LOCUS (LOng Covid-Understanding Symptoms, events and use of services in Portugal): A three-component study protocol.

Approximately 10% of patients experience symptoms of Post COVID-19 Condition (PCC) after a SARS-CoV-2 infection. Akin acute COVID-19, PCC may impact a multitude of organs and systems, such as the cardiovascular, respiratory, musculoskeletal, and neurological systems. The frequency and associated risk factors of PCC are still unclear among both community and hospital settings in individuals with a history of COVID-19. The LOCUS study was designed to clarify the PCC's burden and associated risk factors. LOCUS is a multi-component study that encompasses three complementary building blocks. The "Cardiovascular and respiratory events following COVID-19" component is set to estimate the incidence of cardiovascular and respiratory events after COVID-19 in eight Portuguese hospitals via electronic health records consultation. The "Physical and mental symptoms following COVID-19" component aims to address the community prevalence of self-reported PCC symptoms through a questionnaire-based approach. Finally, the "Treating and living with Post COVID-19 Condition" component will employ semi-structured interviews and focus groups to characterise reported experiences of using or working in healthcare and community services for the treatment of PCC symptoms. This multi-component study represents an innovative approach to exploring the health consequences of PCC. Its results are expected to provide a key contribution to the optimisation of healthcare services design.

Issue 1 - "Update on adverse respiratory effects of outdoor air pollution" Part 2): Outdoor air pollution and respiratory diseases: Perspectives from Angola, Brazil, Canada, Iran, Mozambique and Portugal.

OBJECTIVE: To analyse the GARD perspective on the health effects of outdoor air pollution, and to synthesise the Portuguese epidemiological contribution to knowledge on its respiratory impact. RESULTS: Ambient air pollution has deleterious respiratory effects which are more apparent in larger, densely populated and industrialised countries, such as Canada, Iran, Brazil and Portugal, but it also affects people living in low-level exposure areas. While low- and middle-income countries (LMICs), are particularly affected, evidence based on epidemiological studies from LMICs is both limited and heterogeneous. While nationally, Portugal has a relatively low level of air pollution, many major cities face with substantial air pollution problems. Time series and cross-sectional epidemiological studies have suggested increased respiratory hospital admissions, and increased risk of respiratory diseases in people who live in urban areas and are exposed to even a relatively low level of air pollution. CONCLUSIONS: Adverse respiratory effects due to air pollution, even at low levels, have been confirmed by epidemiological studies. However, evidence from LMICs is heterogeneous and relatively limited. Furthermore, longitudinal cohort studies designed to study and quantify the link between exposure to air pollutants and respiratory diseases are needed. Worldwide, an integrated approach must involve multi-level stakeholders including governments (in Portugal, the Portuguese Ministry of Health, which hosts GARD-Portugal), academia, health professionals, scientific societies, patient associations and the community at large. Such an approach not only will garner a robust commitment, establish strong advocacy and clear objectives, and raise greater awareness, it will also support a strategy with adequate measures to be implemented to achieve better air quality and reduce the burden of chronic respiratory diseases (CRDs).

Characterizing the Chemical Profile of Incidental Ultrafine Particles for Toxicity Assessment Using an Aerosol Concentrator.

Incidental ultrafine particles (UFPs) constitute a key pollutant in industrial workplaces. However, characterizing their chemical properties for exposure and toxicity assessments still remains a challenge. In this work, the performance of an aerosol concentrator (Versatile Aerosol Concentration Enrichment System, VACES) was assessed to simultaneously sample UFPs on filter substrates (for chemical analysis) and as liquid suspensions (for toxicity assessment), in a high UFP concentration scenario. An industrial case study was selected where metal-containing UFPs were emitted during thermal spraying of ceramic coatings. Results evidenced the comparability of the VACES system with online monitors in terms of UFP particle mass (for concentrations up to 95 µg UFP/m3) and between filters and liquid suspensions, in terms of particle composition (for concentrations up to 1000 µg/m3). This supports the applicability of this tool for UFP collection in view of chemical and toxicological characterization for incidental UFPs. In the industrial setting evaluated, results showed that the spraying temperature was a driver of fractionation of metals between UF (<0.2 µm) and fine (0.2-2.5 µm) particles. Potentially health hazardous metals (Ni, Cr) were enriched in UFPs and depleted in the fine particle fraction. Metals vaporized at high temperatures and concentrated in the UF fraction through nucleation processes. Results evidenced the need to understand incidental particle formation mechanisms due to their direct implications on particle composition and, thus, exposure. It is advisable that personal exposure and subsequent risk assessments in occupational settings should include dedicated metrics to monitor UFPs (especially, incidental).

