Estabelecimento de microalgas como alimentos funcionais com ação antioxidante e anti-inflamatória

As doenças crónicas não-transmissíveis (DCNT), tais como doenças cardiovasculares, cancros, doenças respiratórias e diabetes, são a principal causa de mortalidade e morbilidade a nível mundial, sendo consideradas um dos maiores problemas de saúde pública da atualidade pela Organização Mundial de Saúde. Para além das DCNT estarem relacionadas com o aparecimento de diversas comorbilidades, suspeita-se que ampliem os impactos da pandemia por COVID-19, diminuindo a qualidade de vida dos infetados. A maior parte dos fatores de risco para desenvolvimento de DCNT são preveníeis e modificáveis através de mudanças de estilo de vida, como a prática de atividade física e a adoção de uma alimentação saudável. Recentemente tem-se verificado uma maior consciencialização dos consumidores relativamente ao papel da alimentação na modulação da saúde, levando à alteração nos padrões de consumo. Atualmente, os consumidores preocupados com a saúde reconhecem a alimentação saudável como um pilar da prevenção de doenças crónicas e procuram alimentos que para além do seu valor nutricional apresentem também benefícios para a sua saúde. Quando inseridos num estilo de vida saudável, os alimentos funcionais para além de fornecer macronutrientes necessários à sobrevivência, influenciam funções específicas do organismo através dos seus compostos ativos atuando a nível da promoção da saúde e/ou prevenção da doença. Para além das fontes tradicionais de compostos ativos (frutas, vegetais, cereais integrais, entre outros), a necessidade de satisfazer as expetativas dos consumidores tem estimulado a indústria alimentar a investigar fontes alternativas de alimentos funcionais. As microalgas apresentam um elevado potencial como alimentos funcionais devido ao seu perfil nutricional de boa qualidade (elevado teor de proteínas, minerais, vitaminas, ácido gordos polinsaturados, entre outros) e abundância de compostos como atividades biológicas benéficas para o seu humano (atividade antibacteriana, antioxidante anti tumoral, antifúngica, antivírica, anti inflamatória, entre outros). Para além de taxa de crescimento elevada e baixo custo de produção, as algas podem ser induzidas a produzir compostos bioativos de valor acrescido específicos, por manipulação das condições de cultivo. Compostos com atividade antioxidante e anti-inflamatória são de particular interesse, uma vez que o dano oxidativo prolongado e inflamação crónica estão na base da maior parte das patologias.Recently, consumers have become more aware of the relationship between health and nutrition, recognizing healthy diets as cornerstones for health promotion and disease prevention, demanding and seeking functional foods. Functional foods not only provide nutritional value but also promote healthy aging and prevent diseases due to their various biological properties (e.g., antioxidant, anti-inflammatory, antitumorigenic). Microalgae represent a promising opportunity as functional food due to their production of valuable bioactive ingredients, with several health-promoting effects, including anti-oxidative, anti-inflammatory, antimicrobial, and anti-cancer effects. The aim of this study was to assess the antioxidant and anti-inflammatory potential from bioactive compounds present in the extracts from 3 microalgal species (Tisochrysis lutea, Tetraselmis chui, Tetraselmis striata CTP4) and perform a preliminary phytochemical analysis on the most bioactive extracts. Antioxidant activity was determined via DPPH, ABTS, copper chelating, iron chelating and ferrous reducing activity assays. Extracts with highest overall antioxidant activity were identified as ethanolic extracts of Tisochrysis lutea, Tetraselmis chui and Tetraselmis striata CTP4 and hexane Tetraselmis striata CTP4 extract. Additionally, effects of different extraction techniques on yield and bioactivity of Tetraselmis striata CTP4 extracts were investigated. These included milling, which had best yields and antioxidant activity comparing with automated fast solvent extraction and microwave assisted extraction. Anti-inflammatory activity assays were performed regarding ACE and COX inhibitory activity. The highest anti-inflammatory activity was observed for the ethanolic extract of Tetraselmis chui (5.80% for ACE inhibition and 32.2 ± 7.69% COX inhibition) followed by ethanolic T. lutea extract (2.90% for ACE inhibition and 44.5 ± 3.70% COX inhibition). Their phytochemical screening identified palmitic, myristic and stearic acids as the most abundant compounds. The proximate composition of Tisochrysis lutea revealed high fiber and mineral content. Overall, this thesis demonstrated that some of the analyzed algae could have several bioactive ingredients with potential applications as functional food. This study is a part of the Algae4IBD project, that intends to develop commercial functional food products for Inflammatory Bowel Disease (IBD) prevention and treatment using aquatic natural biological resource

