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Antibodies to Congo-Crimean haemorrhagic fever, Dhori, Thogoto and Bhanja viruses in southern Portugal.

Dhori and Thogoto viruses have been isolated from ticks in Portugal. In this country favourable ecologic conditions exist for other tick-borne viruses such as Bhanja and Congo-Crimean haemorrhagic fever (C-CHF) viruses. A serological survey for antibodies to these 4 tick-borne viruses in 258 human and 141 goat sera was done using the plaque reduction neutralization (PRN) and indirect fluorescent antibody (IFA) tests. Six human sera were found with antibodies to Dhori (2), Thogoto (2) and C-CHF (2) viruses, while seven goat sera had neutralizing antibodies (NA) to Dhori (5) or Bhanja (2) virus. From these results it seems likely that Bhanja and C-CHF, not yet isolated in Portugal, may exist focally in certain areas of southern Portugal.

Adolescent↗

[Profile of tropical diseases in Portugal].

The increased incidence of Imported Tropical Diseases in Portugal is correlated to a recent higher standard of living, influence of media and a consequent expansion of tourism, and above all to the close relationship existing between Portugal and Africa. The number and pathology (parasitic diarrhoeas, protozoal and helminthic infections) of in-patients with Tropical Diseases at the Unidade de Doenças Infecciosas, Parasitárias e de Medicina Tropical (UDIP-MT) were described, with special emphasis on Malaria (155 in-patients during the period from 1989 to 1993) and on Sleeping Sickness, where Eflornitin (DFMO) was for the first time used in Portugal. Finally, the impact of HIV epidemic on incidence and different clinical presentations of parasitic and other tropical pathology was also evaluated.

Diarrhea↗

Susceptibility of Planorbarius metidjensis from Portugal and Spain to Schistosoma bovis from Salamanca, Spain.

The susceptibility of Planorbarius metidjensis from Portugal and Salamanca (Spain) to Schistosoma bovis from Salamanca was studied. The degree of susceptibility as measured by positivity rate, number of cercariae, pre-patent period and survival rate, showed that P. metidjensis from Portugal and Spain are very susceptible to S. bovis from Salamanca. The role of P. metidjensis as a host of S. haematobium is questioned and further studies are shown to be necessary. To determine if the disease exists in Portugal, the bovine and snail populations on the border with Salmanaca and Algarve are beginning to be screened.

Animals↗

Programme for the surveillance of influenza in Portugal: results of the period 1990-1996.

OBJECTIVES: To describe the situation of the influenza in Portugal through the estimates of the incidence rates and the identification of the viral strains implicated on it during the period 1990-1996. DESIGN: The integrated clinical and laboratory surveillance system for influenza in Portugal is based on the Portuguese sentinel network. Influenza cases are identified by general practitioners (GP) and notified to Division of Epidemiology (DEP) and to National Influenza Centre. Clinical and epidemiological data based on the clinical diagnosis are recorded and incidence rates are computed for the whole country. Throat swabs and blood samples are taken from the patients with influenza and sent to the National Influenza Centre to identify and classify the viral strains implicated. PARTICIPANTS: Lists of patients of the GPs collaborating on "Médicos-Sentinela" network. RESULTS: In 1990-1991, 1992-1993, and 1994-1995 there was a higher prevalence of influenza B virus and the highest influenza activity occurred in February and March in contrast with 1991-1992, 1993-1994, and 1995-1996 where the highest numbers of influenza cases occurred in November and December, and were associated with influenza A. CONCLUSIONS: During the past six years, 1990-1996, the influenza activity has been moderate in Portugal. From 1990-1996 influenza A and B viruses were prevalent every second year. The prevalence of influenza A was associated with the occurrence of the highest number of influenza cases during December and January and the prevalence of influenza B with the occurrence of the highest number of influenza cases during February and March.

Family Practice↗

Forest fire emissions in Portugal: a contribution to global warming?