Population exposure to particulate-matter and related mortality due to the Portuguese wildfires in October 2017 driven by storm Ophelia.

In October 2017, hundreds of wildfires ravaged the forests of the north and centre of Portugal. The fires were fanned by strong winds as tropical storm Ophelia swept the Iberian coast, dragging up smoke (together with Saharan dust from north-western Africa) into higher western European latitudes. Here we analyse the long-range transport of particulate matter (PM10) and study associations between PM10 and short-term mortality in the Portuguese population exposed to PM10 due to the October 2017 wildfires, the worst fire sequence in the country over the last decades. We analysed space- and ground-level observations to track the smoke plume and dust trajectory over Portugal and Europe, and to access PM10 concentrations during the wildfires. The effects of PM10 on mortality were evaluated using satellite data for exposure and Poisson regression models. The smoke plume covered most western European countries (including Spain, France, Belgium and the Netherlands), and reached the United Kingdom, where the population was exposed in average to an additional PM10 level of 11.7 µg/m3 during seven smoky days (three with dust) in relation to the reference days (days without smoke or dust), revealing the impact of the wildfires on distant populations. In Portugal, the population was exposed in average to additional PM10 levels that varied from 16.2 to 120.6 µg/m3 in smoky days with dust and from 6.1 to 20.9 µg/m3 in dust-free smoky days. Results suggest that PM10 had a significant effect on the same day natural and cardiorespiratory mortalities during the month of October 2017. For every additional 10 µg/m3 of PM10, there was a 0.89% (95% confidence interval, CI, 0-1.77%) increase in the number of natural deaths and a 2.34% (95% CI, 0.99-3.66%) increase in the number of cardiorespiratory-related deaths. With rising temperatures and a higher frequency of storms due to climate change, PM from Iberian wildfires together with NW African dust will tend to be more often transported into Northern European countries, which may carry health threats to areas far from the ignition sites.

Cowden syndrome is a risk factor for multiple neoplasm: a case report.

BACKGROUND: Cowden's syndrome is an autosomal dominant disease with variable penetrance, involving the tumor suppressor phosphatase and tension homolog gene, located on chromosome 10q22-23, responsible for cell proliferation, migration, and cellular apoptosis. Its clinical presentation encompasses mucocutaneous lesions, which are present around 99% of the time; macrocephaly; and cognitive impairment, and it precedes the appearance of neoplasms such as thyroid carcinoma, breast cancer, among others. In addition to these malformations, arteriovenous malformations of the brain and spine, endocrine abnormalities, skeletal defects, and cardiopulmonary lesions may also be found. The relevance of the case is due to the fact that, through a certain phenotype, the patient's genotype can be inferred and thus followed up closely. CASE REPRESENTATION: The clinical case concerns a 28-year-old Caucasian and Portuguese woman with palmar pits, macrocephaly, and cognitive impairment. She was diagnosed with papillary thyroid carcinoma at 22 years of age and proposed total thyroidectomy. At age 27, a pregnancy was diagnosed with a Breast Imaging-Reporting and Data System 2-rated breast lump. After the histological verification, it was concluded that it was a high metastatic breast sarcoma, opting for palliative mastectomy. A genetic evaluation confirmed alteration in the phosphatase and tension homolog gene, confirming Cowden's syndrome. The patient died at age 29 due to neoplastic pathology. CONCLUSION: This report aims to alert to the clinical signs of this entity and the clinical supervision and follow-up of these patients. In order to prevent premature deaths and to improve patient's quality of life, genetic diseases with cancer impact should be diagnosed as early as possible.

Prolonged exposure of Stenotrophomonas maltophilia biofilms to trace levels of clofibric acid alters antimicrobial tolerance and virulence.

