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The essential oil of Cymbopogon citratus (DC.) Stapf is widely used for the production of fragrances, cosmetics, and detergents. However, there is no information on the effects of formulations containing C. citratus essential oil (EOCC) on human skin. This study aimed to evaluate the effects of formulation containing EOCC on human skin physiology. The study involved participants of both sexes (n=12). Two areas (3 cm x 3 cm) were drawn on both forearms. One randomly chosen area was treated for 14 days, 2 times/day with polyacrylic acid gel containing 5% EOCC and the other was used as a control for the same time period. Transepidermal water loss (TEWL), hydration, epidermal lipids, and biomechanics were measured (D0 and D14). High resolution Sonography images were also obtained. Results revealed a significant decrease in TEWL, a significant increase in hydration, firmness and elasticity, and a decrease in lipids, in the areas treated with EOCC. Sonography showed an increase in echogenicity of the epidermis after applying the formulation indicating that the essential oil penetrates only the most superficial layers of the skin. Results also suggest that formulations containing EOCC are safe for topical application and can improve and protect human skin. Keywords: Cymbopogon citratus; essential oil; citral; lemongrass

In Angola, the scarcity of human resources for health (HRH) is well known. Lately, there has been a focus on education and professional training structures, as well as the necessary profile of health units’ managers. The general objective of this study was to describe the perceptions of HRH Managers of Primary Health units of Cabinda Province about HRH training and retention. A cross-sectional observational study was performed, with semi-structured interviews supported by a survey, followed by a focus group, addressed at a convenience sample of HRH and Health Units managers in the province of Cabinda. 10 health units participated, where 13 managers were interviewed. As for the HRH profile, there is a majority of nurses, with a ratio of nurses to physicians of 8.6:1. As for the profile of managers, only three are postgraduate technicians in management. Training schools’ output in the previous year was 746 senior and middle technicians. Managers cited two main areas of improvement as essential to address the HRH imbalances in Cabinda: "Leadership empowerment" and "Improving information system efficiency". Opportunities were identified to improve the training of Health students, retention of HRH and managers of Health and training units in Cabinda. The definition of policies for HRH in Cabinda should focus on improving health teaching and management conditions with a special focus on empowerment of leaderships, and reinforcing the use of management tools and information systems. Desirably, implementing Management, Control and Quality Assurance Systems. Keywords: Health Workforce; Quality of Health Care; Health Management; Angola

The flowers of Tropaeolum majus, popularly known as "capuchinha," garden nasturtium, nasturtium, Indian cress, or monks cress, are currently used worldwide as a food supplement and in plant-based diets, being added to smoothies, soups, mayonnaise and salads by consumers in search of sources of substances considered beneficial to human health. Most studies have shown nutritional qualities and beneficial effects of the plant, especially its flowers and respective aqueous extracts in vitro and in animals. Thus, this pilot study was designed to evaluate the acceptance and possible benefits of daily consumption of 20 g T. majus flowers per day for 30 days in healthy participants. Before and after ingestion, body composition, heart rate, blood pressure, and hematological and biochemical parameters were analysed. Results have shown good acceptance and safe use of T. majus flowers in a balanced and varied diet. However, it is important to highlight that this is the first exploratory study regarding these issues in healthy humans, and therefore, despite the widespread consumption described, additional studies are needed to deepen the results in biometric and clinical indicators in a larger number of volunteers. Keywords: Tropaeolum majus, unconventional food plant (UFP), nasturtium, edible flowers

Food supplements are a widespread group of products ingested as a diet complement, whose consumption has recently skyrocketed due to the consumers' concern with their well-being. Among food supplements, vitamin- and mineral-based ones are the top sellers, and the demand of others, such as those containing polyphenols, is increasing. Owing to their alleged natural characteristics, consumers take the safety of food supplements for granted, and use them even when taking medicines. Thus, their potential interactions with drugs have been sparsely evaluated. This manuscript aims to bring forth an up-to-date overview of the most important knowledge involving the interactions between food supplements and drugs, relevant to be aware by nutritionists and other healthcare professionals. To this end, an extensive bibliographic review was conducted focusing on peer reviewed data from experimental in vivo evidence and clinical studies whenever major clinical interactions have been reported. Elder people and polymedicated or chronic patients are especially vulnerable to the therapeutic ineffectiveness and toxicity caused by these types of interactions. Drugs used to treat cardiovascular, autoimmune, nervous, and oncological diseases are commonly involved in important clinical interactions with food supplements, many with a narrow therapeutic margin.