Um percurso pelos cuidados de saúde primários do Algarve estágio na Administração Regional de saúde do Algarve

O presente relatório de estágio, realizado no âmbito do curso de Mestrado em Gestão de Unidades de Saúde da Faculdade de Economia da Universidade do Algarve, tem como objetivo principal descrever as atividades desenvolvidas no decorrer do estágio do segundo ano deste curso. O estágio foi realizado na Administração Regional de Saúde do Algarve, tendo decorrido, principalmente, no Departamento de Contratualização desta instituição, onde foi possível à estagiária desenvolver um conjunto de atividades, entre as quais se podem destacar: apuramento de suplementos remuneratórios dos profissionais da unidade de saúde familiar modelo B; acompanhamento das consultas a tempo e horas; participação em duas auditorias a entidades convencionadas; e participação no processo de alargamento da rede convencionada de postos de colheita para a pesquisa do vírus SARS-CoV-2. De ressaltar, ainda, a elaboração de dois materiais para o Departamento de Contratualização: (1) Documento técnico de apoio para a Equipa Técnica de Contratualização Hospitalar e Especializada sobre Programas de Gestão da Doença Crónica e outras atividades hospitalares do Contrato-Programa do Centro Hospitalar Universitário do Algarve (CHUA) e (2) Ferramenta de acesso a informação sobre prestadores convencionados no Algarve. O documento (1) tornou- se uma importante ferramenta para a contratualização com o CHUA e o material (2) - a ferramenta de acesso a informação sobre prestadores convencionados no Algarve poderá facilitar a apresentação das informações aos utentes, garantindo um melhor acesso. O estágio contemplou ainda a passagem pelo Agrupamento de Centros de Saúde do Sotavento Algarvio, pela Assessoria Técnica e Financeira e pela Unidade de Compras e Logística. Assim, o estágio na ARS Algarve permitiu complementar de uma forma abrangente a formação teórica da mestranda ao fornecer um conjunto de ferramentas fulcrais em gestão na saúde, para além de ter permitido realizar um percurso pelos Cuidados de Saúde Primários do Algarve.The present internship report, conducted Management of Health Units of the Faculty of Economics of the University of Algarve, aims to describe the activities carried out during the internship of the second year of this course. The internship was carried out at the Regional Health Administration of the Algarve, primarily in the Contracting Department of this institution, where the intern was able to develop a variety of activities, among which the following stand out: calculation of remuneration supplements for healthcare workers of family health unit model B; timely follow-up of consultations; involvement in two audits of contracted healthcare providers and partaking in the process of expanding the agreed network of collection points for research on the SARS-CoV-2 virus. It should also be noted that two materials were prepared for the Contracting Department: (1) a technical support document for the Hospital and Specialized Contractualization Technical Team on the Chronic Disease Management Programs and other hospital activities contemplated in the Hospital-Contract of the Algarve University Hospital Centre (CHUA), and (2) a tool for easier accessing information about contracted healthcare providers in the Algarve. Document (1) has become a valuable tool for contracting with the CHUA and material (2) - the tool for accessing information on agreed providers in the Algarve, will facilitate the presentation of information to users, ensuring better access. The internship also included a visit to the Sotavento Algarvio Health Center Group, the Technical and Financial Advisory and the Purchasing and Logistics Unit. Thus, the internship at ARS Algarve made it possible to comprehensively complement the theoretical training of the master's student by providing a set of key tools in health management, in addition to having allowed her to take a journey through Primary Health Care in the Algarve

