Differential patterns of antimicrobial resistance in population subsets of Escherichia coli isolated from waste- and surface waters

The species Escherichia coli comprises different subgroups with distinct phylogeny, physiology and ecology and, thus, presumably, with different roles in antimicrobial resistance dissemination. E. coli strains isolated from raw and treated municipal wastewater and from urban water streams were characterized in terms of phylogenetic groups, antimicrobial resistance patterns and the presence of class 1 and class 2 integrons. Our main objective was to investigate the contribution of the different phylo-groups in antimicrobial resistance dissemination in urban waters. Groups A and B1 were predominant in all types of water, evidencing, respectively, the lowest and the highest resistance prevalence. Municipal wastewater treatment was accompanied by significant increases of ciprofloxacin and streptomycin resistance (pb0.01). Antimicrobial resistance prevalence differed significantly between the different phylo-groups and within the same group, mainly in group A. Such differences contributed to explain the higher ciprofloxacin and streptomycin resistance rates observed in treated effluent in comparison with the raw wastewater. We conclude that the dynamics of the bacterial populations has a major role on the dissemination of antimicrobial resistance in the environment.info:eu-repo/semantics/acceptedVersio

Diversity of β-lactamase-encoding genes among Gram-negative isolates from water samples in Northern Portugal

Water has been recognized as a reservoir for antibiotic resistance genes (ARG), where the presence of mobile genetic elements, including plasmids, favors their dissemination. It is noteworthy that non- pathogenic environmental organisms, where plasmids encoding multiple ARG are prevalent, can provide resistance to most classes of antimicrobials including :-lactams, aminoglycosides, chloramphenicol, trimethoprim, streptomycin, fosfomycin, quinolones, among others. The main goal of this study was to evaluate the presence of ARGs, related with :-lactam and quinolone resistance, in Gram-negative bacteria isolates from surface and raw and treated waste water environments. Water samples were collected from different environments within an urban water cycle in the region of Northern Portugal, which included treated and raw wastewater, water to the consumers and water surface. Screening of antimicrobial susceptibility of 56 Gram-negative isolates (20 Escherichia coli, 8 Citrobacter spp., 7 Klebsiella spp., 6 Kluyvera spp., 4 Sphingomonas panni, 2 Enterobacter spp., 1 Acinetobacter johnsonii, 3 Aeromonas veronii, 1 Hafnia alvei, 1 Pantoea agglomerans, 1 Roultella ornithinolytica, 1 Serratia sp., 1 Stenotrophomonas maltophilia), identified by 16S rRNA gene sequencing analysis using universal primers, was performed by disk diffusion method. Interpretative reading of susceptibilities allowed to direct the search for antibiotic resistant genes. PCR and sequencing were used to screen and identify beta-lactamase- and plasmid- mediated quinolone resistance (PMQRs)-encoding genes. All isolates were also screened for the presence of class 1 integrons. PCR-based replicon typing (PBRT) was used to type the resistance plasmids of the blaGES-5- producing isolate among the major incompatibility (Inc) groups, specifically FIA, FIB, FIC, HI1, HI2, I1-I , L/M, N, P, W, T, A/C, K, B/O, X, Y, F, and FIIA. Multilocus sequence typing (MLST) of the GES-5 K. pneumoniae-producing isolate was performed according to the Institute Pasteur scheme (http://www.pasteur.fr/recherche/genopole/PF8/mlst/Kpneumoniae.html). Overall, 16/56 isolates were multidrug-resistant (MDR), i.e. presenting a reduced susceptibility to 3 or more structurally unrelated antibiotics, suggesting a great diversity of resistance mechanisms. Noteworthy, 10 isolates (4 S. panni, 1 A. johnsonii, 3 A. veronii, 1 K. pneumoniae, and 1 S. maltophilia) showed nonsusceptibility to carbapenems, which constitutes one of the last resorts on the antimicrobial therapy. Their phenotypic and molecular characterization revealed the expression of several enzymes: the naturally occurring carbapenemase in one S. maltophilia, ImiS in three A. veronii, both MBLs, and OXA-type carbapenemase in one A. johnsonii, responsible for their intrinsic resistance; the class A GES-5-producing K. pneumoniae isolate belonged to a novel MLST sequence type, the ST961 (18-22-18-90-142-13-179). PBRT of the plasmid-carrying blaGES-5 gene showed that it did not belong to any of the Inc groups tested. No carbapenemases were found in the 4 S. panni isolates. The :-lactam resistance, carbapenem susceptibility, found in 33 isolates was justified by the presence of various Class A (12 blaTEM-1 with distinct promoters, 6 blaSHV) and different Class C :-lactamase-encoding genes (blaCMY, blaACC, blaACT), some here firstly described: blaCMY-65 (JF780936), blaCMY-89 (HE819403), blaCMY-90 (HE819404), blaACT-13 (HE819402) and blaACC-5 (HE819401). Class 1 integrons were detected among 6 of TEM- 1-producing isolates. Together, the beta-lactamases identified explain the level of beta-lactam resistance. Besides quinolone resistance detected, none PMQR were identified, suggesting chromosomal alterations in the quinolone resistance-determining region. This study identified ARGs related not only to commonly used antibiotics, but also to carbapenems, providing, at our knowledge, the first description of a GES-5-producing Enterobacteriaceae recovered in an environmental setting. The study highlights the need of surveillance of these antibiotic resistance mechanisms in environmental backgrounds, since it represents a liable reservoir of potential pathogenic resistant bacteria. Worryingly, recent studies demonstrated that while the WWTP reduced the bacterial load, the treatment is inefficient to remove antibiotic resistant bacteria