A forecast of expected evolution of carbon dioxide (CO(2)) emissions in Portugal between 1988 and 2010 is presented. Predictions show that CO(2) emissions will almost double in the next twenty years. The equivalent potential CO(2) emissions from nitrogen oxides (NO(x)) and volatile organic compounds (VOC), for a time horizon of 20 years, is also presented. NO(x) and VOC emissions seem to make a significant contribution to the global warming potential of Portuguese emissions. Estimates of CO(2) emissions due to forest fires have been made, oriented towards the study of the Portuguese contribution to the global warming. If the burned area exceeds 100 000 ha this contribution could reach 7% of the total Portuguese CO(2) emissions. The global warming potential of Portuguese forest emissions were also calculated. The climate change predicted to Portugal could be responsible for an increase in the forest fires and consequently for a greater contribution of its emissions to the total values. It was concluded that it is important to quantify emissions of the greenhouse gases, including the contribution of forest fire emissions, not only in Portugal, but in all the Southern European countries.

Journal Article↗

High relative frequency of thyroid papillary carcinoma in northern Portugal.

Two hundred and twelve papillary and 40 follicular carcinomas were found in 3002 thyroid glands examined from 1931 to 1975 in four Laboratories of Pathology that fairly cover northern Portugal. There was a striking preponderance of women both in papillary (female:male = 6.9:1) and follicular carcinoma (5.7:1). Sex-specific frequency of malignancy was significantly greater in men (13.3%) than in women (8.8%). The overall papillary/follicular ratio was 5.3:1 and did not significantly change throughout the study period. Papillary/follicular ratio was not significantly greater in litoral (5.5:1) than in regions with a low iodine intake and a relatively high prevalence of goiter (3.5:1). It is advanced that this high relative frequency of papillary carcinoma in northern Portugal, even in goiter areas, may reflect the existence of a racial factor since there is not enough evidence to support the influence of dietary iodine, previous irradiation and concurrent thyroiditis.

Adenocarcinoma↗

Genetic epidemiology of familial amyloidotic polyneuropathy (FAP)-type I in Póvoa do Varzim and Vila do Conde (north of Portugal).

Familial amyloidotic polyneuropathy (FAP-type I) was first described in Portugal by Andrade in 1952, a time when 54 among 64 patients (belonging to 25 families) originated from Póvoa do Varzim or its surrounding districts. Since then, a total of 1,233 patients, belonging to 489 pedigrees (so far unrelated), have been diagnosed at Centro de Estudos de Paramiloidose, Porto, Portugal. Although age-of-onset showed a wide range (17 to 78 years), 87% of these 1,233 patients developed symptoms before 40 years of age (mean 33.5, SD 9.4 years). Among all patients, 432 belong to 140 families originating from the area of Póvoa do Varzim/Vila do Conde, 330 of whom lived in that area at the time of diagnosis; age-of-onset was, on average, lower than in the overall group of patients (mean 31.1, SD 6.7 years), and no patient had onset after 57 years (versus 3.3% in the global sample). As in previous studies, women were found to have a later onset (33.7) than men (29.0) years. In 1991, the crude prevalence rate was 90.3 x 10(-5) (one in every 1,108 inhabitants), and the frequency of gene carriers was estimated to be 186 x 10(-5) (one in every 538); about 48.4% of these carriers had manifested symptoms by 1991. Female patients had a significantly higher number of children (mean 3.7, SD 2.6) than male patients (mean 2.7, SD 2.1) and the length of their reproductive period (mean 8.4, SD 5.8 yr) was also greater than for men (mean 5.6, SD 4.4 yr). Altogether, the 122 patients who ever reproduced contributed 457 children to the next generation, a mean fertility of 3.7. Further studies using a control groups may answer the question of whether this is the result of a specific high fertility of these patients or just their belonging to a population in natural expansion.

Adult↗

The equity principle in the allocation of health care expenditure on primary health care services in Portugal: the human capital approach.

