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- Valorising food waste using black soldier fly larvae: a One Health assessment of mycotoxin bioaccumulation and mycotoxigenic fungi under industrial-scale conditionsPublication . Oliveira, Joana; Cervantes, Renata; Pena, Pedro; Gomes, Bianca; Kosicki, Robert; Trindade, Alexandre; Murta, Daniel; Viegas, Carla; Twarużek, Magdalena; Assunção, RicardoFood waste is a major challenge for environmental sustainability and food security. Black soldier fly larvae (BSFL, Hermetia illucens) offer a sustainable solution by converting food waste into high-quality protein, aligned with One Health principles. However, concerns over bioaccumulation of contaminants, including fungi and mycotoxins, have limited the use of food waste as insect substrate. This study evaluated whether BSFL bioaccumulate mycotoxins under industrial-scale rearing conditions, using bioaccumulation factors, while also assessing contamination with fungi of mycotoxin-producing potential. To do that, approximately two tonnes of food waste were collected from restaurants in Santarém, Portugal, processed into a test substrate, along with the cereal-based Gainesville diet as a control. Larvae were reared for 14 days, and samples of substrates, larvae, frass, and BSF meal were analysed for fungal contamination and mycotoxin concentration using culture-based methods and liquid chromatography-tandem mass spectrometry, respectively. Mycotoxigenic fungi belonging to Fusarium, Aspergillus, and Penicillium were predominantly below the limit of detection in larvae. Deoxynivalenol (DON), zearalenone (ZEN), and HT-2 toxin were detected in the substrates, but none of these mycotoxins were detected or quantified in larvae, with bioaccumulation factors consistently below one, indicating no significant accumulation. DON and ZEN were also detected in frass, in some cases at higher concentrations than in the corresponding initial substrates. These findings demonstrate that, under the conditions tested, BSFL did not bioaccumulate the mycotoxins detected in the rearing substrates, while their occurrence in frass highlights the importance of considering contaminant distribution across outputs of the bioconversion process. Overall, this study supports the safe use of BSFL for industrial-scale food waste valorisation and highlights their contribution to improving public health.
- Tradução e validação de um instrumento para avaliar a perceção dos técnicos de radiologia sobre o processo de acreditação num hospital público da região de LisboaPublication . Neto, Bruna; Eiras , Margarida; Silva, Carina; Carvalho, Ana SofiaAs instituições de saúde atuam num mundo focado na competência e qualidade. Os padrões de acreditação são elaborados para estimular a melhoria contínua da qualidade dos cuidados prestados pelas instituições acreditadas. Deste modo, um programa de acreditação é importante para garantir consistência na prática clínica da radiologia, aderindo aos padrões e diretrizes estabelecidos. A cultura de um determinado hospital/serviço pode influenciar a forma como os profissionais percebem o papel de um programa de acreditação. Este estudo teve como objetivo traduzir e validar um instrumento e avaliar a perceção dos técnicos de radiologia de um hospital público da cidade de Lisboa sobre o processo de acreditação. Foi desenvolvido um estudo descritivo, correlacional e transversal através da utilização de um questionário de autopreenchimento. Foi utilizada uma técnica de amostragem não probabilística. Na validação do instrumento avaliaram-se a fiabilidade do questionário, a validade teórica do questionário e a validação do ajustamento do modelo teórico do questionário. As propriedades psicométricas mostraram-se satisfatórias exceto na validação do ajustamento do modelo teórico do questionário em que se observou fragilidade no modelo proposto. Uma atitude positiva global em relação à acreditação foi demonstrada pelos participantes com concordância no impacto positivo do processo na melhoria dos cuidados de saúde ao utente. Resultados menos positivos foram obtidos no domínio relacionado com a utilização de recursos humanos. Os resultados sugerem a necessidade de reconhecer o desempenho da equipa demonstrado neste processo pela gestão do serviço para que os objetivos da instituição possam ser atingidos.