The presence of pharmaceuticals in water sources, including in drinking water (DW), is increasingly being recognized as an emerging and global concern for the environment and public health. Based on the principles of the "One Health" initiative, the present work aims to understand the effects of clofibric acid (CA), a lipid regulator, on the behavior of a selected bacterium isolated from drinking water (DW). Biofilms of the opportunistic pathogen Stenotrophomonas maltophilia were exposed to CA for 12 weeks at 170 and 17000 ng/L. The effects of CA were evaluated on planktonic S. maltophilia susceptibility to chlorine and antibiotics (amoxicillin, ciprofloxacin, erythromycin, kanamycin, levofloxacin, oxacillin, spectinomycin, tetracycline and trimethoprim-sulfamethoxazole), biofilm formation, motility, siderophores production and on the adhesion and internalization of the human colon adenocarcinoma cell line (HT-29). It was found that CA did not affect planktonic S. maltophilia tolerance to chlorine exposure. Additionally, no effects were observed on biofilm formation, motility and siderophores production. However, biofilms formed after CA exposure were more tolerant to chlorine disinfection and lower CFU reductions were obtained. Of additional concern was the effect of CA exposure on S. maltophilia increased tolerance to erythromycin. CA exposure also slightly reduced S. maltophilia ability to invade HT-29 cells. In conclusion, this work reinforces the importance of studying the effects of non-antibiotic contaminants on the behavior of environmental microorganisms, particularly their role as drivers affecting resistance evolution and selection.

Fluctuating potentials in GaAs:Si nanowires: critical reduction of the influence of polytypism on the electronic structure.

In this work, the effects of Si doping in GaAs nanowires (NWs) grown on GaAs (111)B by molecular beam epitaxy with different Si doping levels (nominal free carrier concentrations of 1 × 1016, 8 × 1016, 1 × 1018 and 5 × 1018 cm-3) are deeply investigated using scanning electron microscopy (SEM), transmission electron microscopy (TEM), grazing incidence X-ray diffraction (GID), photoluminescence (PL) and cathadoluminescence (CL). TEM results reveal a mixture of wurtzite (WZ) and zinc-blende (ZB) segments along the NW axis independently of the Si doping levels. GID measurements suggest a slight increase of the ZB fraction with the Si doping. Low temperature PL and CL spectra exhibit sharp lines in the energy range 1.41-1.48 eV, for the samples with lower Si doping levels. However, the emission intensity increases and is accompanied by a clear broadening of the observed lines for the samples with higher Si doping levels. The staggered type-II band alignment only determines the optical properties of the lower doping levels in GaAs:Si NWs. For the higher Si doping levels, the electronic energy level structure of the NWs is determined by electrostatic fluctuating potentials intimately related to the amphoteric behavior of the Si dopant in GaAs. For the heavily doped NWs, the estimated depth of the potential wells is ∼96-117 meV. Our results reveal that the occurrence of the fluctuating potentials is not dependent on the crystalline phase and shows that the limitation imposed by the polytypism can be overcome.

A cost-efficiency and health benefit approach to improve urban air quality.

When ambient air quality standards established in the EU Directive 2008/50/EC are exceeded, Member States are obliged to develop and implement Air Quality Plans (AQP) to improve air quality and health. Notwithstanding the achievements in emission reductions and air quality improvement, additional efforts need to be undertaken to improve air quality in a sustainable way - i.e. through a cost-efficiency approach. This work was developed in the scope of the recently concluded MAPLIA project "Moving from Air Pollution to Local Integrated Assessment", and focuses on the definition and assessment of emission abatement measures and their associated costs, air quality and health impacts and benefits by means of air quality modelling tools, health impact functions and cost-efficiency analysis. The MAPLIA system was applied to the Grande Porto urban area (Portugal), addressing PM10 and NOx as the most important pollutants in the region. Four different measures to reduce PM10 and NOx emissions were defined and characterized in terms of emissions and implementation costs, and combined into 15 emission scenarios, simulated by the TAPM air quality modelling tool. Air pollutant concentration fields were then used to estimate health benefits in terms of avoided costs (external costs), using dose-response health impact functions. Results revealed that, among the 15 scenarios analysed, the scenario including all 4 measures lead to a total net benefit of 0.3M€·y(-1). The largest net benefit is obtained for the scenario considering the conversion of 50% of open fire places into heat recovery wood stoves. Although the implementation costs of this measure are high, the benefits outweigh the costs. Research outcomes confirm that the MAPLIA system is useful for policy decision support on air quality improvement strategies, and could be applied to other urban areas where AQP need to be implemented and monitored.

