B Cells and Double-Negative B Cells (CD27-IgD-) Are Related to Acute Pancreatitis Severity.

Acute pancreatitis (AP) is an increasingly frequent disease in which inflammation plays a crucial role. Fifty patients hospitalized with AP were included and peripheral blood samples were analyzed for B and T cell subpopulations at the time of hospitalization and 48 h after diagnosis. The Bedside Index of Severity in Acute Pancreatitis (BISAP) and length of hospital stay were also recorded. A healthy control (HC) group of 15 outpatients was included. AP patients showed higher neutrophil/lymphocyte (N/L) ratios and higher percentages of B cells than the HC group. The total B cell percentages were higher in patients with moderate/severe AP than in patients with mild AP. The percentages of B cells as well as the percentages of the CD27-IgD- B cell subset decreased from admission to 48 h after admission. The patients with higher BISAP scores showed lower percentages of peripheral lymphocytes but higher percentages of CD27-IgD- B cells. Higher BISAP scores, N/L ratios, and peripheral blood B cell levels emerged as predictors of hospital stay length in AP patients. Our findings underscore the importance of early markers for disease severity. Additionally, the N/L ratio along with the BISAP score and circulating B cell levels form a robust predictive model for hospital stay duration of AP patients.

Burnout, resilience, and subjective well-being among Portuguese lecturers' during the COVID-19 pandemic.

Background: Lecturers face a large wide of occupational stressors. If the prolonged stress and the symptomatology associated with the working conditions to which lecturers were exposed were already a concern before the pandemic, the pandemic may have exacerbated this psychosocial vulnerability. Burnout is a psychological syndrome that develops in response to chronic work stress. This study aims to describe burnout amongst lecturers working in Portugal and to analyse potential determinants of burnout during the COVID-19 pandemic. Methods: A cross-sectional study was performed using an online questionnaire distributed via social networks. The survey collected sociodemographic and sleep patterns data in addition to applying the Copenhagen Burnout Inventory (personal, work- and student-related burnout), the Resilience Scale, the Depression Anxiety and Stress Scales, and the Satisfaction with Life Scale. Results: The sample included 331 lecturers from 35 different colleges and faculties. Three significant models explained personal (R2 = 54%), work- (R2 = 47%) and student- (R2 = 19%) related burnout. Lower levels of resilience and higher levels of depression and stress were significantly associated with personal and work-related burnout. Changes in sleep patterns were additionally associated with both personal and work-related burnout. Conclusion: Higher education institutions must recognize the impact of the work environment and organizational culture on faculty mental health and take proactive measures to improve this environment. These institutions can implement support strategies such as educational technology training, professional development programmes, emotional support resources, and workload flexibility. Implementing measures to enhance lecturers' resilience and overall life satisfaction could potentially help mitigate burnout and improve the well-being of educators, ultimately contributing to the overall quality of education.

Phenolic Compounds from By-Products for Functional Textiles.

Textile dyeing is known to have major environmental concerns, especially with the high use of toxic chemicals. The use of alternatives such as natural dyes rich in phenolic compounds has become extremely appealing in order to move towards a more sustainable circular economy. Phenolic dyes have the potential to functionalize textile fabrics with properties such as antimicrobial, antioxidant, and UV protection. Wastes/residues from the agri-food industries stand out as highly attractive sources of these compounds, with several by-products showing promising results in textile dyeing through the implementation of more sustainable and eco-friendly processes. This review presents an up-to-date exploration of the sources of phenolic compounds used in the textile industry over the past two decades, with a primary focus on the functional properties they provide to different fabrics. The research highlights a surge in interest in this theme since 2017, accentuating a noticeable upward trend. Throughout this review, emphasis is given to by-products from the agri-food industry as the sources of these compounds. The reviewed papers lay the foundation for future research, paving the way for exploring the potential of raw materials and by-products in the creation of functional and smart textiles.

Abnormal uterine bleeding: an insidious presentation.