This article examines the equity principle as it could be applied to the financing of primary health care resources in Portugal. Three resource allocation criteria are considered: namely, the demand/utilization criterion; the health situation criterion; and, the coverage by health services criterion. With data based on health service expenditure, district by district, for 1983, the article shows that quite different results would emerge from the selection of one criterion rather than another. In particular, a policy of positive discrimination would reallocate resources towards the north rather than the south of Portugal, though differences would emerge between districts and between specific activities provided within the framework of primary health care. The results are presented and conclusions drawn.

Health Expenditures↗

Genetic analysis of human immunodeficiency virus type 1 nef in Portugal: subtyping, identification of mosaic genes, and amino acid sequence variability.

Extending our previous genetic characterization of human immunodeficiency virus type 1 (HIV-1) strains circulating in Portugal, we here report the first phylogenetic and putative amino acid sequence variability analyses of nef accessory gene. Viral sequences (n = 53) were amplified by nested PCR from proviral DNA purified from peripheral blood mononuclear cells of HIV-1 infected individuals (n = 49). Phylogenetic inference analysis demonstrated a distribution of the viral sequences between subtypes A (sub-subtype A1), B, D, F (sub-subtype F1), G, H, and J, with subtypes G and B accounting altogether for more than half of the genotypes found. A significant number of the proviral DNA sequences analyzed (18.4%) were shown to correspond to intragenic nef recombinants, with the majority having the typical CRF02_AG nef structure. In addition, three novel intragenic recombinant structures were found (B/G/B, CRF02_AG/H, and D/G). From phylogenetic analysis, it was concluded that part of the non-recombinant nef genes might have actually been amplified from mosaic viruses: CRF06_cpx, CRF14_BG, and a new envA/nefJ recombinant. While comparing all the putative Nef sequences, significant amino acid sequence variability was observed. However, most of the described nef functional motifs were relatively well conserved in the majority of the sequences analyzed and numerous amino acid changes fell outside these regions. The results presented unambiguously endorse the high level of complexity of HIV-1 epidemics in Portugal.

Adolescent↗

Using a pharmaco-epidemiological approach to estimate diabetes type 2 prevalence in Portugal.

PURPOSE: To estimate the prevalence of drug-treated diabetes type 2 in Portugal using drug consumption data and accounting for the proportion of patients treated with combinations of oral hypoglycaemic agents (OHAs). METHODS: The prevalence of diabetes treated by OHAs was calculated on the basis of: IMS-Health data for Portugal (2003) and two measures of daily drug intake-defined daily dose (DDD) and prescribed daily dose (PDD), after correcting for the proportion of patients treated with two or more OHAs. The PDD and proportion of patients in combination therapies have been obtained in a descriptive, cross-sectional national survey, conducted in 2003, by inquiry of 1,046 type 2 diabetics country wide distributed. RESULTS: Drug use study: We have studied 1046 type 2 diabetics (539 women, 501 men, 6 sex unknown), with a mean age of 64.5 (SD=11) years. OHAs were prescribed as monotherapy in 46.8% (489/1,046) of the patients and the remaining 557 (53.2%) received from 2 to 4 OHAs concomitantly.Diabetes prevalence: Using DDD as the mean daily intake consumption unit, the prevalence of drug-treated type 2 diabetes was 4.15%, which dropped to 2.52% when the proportion of OHAs associations was taken into account. Using PDD these values were 4.48% and 2.72%, respectively. CONCLUSIONS: Since a high proportion of patients are treated with combination of OHAs in clinical practice, it is imperative to account for that confounder in order to improve the accuracy of estimate from drug consumption data. The use of this methodology provided a slight under-estimation of diabetes prevalence, compared with the National Health Authorities values (3%-5%). Nevertheless we consider this as an efficient tool to estimate drug-treated diabetes prevalence that should be implemented in a regular way for longitudinal observations, in order to generate signals.

Administration, Oral↗

Glucose-6-phosphate dehydrogenase deficiency in Portugal: biochemical and mutational profiles, heterogeneity, and haplotype association.