COVID-19 symptoms at hospital admission vary with age and sex: results from the ISARIC prospective multinational observational study

Background: The ISARIC prospective multinational observational study is the largest cohort of hospitalized patients with COVID-19. We present relationships of age, sex, and nationality to presenting symptoms. Methods: International, prospective observational study of 60 109 hospitalized symptomatic patients with laboratory-confirmed COVID-19 recruited from 43 countries between 30 January and 3 August 2020. Logistic regression was performed to evaluate relationships of age and sex to published COVID-19 case definitions and the most commonly reported symptoms. Results: ‘Typical’ symptoms of fever (69%), cough (68%) and shortness of breath (66%) were the most commonly reported. 92% of patients experienced at least one of these. Prevalence of typical symptoms was greatest in 30- to 60-year-olds (respectively 80, 79, 69%; at least one 95%). They were reported less frequently in children (≤ 18 years: 69, 48, 23; 85%), older adults (≥ 70 years: 61, 62, 65; 90%), and women (66, 66, 64; 90%; vs. men 71, 70, 67; 93%, each P < 0.001). The most common atypical presentations under 60 years of age were nausea and vomiting and abdominal pain, and over 60 years was confusion. Regression models showed significant differences in symptoms with sex, age and country. Interpretation: This international collaboration has allowed us to report reliable symptom data from the largest cohort of patients admitted to hospital with COVID-19. Adults over 60 and children admitted to hospital with COVID-19 are less likely to present with typical symptoms. Nausea and vomiting are common atypical presentations under 30 years. Confusion is a frequent atypical presentation of COVID-19 in adults over 60 years. Women are less likely to experience typical symptoms than men

The evolving SARS-CoV-2 epidemic in Africa: Insights from rapidly expanding genomic surveillance

INTRODUCTION Investment in Africa over the past year with regard to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing has led to a massive increase in the number of sequences, which, to date, exceeds 100,000 sequences generated to track the pandemic on the continent. These sequences have profoundly affected how public health officials in Africa have navigated the COVID-19 pandemic. RATIONALE We demonstrate how the first 100,000 SARS-CoV-2 sequences from Africa have helped monitor the epidemic on the continent, how genomic surveillance expanded over the course of the pandemic, and how we adapted our sequencing methods to deal with an evolving virus. Finally, we also examine how viral lineages have spread across the continent in a phylogeographic framework to gain insights into the underlying temporal and spatial transmission dynamics for several variants of concern (VOCs). RESULTS Our results indicate that the number of countries in Africa that can sequence the virus within their own borders is growing and that this is coupled with a shorter turnaround time from the time of sampling to sequence submission. Ongoing evolution necessitated the continual updating of primer sets, and, as a result, eight primer sets were designed in tandem with viral evolution and used to ensure effective sequencing of the virus. The pandemic unfolded through multiple waves of infection that were each driven by distinct genetic lineages, with B.1-like ancestral strains associated with the first pandemic wave of infections in 2020. Successive waves on the continent were fueled by different VOCs, with Alpha and Beta cocirculating in distinct spatial patterns during the second wave and Delta and Omicron affecting the whole continent during the third and fourth waves, respectively. Phylogeographic reconstruction points toward distinct differences in viral importation and exportation patterns associated with the Alpha, Beta, Delta, and Omicron variants and subvariants, when considering both Africa versus the rest of the world and viral dissemination within the continent. Our epidemiological and phylogenetic inferences therefore underscore the heterogeneous nature of the pandemic on the continent and highlight key insights and challenges, for instance, recognizing the limitations of low testing proportions. We also highlight the early warning capacity that genomic surveillance in Africa has had for the rest of the world with the detection of new lineages and variants, the most recent being the characterization of various Omicron subvariants. CONCLUSION Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve. This is important not only to help combat SARS-CoV-2 on the continent but also because it can be used as a platform to help address the many emerging and reemerging infectious disease threats in Africa. In particular, capacity building for local sequencing within countries or within the continent should be prioritized because this is generally associated with shorter turnaround times, providing the most benefit to local public health authorities tasked with pandemic response and mitigation and allowing for the fastest reaction to localized outbreaks. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century