In vitro neurotoxicity evaluation of piperazine designer drugs in differentiated human neuroblastoma SH-SY5Y cells.

Abuse of synthetic drugs is widespread worldwide. Studies indicate that piperazine designer drugs act as substrates at dopaminergic and serotonergic receptors and/or transporters in the brain. This work aimed to investigate the cytotoxicity of N-benzylpiperazine, 1-(3-trifluoromethylphenyl)piperazine, 1-(4-methoxyphenyl)piperazine and 1-(3,4-methylenedioxybenzyl)piperazine in the differentiated human neuroblastoma SH-SY5Y cell line. Cytotoxicity was evaluated after 24 h incubations through the MTT reduction and neutral red uptake assays. Oxidative stress (reactive oxygen and nitrogen species production and glutathione content) and energetic (ATP content) parameters, as well as intracellular Ca(2+), mitochondrial membrane potential, DNA damage (comet assay) and cell death mode were also evaluated. Complete cytotoxicity curves were obtained after 24 h incubations with each drug. A significant decrease in intracellular total glutathione content was noted for all the tested drugs. All drugs caused a significant increase of intracellular free Ca(2+) levels, accompanied by mitochondrial hyperpolarization. However, ATP levels remained unchanged. The investigation of cell death mode revealed a predominance of early apoptotic cells. No genotoxicity was found in the comet assay. Among the tested drugs, 1-(3-trifluoromethylphenyl)piperazine was the most cytotoxic. Overall, piperazine designer drugs are potentially neurotoxic, supporting concerns on risks associated with the abuse of these drugs.

Indoor air quality in Portuguese schools: levels and sources of pollutants.

Indoor air quality (IAQ) parameters in 73 primary classrooms in Porto were examined for the purpose of assessing levels of volatile organic compounds (VOCs), aldehydes, particulate matter, ventilation rates and bioaerosols within and between schools, and potential sources. Levels of VOCs, aldehydes, PM2.5 , PM10 , bacteria and fungi, carbon dioxide (CO2 ), carbon monoxide, temperature and relative humidity were measured indoors and outdoors and a walkthrough survey was performed concurrently. Ventilation rates were derived from CO2 and occupancy data. Concentrations of CO2 exceeding 1000 ppm were often encountered, indicating poor ventilation. Most VOCs had low concentrations (median of individual species <5 µg/m(3) ) and were below the respective WHO guidelines. Concentrations of particulate matter and culturable bacteria were frequently higher than guidelines/reference values. The variability of VOCs, aldehydes, bioaerosol concentrations, and CO2 levels between schools exceeded the variability within schools. These findings indicate that IAQ problems may persist in classrooms where pollutant sources exist and classrooms are poorly ventilated; source control strategies (related to building location, occupant behavior, maintenance/cleaning activities) are deemed to be the most reliable for the prevention of adverse health consequences in children in schools.

Environment and Health in Children Day Care Centres (ENVIRH) - Study rationale and protocol.

