 years; 21.1% women). Median Lp(a) was 32 nmol/L (Q1-Q3: 11-89 nmol/L) overall, with 17.6% having levels ≥125 nmol/L. Median levels varied by region—highest in Africa (62 nmol/L) and lowest in Western Pacific (22 nmol/L)—and also between countries within regions: Europe (Portugal: 59 nmol/L vs Poland: 19.5 nmol/L), South America (Colombia: 46 nmol/L vs Argentina: 32 nmol/L) and Western Pacific (Malaysia: 39.5 nmol/L vs Philippines: 14 nmol/L). Overall, the proportions of patients with Lp(a) ≥150, 175, and 200 nmol/L (hence eligibility for future Lp(a)-lowering therapies) were 13.0%, 9.3%, and 6.2%, respectively, with eligibility also varying among countries: highest in Portugal (25.5%, 18.3%, and 11.6%) and lowest in Philippines (4.3%, 2.5%, and 1.3%). Conclusions The vast majority of patients with CHD have Lp(a) levels far below what is considered a typical risk-enhancing threshold, suggesting that the attributable risk from Lp(a) is more complex than previously perceived. Furthermore, wide geographical variations in Lp(a) levels above entry criteria for ongoing trials could impact equitable access to therapies, if these trials are positive.
- Frequency of residual combined dyslipidemia and hypertriglyceridemia in patients with coronary heart disease in 13 countries across 6 WHO Regions: results from INTERASPIREPublication . Santos, Raul D.; Ray, Kausik K.; De Bacquer, Dirk; Jennings, Catriona; Kotseva, Kornelia; Rydén, Lars; Lip, Gregory Y. H.; Erlund, Iris; Ganly, Sandra; Vihervaara, Terhi; Adamska, Agnieszka; Abreu, Ana; Almahmeed, Wael; Ambari, Ade Meidian; Ge, Junbo; Hasan-Ali, Hosam; Huo, Yong; Jankowski, Piotr; Jimenez, Rodney M.; Li, Yong; Mahmood Zuhdi, Ahmad Syadi; Makubi, Abel; Mbakwem, Amam Chinyere; Mbau, Lilian; Navarro Estrada, Jose Luis; Ogah, Okechukwu Samuel; Ogola, Elijah Nyainda; Quintero–Baiz, Adalberto; Sani, Mahmoud Umar; Sosa Liprandi, Maria Ines; Chieh Tan, Jack Wei; Urina-Triana, Miguel Alberto; Yeo, Tee Joo; Wood, David; McEvoy, John William; Libby, PeterBackground and aims: Hypertriglyceridemia (HTG) is independently associated with risk of atherosclerotic events, even when LDL-cholesterol levels appear controlled. This INTERASPIRE study determined the frequency of HTG and residual combined dyslipidemia and their related factors in patients with coronary heart disease (CHD) from 13 countries across six World Health Organization (WHO) regions. Methods: Participants with CHD underwent a standardized study interview and examination, including a centralized analysis of fasting blood samples. Elevated triglyceride (TG) and LDL-cholesterol were defined as ≥ 1.7 mmol/L and 1.8 mmol/L, respectively. Elevation in both was considered combined dyslipidemia. Results: Lipid profiles were available for 4069 patients. The mean age was 60.1 years (21.1 % women, 12.6 % smokers, 24 % obesity by body mass index [BMI], 61 % hypertension, and 44 % self-reported diabetes). Participants were evaluated 1.05 (0.76-1.45) years after their index CHD hospitalization. Overall, 12.7 % used no lipid-lowering therapies (LLT), 50.0 % used high-dose statins, and 11.8 % used combination therapies. Specific TG-lowering therapies were used by 2.3 %. One-third of patients had HTG, and 24.6 % had combined dyslipidemia. HTG was seen in all countries, but median TG values varied, with higher values among those not using LLT. HTG was independently associated with female sex, smoking, BMI, blood pressure, and LDL-cholesterol. HTG was inversely associated with HDL-cholesterol. Conclusions: HTG and residual combined dyslipidemia are common, although with wide variability between countries. A healthier lifestyle, weight reduction, greater use of combination therapy, and evidence-based TG-lowering treatments are necessary to reduce the risks of HTG and combined dyslipidemia.
- Exercise in advanced chronic kidney disease patients: risk or gain?Publication . Abreu, AnaCardiovascular (CV) disease (CVD), sharing many common risk factors with chronic kidney disease (CKD), is a major contributor to reduced life expectancy in CKD patients, being CV risk exponentially related to renal function decline. Exercise training (ExT), and the broader spectrum CV rehabilitation (CVR), can contribute to CV and renal risk factors and disease management, but are rarely prescribed to patients with CKD, especially in more advanced stages. Frequently, the presence of old age, geriatric specificities, comorbidities like anaemia, muscle atrophy, hyperparathyroidism, vitamin D deficiency and osteoporosis, transform these patients into complex cases, difficult to be managed by only one specialist, requiring an integrated look and specific attention. A multidisciplinary and multicomponent approach is needed for these multimorbidity patients, including the nephrologist, together with the cardiologist and the exercise expert as a central core in the rehabilitation team. However, CVR centres are not used to deal with these cases, focusing more often in CV patients (coronary artery disease, heart failure, post-cardiovascular surgery) with less severe renal failure.