- Association between high myopia and non-alcoholic fatty liver disease in adolescentsPublication . Guo, Ting-Han; Dong, Xing-Xuan; Li, Dan-Lin; Grzybowski, Andrzej; Lança, Carla; Qin, Yu; Zheng, Ya-Jie; Liang, Gang; Pan, Chen-WeiPurpose: To investigate the association between high myopia and non-alcoholic fatty liver disease (NAFLD) in adolescents and to explore potential metabolic mechanisms. Methods: A total of 550 freshmen from Dali University were included. Data on refractive status, questionnaires, and serum metabolomics were collected. Multivariable logistic regression was used to assess the independent association between high myopia and NAFLD. Mediation analysis was performed to explore potential mediating metabolites, and enrichment analysis was utilized to explore key metabolic pathways. Results: The prevalence of NAFLD in the study population was 11.3%. High myopia was associated with higher odds of NAFLD (OR = 2.81, 95% CI: 1.34-5.86). Mediation analysis suggested 15 metabolites as potential mediators, with L-phenylalanine (mediating effect: 23.0%) and L-leucine (mediating effect: 16.7%) showing the largest effects. Enrichment analysis revealed that these key metabolites were primarily enriched in pathways such as aromatic and branched-chain amino acid metabolism, lysine degradation, and pantothenate and CoA biosynthesis. Conclusion: High myopia was associated with increased odds of NAFLD in adolescents, and this relationship may be partially mediated by abnormalities in amino acid and energy metabolism, suggesting potential metabolic links between ocular and hepatic conditions.
- Multimodal ultrasound assessment of the diaphragm during the maximal inspiratory pressure maneuverPublication . Leote, João; Nunes, Daniela; Oliveira, Inês; Silva, Rafael; Pereira, Marco; Bacariza, Jacobo; Gonzalez, Filipe; Hermínia Brites DiasDiaphragm ultrasound (DU) is increasingly used to assess diaphragmatic function, but its relationship with maximal inspiratory pressure (MIP), particularly when both are acquired during the same maneuver, remains unclear. This exploratory cross-sectional study investigated associations between MIP and DU parameters, compared diaphragmatic strain obtained with two different probes and imaging planes, and explored the association between diaphragmatic strain and the diaphragm thickening fraction (TF). Eleven healthy participants (median age 21 years; median body mass index 22.1 kg/m2) with normal phrenic nerve conduction, transcranial magnetic stimulation, and occlusion pressure at 100 ms underwent DU during the MIP maneuver using phased-array and linear probes at the subcostal window and zone of apposition, respectively. Each ultrasound acquisition was paired with an MIP recorded simultaneously during that acquisition; the two probes were therefore studied within the same session and not during a single shared maneuver. No a priori sample size or power calculation was performed. MIP showed moderate positive associations with diaphragmatic excursion (DE) (rs = 0.603, p = 0.050) and TF (rs = 0.482, p = 0.133), and moderate negative associations with time to peak diaphragmatic excursion (TPDE) (rs = −0.400, p = 0.223) and linear-probe strain (rs = −0.469, p = 0.241). Linear-probe strain was strongly associated with TF (rs = −0.710, p = 0.048). Every bootstrap 95% confidence interval included zero. In this exploratory sample, DE and TF showed the strongest associations with MIP, while zone-of-apposition strain was strongly associated with TF; they merit evaluation as part of a multimodal DU assessment as candidate quantitative parameters rather than validated markers.