Thrombotic and hemorrhagic complications of COVID-19 in adults hospitalized in high-income countries compared with those in adults hospitalized in low- and middle-income countries in an international registry

Background: COVID-19 has been associated with a broad range of thromboembolic, ischemic, and hemorrhagic complications (coagulopathy complications). Most studies have focused on patients with severe disease from high-income countries (HICs). Objectives: The main aims were to compare the frequency of coagulopathy complications in developing countries (low- and middle-income countries [LMICs]) with those in HICs, delineate the frequency across a range of treatment levels, and determine associations with in-hospital mortality. Methods: Adult patients enrolled in an observational, multinational registry, the International Severe Acute Respiratory and Emerging Infections COVID-19 study, between January 1, 2020, and September 15, 2021, met inclusion criteria, including admission to a hospital for laboratory-confirmed, acute COVID-19 and data on complications and survival. The advanced-treatment cohort received care, such as admission to the intensive care unit, mechanical ventilation, or inotropes or vasopressors; the basic-treatment cohort did not receive any of these interventions. Results: The study population included 495,682 patients from 52 countries, with 63% from LMICs and 85% in the basic treatment cohort. The frequency of coagulopathy complications was higher in HICs (0.76%-3.4%) than in LMICs (0.09%-1.22%). Complications were more frequent in the advanced-treatment cohort than in the basic-treatment cohort. Coagulopathy complications were associated with increased in-hospital mortality (odds ratio, 1.58; 95% CI, 1.52-1.64). The increased mortality associated with these complications was higher in LMICs (58.5%) than in HICs (35.4%). After controlling for coagulopathy complications, treatment intensity, and multiple other factors, the mortality was higher among patients in LMICs than among patients in HICs (odds ratio, 1.45; 95% CI, 1.39-1.51). Conclusion: In a large, international registry of patients hospitalized for COVID-19, coagulopathy complications were more frequent in HICs than in LMICs (developing countries). Increased mortality associated with coagulopathy complications was of a greater magnitude among patients in LMICs. Additional research is needed regarding timely diagnosis of and intervention for coagulation derangements associated with COVID-19, particularly for limited-resource settings

Association of Country Income Level With the Characteristics and Outcomes of Critically Ill Patients Hospitalized With Acute Kidney Injury and COVID-19

Introduction: Acute kidney injury (AKI) has been identified as one of the most common and significant problems in hospitalized patients with COVID-19. However, studies examining the relationship between COVID-19 and AKI in low- and low-middle income countries (LLMIC) are lacking. Given that AKI is known to carry a higher mortality rate in these countries, it is important to understand differences in this population. Methods: This prospective, observational study examines the AKI incidence and characteristics of 32,210 patients with COVID-19 from 49 countries across all income levels who were admitted to an intensive care unit during their hospital stay. Results: Among patients with COVID-19 admitted to the intensive care unit, AKI incidence was highest in patients in LLMIC, followed by patients in upper-middle income countries (UMIC) and high-income countries (HIC) (53%, 38%, and 30%, respectively), whereas dialysis rates were lowest among patients with AKI from LLMIC and highest among those from HIC (27% vs. 45%). Patients with AKI in LLMIC had the largest proportion of community-acquired AKI (CA-AKI) and highest rate of in-hospital death (79% vs. 54% in HIC and 66% in UMIC). The association between AKI, being from LLMIC and in-hospital death persisted even after adjusting for disease severity. Conclusions: AKI is a particularly devastating complication of COVID-19 among patients from poorer nations where the gaps in accessibility and quality of healthcare delivery have a major impact on patient outcomes

