Bioaccessibility data of potentially toxic elements in complementary foods for infants: A review.

The introduction of complementary foods (CFs) is a critical step in an infant's transition to solid foods, providing essential nutrients beyond breast milk. However, CFs may contain potentially toxic elements (PTEs), such as arsenic and cadmium that pose health risks to infants. In this context, understanding the bioaccessibility of PTEs is vital as it determines the fraction of a contaminant released from the food matrix and available for absorption in the gastrointestinal tract. Efforts have been made to standardize the assessment methodology for bioaccessibility, ensuring consistent and reliable data. Moreover, regulatory agencies have established guidelines for PTEs levels in food. However, important gaps still exist, which motivates many research opportunities on this topic.

Current Advances, Research Needs and Gaps in Mycotoxins Biomonitoring under the HBM4EU-Lessons Learned and Future Trends.

Mycotoxins are natural metabolites produced by fungi that contaminate food and feed worldwide. They can pose a threat to human and animal health, mainly causing chronic effects, e.g., immunotoxic and carcinogenic. Due to climate change, an increase in European population exposure to mycotoxins is expected to occur, raising public health concerns. This urges us to assess the current human exposure to mycotoxins in Europe to allow monitoring exposure and prevent future health impacts. The mycotoxins deoxynivalenol (DON) and fumonisin B1 (FB1) were considered as priority substances to be studied within the European Human Biomonitoring Initiative (HBM4EU) to generate knowledge on internal exposure and their potential health impacts. Several policy questions were addressed concerning hazard characterization, exposure and risk assessment. The present article presents the current advances attained under the HBM4EU, research needs and gaps. Overall, the knowledge on the European population risk from exposure to DON was improved by using new harmonised data and a newly derived reference value. In addition, mechanistic information on FB1 was, for the first time, organized into an adverse outcome pathway for a congenital anomaly. It is expected that this knowledge will support policy making and contribute to driving new Human Biomonitoring (HBM) studies on mycotoxin exposure in Europe.

The first harmonised total diet study in Portugal: Nitrate occurrence and exposure assessment.

A harmonised TDS methodology was used to assess the Portuguese population's nitrate baseline dietary exposure and the risk of exceeding the Acceptable Daily Intake (ADI). Nitrate occurrence in 164 TDS samples pooled based on 20 FoodEx2 groups, representative of 18 to 75 years old population diet, was determined using UV-HPLC. The 'vegetables' group had the highest mean nitrate concentration (353 mg/kg), followed by 'starchy roots' (62 mg/kg), 'composite dishes' (53 mg/kg) and 'fruits' (46 mg/kg). Lettuce contained the most nitrates (1729 mg/kg). The estimated mean nitrate exposure of 1.17 mg/kg bw/day, with 3.18% of individuals exceeding the ADI, was assessed on a semi-probabilistic approach using the MCRA software. Lettuce (28%) contributed most to nitrate exposure followed by vegetable soup (13%). Processed meat contribution to exposure was 0.86% and 2.44% (overall population and consumers only). At population level the nitrate estimated exposure (mean and 95th percentile) revealed no reason for concern.

The first harmonised total diet study in Portugal: Planning, sample collection and sample preparation.

The first Total Diet Study (TDS) was carried out in Portugal using harmonised procedures developed under the TDS-Exposure project. This publication describes in detail the TDS planning, sample collection and preparation, filling a gap found in literature. TDS food list (1070 items) by food group for 18-74 years olds was derived using 24 h recall food consumption survey data. Of the 164 TDS samples defined based on FoodEx2, the most represented belonged to 'Composite dishes' (21%) and 'Fish and Fish products' (15%). A total of 227 TDS samples (12 subsamples each), were collected (2014-2016) in Greater Lisbon region as 126 'national', 17 'regional non-seasonal' and 21 'regional seasonal'. Seasonal samples were mostly fruits, vegetables and some fish. Subsamples were prepared as consumed, pooled, homogenised and stored at -18 °C. The harmonised procedures used allow comparison of exposure assessment with other countries and evaluation of exposure trends if TDS are used.

Severe immune thrombocytopenia in pregnancy treated with Eltrombopag - A case report.