BACKGROUND: Indoor air quality (IAQ) is considered an important determinant of human health. The association between exposure to volatile organic compounds, particulate matter, house dust mite, molds and bacteria in day care centers (DCC) is not completely clear. The aim of this project was to study these effects. METHODS - STUDY DESIGN: This study comprised two phases. Phase I included an evaluation of 45 DCCs (25 from Lisbon and 20 from Oporto, targeting 5161 children). In this phase, building characteristics, indoor CO2 and air temperature/relative humidity, were assessed. A children's respiratory health questionnaire derived from the ISAAC (International Study on Asthma and Allergies in Children) was also distributed. Phase II encompassed two evaluations and included 20 DCCs selected from phase I after a cluster analysis (11 from Lisbon and 9 from Oporto, targeting 2287 children). In this phase, data on ventilation, IAQ, thermal comfort parameters, respiratory and allergic health, airway inflammation biomarkers, respiratory virus infection patterns and parental and child stress were collected. RESULTS: In Phase I, building characteristics, occupant behavior and ventilation surrogates were collected from all DCCs. The response rate of the questionnaire was 61.7% (3186 children). Phase II included 1221 children. Association results between DCC characteristics, IAQ and health outcomes will be provided in order to support recommendations on IAQ and children's health. A building ventilation model will also be developed. DISCUSSION: This paper outlines methods that might be implemented by other investigators conducting studies on the association between respiratory health and indoor air quality at DCC.

Biomonitoring of several toxic metal(loid)s in different biological matrices from environmentally and occupationally exposed populations from Panasqueira mine area, Portugal.

In the Panasqueira mine area of central Portugal, some environmental media show higher metal(loid) concentrations when compared with the local geochemical background and the values proposed in the literature for these environmental media. In order to evaluate the effect of the external contamination on selected indexes of internal dose, As, Cd, Cu, Cr, Fe, Hg, Mg, Mn, Mo, Ni, Pb, S, Se, Si, and Zn were quantified by inductively coupled plasma mass spectrometry and inductively coupled plasma optical emission spectrometry in blood, urine, hair and nail samples from individuals environmentally (N = 41) and occupationally exposed (N = 41). A matched control group (N = 40) was also studied, and data from the three groups were compared. Results obtained agreed with those reported by environmental studies performed in this area, pointing to populations living nearby and working in the mine being exposed to metal(loid)s originated from mining activities. Arsenic was the element with the highest increase in exposed populations. The concentration of other elements such as Cr, Mg, Mn, Mo, Ni, Pb, S, Se, and Zn was also increased, although at a lesser extent, specifically in the individuals environmentally exposed and in females. These findings confirm the need for competent authorities to act as soon as possible in this area and implement strategies aimed to protect exposed populations and the entire ecosystem.

Environment and Health in Children Day Care Centres (ENVIRH) - Study rationale and protocol.

BACKGROUND: Indoor air quality (IAQ) is considered an important determinant of human health. The association between exposure to volatile organic compounds, particulate matter, house dust mite, molds and bacteria in day care centers (DCC) is not completely clear. The aim of this project was to study these effects. METHODS ­ STUDY DESIGN: This study comprised two phases. Phase I included an evaluation of 45 DCCs (25 from Lisbon and 20 from Oporto, targeting 5161 children). In this phase, building characteristics, indoor CO2 and air temperature/relative humidity, were assessed. A children's respiratory health questionnaire derived from the ISAAC (International Study on Asthma and Allergies in Children) was also distributed. Phase II encompassed two evaluations and included 20 DCCs selected from phase I after a cluster analysis (11 from Lisbon and 9 from Oporto, targeting 2287 children). In this phase, data on ventilation, IAQ, thermal comfort parameters, respiratory and allergic health, airway inflammation biomarkers, respiratory virus infection patterns and parental and child stress were collected. RESULTS: In Phase I, building characteristics, occupant behavior and ventilation surrogates were collected from all DCCs. The response rate of the questionnaire was 61.7% (3186 children).Phase II included 1221 children. Association results between DCC characteristics, IAQ and health outcomes will be provided in order to support recommendations on IAQ and children's health. A building ventilation model will also be developed. DISCUSSION: This paper outlines methods that might be implemented by other investigators conducting studies on the association between respiratory health and indoor air quality at DCC.