Preparations of the Cymbopogon citratus leaves are used in folk medicine for the treatment of inflammatory processes. The present study investigated the proposed anti-inflammatory properties of C. citratus essential oil (EOCC) in human skin in vivo using the methylnicotinate (MN) microinflammation skin model. Skin exposure to MN causes a disturbance that triggers the production of reactive oxygen species and evokes a short duration microinflammatory reaction that might be explored to meet this objective. Fourteen participants of both sexes were selected after providing informed consent. Three areas (3 cm × 3 cm) were drawn on both forearms. One randomly chosen area was treated for 14 days, twice a day, with a polyacrylic acid gel containing 5% EOCC. Remaining areas were used as controls. Results revealed a clear protective effect at the EOCC-treated site. The MN reaction showed significantly lower transepidermal water loss, blood perfusion, erythema, and edema when compared with the other areas. Furthermore, the methodology here proposed is an innovative approach to study the clinical impact of these substances on human skin, contributing to an evidence-based support regarding the interest of using these products in human health.

The nature, diversity, and hazardousness of hospital waste (HW) require specific management procedures. Specific interventions on HW are imperative for modern societies, imposed by public and environmental health policies. The health institutions strategic management plan integrates HW management policies considering a social technic perspective process in their institutional strategic management plan, taking into account a sociotechnical perspective, based on related good practices. Sorting is one of the most critical phases for effective management in reducing risks of generated hospital waste, more specifically at the generation site. Health professionals play an important role in this process since they participate in sorting in different contexts of clinical practice. This research aimed to identify the periodicity of contact of different health professionals such as nurses, doctors and medical assistants (MA) with HW, and their knowledge regarding the practices of sorting and storing of HW. An observational, descriptive, and correlational cross-sectional study was developed. Data were gathered through a questionnaire applied to a sample of 1800 health professionals recruited from a Hospital Center in Porto ( Portugal). Results showed that from the 79% of health professionals who were in contact with HW, 68.7% had adequate knowledge about sorting practices. Health professionals presented more doubts in sorting and storing wastes from Groups III (Biological Hazard HW) and IV (HW of obligatory incineration).

Background and objectives The prevalence of fish allergy has increased in recent years. The parvalbumin Gad c 1 is a major cod allergen that is used as a follow-up marker in patients with fish allergy. Objectives: To determine the clinical and laboratory characteristics of a population of patients with fish allergy. To analyze the role of the specific IgE (sIgE) of recombinant Gad c 1 (rGad c 1) and skin prick tests (SPTs) in confirming the acquisition of tolerance to fish. Methods We performed a retrospective study of patients with fish allergy from July 1, 2005 to December 31, 2016. The population was characterized according to demographic data, species of fish associated with allergic reactions, and symptoms. The SPT wheal diameter and sIgE for fish and rGad c 1 were evaluated before acquisition of tolerance (T0) and afterwards (T1). Results The study population comprised 81 patients (68% male). Most reactions were triggered by hake (51%), mackerel (30%), and cod (26%). The most frequent manifestations were urticaria/angioedema (72%), gastrointestinal symptoms (35%), and eczema (33%); 42% of patients experienced anaphylaxis. At T0, the average sIgE values were as follows: cod, 32.2 kUA/L; sardine, 18.4 kUA/L; hake, 17.5 kUA/L; salmon, 13.9 kUA/L; tuna, 4.5 kUA/L; and rGad c 1, 22.9 kUA/L. In patients who acquired tolerance to at least 1 fish species (n=60; 74%), the mean value of rGad c 1 at T1 (5.1 kUA/L) was significantly lower than at T0 (16.8 kUA/L) (P=.001). Significant values were also recorded for the average diameter of the SPT wheal and the evaluations at T0 and T1 for hake (9.42 mm/3.79 mm) and salmon (7.8 mm/2.8 mm) (P=.002 and P=.026, respectively). Conclusion The decrease in sIgE to rGad c 1 and the mean wheal diameter of SPT for hake and salmon can be used as markers of prognosis in the acquisition of tolerance by fish-allergic patients.