Immune thrombocytopenia (ITP) during pregnancy is an acquired autoimmune disease present in 1-2 of every 1000 pregnancies. Thrombopoietin (TPO)-mimetic drugs, such as eltrombopag, have been successfully used for treatment of ITP during pregnancy, but studies regarding its safety during gestation are lacking. A 33-year-old nulliparous woman with a history of chronic ITP, presented at the emergency department with petechiae, epistaxis, bruises, conjunctival effusions and a platelet count of 3×109/L at 25 weeks gestation. Her pregnancy had been uneventful until then. She was unresponsive to a therapeutic escalade of corticosteroids, azathioprine and intravenous immunoglobulin (IV Ig) so, at 27 weeks, eltrombopag was initiated, and analytical and clinical improvement was achieved. Labor was induced at 37 weeks due to preeclampsia, culminating in a vacuum-assisted vaginal delivery. A healthy female newborn weighing 2400g was born. After delivery, both had normal platelet counts and remained clinically stable through follow-up.

Portuguese children dietary exposure to multiple mycotoxins - An overview of risk assessment under MYCOMIX project.

Mycotoxins are secondary fungi metabolites that induce acute and chronic toxic effects in humans and animals. Simultaneous contamination of cereal-based products by multiple mycotoxins has been increasingly reported, including in food products usually consumed by children. Although some previous authors assessed the health risk of children exposed to multiple mycotoxins, scarce data are available on the risk associated with the ingestion of multiple mycotoxins through different food products. MYCOMIX, a national funded project, intended to contribute to fill this gap. The present study aimed to overview the risk assessment of multiple mycotoxins performed under MYCOMIX, assessing for the first time, the risk associated with the exposure to 13 mycotoxins in breakfast cereals, infant cereals and biscuits consumed by children from Lisbon region, Portugal. Results on mycotoxins occurrence showed that 94% of samples were contaminated with at least one mycotoxin, although at levels below the legislated limits. Co-contamination was observed in 75% of the analysed samples. Estimated aflatoxins exposure suggested a potential adverse health effect for percentiles of intake above or equal to P50. The obtained results suggested that future research actions should be set in motion in order to protect children health.

A conceptual framework for the collection of food products in a Total Diet Study.

A total diet study (TDS) provides representative and realistic data for assessing the dietary intake of chemicals, such as contaminants and residues, and nutrients, at a population level. Reproducing the diet through collection of customarily consumed foods and their preparation as habitually eaten is crucial to ensure representativeness, i.e., all relevant foods are included and all potential dietary sources of the substances investigated are captured. Having this in mind, a conceptual framework for building a relevant food-shopping list was developed as a research task in the European Union's 7th Framework Program project, 'Total Diet Study Exposure' (TDS-Exposure), aimed at standardising methods for food sampling, analyses, exposure assessment calculations and modelling, priority foods, and selection of chemical contaminants. A stepwise approach following the knowledge translation (KT) model for concept analysis is proposed to set up a general protocol for the collection of food products in a TDS in terms of steps (characterisation of the food list, development of the food-shopping list, food products collection) and pillars (background documentation, procedures, and tools). A simple model for structuring the information in a way to support the implementation of the process, by presenting relevant datasets, forms to store inherent information, and folders to record the results is also proposed. Reproducibility of the process and possibility to exploit the gathered information are two main features of such a system for future applications.

Acute Onset Neurological Disorders during Pregnancy: A Literature Review / Doenças neurológicas de início durante a gravidez: análise crítica da literatura

Abstract Objectives To characterize the most common peripheral and central neurological disorders during pregnancy. Methods Original research and review of the literature on neurological complications during pregnancy. We searched for keywords related to the topic on different databases. Results Pregnancy involves physiological changes that can trigger peripheral neurological and/or central nervous system pathologies, which can sometimes be associated with hypertensive disorders. A definitive diagnosis of neurological disorders can be made according to the trimester of pregnancy and the clinical findings. Carpal tunnel syndrome and peripheral facial palsy are common peripheral neurological disorders, more frequent in the second half of pregnancy. Central nervous disorders are more complex and a precise diagnosis must be made in order to improve perinatal outcomes, provide correct management and treatment and to prevent acute and long-term complications. Conclusions It is possible to achieve a precise diagnosis,management and treatment of neurological disorders during pregnancy, but these require a multidisciplinary approach, crucial to improve perinatal outcomes.