ANTECEDENTES: A qualidade do ar interior (IAQ) é considerada um determinante importante da saúde humana. A associação entre a exposição a compostos orgânicos voláteis, partículas, ácaros, bolores e bactérias em creches (DCC) não é perfeitamente clara. O objectivo deste estudo foi estudar esses efeitos. METODOLOGIA ­ DESENHO DO ESTUDO: Este estudo decorreu em duas Fases. A Fase I incluiu uma avaliação de 45 DCCs (25 em Lisboa e 20 no Porto, visando 5.161 crianças). Nesta Fase, foram avaliadas as características dos edifícios, o CO2 e a temperatura ambiente/humidade relativa no interior. Também foi distribuído um questionário de saúde respiratória das crianças derivado do ISAAC (Estudo Internacional sobre a Asma e Alergias em Crianças). A Fase II englobou duas avaliações e incluiu 20 DCCs seleccionadas da fase I, após uma análise de clusters (11 em Lisboa e 9 no Porto, visando 2.287 crianças). Nesta Fase, foram recolhidos dados sobre a ventilação, IAQ (qualidade do ar interior), parâmetros de conforto térmico, saúde em termos respiratórios e alérgicos, marcadores biológicos de inflamação das vias respiratórias, padrões de infecção de vírus respiratórios e stress dos pais e crianças. RESULTADOS: Na Fase I, foram recolhidas as características dos edifícios, o comportamento dos ocupantes e os marcadores de ventilação, para todas as DCCs. A taxa de resposta ao questionário foi de 61,7% (3.186 crianças).A Fase II incluiu 1.221 crianças. Os resultados da associação entre as características dos DCC, a IAQ e os resultados para a saúde serão fornecidos para apoiar as recomendações sobre a IAQ e a saúde das crianças. Um modelo de ventilação de edifícios também será desenvolvido. DISCUSSÃO: Este documento destaca a metodologia que pode ser implementada por outros investigadores que realizam estudos sobre a associação entre a saúde respiratória e a qualidade do ar interior, em creches e infantários.

Surgical management of acute cholecystitis (experience of 249 cases).

BACKGROUND/AIMS: Although laparoscopic cholecystectomy is the most widely used technique in the surgical treatment of acute cholecystitis, some schools continue to perform the open approach in the treatment of that disease. Our objective is to make a comparative analysis of results obtained with laparoscopic cholecystectomy (LC) and gall bladder removal by open cholecystectomy (OC). METHODOLOGY: The study includes 249 acute cholecystitis cases operated on between January 2007 to December 2008. Mean age was 60.9 years (+/- 16.6) (21-94 years); 51.8% men and 48.2% women. The diagnosis was made considering clinical, laboratory and echographic findings. There were 217 acute calculous cholecystititis and 32 noncalculous. Surgery was performed as follows: 167 LCs, 64 by OC and 18 percutaneous cholecystostomies (PC). RESULTS: The comparative analysis of mortality and morbidity of LC with gall bladder removal by OC showed the following results: mortality (1.19% vs 4.6% p=n.s.), major morbidity (5.3% vs 31.25% p<0.001), lesions of the main bile duct (0.5% vs 3.1% p=n.s.) reoperation (3.6% vs 12.5% p<0.05) and hospital discharge up to 48 hours (69.5% vs 10.9% p<0.001). CONCLUSIONS: Laparoscopic cholecystectomy provides superior results to open cholecystectomy, and is therefore the first choice treatment in acute cholecystitis.

Efeito protetor das frações proteicas do soro de leite em camundongos Balb/C infectados por Escherichia coli O157: H7 / Protective effect of whey proteic fractions on Balb/C mice infected by Escherichia coli O157: H7

Avaliou-se o efeito protetor das frações proteicas do soro do leite sobre as vilosidades intestinais de camundongos Balb/C, fêmeas, infectadas por Escherichia coli O157:H7. Foram utilizados 48 animais, distribuídos aleatoriamente em oito grupos de seis fêmeas cada um. Os animais dos grupos 1 e 2 (controles) receberam dieta AIN93G padrão; os dos grupos 3 e 4, AIN93G + alfalactalbumina; os dos grupos 5 e 6, AIN93G + betalactoglobulina e os dos grupos 7 e 8, AIN93G + concentrado proteico total e água ad libitum por sete dias. No dia zero, os animais dos grupos 2, 4, 6 e 8 foram inoculados, por meio de cânula de gavagem, com 0,5mL de E. coli O157:H7, na concentração de 7 x 10(10)UFC/mL. Os animais foram acompanhados clinicamente e sacrificados, no oitavo dia experimental. Verificou-se, por meio de exames histológicos e da morfometria, que as frações betalactoglobulina e alfalactalbumina exerceram efeito protetor sobre as vilosidades intestinais do jejuno distal e do íleo (P<0,05), respectivamente. O concentrado proteico total não demonstrou efeito protetor sobre as vilosidades intestinais.