An adolescent was referred to the emergency department due to abnormal uterine haemorrhages in the previous 2 months, associated with dizziness in the last month. At observation, she was haemodynamically stable, with good clinical impression, but evident mucocutaneous pallor. Full blood count confirmed a severe anaemia (haemoglobin 47 g/L). She received red blood cell transfusion (10 mL/kg) and started oral oestradiol. She was discharged, with oral oestradiol and oral iron supplementation. Two weeks later, she started treatment with oestradiol and progestin. The patient had a good recovery, without new similar episodes.

Salmonella spp., Escherichia coli and Enterobacteriaceae Control at a Pig Abattoir: Are We Missing Lairage Time Effect, Pig Skin, and Internal Carcass Surface Contamination?

To provide meat safety and consumer protection, appropriate hygiene control measures at an abattoir are required. This study aimed to evaluate the influence of visual fecal contamination level (VFCL) and lairage time (LT) on pig skin (PS) and external (ECS) and internal (ICS) carcass surfaces. The presence of Enterobacteriaceae, Escherichia coli (E. coli) and Salmonella in PS, ECS, and ICS were evaluated. A total of 300 paired samples were collected from 100 pigs. Results underlined the importance of the skin (Enterobacteriaceae: 3.27 ± 0.68 log CFU/cm2; E. coli: 3.15 ± 0.63 log CFU/cm2; Salmonella: 21% of samples) as a direct or indirect source of carcass contamination. Although VFCL revealed no significant effect (p > 0.05), the increase of LT had a significant impact (p < 0.001) on Enterobacteriaceae and E. coli levels across all analysed surfaces, and Salmonella presence on ICS (p < 0.01), demanding attention to LT. Also, the ICS showed a higher level of these bacteria compared to ECS. These results highlight the need of food business operators to consider ICS as an alternative area to sample for Salmonella, as a criterion for process hygiene based on EC Regulation No. 2073/2005, and as a potential contamination source to be integrated in the hazard analysis critical control point (HACCP) plans.

Inflammatory Presentation of a Primary Extranodal Diffuse Large B-cell Lymphoma of the Maxillary Sinus.

Diffuse large B-cell lymphoma originating from the maxillary sinus is rarely reported in the literature. Diagnosis is challenging since the long absence of signs and symptoms allows it to grow undetected or be confused with benign inflammatory conditions. The purpose of this paper is to present an unusual manifestation of this rare pathology. A patient in his 50s, presented to his local emergency department with malar and left eye pain after local trauma. Physical examination showed infraorbital edema, palpebral ptosis, exophthalmos, and left ophthalmoplegia. CT scan showed a soft tissue mass measuring 43x31 mm in the left maxillary sinus. An incisional biopsy was performed, and results showed diffuse large B-cell lymphoma with positivity for CD10+, BCL6+, BCL2+, and Ki-67 index greater than 95%. Afterward, the patient promptly started treatment with rituximab-cyclophosphamide-hydroxydaunorubicin-Oncovin-prednisone (R-CHOP) chemotherapy. A good medical history, clinical and imaging evaluations, and anatomopathological studies are crucial to establish an early diagnosis of diffuse large B-cell lymphoma (DLBCL).

Impact of gastrointestinal digestion simulation on brewer's spent grain green extracts and their prebiotic activity.