Glucose-6-phosphate dehydrogenase (G6PD) deficiency is the most common human enzymopathy. This deficiency in erythrocytes has a prevalence of 0.51 +/- 0.109 in the Caucasoid male population of Portugal. The frequency for deficiency-conferring genes is 0.39% in the Portuguese population. In the herein study populations males from areas of Portugal presenting with the highest prevalence of G6PD deficiency (Castelo Branco, Setúbal, Faro, and Lisbon) as well as similar subjects located in the border Center/North area of the country (Viseu) have been analyzed for biochemical parameters and screened for mutations and haplotype-associated mutations commensurate with G6PD deficiency. Six intragenic restriction fragment length polymorphisms (RFLPs) were studied: exon 5, nt 376 A -->G, FokI; intron 5, nt 611 C--> G, PvuII; intron 8, nt 163 C--> T, BspHI; exon 10, nt 116 G --> A, PstI; exon 11, nt 1311 C--> T, BclI; and intron 11, nt 93 T -->C, NlaIII. New haplotypes were constructed with the inclusion of intron 11, nt 93 T--> C, NlaIII, and only 5 of 64 possible haplotypes were found to show a marked linkage disequilibrium for several RFLPs and also for mutations and specific haplotypes. The control population (n = 168 males) presented the G6PD B variant and corresponded to haplotypes I (- - + + - -), Ia (- - + + - +), and VIIa (- - + + + +), in 91.8, 2.3, and 5.9%, respectively. The PCR and sequencing analysis of extracted DNAs from the deficient G6PD group showed 48.6% (16/33) of individuals with the G6PD A- mutation, corresponding to haplotype VIa (+ + - + - +); 9% (3/33) with the Betica mutation and 18% (6/33) with the Santa Maria mutation, both of them associated with haplotype IVa (+ - - + \- +); 6.1% (2/33) with the Mediterranean mutation associated with haplotype VIIa; 12.3% (4/33) with the Seattle mutation, 3.0% (1/33) with Gaohe mutation; and a new mutation, 3.0% (1/33), which we designated by G6PD Flores, all of them associated with haplotype I.

Adolescent↗

Evora district as a new focus for canine leishmaniasis in Portugal.

On the basis of information acquired from local health authorities in Evora district of Portugal on cases of visceral leishmaniasis (VL), an epidemiology survey study was conducted. To determine the prevalence of anti-Leishmania antibodies in the local human and canine populations residing in Evora town and 14 adjacent villages, blood samples collected from 885 children and 3,614 dogs were tested in a direct agglutination test (DAT). Seropositivity for Leishmania parasite obtained by DAT in both endemic populations was further confirmed by an enzyme-linked immunosorbent assay (ELISA) and immunofluorescence test (IFAT). For identification of the responsible sandfly vector, 79 biotopes within the study areas were surveyed. In the infantile population assessed, none of the children screened showed an antibody level indicative (titer, > = 1:3200) of visceral leishmaniasis in the DAT. However, agglutinating antibody rates ranging from 0.7% to 6.9% were obtained in dogs residing in Evora and 11 adjacent villages. Concordant seropositivity of 94.04% was obtained by ELISA and IFAT in the same canine population (141) identified by DAT. Of the 159 sandflies captured, 67 were identified as Phlebotomus sergenti; 15, as P. ariasi; 58, as P. perniciosus; and 19, as Sergentomyia minuta. Unlike the results previously reported in Alto-Douro and Algarve districts of Portugal, as compared with the other three species, P. sergenti appears to be more abundant in Evora district.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

The distribution of HLA DQA1 and D1S80 (pMCT118) alleles and genotypes in the populations of Galicia and central Portugal.