Background. Cardiovascular risk (CVR) underlies aging process and longevity. Previous work points to genetic and environmental factors associated with this risk.Objectives. The aim of this research is to look for any CVR gene-gene and gene-multifactorial/lifestyle interactions that may impact health and disease and underlie exceptional longevity.Methods. A case-control study involving 521 both gender individuals, 253 centenarians (100.26±1.98years), and 268 controls (67.51±3.25years), low (LCR,n=107) and high (HCR,n=161) CVR. Hypertension, diabetes, obesity (BMI, kg·m-2), and impaired kidney function were defined according to standard criteria. CVR was calculated using Q risk®. DNA was genotyping (ACE-rs4646994,AGT-rs4762,AGR1-rs5182,GRK4-rs2960306,GRK4-rs1024323,NOS3-rs1799983, andSLC12A3-rs13306673) through iPlex-MassARRAY®, read by MALDI-TOF mass spectrometry, and analyzed by EARTDECODE®.Results. Antilongevity factors consisted (OR 95% CI,p<0.05) BMI 1.558 (1.445-1.680), hypertension 2.358 (1.565-3.553), smoking habits 4.528 (2.579-7.949), diabetes 5.553 (2.889-10.675), hypercholesterolemia 1.016 (1.010-1.022), and regular consumption of red meat 22.363 (13.987-35.755). Genetic aspects particularly for HCR individualsACEII (OR: 3.96 (1.83-8.56),p<0.0001) andNOS3TT (OR: 3.11 (1.70-5.70),p<0.0001) genotypes were also risk associate. Obesity, smoking, hypercholesterolemia, and frequent consumption of red meat have an additive action to hypertension in the longevity process. There was a synergistic interaction between the endothelialNOS3genotypes and the severity of arterial hypertension. An epistatic interaction between functional genetic variants ofGRK4and angiotensinogen was also observed.Conclusions.Cardiovascular risk-related genetic and multifactorial or predominantly lifestyle aspects and its interactions might influence the aging process and contribute to exceptional longevity in Portuguese centenarians. Besides lifestyle, the activity of nitrite oxide synthase may be one of the main physiologic regulators of cardiovascular protection in the path of longevity.

The nature, diversity, and hazardousness of hospital waste (HW) require specific management procedures. Specific interventions on HW are imperative for modern societies, imposed by public and environmental health policies. The health institutions strategic management plan integrates HW management policies considering a social technic perspective process in their institutional strategic management plan, taking into account a sociotechnical perspective, based on related good practices. Sorting is one of the most critical phases for effective management in reducing risks of generated hospital waste, more specifically at the generation site. Health professionals play an important role in this process since they participate in sorting in different contexts of clinical practice. This research aimed to identify the periodicity of contact of different health professionals such as nurses, doctors and medical assistants (MA) with HW, and their knowledge regarding the practices of sorting and storing of HW. An observational, descriptive, and correlational cross-sectional study was developed. Data were gathered through a questionnaire applied to a sample of 1800 health professionals recruited from a Hospital Center in Porto ( Portugal). Results showed that from the 79% of health professionals who were in contact with HW, 68.7% had adequate knowledge about sorting practices. Health professionals presented more doubts in sorting and storing wastes from Groups III (Biological Hazard HW) and IV (HW of obligatory incineration).