Brewer's spent grain (BSG) is a by-product of the beer industry and a potential source of bioactive compounds. In this study, two methods of extracting bioactive compounds from brewer's spent grain were used - solid-to-liquid conventional extraction (SLE) and solid-to-liquid ohmic heating extraction (OHE) coupled with two ratio combinations of solvents: 60 % and 80 % ethanol:water (v/v). The bioactive potential of the BSG extracts was assessed during the gastrointestinal tract digestion (GID) and the differences in their antioxidant activity, total phenolic content and characterization of the polyphenol profile was measured. The SLE extraction using 60 % ethanol:water (v/v) was the extraction method with higher antioxidant activity (33.88 mg ascorbic acid/g BSG - initial; 16.61 mg ascorbic acid/g BSG - mouth; 15.58 mg ascorbic acid/g BSG - stomach; 17.26 mg ascorbic acid/g BSG - duodenum) and higher content in total phenolics (13.26 mg gallic acid/g BSG - initial; 4.80 mg gallic acid/g BSG - mouth; 4.88 mg gallic acid/g BSG - stomach; 5.00 mg gallic acid/g BSG - duodenum). However, the OHE extraction using 80 % ethanol:water (v/v), had a higher bioaccessibility index (99.77 % for ferulic acid, 72.68 % for 4-hydroxybenzoic acid, 65.37 % for vanillin, 28.99 % for p-coumaric, 22.54 % for catechin) values of polyphenols. All the extracts enhanced (except for SLE for 60 % ethanol:water (v/v) at 2 and 1.5 %, and for 80 % ethanol:water (v/v) at 2 % with Bifidobacterium animalis spp. lactis BB12, where no growth was observed) the growth of the probiotic microorganisms tested (Bifidobacterium animalis B0 - O.D.'s between 0.8240 and 1.7727; Bifidobacterium animalis spp. lactis BB12 - O.D.'s between 0.7219 and 0.8798; Lacticaseibacillus casei 01 - O.D.'s between 0.9121 and 1.0249; and Lactobacillus acidophilus LA-5 - O.D.'s between 0.8595 and 0.9677), demonstrating a potential prebiotic activity of BSG extracts.

Prospective study of loss of health-related quality adjusted life years in children and their families due to uncomplicated and hospitalised varicella.

INTRODUCTION AND AIMS: Although usually benign, varicella can lead to serious complications and sometimes long-term sequelae. Vaccines are safe and effective but not yet included in immunisation programmes in many countries. We aimed to quantify the impact on health-related quality of life (HRQoL) in terms of quality-adjusted life years (QALY) in children with varicella and their families, key to assessing cost-utility in countries with low mortality due to this infection. METHODS: Children with varicella in the community and admitted to hospitals in Portugal were included over 18 months from January 2019. Children's and carers' HRQoL losses were assessed prospectively using standard multi-attribute utility instruments for measuring HRQoL (EQ-5D and CHU9D), from presentation to recovery, allowing the calculation of QALYs. RESULTS: Among 109 families with children with varicella recruited from attendees at a pediatric emergency service (community arm), the mean HRQoL loss/child was 2.0 days (95 % CI 1.9-2.2, n = 101) (mean 5.4 QALYs/1000 children (95 % CI 5.3-6.1) and 1.3 days/primary carer (95 % CI 1.2-1.6, n = 103) (mean 3.6 QALYs /1000 carers (95 % CI 3.4-4.4). Among 114 families with children admitted to hospital because of severe varicella or a complication (hospital arm), the mean HRQoL loss/child was 9.8 days (95 % CI 9.4-10.6, n = 114) (mean 26.8 QALYs /1000 children (95 % CI 25.8-29.0) and 8.5 days/primary carer (95 % CI 7.4-9.6, n = 114) (mean 23.4 QALYs/1000 carers (95 % CI 20.3-26.2). Mean QALY losses/1000 patients were particularly high for bone and joint infections [67.5 (95 % CI 43.9-97.6)]. Estimates for children's QALYs lost using the CHU9D tool were well correlated with those obtained using EQ-5D, but substantially lower. CONCLUSIONS: The impact of varicella on HRQoL is substantial. We report the first measurements of QALYs lost in hospitalised children and in the families of children both in the community and admitted to hospital, providing important information to guide vaccination policy recommendations.

Pathogenic Escherichia coli, Salmonella spp. and Campylobacter spp. in Two Natural Conservation Centers of Wildlife in Portugal: Genotypic and Phenotypic Characterization.

Human-wildlife coexistence may increase the potential risk of direct transmission of emergent or re-emergent zoonotic pathogens to humans. Intending to assess the occurrence of three important foodborne pathogens in wild animals of two wildlife conservation centers in Portugal, we investigated 132 fecal samples for the presence of Escherichia coli (Shiga toxin-producing E. coli (STEC) and non-STEC), Salmonella spp. and Campylobacter spp. A genotypic search for genes having virulence and antimicrobial resistance (AMR) was performed by means of PCR and Whole-Genome Sequencing (WGS) and phenotypic (serotyping and AMR profiles) characterization. Overall, 62 samples tested positive for at least one of these species: 27.3% for STEC, 11.4% for non-STEC, 3.0% for Salmonella spp. and 6.8% for Campylobacter spp. AMR was detected in four E. coli isolates and the only Campylobacter coli isolated in this study. WGS analysis revealed that 57.7% (30/52) of pathogenic E. coli integrated genetic clusters of highly closely related isolates (often involving different animal species), supporting the circulation and transmission of different pathogenic E. coli strains in the studied areas. These results support the idea that the health of humans, animals and ecosystems are interconnected, reinforcing the importance of a One Health approach to better monitor and control public health threats.