Two South-West European populations (Galicia and Central Portugal) have been studied for the HLA DQA1 and D1S80 systems. The allele and genotype frequencies found have been compared with other previously published data. The distribution of the observed genotypes is in Hardy-Weinberg equilibrium for both systems. In the D1S80 system, no significant differences were found between both populations, although in the HLA DQA1 system the allele DQA1*0301 is twice as frequent in the Galician population. Other populations that have been compared showed a certain degree of divergence for the HLA DQA1 system. The combined chance of exclusion for both systems is 0.84 in Galicia and 0.85 in Central Portugal, and the combined power of discrimination is 0.993 in the 2 populations studied.

Alleles↗

Genetic diversity of nine STRs in two northwest Iberian populations: Galicia and northern Portugal.

The genotyping of two population samples from Galicia and northern Portugal was performed for nine STR loci using a single multiplex reaction with the AmpF/STR Profiler Plus PCR amplification kit which co-amplifies the systems D3S1358, vWA, FGA, D8S1179, D21S11, D18S51, D5S818, D13S317, D7S820 and the XY homologous gene amelogenin. Allele frequencies for these nine tetranucleotide repeat markers were calculated and no significant differences were observed when comparing these two populations. Conformity with Hardy-Weinberg equilibrium proportions was good for all systems in both samples. The combined power of exclusion was 99.981% and 99.980% in Galicia and northern Portugal, respectively and the combined power of discrimination was greater than 99.999%. Segregation analysis of all loci detected two incompatibilities, one in D3S1358 (out of 112 meioses) and another in D7S820 (out of 104 meioses). Both could be explained by single-step mutations. In general co-amplification was good except for some relatively degraded samples in which poor amplification was observed for the largest STRs. Nevertheless the system is technically robust even when small amounts of template DNA are used and in the addition is highly informative and time-saving. However, caution should be taken in the interpretation of profiles in degraded samples and the apparently high mutation rate of D3S1358 and D7S820 should also be kept in mind.

Adult↗

The photoreceptor cell-specific nuclear receptor gene (PNR) accounts for retinitis pigmentosa in the Crypto-Jews from Portugal (Marranos), survivors from the Spanish Inquisition.

The last Crypto-Jews (Marranos) are the survivors of Spanish Jews who were persecuted in the late fifteenth century, escaped to Portugal and were forced to convert to save their lives. Isolated groups still exist in mountainous areas such as Belmonte in the Beira-Baixa province of Portugal. We report here the genetic study of a highly consanguineous endogamic population of Crypto-Jews of Belmonte affected with autosomal recessive retinitis pigmentosa (RP). A genome-wide search for homozygosity allowed us to localize the disease gene to chromosome 15q22-q24 (Zmax=2.95 at theta=0 at the D15S131 locus). Interestingly, the photoreceptor cell-specific nuclear receptor (PNR) gene, the expression of which is restricted to the outer nuclear layer of retinal photoreceptor cells, was found to map to the YAC contig encompassing the disease locus. A search for mutations allowed us to ascribe the RP of Crypto-Jews of Belmonte to a homozygous missense mutation in the PNR gene. Preliminary haplotype studies support the view that this mutation is relatively ancient but probably occurred after the population settled in Belmonte.

Chromosomes, Human, Pair 15↗

Ticks parasitizing wild birds in Portugal: detection of Rickettsia aeschlimannii, R. helvetica and R. massiliae.

From January 2002 to December 2004, 152 ticks were collected from 40 wild birds recovered in Santo André Natural Reserve and Monsanto Forestal Park, Portugal mainland. Five ticks species were identified from 22 species of birds, and new host record were provided for some species. In addition, 32 (21%) ticks were screened by PCR to detect infections with agents belonging to order Rickettsiales: Anaplasma phagocytophilum, Ehrlichia chaffeensis, and Rickettsia spp. PCR amplicons were obtained in 5 (15.6%) tick samples. Rickettsia DNA exhibiting gltA sequences similar to those of Rickettsia aeschilimannii, R. helvetica and R. massiliae were identified in Hyalomma marginatum, Ixodes ventalloi and in Rhipicephalus turanicus, respectively. This is the first report of rickettsiae infections in ticks collected from wild birds in Portugal. Giving the results presented above wild birds play an important role in the maintenance and dissemination of several tick species and associated rickettsiae.