- Cytotoxic activity of settled dust in primary schools: a multi-matrix, multi-season screening approach for children’s environmental healthPublication . Cervantes, Renata; Pena, Pedro; Carolino, Elisabete; Soszczyńska, Ewelina; Twarużek, Magdalena; Viegas, Susana; Viegas, CarlaChildren spend up to nine hours daily in school environments, yet the potential health impact of accumulated indoor dust remains largely uncharacterised. This study provides the first multi-matrix, multi-season assessment of passive dust samples from Portuguese primary schools, using the MTT assay to evaluate the biological activity of complex indoor pollutant mixtures. 207 passive samples were collected across 11 primary schools in the Lisbon Metropolitan Area, using four sampling matrices, settled dust filters, electrostatic dust cloths (EDC), electrostatic dust cloths on T-shirts (EDCT), and floor mops, across six indoor locations, warm and cold seasons, and in urban and rural contexts. Cytotoxic activity was assessed in A549 (human alveolar epithelial) and SK (swine kidney) cells, potential azole resistance was detected by growth on azole-supplemented culture media. Cytotoxic activity was detected in 64.7% (A549) and 24.6% (SK) of samples. Sampling matrix was the strongest predictor of cytotoxic variability for both cell lines (A549: R2 = 0.199; SK: R2 = 0.081; p < 0.001), with floor mops exhibiting the highest cytotoxic rates (A549: 94.4%; SK: 83.3%). Season was a significant secondary modulator exclusively for A549 cells, with cold-season positivity of 82.8% versus 50.0% (p < 0.001). Geographic context, school identity, and indoor location showed no significant effects, suggesting cytotoxic variability reflects building-level operational factors, cleaning practices, and ventilation, rather than environmental setting. Spearman analysis revealed cell-line and compound-specific associations between fungal burden, potential azole resistance detected by growth on azole-supplemented culture media, and cytotoxic responses, with reduced susceptibility to itraconazole, voriconazole, and posaconazole detected in school dust isolates. These findings demonstrate that microbial contamination in school settled dust may result in potential health effects involving clinically relevant antifungal resistance species. Floor mop sampling is identified as a high-sensitivity sentinel approach for the combined biological and chemical toxic burden accumulated at floor level. Passive multi-matrix cytotoxicity assessment should be integrated into school indoor air quality surveillance to protect this vulnerable population.
- Generational changes in lung function in adults from several world regions: results from the Burden of Obstructive Lung Disease studyPublication . Ma, Jixuan; Burney, Peter G.; Mannino, David M.; Janson, Christer; Gíslason, Thorarinn; Obaseki, Daniel O.; Jõgi, Rain; Santofimio, Valentina Quintero; Potts, James; Rashid, Abdul; Erhabor, Gregory E.; Nielsen, Rune; Kocabas, Ali; Nafees, Asaad; Ahmed, Rana; Denguezli, Meriam; Barbara, Cristina; Cardoso, Joao; Dias, Maria Hermínia Monteiro Brites; Rodrigues, Fátima; Agarwal, Dhiraj; Juvekar, Sanjay; Franssen, Frits M.; Seemungal, Terence; Mortimer, Kevin; El Biaze, Mohammed; Mahesh, Padukudru Anand; Koul, Parvaiz; Studnicka, Michael; Amaral, Andre F.This study estimated birth cohort effects on lung function using BOLD (Burden of Obstructive Lung Disease) data from 28,569 adults born between 1902 and 1976 across 41 sites in 34 countries. Forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1) and the FEV1/FVC increased across successive birth cohorts in both high-income countries (HICs) and low- and middle-income countries (LMICs), with mean values rising steadily with later birth year. In fully adjusted models, FVC increased by 21.4 mL, FEV1 by 24.6 mL and FEV1/FVC by 0.25% per birth year. These positive associations were consistent across sex, smoking status, and country-income subgroups (HICs and LMICs).