Respiratory support in patients with severe COVID-19 in the International Severe Acute Respiratory and Emerging Infection (ISARIC) COVID-19 study: a prospective, multinational, observational study

Background: Up to 30% of hospitalised patients with COVID-19 require advanced respiratory support, including high-flow nasal cannulas (HFNC), non-invasive mechanical ventilation (NIV), or invasive mechanical ventilation (IMV). We aimed to describe the clinical characteristics, outcomes and risk factors for failing non-invasive respiratory support in patients treated with severe COVID-19 during the first two years of the pandemic in high-income countries (HICs) and low middle-income countries (LMICs). Methods: This is a multinational, multicentre, prospective cohort study embedded in the ISARIC-WHO COVID-19 Clinical Characterisation Protocol. Patients with laboratory-confirmed SARS-CoV-2 infection who required hospital admission were recruited prospectively. Patients treated with HFNC, NIV, or IMV within the first 24 h of hospital admission were included in this study. Descriptive statistics, random forest, and logistic regression analyses were used to describe clinical characteristics and compare clinical outcomes among patients treated with the different types of advanced respiratory support. Results: A total of 66,565 patients were included in this study. Overall, 82.6% of patients were treated in HIC, and 40.6% were admitted to the hospital during the first pandemic wave. During the first 24 h after hospital admission, patients in HICs were more frequently treated with HFNC (48.0%), followed by NIV (38.6%) and IMV (13.4%). In contrast, patients admitted in lower- and middle-income countries (LMICs) were less frequently treated with HFNC (16.1%) and the majority received IMV (59.1%). The failure rate of non-invasive respiratory support (i.e. HFNC or NIV) was 15.5%, of which 71.2% were from HIC and 28.8% from LMIC. The variables most strongly associated with non-invasive ventilation failure, defined as progression to IMV, were high leukocyte counts at hospital admission (OR [95%CI]; 5.86 [4.83-7.10]), treatment in an LMIC (OR [95%CI]; 2.04 [1.97-2.11]), and tachypnoea at hospital admission (OR [95%CI]; 1.16 [1.14-1.18]). Patients who failed HFNC/NIV had a higher 28-day fatality ratio (OR [95%CI]; 1.27 [1.25-1.30]). Conclusions: In the present international cohort, the most frequently used advanced respiratory support was the HFNC. However, IMV was used more often in LMIC. Higher leucocyte count, tachypnoea, and treatment in LMIC were risk factors for HFNC/NIV failure. HFNC/NIV failure was related to worse clinical outcomes, such as 28-day mortality. Trial registration This is a prospective observational study; therefore, no health care interventions were applied to participants, and trial registration is not applicable

Characteristics and outcomes of an international cohort of 600 000 hospitalized patients with COVID-19