Impact of Circular Brewer's Spent Grain Flour after In Vitro Gastrointestinal Digestion on Human Gut Microbiota.

Brewer's spent grain (BSG) solid residues are constituted by dietary fibre, protein, sugars, and polyphenols, which can have potential effects on human health. In this study, for the first time, the flours obtained from solid residues of solid-liquid extraction (SLE) and ohmic heating extraction (OHE) were applied throughout the gastrointestinal digestion simulation (GID), in order to evaluate their prebiotic potential and in vitro human gut microbiota fermentation. The results showed that the digestion of BSG flours obtained by the different methods lead to an increase throughout the GID of total phenolic compounds (SLE: from 2.27 to 7.20 mg gallic acid/g BSG-60% ethanol:water (v/v); OHE: 2.23 to 8.36 mg gallic acid/g BSG-80% ethanol:water (v/v)) and consequently an increase in antioxidant activity (ABTS-SLE: from 6.26 to 13.07 mg ascorbic acid/g BSG-80% ethanol:water (v/v); OHE: 4.60 to 10.60 mg ascorbic acid/g BSG-80% ethanol:water (v/v)-ORAC-SLE: 3.31 to 14.94 mg Trolox/g BSG-80% ethanol:water (v/v); OHE: from 2.13 to 17.37 mg Trolox/g BSG-60% ethanol:water (v/v)). The main phenolic compounds identified included representative molecules such as vanillic and ferulic acids, vanillin and catechin, among others being identified and quantified in all GID phases. These samples also induced the growth of probiotic bacteria and promoted the positive modulation of beneficial strains (such as Bifidobacterium spp. and Lactobacillus spp.) present in human faeces. Moreover, the fermentation by human faeces microbiota also allowed the production of short chain fatty acids (acetic, propionic, and butyric). Furthermore, previous identified polyphenols were also identified during fecal fermentation. This study demonstrates that BSG flours obtained from the solid residues of SLE and OHE extractions promoted a positive modulation of gut microbiota and related metabolism and antioxidant environment associated to the released phenolic compounds.

Biocontrol Ability and Production of Volatile Organic Compounds as a Potential Mechanism of Action of Olive Endophytes against Colletotrichum acutatum.

Olive anthracnose, mainly caused by Colletotrichum acutatum, is considered a key biotic constraint of the olive crop worldwide. This work aimed to evaluate the ability of the endophytes Aureobasidium pullulans and Sarocladium summerbellii isolated from olive trees to reduce C. acutatum growth and anthracnose symptoms, and to assess A. pullulans-mediated changes in olive fruit volatile organic compounds (VOCs) and their consequences on anthracnose development. Among the endophytes tested, only A. pullulans significantly reduced the incidence (up to 10-fold) and severity (up to 35-fold) of anthracnose in detached fruits, as well as the growth (up to 1.3-fold), sporulation (up to 5.9-fold) and germination (up to 3.5-fold) of C. acutatum in dual culture assays. Gas chromatography-mass spectrometry analysis of olives inoculated with A. pullulans + C. acutatum and controls (olives inoculated with C. acutatum, A. pullulans or Tween) led to the identification of 37 VOCs, with alcohols being the most diversified and abundant class. The volatile profile of A. pullulans + C. acutatum revealed qualitative and quantitative differences from the controls and varied over the time course of microbial interactions. The most significant differences among treatments were observed at a maximal reduction in anthracnose development. At this stage, a set of VOCs, particularly Z-3-hexen-1-ol, benzyl alcohol and nonanal, were highly positively correlated with the A. pullulans + C. acutatum treatment, suggesting they play a critical role in anthracnose reduction. 6-Methyl-5-hepten-2-one and 2-nonanone were positively associated with the C. acutatum treatment and thus likely have a role in pathogen infection.