- From benign parasite to emerging pathogen: a review of Theileria orientalis in ruminantsPublication . Felício, Maria; Zúquete, Sara Tudela; Delgado, Inês L.; Inácio, Esmeralda; Nolasco, Sofia; Caetano, Pedro; Basto, Afonso P.; Padre, Ludovina; Leitão, AlexandreOnce regarded as a benign, clinically overlooked organism, Theileria orientalis has undergone a paradigm shift in its perceived status and is now recognised as a tick-borne haemoparasite of clinical and economic importance. Severe outbreaks characterised by haemolytic anaemia, reproductive losses, and mortality, primarily associated with the Ikeda and Chitose genotypes, have been increasingly reported in Australasia, Asia, and North America. In Europe and parts of Africa, however, the epidemiological status of T. orientalis remains poorly defined, despite increasing molecular evidence of circulation and reports of predominantly subclinical infections. The parasite is transmitted transstadially in ixodid ticks, with Haemaphysalis longicornis as the principal confirmed biological vector, although vector competence remains unverified for most suspected tick species. This narrative review was based on a comprehensive PubMed search from database inception up to the date of initial manuscript submission, supplemented by reference-list screening and targeted searches. This review synthesises current knowledge on taxonomy, life cycle, transmission, genetic diversity based on the major piroplasm surface protein gene, global epidemiology, pathogenesis, clinical manifestations, co-infections, production losses, diagnostics, and control strategies. Key gaps include limited understanding of the mechanisms driving erythrocyte destruction, insufficient experimental confirmation of vector competence, absence of licensed vaccines, and incomplete epidemiological data in several regions. Future research priorities are discussed in the context of climate change and the expanding geographic distribution of tick vectors.
- Incidental subfoveal choroidal synphlebia in non-neovascular age-related macular degenerationPublication . Mendo, Inês; Camacho, Pedro; Cabral, DiogoLeft-eye colour fundus photography shows dilated subfoveal choroidal vessels and a large patch of retinal atrophy sparing the fovea. En face OCT of the choroid reveals confluence of two large choroidal veins beneath the macula. OCT B-scans at different locations show two separate enlarged choroidal venous channels beneath the atrophic area, which merge at a different scan level into a single venous complex occupying almost the full choroidal thickness, with near-complete absence of visible overlying Sattler’s layer. These findings represent the fused large-vein variant of choroidal synphlebia. These images were acquired from a woman in her 80 s with bilateral non-neovascular AMD and no history or imaging signs of central serous chorioretinopathy, supporting choroidal synphlebia as an incidental imaging finding rather than a disease-related finding.
- Individual Participant Data Meta-Analysis (IPDMA) of long-term COVID-19 outcomes in a systematic review-informed, international, multidisciplinary databasePublication . Ali, Myzoon; Brady, Marian C.; Campbell, Pauline; Rooney, Scott; Williams, Linda; Paul, Lorna; Pereira, Filipe AlexandreBackground: Identifying and addressing long-term health and societal challenges after COVID-19 is a research priority. Objectives: To create an international, multidisciplinary COVID-19 database, and synthesise long-term outcomes, predictors and costs. Design: Systematic identification of COVID-19 data sets and meta-analysis of individual participant data on long-term outcomes after COVID-19. Setting: Contributed data were collected in clinical, community and research settings. Interventions: Interventions from original studies were included as covariates in models. Data sources: MEDLINE, Cochrane Central Register of Controlled Trials, EMBASE, Web of Science, PsycInfo® (American Psychological Association, Washington, DC, USA), Cumulative Index to Nursing and Allied Health Literature, World Health Organization Global Index Medicus, Epistemonikos, LitCOVID; World Health Organization International Clinical Trials Registry Platform; ClinicalTrials.gov and supplementary searches for studies (November 2019-November 2021) were searched for studies on > 10 people from cohort, case-control, survey or randomised controlled trial studies, across any setting, describing validated assessment instruments, symptoms, hospitalisation, discharge destination or mortality beyond 28-days after COVID-19 onset. Data were extracted by two independent reviewers. Methods: Principal investigators contributed fully anonymised individual participant data. Demography, equity and symptoms were described. Assessment instruments were mapped to the International Classification of Functioning, Disability and Health. Factors