Background: We describe demographic features, treatments and clinical outcomes in the International Severe Acute Respiratory and emerging Infection Consortium (ISARIC) COVID-19 cohort, one of the world's largest international, standardized data sets concerning hospitalized patients. Methods: The data set analysed includes COVID-19 patients hospitalized between January 2020 and January 2022 in 52 countries. We investigated how symptoms on admission, co-morbidities, risk factors and treatments varied by age, sex and other characteristics. We used Cox regression models to investigate associations between demographics, symptoms, co-morbidities and other factors with risk of death, admission to an intensive care unit (ICU) and invasive mechanical ventilation (IMV). Results: Data were available for 689 572 patients with laboratory-confirmed (91.1%) or clinically diagnosed (8.9%) SARS-CoV-2 infection from 52 countries. Age [adjusted hazard ratio per 10 years 1.49 (95% CI 1.48, 1.49)] and male sex [1.23 (1.21, 1.24)] were associated with a higher risk of death. Rates of admission to an ICU and use of IMV increased with age up to age 60 years then dropped. Symptoms, co-morbidities and treatments varied by age and had varied associations with clinical outcomes. The case-fatality ratio varied by country partly due to differences in the clinical characteristics of recruited patients and was on average 21.5%. Conclusions: Age was the strongest determinant of risk of death, with a ∼30-fold difference between the oldest and youngest groups; each of the co-morbidities included was associated with up to an almost 2-fold increase in risk. Smoking and obesity were also associated with a higher risk of death. The size of our international database and the standardized data collection method make this study a comprehensive international description of COVID-19 clinical features. Our findings may inform strategies that involve prioritization of patients hospitalized with COVID-19 who have a higher risk of death

Paediatric COVID-19 mortality: a database analysis of the impact of health resource disparity

Background The impact of the COVID-19 pandemic on paediatric populations varied between high-income countries (HICs) versus low-income to middle-income countries (LMICs). We sought to investigate differences in paediatric clinical outcomes and identify factors contributing to disparity between countries.Methods The International Severe Acute Respiratory and Emerging Infections Consortium (ISARIC) COVID-19 database was queried to include children under 19 years of age admitted to hospital from January 2020 to April 2021 with suspected or confirmed COVID-19 diagnosis. Univariate and multivariable analysis of contributing factors for mortality were assessed by country group (HICs vs LMICs) as defined by the World Bank criteria.Results A total of 12 860 children (3819 from 21 HICs and 9041 from 15 LMICs) participated in this study. Of these, 8961 were laboratory-confirmed and 3899 suspected COVID-19 cases. About 52% of LMICs children were black, and more than 40% were infants and adolescent. Overall in-hospital mortality rate (95% CI) was 3.3% [=(3.0% to 3.6%), higher in LMICs than HICs (4.0% (3.6% to 4.4%) and 1.7% (1.3% to 2.1%), respectively). There were significant differences between country income groups in intervention profile, with higher use of antibiotics, antivirals, corticosteroids, prone positioning, high flow nasal cannula, non-invasive and invasive mechanical ventilation in HICs. Out of the 439 mechanically ventilated children, mortality occurred in 106 (24.1%) subjects, which was higher in LMICs than HICs (89 (43.6%) vs 17 (7.2%) respectively). Pre-existing infectious comorbidities (tuberculosis and HIV) and some complications (bacterial pneumonia, acute respiratory distress syndrome and myocarditis) were significantly higher in LMICs compared with HICs. On multivariable analysis, LMIC as country income group was associated with increased risk of mortality (adjusted HR 4.73 (3.16 to 7.10)).Conclusion Mortality and morbidities were higher in LMICs than HICs, and it may be attributable to differences in patient demographics, complications and access to supportive and treatment modalities

ISARIC-COVID-19 dataset: A Prospective, Standardized, Global Dataset of Patients Hospitalized with COVID-19

The International Severe Acute Respiratory and Emerging Infection Consortium (ISARIC) COVID-19 dataset is one of the largest international databases of prospectively collected clinical data on people hospitalized with COVID-19. This dataset was compiled during the COVID-19 pandemic by a network of hospitals that collect data using the ISARIC-World Health Organization Clinical Characterization Protocol and data tools. The database includes data from more than 705,000 patients, collected in more than 60 countries and 1,500 centres worldwide. Patient data are available from acute hospital admissions with COVID-19 and outpatient follow-ups. The data include signs and symptoms, pre-existing comorbidities, vital signs, chronic and acute treatments, complications, dates of hospitalization and discharge, mortality, viral strains, vaccination status, and other data. Here, we present the dataset characteristics, explain its architecture and how to gain access, and provide tools to facilitate its use