Resumo Objetivos Caracterizar as alterações neurológicas centrais e periféricas mais comuns durante a gravidez. Métodos Foi efetuada uma revisão da literatura acerca de complicações neurológicas durante a gravidez. Foram utilizadas diversas bases de dados usando palavras-chave relacionadas com o tema. Resultados A gravidez envolve alterações fisiológicas que podem desencadear alterações neurológicas periféricas e/ou do sistema nervoso central, por vezes associadas a distúrbios hipertensivos. Um diagnóstico definitivo pode ser feito tendo em conta o trimestre de gravidez e os achados clínicos encontrados. A síndrome do túnel carpal e a paralisia facial periférica são alterações neurológicas periféricas comuns que ocorrem mais frequentemente na segunda metade da gravidez. As alterações em termos do sistema nervoso central são mais complexas. Um diagnóstico preciso é fulcral, não só para melhorar os desfechos perinatais, mas também para efetuar uma vigilância e tratamento adequados e para prevenir complicações agudas e a longo prazo. Conclusões Um diagnóstico preciso e um acompanhamento e tratamento apropriados dos distúrbios neurológicos durante a gravidez são ações exequíveis. Contudo, requerem uma abordagem multidisciplinar, crucial para melhorar os desfechos perinatais.

Acute Onset Neurological Disorders during Pregnancy: A Literature Review.

Objectives To characterize the most common peripheral and central neurological disorders during pregnancy. Methods Original research and review of the literature on neurological complications during pregnancy. We searched for keywords related to the topic on different databases. Results Pregnancy involves physiological changes that can trigger peripheral neurological and/or central nervous system pathologies, which can sometimes be associated with hypertensive disorders. A definitive diagnosis of neurological disorders can be made according to the trimester of pregnancy and the clinical findings. Carpal tunnel syndrome and peripheral facial palsy are common peripheral neurological disorders, more frequent in the second half of pregnancy. Central nervous disorders are more complex and a precise diagnosis must be made in order to improve perinatal outcomes, provide correct management and treatment and to prevent acute and long-term complications. Conclusions It is possible to achieve a precise diagnosis, management and treatment of neurological disorders during pregnancy, but these require a multidisciplinary approach, crucial to improve perinatal outcomes.

Objetivos Caracterizar as alterações neurológicas centrais e periféricas mais comuns durante a gravidez. Métodos Foi efetuada uma revisão da literatura acerca de complicações neurológicas durante a gravidez. Foram utilizadas diversas bases de dados usando palavras-chave relacionadas com o tema. Resultados A gravidez envolve alterações fisiológicas que podem desencadear alterações neurológicas periféricas e/ou do sistema nervoso central, por vezes associadas a distúrbios hipertensivos. Um diagnóstico definitivo pode ser feito tendo em conta o trimestre de gravidez e os achados clínicos encontrados. A síndrome do túnel carpal e a paralisia facial periférica são alterações neurológicas periféricas comuns que ocorrem mais frequentemente na segunda metade da gravidez. As alterações em termos do sistema nervoso central são mais complexas. Um diagnóstico preciso é fulcral, não só para melhorar os desfechos perinatais, mas também para efetuar uma vigilância e tratamento adequados e para prevenir complicações agudas e a longo prazo. Conclusões Um diagnóstico preciso e um acompanhamento e tratamento apropriados dos distúrbios neurológicos durante a gravidez são ações exequíveis. Contudo, requerem uma abordagem multidisciplinar, crucial para melhorar os desfechos perinatais.

Development of harmonised food and sample lists for total diet studies in five European countries.

A total diet study (TDS) is a public health tool for determination of population dietary exposure to chemicals across the entire diet. TDSs have been performed in several countries but the comparability of data produced is limited. Harmonisation of the TDS methodology is therefore desirable and the development of comparable TDS food lists is considered essential to achieve the consistency between countries. The aim of this study is to develop and test the feasibility of a method for establishing harmonised TDS food and sample lists in five European countries with different consumption patterns (Czech Republic, Finland, Germany, Iceland and Portugal). The food lists were intended to be applicable for exposure assessment of wide range of chemical substances in adults (18-64 years) and the elderly (65-74 years). Food consumption data from recent dietary surveys measured on individuals served as the basis for this work. Since the national data from these five countries were not comparable, all foods were linked to the EFSA FoodEx2 classification and description system. The selection of foods for TDS was based on the weight of food consumed and was carried out separately for each FoodEx2 level 1 food group. Individual food approach was respected as much as possible when the TDS samples were defined. TDS food lists developed with this approach represented 94.7-98.7% of the national total diet weights. The overall number of TDS samples varied from 128 in Finland to 246 in Germany. The suggested method was successfully implemented in all five countries. Mapping of data to the EFSA FoodEx2 coding system was recognised as a crucial step in harmonisation of the developed TDS food lists.

Single-compound and cumulative risk assessment of mycotoxins present in breakfast cereals consumed by children from Lisbon region, Portugal.