The protective effect of protein fractions of whey on intestinal villi of Balb/C female mice infected with Escherichia coli O157: H7 was evaluated. A total of 48 animals were randomly distributed into eight groups of six females each. Animals in groups 1 and 2 (controls) received AIN93G standard diet; the groups 3 and 4, AIN93G + alpha-lactalbumin; while groups 5 and 6, AIN93G + beta-lactoglobulin; and groups 7 and 8, AIN93G + total protein concentrate and water ad libitum for seven days. On day zero, animals of groups 2, 4, 6, and 8 were inoculated by gavage tube with 0.5mL of E. coli O157: H7 at a concentration of 7 x 10(10)CFU/mL. The animals were clinically followed and sacrificed on the eighth day. It was verified by histological examination and morphometry that the beta-lactoglobulin and alpha-lactalbumin exerted a protective effect on the villi of the distal jejunum and ileum (P<0.05), respectively. The total protein concentrate showed no protective effect on the villi.

Long-term outcomes of quality of life after laparoscopic Nissen fundoplication.

BACKGROUND/AIMS: Several years after the surgery, the results obtained with the operation by Nissen laparoscopy in the treatment of GERD are not sufficiently clarified. Some series reveal good results at short-term; however, the results obtained at long-term are still little known. The aim of our research is to evaluate the results regarding quality of life in patients operated with the laparoscopic Nissen technique. METHODOLOGY: We carried out a study of 143 laparoscopic Nissen's, operated from January 1995 to August 2004. There were 60 men and 83 women with an average age of 49.9 years (18-75); the average follow-up was of 5.42 years (2-11 years). There was no operative mortality; morbidity was of 8.4% and the rate of conversion 2.79%. The analysis of quality of life was made according to our personal questionnaire, consisting of a group of symptoms (23 items) and another related to physical, emotional and psycho-social activities (9 items) duly validated in healthy individuals. We recorded the values corresponding to the sum of the two mentioned groups before and after surgery, referred to in the pre and post-operative according to answers based on an increasing scale of values (from 0 to 3). The higher the score, the higher is the quality of life. In the statistical analysis we resorted to parametric tests (t Student and Anova) and non-parametric (McNemar and Cochran); Values of p < 0.05 were considered significant. RESULTS: The overall analysis in increasing values on a scale of 0 to 3 showed a clear significant improvement of the quality of life after the surgery (+17.50 p < 0.001), although never reaching the values recorded in healthy individuals. Such improvement was more evident in the symptoms group than in the one corresponding to physical, emotional and psycho-social activities (+16.11 vs +2.27, p < 0.001). Among the specific reflux symptoms the ones that benefited most from the surgery were: heartburn (+2.203), regurgitation (+1.95), gastralgia (+1.23) and need to eat slowly (+1.50). Though significant, less satisfactory results were registered in the gas bloating (+0.40), fullness (+0.62) and incapacity to belch (+0.74). In 13.3% it was necessary to resort to medication. In 92.3% the results were considered very good or good and 7.7% bad. There was not any correlation between the quality of life and the different factors included in those operated on: age, sex, operative period, esophagitis and diaphragmatic hernia. CONCLUSION: The Nissen operation by laparoscopy is an excellent option in the treatment of GERD. After it takes place there is a clear improvement in the quality of life of these people, especially in relation to the symptoms typical of GERD; it is, however, less evident in relation to fullness and abdominal bloating.

Styrene-oxide N-terminal valine haemoglobin adducts as biomarkers of occupational exposure to styrene.

Styrene is widely used in the production of various plastics, synthetic rubber and resins. Occupational exposure occurs mainly via inhalation and relatively high exposure occurs due to its use in manual application techniques. The aim of this study was to evaluate if SO-Hb adducts are a suitable biomarker for assessing occupational exposure to styrene. Seventy-five reinforced plastic workers and 77 control subjects were studied. In the selected population the main urinary styrene metabolites and the styrene oxide N-terminal valine (SO-Hb) adducts in human globin were quantified. The levels of SO-Hb adducts were significantly higher (p<0.01) in the exposed subjects (5.98pmol/g globin) when compared with controls (2.59pmol/g globin) and a significant difference was found in levels of SO-Hb adducts between non-smokers and smokers among the control group. From our data we conclude that SO-Hb adduct measurement is a sensitive and specific means of assessing exposure to styrene at the occupational and environmental level.