Coronaviruses have been responsible for major epidemic crises in 2003 with SARS-CoV-1, in 2012 with MERS-CoV and in 2019 with SARS-CoV-2 (COVID-19), causing serious atypical pneumonia in humans. We intend, with this systematic analysis and meta-analysis, to clarify the prevalence of the various strains of coronavirus in different animal species. For this purpose, we carried out an electronic survey using Pubmed’s Veterinary Science search tool to conduct a systematic assessment of published studies reporting the prevalence of different strains of coronavirus in different animal species between 2015 and 2020. We conducted different analysis to assess sensitivity, publication bias, and heterogeneity, using random and fixed effects. The final meta-analysis included 42 studies for systematic review and 29 in the meta-analysis. For the geographic regions with a prevalence greater than or equal to 0.20 (Forest plot overall; prevalence = 0.20, p < 0.01, Q = 10476.22 and I2 = 100%), the most commonly detected viruses were: enteric coronavirus (ECoV), pigeon-dominant coronavirus, (PdCoV), Avian coronavirus M41, Avian coronavirus C46, Avian coronavirus A99, Avian coronavirus JMK, MERS-CoV, Bovine coronavirus, Ro-BatCoV GCCDC1, Alphacoronavirus, Betacoronavirus, Deltacoronavirus, Gamacoronavirus and human coronaviruses (HCoVs). The wide presence of different strains of coronavirus in different animal species on all continents demonstrates the great biodiversity and ubiquity of these viruses.The most recent epidemiological crises caused by coronavirus demonstrates our unpreparedness to anticipate and mitigate emerging risks, as well as the need to implement new epidemiological surveillance programs for viruses. Combined with the need to create advanced training courses in One Health, this is paramount in order to ensure greater effectiveness in fighting the next pandemics.

International audience; According to the European Union regulation, some countries have established a pre-market notification system for food supplements while others have not. As this regulation is unfulfilled, a notified and marketed food supplement ingredient in one country may be forbidden in another. Even though food supplements shall not be placed on the market if unsafe, some products may still expose the consumers to risks. The risk is increased by easier access due to worldwide dissemination fostered by the internet and free movement of goods in the European Union. The Rapid Alert System for Food and Feed and the Emerging Risks Exchange Network are described. To date, the European Union legislation does not include a provision to establish a dedicated vigilance system for food supplements (Nutrivigilance). Six European Union countries have nevertheless set up national systems, which are presented. The present lack of European Union data collection harmonization, does not allow easy cooperation between countries. This article advocates for creating a coordinated European Nutrivigilance System to detect and scrutinize adverse effects of food supplements. This, to help in directing science-based risk assessments and reinforce the science-based decision of policy makers to improve public health safety.

Kefir is a fermented beverage produced from kefir starter, by means of the milk fermentation with kefir grains. These grains are a protein and polysaccharide matrix that contains Lactic Acid Bacteria (LAB), Acetic Acid Bacteria (BAA) and yeasts. This study aimed to assess the protective activity of the lyophilization process on the activity of kefir grains by comparing their microbiological composition, sensory characteristics and antimicrobial effect on fermented products obtained either from lyophilized and fresh kefir grains. Acidification kinetics and microbial counts were performed on fermented milks obtained from fresh or freeze-dried grains. Inhibitory activity tests against Escherichia coli and Salmonella enterica serovar Enteritidis were carried out with different dilutions of cell free supernatants from fermented milks. On the other hand, similarity and acceptability tests were performed to compare the sensory characteristics of fermented milks obtained from fresh and freeze-dried grains. The microbiological composition and acidification capability of the freeze-dried grains were stable until 6 months of storage at 4°C. Moreover, the minimum inhibitory concentration of fresh and freeze-dried grains was similar (20% v/v) for both pathogens. Additionally, the sensory panel did not detect differences between milk fermented with fresh or freeze-dried kefir grains; the kefir beverage obtained from the freeze-dried kefir grains fermentation showed a wide sensory acceptance among the population surveyed. We considered that lyophilization followed by the storage conditions applied were suitable for the survival of the kefir micro biota, the sensory characteristics and the antimicrobial capability of the fermented beverage after an adequate reactivation process of the grains. In conclusion, the reactivation process risk management is an important stage to ensure a suitable carriage and therefore maximize the kefir grains for large scale use. Fil: Moretti, Ana Florencia. Provincia de Buenos Aires. Gobernación. Comisión de Investigaciones Científicas. Centro de Investigación y Desarrollo en Criotecnología de Alimentos. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata. Centro de Investigación y Desarrollo en Criotecnología de Alimentos. Universidad Nacional de La Plata. Facultad de Ciencias Exactas. Centro de Investigación y Desarrollo en Criotecnología de Alimentos; Argentina Fil: Gamba, Raul Ricardo. Universidad Nacional de La Plata. Facultad de Ciencias Exactas. Departamento de Ciencias Biológicas. Cátedra de Microbiología General; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata; Argentina Fil: do Céu Costa, María. Universidade Lusófona. Escola de Ciências e Tecnologias da Saúde; Portugal Fil: de Antoni, Graciela Liliana. Provincia de Buenos Aires. Gobernación. Comisión de Investigaciones Científicas; Argentina. Provincia de Buenos Aires. Gobernación. Comisión de Investigaciones Científicas. Centro de Investigación y Desarrollo en Criotecnología de Alimentos. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata. Centro de Investigación y Desarrollo en Criotecnología de Alimentos. Universidad Nacional de La Plata. Facultad de Ciencias Exactas. Centro de Investigación y Desarrollo en Criotecnología de Alimentos; Argentina Fil: León Peláez, Angela Maria. Universidad Nacional de La Plata. Facultad de Ciencias Exactas. Departamento de Ciencias Biológicas. Cátedra de Microbiología General; Argentina