- Risk of colonization with multidrug-resistant gram-negative bacteria among travellers and migrants: a narrative reviewPublication . Pedro, Diogo; Santos, Daniela; Meneses, Maria; Gonçalves, Fátima; Jantarada Domingos, Gonçalo; Caneiras, CatiaGlobalization in the 21st century has posed several challenges. In particular, the spread of multidrug-resistant bacterial strains, especially Gram-negative bacteria, which are prevalent in certain regions of the world, is one of the most critical issues. This raises concerns about the risks associated with the booming tourism industry and migratory flows. In fact, even transient colonization with multidrug-resistant strains can present significant challenges to individual, family, and public health. Understanding the epidemiology and mechanisms of resistance, associated risk factors and prevention policies is therefore essential to ensure that strategies are in place to limit the global spread of high-risk bacterial clones and thereby protect public health.
- Effectiveness and use of home high flow nasal cannula in Portugal: Where are we?Publication . Jácome, Cristina; Duarte, Mónica; Winck, João Carlos; Díaz Lobato, Salvador; Caneiras, CatiaOver the past two decades, high flow nasal cannula (HFNC) has emerged as a home treatment for patients with chronic respiratory diseases and chronic respiratory failure. This therapy provides heated and humidified gas admixture at a high flow rate (up to 60 L/min) via a wide-bore nasal cannula and its key benefits include its ability to deliver precise oxygen concentrations and reduce work of breathing.1 It serves as an alternative to traditional home respiratory treatments by improving oxygenation, enhancing carbon dioxide clearance and promoting mucociliary clearance.
- Reliability and validity of the Global Physical Activity Questionnaire for portuguese adultsPublication . Ribeiro, Mariana; Fernandes, Elisabete; Borges, Mariana; Pires, Madalena; Melo, Xavier; Pinto, Fausto J.; Abreu, Ana; Pinto, RitaThe Global Physical Activity Questionnaire (GPAQ) has been used often to assess physical activity (PA) patterns. However, the European Portuguese version of this instrument has not been validated. We aimed to validate the self-administered GPAQ, version 2, (GPAQv2) for Portuguese adults. We included 32 participants in a pilot study of a Portuguese adaptation of the test and 108 participants in an assessment of their PA patterns and sedentary behavior (SB) through the GPAQv2. For its validation, we compared the GPAQv2 to the International PA Questionnaire-Long Form (IPAQ-LF) (concurrent validity) and the ActiGraph wGT3X-BT accelerometer (criterion validity). We evaluated PA and SB at baseline and after seven consecutive days. Test-retest reliability with the Kappa test (k) and the Intraclass Correlation Coefficient (ICC) ranged from strong to almost perfect (k: 0.864-0.976) and from moderate to excellent (ICC: 0.56-0.994), respectively. Concurrent validity, assessed by Spearman's Correlation Coefficient, was moderate to substantial (rho: 0.471-0.680), and there was fair to substantial criterion validity (rho: 0.226-0.672). Bland-Altman plots showed that the GPAQv2 overestimated vigorous and moderate to vigorous PA and underestimated moderate PA. The largest difference values were related to SB, since the GPAQv2 underestimated sitting time. In sum, we found the GPAQv2 to have acceptable validity and reliability for assessing PA and SB patterns, and we recommend its use for Portuguese adults.
- In the flow of molecular miniaturized fungal diagnosisPublication . Zolotareva, Maria; Cascalheira, Francisco; Caneiras, Catia; Bárbara, Cristina; Caetano, Diogo Miguel; Teixeira, Miguel CachoThe diagnosis of fungal infections presents several challenges and limitations, stemming from the similarities in symptomatology, diversity of underlying pathogenic species, complexity of fungal biology, and scarcity of rapid, affordable, and point-of-care approaches. In this review, we assess technological advances enabling the conversion of cutting-edge laboratory molecular diagnostic methods to cost-effective microfluidic devices. The most promising strategies toward the design of DNA sequence-based fungal diagnostic systems, capable of capturing and deciphering the highly informative DNA of the pathogen and adapted for resource-limited settings, are discussed, bridging fungal biology, molecular genetics, microfluidics, and biosensors.
- The Young Community of the European Association of Preventive Cardiology: fostering the future of cardiovascular prevention: a statement of the European Association of Preventive Cardiology (EAPC) of the ESCPublication . Perone, Francesco; Jorstad, Harald Thune; D’Ascenzi, Flavio; Castelletti, Silvia; Abreu, Ana; Papadakis, MichaelThe European Association of Preventive Cardiology (EAPC) of the ESC is a multidisciplinary network of healthcare professionals with an interest in all aspects of cardiovascular disease prevention. Its mission is to promote excellence in research, clinical practice, education, and policy in cardiovascular health, including population science, primary care, secondary prevention and rehabilitation, and sports cardiology and exercise. To achieve this goal, young professionals are actively encouraged to get involved in the association. The EAPC Young Community and its activities within the association prepare the leaders of tomorrow through a dedicated and unique career development pathway.