Styrene-oxide N-terminal valine haemoglobin adducts in reinforced plastic workers: possible influence of genetic polymorphism of drug-metabolising enzymes.

Styrene is one of the most important organic chemicals used worldwide. In humans, styrene metabolism involves oxidation by cytochrome P450 monooxygenases (CYPs) to styrene-7,8-oxide, an epoxide thought to be responsible for the genotoxic effects of styrene exposure, and detoxification by means of epoxide hydrolase (mEH) and glutathione S-transferases (GSTs). The objective of this study was to investigate if genetic polymorphisms of metabolic enzymes modulate the level of urinary styrene metabolites and styrene oxide adducts with N-terminal valine of human globin (SO-Hb) in 75 workers occupationally exposed to styrene and 77 unexposed controls. The mean air concentration of styrene in the breathing zone of workers (30.4ppm) was higher than the threshold limit value of 20ppm recommended by the American Conference of Governmental Industrial Hygienists (ACGIH), and the biological exposure index adopted by the ACGIH for exposure to styrene prior to the next shift (MA+PGA=400mg/g creatinine) was exceeded, indicating that styrene exposure for this group of workers was higher than recommended. A highly significant correlation was observed between styrene concentration in the breathing zone and the MA+PGA in urine of workers (r=0.85, P<0.001). The levels of SO-Hb adducts in exposed workers were significantly increased as compared with controls, although no difference was observed between subjects stratified as high and medium exposure categories based on MA+PGA excretion. Regarding the effect of the genetic polymorphisms we found that the level of SO-Hb adducts might be modulated by the predicted mEH enzymatic activity in the exposed workers. From our data we conclude that SO-Hb adduct measurement is a complementary method to MA+PG measurement for assessing exposure to styrene at occupational and environmental levels, which reflects a more extensive exposure period.

Lead exposure of children and newborns in Porto, Portugal.

Lead is a naturally occurring element that has multipurpose applications and has been used since early civilizations being widespread in the environment. Lead is not biodegradable and its continual use has contaminated air, water, and soil. It is highly toxic affecting the whole body and is particularly harmful to newborns and children, adversely affecting cognitive development and behaviour. For children aged <6 years the Centres for Disease Control and Prevention (CDC), in 1991, defined an elevated blood lead level (BLL) as >or= 10 microg/dl, but evidence exists for subtle effects at lower levels. From the 1980s, the international trend has been to phase-out lead content in gasoline, which has contributed to substantially lower average BLLs in these populations. However, its complete elimination from gasoline in Portugal was not reached before 1999. Our group has from long participated in BLL surveillance programs to help target prevention efforts and monitor progress toward reducing BLLs in Portugal. Here are presented the studies carried out with children.

Genotoxic effects in a population of nurses handling antineoplastic drugs, and relationship with genetic polymorphisms in DNA repair enzymes.

BACKGROUND: Concern about the genotoxic risk associated with chronic handling of antineoplastic drugs has increased, and usual safety practices may not avoid exposure. METHODS: Comet assay and MN test were performed on 30 oncology nurses and 22 controls. Genetic polymorphisms of XRCC1, XRCC3, and APE1 genes were determined by PCR-RFLP. RESULTS: Data obtained showed increased cytogenetic and DNA damage in the exposed group, although statistical significance was only reached in the comet assay. Significant differences in TL were observed for carriers of the variant alleles of every gene analyzed. However, no significant effect was detected in the MN test. CONCLUSIONS: Evidence that the present handling practices of antineoplastic drugs in some Portuguese hospitals are not enough to prevent exposure are provided. Present data suggest that genetic polymorphisms in the studied DNA repair enzymes may influence the individual susceptibility to DNA damage related to chronic handling of antineoplastic drugs.