The purpose of this study was to identify the problems arising from the importance attributed to the control of infections in dental practice in Luanda. An analytical, descriptive, and prospective study was designed to establish a cause and effect relationship based on an original semi-structured interview form with open and closed questions. In the sample, consisting of 28 dental professionals and 7 managers of dental care units, more than 75% were fully satisfied or satisfied with the notions of microbiology, 82% reported having had laboratory practice and 86% considered receiving knowledge during training to perform their activity. However, 86% did not receive any continuous training in the last three years. Infection Control Committees are operational, but in 71% of the cases there are no records of the Commissions' work reports or any microbiological mapping.

Background Botanical ingredients based on plants, algae, fungi or lichens have become widely available on the European Union market offering numerous preparations with considerable differences in classification. They are under the categories of food supplements, herbal medicinal products, cosmetics or medical devices. Purpose The aim of the present work is to highlight how the European regulations concerning the different categories of botanicals can lead to different commercial choices such as time/cost for product development, application for a marketing authorisation, permitted indication (medical or health claim), and as a consequence, the same botanical products are sold in European Union as herbal medicinal products, food supplements, cosmetics or medical devices. Five different widely used botanicals, namely St. John's wort, valerian, ginkgo, ginseng, and green tea were selected to better explain the failure of harmonization through European Union. Methods A search of PubMed, ScienceDirect, European Medicines Agency and European commission web sites for medical devices and cosmetics, and European Food Safety Authority websites were conducted and the available information on regulation of herbal medicinal products, food supplements, medical devices and cosmetics in the European Union was collected. In addition, a market survey of all the sold botanical products in Europe was analysed by consultation of the medicines, medical devices, cosmetic and food agencies websites of the European countries. Results The current European legislation needs implementation and follow up because in the different countries the legal positions of the botanical products varied and it is possible to find the same product classified in the different categories, namely registered medicinal product including prescription only medicine, traditional herbal medicinal product, well established herbal medicinal products or food supplement, or medical device, or homoeopathic/anthroposophical medical product, cosmetic. Conclusions There is an urgent need of harmonization, together with the implementation of interoperable vigilance databases, to avoid borderline options.

The importance of waste management in hospitals is indisputable in preserving the environment and protecting public health, but management models are rarely discussed. This study presents the legal and conceptual frameworks of good waste management practices applicable to hospitals and associated indicators. As a case study, the overall performance of Hospital Centre of São João, in Porto, was analysed based on published reports. Data on the production of waste in their different typologies were collected from 2010 to 2016, enabling a correlation of the waste production with the kg/bed/day indicator. The aim of this study was to gather data and discuss trends in a real scenario of evolution over a six-year period in order to contribute to a future research proposal on indicators that can be used as reference for benchmarking the construction of methodological guides for hospital waste management.