Humans can be exposed to multiple chemicals, but current risk assessment is usually carried out on one chemical at a time. Mycotoxins are commonly found in a variety of foods including those intended to consumption by children namely breakfast cereals. The present study aims to perform, the risk assessment of single and multiple mycotoxins present in breakfast cereals consumed by children (1-3 years old) from Lisbon region, Portugal. Daily exposure of children to ochratoxin A, fumonisins and trichothecenes showed no health risks to the children population considering individual mycotoxins, while exposure to aflatoxin B1 (AFB1) suggested a potential health concern for the high percentiles of intake (P90, P95 and P99). The combined exposure to fumonisins and trichothecenes are not expected to be of health concern. The combined margin of exposure (MoET) for the aflatoxins group could constitute a potential health concern and AFB1 was the main contributor for MoET. Legal limits and control strategies regarding the presence of multiple mycotoxins in foodstuffs is an urgent need. To the best of our knowledge, this is the first time a cumulative risk assessment was performed on multiple mycotoxins present in breakfast cereals consumed by children.

Total mercury in infant food, occurrence and exposure assessment in Portugal.

Commercial infant food labelled as from organic and conventional origin (n = 87) was analysed for total mercury content using a direct mercury analyser (DMA). Median contents of mercury were 0.50, 0.50 and 0.40 µg kg⁻¹ for processed cereal-based food, infant formulae and baby foods, respectively, with a maximum value of 19.56 µg kg⁻¹ in a baby food containing fish. Processed cereal-based food samples showed statistically significant differences for mercury content between organic and conventional analysed products. Consumption of commercial infant food analysed did not pose a risk to infants when the provisionally tolerable weekly intake (PTWI) for food other than fish and shellfish was considered. By the contrary, a risk to some infants could not be excluded when using the PTWI for fish and shellfish. This is the first study reporting contents of total mercury in commercial infant food from both farming systems and the first on exposure assessment of children to mercury in Portugal.

Occurrence and infant exposure assessment of nitrates in baby foods marketed in the region of Lisbon, Portugal.

Commercial baby food labelled as from organic or conventional origin, including vegetable-based baby foods, fruit purees and fruit juices (n = 80), were analysed for nitrate content by an in-house validated HPLC method. Nitrate contents ranged from 5 to 230 mg kg(-1) with a mean concentration of 102 mg kg(-1) for vegetable-based baby foods, and a median of 5 mg kg(-1) for both fruit purees and juices. One sample of vegetable-based baby food was higher than the legislated value (200 mg kg(-1)). There were no significant differences between average nitrate levels in analysed samples regarding both farming systems. The estimated nitrate intake through baby foods for a mean nitrate concentration of 47 mg kg(-1) ranged between 0.5 (15% of ADI) and 1.3 mg kg(-1) bw day(-1) (35% of ADI). The ADI level was exceeded (107-146% of ADI) only for the 95th and 99th percentiles of nitrate concentration.

Should apparently uncomplicated monochorionic twins be delivered electively at 32 weeks?

OBJECTIVES: We aimed to estimate the optimal time of delivery and investigated the residual risk of fetal death after viability in otherwise uncomplicated monochorionic diamniotic twin pregnancies. STUDY DESIGN: A database of 576 completed multiple pregnancies that were managed in our tertiary referral fetal medicine department between 1996 and 2007 was reviewed and the uncomplicated 111 monochorionic and the 290 dichorionic diamniotic twin pregnancies delivered after 24 weeks were selected. The rate of fetal death was derived for two-week periods starting at 24 weeks' gestation and the prospective risk of fetal death was calculated by determining the number of intrauterine fetal deaths that occurred within the two-week block divided by the number of continuing uncomplicated monochorionic twin pregnancies during that same time period. RESULTS: The unexpected single intrauterine deaths rate was 2.7% versus 2.8% in previously uncomplicated monochorionic and dichorionic diamniotic pregnancies, respectively. The prospective risk of unexpected stillbirth after 32 weeks of gestation was 1.3% for monochorionic and 0.8% for dichorionic pregnancies. CONCLUSIONS: In otherwise apparently uncomplicated monochorionic diamniotic pregnancies this prospective risk of fetal death after 32 weeks of gestation is lower than reported and similar to that of dichorionic pregnancies, so does not sustain the theory of elective preterm delivery.

[Echovirus type 13 meningitis: admissions to a paediatric ward at a Lisbon hospital]. / Meningite por echovirus tipo 13.

Infections by echovirus 13 are rare. In our country, it had not been previously reported any infection of this sort until 2000, when eleven echovirus 13 meningitis were observed in the Department of Pediatrics of the Hospital Fernando Fonseca. In England and Spain outbreaks of echovirus 13 meningitis during 2000 was also reported. Based on these facts the authors make an epidemiological analyses of their series.