associated with outcomes at 3-6 months, 9-12 months and beyond 12 months of index infection, for n > 500 individual participant data and > 1 data set were described using ratio of difference, point estimates, odds ratio and 95% confidence interval, as appropriate. The Mixed Methods Appraisal Tool described study quality; models were appraised using a Grading of Recommendations Assessment, Development and Evaluation-informed approach; heterogeneity was described using I2. Outcome measures: Included overall perception of health, multidomain cognitive function, anxiety, depression, stress, post-traumatic stress disorder, fatigue, strength, walking ability, mobility, coping with daily life, breathlessness, mortality, later hospitalisation and health-related quality of life. Results: PRECIOUS collated 116 data sets from 40 countries (individual participant data = 62,849), comprising 20 randomised controlled trials, 13 case-control, 60 cohort 2 longitudinal, 1 survey and 20 other study types. Participants' median age was 58 years interquartile range (45-68); 34,185 (54.4%) were female; 158 unique symptoms and 137 unique assessment instruments were captured, predominantly describing International Classification of Function, Disability and Health-body functions. Women had poorer outcomes across 30/37 models, compared with men. In 15/37 models, pre-existing lung disease and increasing age were associated with poorer outcomes; hospitalisation, diabetes and chronic kidney disease were each associated with poorer outcomes in 8/37 models. Initial hospitalisation resulted in lower health-related quality of life that did not recover for up to 2 years after initial infection. Heterogeneity was low in 34/37 models; 22/37 models were of moderate and 11/37 were of low quality. Limitations: Use of secondary data limits available covariates, outcomes and time points to those included in primary data sets; evidence was primarily based on high-income countries. There was a lack of data on longer-term healthcare resource use to estimate the costs to the healthcare system. Conclusions: PRECIOUS contributes to the overall picture of long-term COVID-19 outcomes beyond the long-COVID condition and highlights poorer long-term outcomes in women and people with pre-existing comorbidities. Future work: Evidence gaps included healthcare resource use, isolation, loneliness, societal participation and return to work outcomes. Data are needed on the role of health inequity on long-term outcomes. Study registration: This study is registered as PROSPERO (CRD42020224323, IRAS ID: 293578).
- NeuroPORTRESS: prevalence, clinical spectrum, and factors associated with neurological involvement in Sjögren’s diseasePublication . Costa, Roberto Pereira da; Bandeira, Matilde; Silvério-António, Manuel; Lopes, Ana R.; Cunha-Santos, Filipe; Pereira, Paulo J.; Raimundo, Diana Belchior; Cunha, Anita; Oliveira, Cláudia Pinto; Duarte, Ana C.; Dias, João Madruga; Santos, Mariana Emília; Gonçalves, Maria JoãoObjectives: Neurological involvement is a heterogeneous complication of Sjögren's disease (SjD). We aimed to describe its prevalence and spectrum and identify factors associated with peripheral (PNS) and central nervous system (CNS) involvement. Methods: We conducted a cross-sectional, multicentre study based on PORTRESS, the Portuguese SjD registry. Demographic and clinical data were compared between groups. Independent associations of overall neurological, PNS, and CNS involvement were identified through logistic regression models using complete-case analysis. Results: Among 1234 patients, 62 (5.0%) had neurological involvement: 46 (3.7%) PNS, 17 (1.4%) CNS, with one patient having both. Patients with neurological manifestations had higher ESSDAI, more cryoglobulinaemia, purpura/cutaneous vasculitis and monoclonal gammopathy, and higher mortality. Cryoglobulinaemia and higher baseline ESSDAI (excluding neurological domains) were independently associated with neurological involvement. PNS involvement was associated with older age at symptom onset, cryoglobulinaemia, lymphopenia and higher ESSDAI. A sensitivity analysis revealed that low C4, persistent salivary gland swelling, and purpura/cutaneous vasculitis were also independently associated with PNS involvement. CNS involvement was associated with male sex and younger age at diagnosis. Conclusion: Neurological involvement in SjD was infrequent. PNS involvement clustered with vasculitic and B-cell-driven features and worse outcomes, whereas CNS manifestations appeared to show a distinct demographic profile, characterised by younger age and male sex. These findings support separate evaluation of PNS and CNS involvement and may help identify patients requiring neurological surveillance. Given the limited number of cases, particularly of CNS involvement, these findings remain exploratory and require confirmation in larger cohorts.