The aim of this study was to verify the adherence of general practitioners to the therapy with medicinal plants, and the constraint underlying the acceptance of their therapeutic value and use in clinical practice. An observational-transversal exploratory study was carried out through the application of a questionnaire to physicians of the National Health System in the Greater Lisbon area. A total of 80 valid questionnaires were obtained. The doctors’ ages ranged from 29 to 64 years (51.85 ± 9.95), 71.4% of whom were female, and 52.6% with more than 30 years of clinical practice. There was a general lack of knowledge regarding phytotherapy legislation. Of the sample of physicians interviewed, it was verified that 33.8% never and 28.85% only a few times recommended/prescribed any type of herbal therapy. Concerning their own use, 61.25% indicated that they never, and 21.08% rarely, used herbal medicines, primarily as self-medication. There is a poor adherence on the use of herbal medicines or medicinal plants by physicians. This underuse may underlie the lack of training on both herbal medicinal products and legislative aspects more than rejection of this therapeutic approach. Education in phytotherapy can prevent misuse and reduce risks linked to herbal-drug interactions, dealing with patient´s preference in behalf of a healthy physician-patient interaction.

Food supplements (FS) are often consumed as one of the strategies to fight ageing-associated pathologies, especially in the case of oxidative stress-related diseases. Despite the popularity of FS, some concerns about their quality and safety have been raised, especially regarding the presence of contaminants. This paper reviews and discusses the occurrence of contaminants in marketed samples of FS in the last two decades, considering both scientific literature and notifications registered on RASFF portal. The most relevant classes of contaminants were included namely metals, toxins, pesticides, dioxins and PCBs, as well as pharmacologically active ingredients. Variable amounts of contaminants were reported in a significant number of commercially available FS. Although the presence of contaminants does not necessarily mean that their levels exceed the regulatory limits or that the FS intake constitutes a risk to human health, it alerts for the need to further monitor FS safety. The evaluation of the risk associated to the consumption of FS, especially in the elderly population, is particularly challenging due to the frequent exposure to multiple toxicants and to different exposure sources, as well as due to possible pre-existing diseases and respective therapeutics. Therefore, improved quality control procedures and monitoring programs should be pursued in order to avoid undesirable products and assure the safety of FS.

Estrogen-like metabolites have been identified in S. haematobium, the helminth parasite that causes urogenital schistosomiasis (UGS) and in patients´ blood and urine during UGS. Estrogen receptor (ER) activation is enriched in the luminal molecular subtype bladder cancer (BlaCa). To date, the significance of ER to these diseases remains elusive. We evaluated ERα and ERβ expression in UGS-related BlaCa (n = 27), UGS-related non-malignant lesions (n = 35), and noninfected BlaCa (n = 80). We investigated the potential of ERα to recognize S. haematobium-derived metabolites by docking and molecular dynamics simulations and studied ERα modulation in vitro using 3 BlaCa cell lines, T24, 5637 and HT1376. ERα was expressed in tumor and stromal cells in approximately 20% noninfected cases and in 30% of UGS-related BlaCa, predominantly in the epithelial cells. Overall, ERα expression was associated with features of tumor aggressiveness such as high proliferation and p53 positive expression. ERα expression correlated with presence of schistosome eggs. ERβ was widely expressed in both cohorts but weaker in UGS-related cases. molecular dynamics simulations of the 4 most abundant S. haematobium-derived metabolites revealed that smaller metabolites have comparable affinity for the ERα active state than 17β-estradiol, while the larger metabolites present higher affinity. Our in vitro findings suggested that ERα activation promotes proliferation in ERα expressing BlaCa cells and that this can be reverted with anti-estrogenic therapy. In summary, we report differential ER expression between UGS-related BlaCa and noninfected BlaCa and provide evidence supporting a role of active ERα during UGS and UGS-induced carcinogenesis. Highlights: Estrogen receptor (ERs) are expressed in both urogenital schistosomiasis and bladder cancer; ERα was associated with aggressive tumor features and presence of schistosome eggs; In silico analysis shows an agonistic putative action of S. haematobium-derived metabolites for ERα; ERα induced proliferation in bladder cancer cells can be reverted by anti-estrogens; Evidence suggests that activation of ERα could play a role in urogenital schistosomiasis and urogenital schistosomiasis-induced carcinogenesis. PJB acknowledges support from award R01CA164719 from the National Cancer Institute (NCI), National Institutes of Health (NIH), USA. info:eu-repo/semantics/publishedVersion