Anaplasma phagocytophilum↗

Anguilla anguilla L. oxidative stress biomarkers: an in situ study of freshwater wetland ecosystem (Pateira de Fermentelos, Portugal).

Pateira de Fermentelos (PF) is a natural freshwater wetland in the central region of Portugal. In the last decade, the introduction of agricultural chemicals, heavy metals, domestic wastes, as well as eutrophication and incorrect utility of resources resulted in an increased water pollution. The present research work was carried out to check the various oxidative stress biomarker responses in European eel (Anguilla anguilla L.) gill, kidney and liver due to this complex water pollution. Eels were caged and plunged at five different PF sites (A-E) for 48h. A reference site (R) was also selected at the river spring where no industrial contamination should be detected. Lipid peroxidation (LPO), catalase (CAT), glutathione peroxidase (GPX), glutathione S-transferase (GST) and reduced glutathione (GSH) were the oxidative stress biomarkers studied. In gill, site A exposure induced a significant GST activity increase and site B exposure induced CAT activity increase when compared to R. Site C exposure showed a significant CAT and GPX activity increase. Data concerning site D exposure were not determined due to cage disappearance. Site E exposure displayed a significant CAT and GST activity increase. In kidney, site A exposure induced a significant CAT and GPX decrease as well as a GST increase. Site B exposure showed a significant decrease in GPX activity and GSH content. However, site C exposure demonstrated a significant increase in CAT and a decrease in GPX. Site E exposure showed a significant decrease in GPX and increase in GST. In liver, site A exposure showed a significant GST activity decrease as well as GSH content increase. Site B exposure showed a significant CAT, GST and LPO decrease. Site C exposure showed only GST activity decrease, while site E exposure induced a significant increase in GPX. These investigation findings provide a rational use of oxidative stress biomarkers in freshwater ecosystem pollution biomonitoring using caged fish, and the first attempt reported in Portugal as a study of this particular watercourse under the previous conditions. The presence of pollutants in the PF water was denunciated even without a clear relation to the main pollution source distance. The organ specificity was evident for each parameter but without a clear pattern.

Anguilla↗

Leg ulceration in Portugal: prevalence and clinical history.

OBJECTIVE: To determine the prevalence and clinical history of leg ulceration in Portugal. DESIGN: Case identification of patients through health professionals providing care for patients with leg ulceration. SETTING: Clinical areas in hospital, community centres and patients' homes. PARTICIPANTS: Patients registered with five health centres within Lisbon suffering from ulceration of the leg receiving care from hospital and community staff. METHODS: Patients identified by health care professionals working in one area of Lisbon were asked to complete a simple proforma on each patient with leg ulceration. Patients were followed up prospectively to determine healing rates during this baseline period of evaluation. RESULTS: In total 263 patients were identified in a population of 186,000 (total prevalence 1.41 (95%CI 1.25-1.59) per 1000 population). The prevalence was similar between men and women (1.3 and 1.46 per 1000, respectively). As expected this was highly age dependent being most common in the patients aged over 80 years (6.5 and 4.9 per 1000, respectively). Median duration of ulceration was 18 months, with 158/240 (66%) present for longer than 1 year, and 40 (17%) for longer than 5 years. The cause of ulceration was unknown to the health professional treating the patient in 86 (33%) patients. Diagnosis of aetiology was usually on the basis of clinical examination alone (145, 56%), with 21 (8%) having undergone ankle to brachial pressure index (ABPI) measurements and a further eight undergoing either echo-Doppler or arteriography. Most care was provided by community services, with 145 (55%) treated in health centres and 77 (29%) treated in the patient's home. CONCLUSIONS: The prevalence of chronic leg ulceration is similar to other reported studies in western Europe, and indicates that approximately 14,000 patients suffer from leg ulceration at any one time in Portugal. Leg ulceration causes a considerable burden on both hospital and community services.

Aged↗