Content Validity and Reliability of the Pressure Ulcer Knowledge Test and the Knowledge Level of Portuguese Nurses at Long-Term Care Units: A Cross-Sectional Survey.

(1) Background: Improvement in pressure ulcer care depends both on the dissemination of knowledge and its implementation. This study aims to translate the Pressure Ulcer Knowledge Test into Portuguese from Portugal and evaluate the internal consistency of the questionnaire. The second aim is to assess nurses' pressure ulcer knowledge level. (2) Methods: The Pressure Ulcer Knowledge Test was translated into Portuguese, and the translated test's internal consistency and content validity were assessed. Further, the authors conducted a cross-sectional survey using the test among 221 nurses working in long-term care units. (3) Results: The Cronbach's alpha internal coefficient of reliability recorded for the 47 items was 0.738, which is higher than the minimum acceptable level of 0.7. The Cronbach's alpha for the subscales was 0.709 for prevention/risk and less than 0.5 for staging and wound description. Only two of the 221 nurses achieved a score of 90% correct answers or more. The nurses scored lower in questions related to prevention/risk (Me = 67.4%, IQR = 60.6-75.8% vs. staging: ME = 85.7%, IQR = 71.4-85.7%, description: ME = 85.7%, IQR = 71.4-85.7%, p < 0.001). (4) Conclusion: The internal consistency of the instrument was acceptable. The instrument can accurately measure Portuguese nurses' knowledge of pressure ulcers, and its information can help improve education and implementation of best practices.

Genotypic and Phenotypic Characterization of Pathogenic Escherichia coli, Salmonella spp., and Campylobacter spp., in Free-Living Birds in Mainland Portugal.

Birds are potential carriers of pathogens affecting humans and agriculture. Aiming to evaluate the occurrence of the top three most important foodborne pathogens in free-living birds in Portugal, we investigated 108 individual fecal samples from free-living birds and one pooled sample of gull feces (n = 50) for the presence of Escherichia coli (pathogenic and non-pathogenic), Salmonella spp. and Campylobacter spp. Virulence- and antimicrobial resistance- (AMR) associated genes were detected by PCR and Whole-Genome Sequencing (WGS), and phenotypic (serotyping and AMR profiles) characterization was performed. Overall, 8.9% of samples tested positive for pathogenic E. coli, 2.8% for Salmonella spp., and 9.9% for Campylobacter spp. AMR was performed on all pathogenic isolates and in a fraction of non-pathogenic E. coli, being detected in 25.9% of them. Ten of the tested E. coli isolates were multidrug-resistant (MDR), and seven of them were Extended-spectrum ß-lactamase (ESBL) producers. Among Salmonella (n = 3) and Campylobacter (n = 9), only one strain of C. jejuni was identified as MDR. Most of the identified serotypes/sequence types had already been found to be associated with human disease. These results show that free-living birds in Portugal may act as carriers of foodborne pathogens linked to human disease, some of them resistant to critically important antimicrobials.

Correction: Bioactive extracts from brewer's spent grain.

Correction for 'Bioactive extracts from brewer's spent grain' by Teresa Bonifácio-Lopes et al., Food Funct., 2020, 11, 8963-8977, DOI: 10.1039/D0FO01426E.

Impact of Phlorotannin Extracts from Fucus vesiculosus on Human Gut Microbiota.

Recent studies indicate that plant polyphenols could be pointed as potential prebiotic candidates since they may interact with the gut microbiota, stimulating its growth and the production of metabolites. However, little is known about the fate of brown seaweeds' phlorotannins during their passage throughout the gastrointestinal tract. This work aimed to evaluate the stability and bioaccessibility of Fucus vesiculosus phlorotannins after being submitted to a simulated digestive process, as well as their possible modulatory effects on gut microbiota and short-chain fatty acids production following a fermentation procedure using fecal inoculates to mimic the conditions of the large intestine. The stability of phlorotannins throughout the gastrointestinal tract was reduced, with a bioaccessibility index between 2 and 14%. Moreover, slight alterations in the growth of certain commensal bacteria were noticed, with Enterococcus spp. being the most enhanced group. Likewise, F. vesiculosus phlorotannins displayed striking capacity to enhance the levels of propionate and butyrate, which are two important short-chain fatty acids known for their role in intestinal homeostasis. In summary, this work provides valuable information regarding the behavior of F. vesiculosus phlorotannins along the gastrointestinal tract, presenting clear evidence that these compounds can positively contribute to the maintenance of a healthy gastrointestinal condition.