International scientific experts in food, nutrition, dietetics, endocrinology, physical activity, paediatrics, nursing, toxicology and public health met in Lisbon on 2–4 July 2017 to develop a Consensus on the use of low- and no-calorie sweeteners (LNCS) as substitutes for sugars and other caloric sweeteners. LNCS are food additives that are broadly used as sugar substitutes to sweeten foods and beverages with the addition of fewer or no calories. They are also used in medicines, health-care products, such as toothpaste, and food supplements. The goal of this Consensus was to provide a useful, evidence-based, point of reference to assist in efforts to reduce free sugars consumption in line with current international public health recommendations. Participating experts in the Lisbon Consensus analysed and evaluated the evidence in relation to the role of LNCS in food safety, their regulation and the nutritional and dietary aspects of their use in foods and beverages. The conclusions of this Consensus were: (1) LNCS are some of the most extensively evaluated dietary constituents, and their safety has been reviewed and confirmed by regulatory bodies globally including the World Health Organisation, the US Food and Drug Administration and the European Food Safety Authority; (2) Consumer education, which is based on the most robust scientific evidence and regulatory processes, on the use of products containing LNCS should be strengthened in a comprehensive and objective way; (3) The use of LNCS in weight reduction programmes that involve replacing caloric sweeteners with LNCS in the context of structured diet plans may favour sustainable weight reduction. Furthermore, their use in diabetes management programmes may contribute to a better glycaemic control in patients, albeit with modest results. LNCS also provide dental health benefits when used in place of free sugars; (4) It is proposed that foods and beverages with LNCS could be included in dietary guidelines as alternative options to products sweetened with free sugars; (5) Continued education of health professionals is required, since they are a key source of information on issues related to food and health for both the general population and patients. With this in mind, the publication of position statements and consensus documents in the academic literature are extremely desirable., This Consensus is the results of the Ibero–American Consensus Meeting on Low- and No-Calorie Sweeteners held in Lisbon, Portugal, 2–4 July 2017, that was supported with funding from the Nutrition Research Foundation (FIN). The different organizations and institutions that participated and supported this Consensus are greatly acknowledged.

Background Mycobacterium abscessus causes a wide range of clinical diseases that are difficult to treat. This microorganism is resistant not only to the classical antituberculosis agents but also to most of the antimicrobials that are currently available, resulting in limited therapeutic options and treatment failure. This scenario stresses the need to search for new drugs with activity against M. abscessus. Objective To evaluate in vitro the antimycobacterial activity and cytotoxicity of rifabutin (RFB 1) and ten derivatives (2-11) against M. abscessus ATCC 19977. Method The minimum inhibitory concentration (MIC) of the molecules was determined by the microdilution broth method according to the guideline described in CLSI. The toxicity evaluation was carried in 96-well microplates, using the cell line J774A.1 (ATCC TIB-67). Result From the eleven molecules tested, RFB 1 and RFB 4 were the compounds showing higher activities against M. abscessus, with MICs of 0.9 and 1.0 µM, respectively. The R1 and R2 moieties seem to have deciding influence over the final activity. Furthermore, N-oxide derivatives 9, 10, and 11 were also active against M. abscessus, with MICs of 7.2 µM, 1.8 µM and 3.8 µM, respectively. An explanatory hypothesis for the better activities of compounds RFB 1, RFB 4, RFB 10 and RFB 11 considers the likely hydrogen bonding between ligands and receptor, balancing the global flexibility and interaction energies. RFB 1 and its most effective derivatives were found to be not toxic. Conclusion Besides RFB 1, its derivatives 4, 10 and 11 show potential for clinical development in the M. abscessus treatment.

Many bacteria pathogenic to man can interfere in water distribution systems, forming aggregates that give rise to a complex structure called biofilm. In order to monitor the microbiological content of water from beach showers from ten sites along the coast from Lisboa-Carcavelos to Foz do Arelho beaches, 24 water samples were analyzed in 2013, 12 during January and February, and other 12 during June. The samples were collected in 500 mL sterile bottles with sodium thiosulfate. Biofilms were collected on swabs (at the same water sampling points) with transport medium Tween 20, and maintained between 2 oC and 4 ° C, such as water samples. The following microbiological parameters were investigated for water samples: total microbial count at 22 oC and 37 oC, total coliforms and Escherichia coli, Pseudomonas aeruginosa, fecal streptococci, total Staphylococcus and coagulase-positive Staphylococcus. The swabs lead to the isolation of the microorganisms grown on the nutrient agar medium, in order to determine the the same microbiological parameters investigated in water showers. Globally, the water quality was found to be suitable, but that does not rule out the need for constant monitoring of the beach showers. Taking into account that there have been reports of plankton invasions and allergic eruptions after bathing in some seaside spots near Lisboa, these study results prompt us to recommend that swimmers should always shower after bathing or diving since showerheads were found safe all over the coast.

This study aimed to review published literature concerning the major changes that occur in the respiratory system after stroke, and also the impact of respiratory muscle training in these patients. The literature search was conducted through electronic databases (PubMed, SciELO and Pedro) in Portuguese and English languages on themes related to changes in the respiratory system and methods of assessment and rehabilitation of respiratory muscle strength in individuals affected by stroke. There is scientific evidence that individuals affected by stroke may show decreased inspiratory and expiratory muscle strength. Studies suggest that respiratory muscle training through threshold load can bring benefits by improving respiratory function and respiratory muscle strength. However, more studies should be conducted to deepen the knowledge about the benefits and long-term effects of pulmonary rehabilitation in patients with stroke.

Olmesartan-associated enteropathy is a rare cause of severe enteropathy that should be considered in the differential diagnosis of patients with unexplained chronic diarrhoea. It may be difficult to recognise because of its clinical and histologic similarities to other clinical entities. The authors present the case of a 72-year-old woman with a 6-month clinical history of non-bloody diarrhoea and weight loss. Discontinuation of olmesartan resulted in clinical and histologic recovery, and therefore, physicians need to be aware of olmesartan-associated enteropathy in order to avoid unnecessary testing. Although rare, it is considered an emerging and underdiagnosed enteropathy. LEARNING POINTS Olmesartan-associated enteropathy is characterised by chronic diarrhoea (often severe) and weight loss that is unresponsive to a gluten-free diet. When a patient presents with unexplained chronic diarrhoea, a detailed medication review is needed. If duodenal biopsies reveal villous atrophy and coeliac disease is excluded, drug-induced enteropathy is likely. Clinical response and histologic improvement are expected after olmesartan is withdrawn.

The Portuguese population is undergoing an irreversible aging process and must deal with this demographic issue. Many influencing factors have been identified, including biological, psychological and social changes which have led to this new social stratification. The increasing prevalence of chronic and debilitating illnesses as a direct result of human aging has increased the demand for answers on both a health and social level. Life expectancy at birth in Portugal is almost 81 years, one year above the OECD mean. Life expectancy for women is 84 years, compared to 78 years for men. The National Network for Continuous Care (REDE) was formed in response to this new issue. The implementation of Continuous Care Units (UCCI) provide an alternative to hospitalization for dependent people needing special care but who do not require the specific care of an acute unit. The UCCI present a model of multidisciplinary intervention that covers all aspects of a health, social and economic nature and, consists of multidisciplinary teams. Due to the characteristics of the elderly and / or their situation of dependency, the intervention from specialized professionals of UCCI must be carefully prepared. Focused training and team expertise are key factors of the REDE’s success.

This is an exploratory and correlational study, with an initial number of 150 participants using a convenience sampling from five medical clinics and five centers of traditional Chinese medicine in Lisbon, where subjects were allowed to respond voluntarily to questionnaires. A response rate of 74% (N = 111) was achieved. Adherence to acupuncture is higher in females and in the age group 31-50 years (40% men and 48% women). Muscle and joint problems, in addition to psychological disorders are described as the most common reasons for recourse to acupuncture, although it is also referred to as an effective treatment for other types of complaints. However, acupuncture is not the first treatment that the people turn to. It is recognized that results may occur in the medium to long term and after several therapy sessions. This does not seem to affect the study population's perception of the treatment which is shown to be content with very good and/or good value for money (53%). Overall, the majority of the population (93%) relies on the therapy for the good and/or very good (79%) or reasonable (16%) results obtained, and shows trust (88%) in the competences of the health care provider who performs the acupuncture.