Bioactive extracts from brewer's spent grain.

In this study, antioxidant-rich extracts from brewer's spent grain (BSG) extracted by solid-to-liquid extraction using different solvents water and ethanol and their mixtures at two ratios (80% ethanol : water (v/v) and 60% ethanol : water (v/v)) were characterized. Nutritional composition was evaluated for the extracts and for the solid residues obtained after extraction. Additionally, the extracts were analyzed for the total phenolic content and individual phenolic compounds and related biological properties including antioxidant capacity (ABTS; ORAC and DNA protection), antihypertensive capacity, antibacterial activity and antibiofilm capacity. Safety was also demonstrated through genotoxicity and cytotoxicity tests. The results obtained showed that while all the extracts exhibited high antioxidant capacity (except ethanolic extract), the highest values were obtained for the 60% ethanol : water extract. The identification of phenolic compounds using HPLC showed that catechin and vanillin were the main compounds identified with the highest concentration being obtained for 60% ethanol : water extraction. In the biological activity assays, water and hydroethanolic extracts were multifunctional (antioxidant and antihypertensive capacity, antibacterial and antibiofilm activity), and the 80% ethanol : water presented better results in some assays. All were non-genotoxic, but the cytotoxicity was dependent on the extract concentration, with complete safe application for all up to 1 mg mL-1. Therefore, this study shows the potential of a viable green solvent based and low cost extraction recovery method of bioactive compounds from brewer's spent grain.

Botulism disguised as parotitis.

Botulism is an acute toxin-mediated neuroparalytic syndrome caused by some Clostridium species. It typically presents itself as an acute symmetric descending paralysis of cranial and peripheral nerves, which can potentially evolve to respiratory failure and death. We report a case of botulism diagnosed in a patient presenting with a parotitis probably due to xerostomia, even though he had already sought medical assistance for blurred vision and dysphagia. The neurological symptoms resolved without administration of antitoxin and botulism diagnosis was confirmed with identification of both toxins B and F in patient's serum. We aim to illustrate the need for a high clinical suspicion for the diagnosis of botulism and to report an atypical case of botulism with the production of toxins B and F, the latter being of rare occurrence.

Multicentre study of pressure ulcer point prevalence in a Portuguese region.

AIM: To conduct an exploratory investigation concerning the prevalence of Pressure Ulcers in different care settings, in the Portuguese region of Cova da Beira. MATERIAL AND METHODS: Descriptive cross-sectional multicenter analysis through direct skin assessment of 473 persons with at least one wound that gave informed consent and were in the care settings of this investigation. Research was conducted during the second weeks of February and June 2018, involving 295 hospital inpatients, 993 residents from nursing homes and 85.655 persons from primary health care centers. RESULTS: A total of 115 pressure ulcers were documented, representing 18.3% of all identified wounds, most of them grade 3. Most of pressure ulcers were acquired in nursing homes, during hospital admission or at home. Pressure ulcer point prevalence rates identified corresponded to 5.76% amongst hospitalized persons, 4.03% in nursing home residents and 0.02% in community population. Within population with wounds, older age, having more wounds, more PU, being immobile and congestive heart failure were associated and had a statistically significant difference in participants with at least one pressure ulcer. CONCLUSIONS: The prevalence rates of participants with pressure ulcers of our study were similar to published international literature. We identified a higher frequency and prevalence of severe ulcers (grade 3 and 4) in hospital and nursing home populations, highlighting the need for implementing global prevention programs. Although we acknowledged many study limitations, this investigation was the first known attempt to conduct a multicenter analysis of wound epidemiology in Portugal, which included all care settings.