Occurrence of beta-lactamases, namely GES-5 carbapenemase, among Gram-negative isolates from wastewater samples in Northern Portugal

Antimicrobial resistant pathogens are profoundly relevant to human health and many were the studies that focused on their spread. However, natural and human associated environmental reservoirs of resistance are yet poorly understood. The main goal of this study was to evaluate the main antibiotic resistance mechanisms in Gram-negative bacteria isolates from different wastewater environments. Water samples were collected from different environments within an urban water cycle in the region of Northern Portugal, which included treated and raw wastewater, water to the consumers and water surface. Screening of antimicrobial susceptibility of 48 Gram-negative isolates (20 Escherichia coli, 8 Citrobacter spp, 7 Klebsiella spp, 6 Kluyvera spp, 2 Enterobacter spp, 1 Hafnia alvei, 1 Pantoea agglomerans, 1Pseudomonas luteola, 1Roultella ornithinolytica, 1Serratia spp) was performed by disk diffusion method. Interpretative reading of susceptibilities allowed to direct the search for antibiotic resistant genes. PCR and sequencing were used to screen and identify bla and plasmid-mediated quinolone resistance (PMQRs) genes. All isolates were also screened for the presence of class 1 integrons. Overall, 29.2% of the isolates were multidrug resistant, suggesting a great diversity of resistance mechanisms. Noteworthy, 2 isolates showed non-susceptibility to carbapenems, which constitutes one of the last resorts on the antimicrobial therapy. Their phenotypic and molecular characterization revealed the expression of a chromosomal metalo-beta-lactamase in P. luteola and the presence of a GES-5 encoding gene in a Klebsiella pneumoniae isolate. Furthermore, we detected a vast variety of beta-lactamase encoding genes, specifically 12 blaTEM-1 with distinct promoters, 4 blaSHV (2 blaSHV-1 and 2 blaSHV-11), besides different chromossomal AmpC beta-lactamases, namely CMY-65. Class 1 integrons were detected among 6 of TEM-1-producing isolates. Together, these beta-lactamases explain the level of beta-lactam resistance. None PMQR genes were detected. In conclusion, this study provides the first description of a class A carbapenemase in an environmental setting in Portugal, in addition to several other beta-lactam resistance mechanisms. The study highlights the need of surveillance of these resistance mechanisms in environmental backgrounds, since it represents a liable reservoir of potential pathogenic resistant bacteria

Backpack weight and load distribution: kinetic assessment tools in schoolchildren - scope review

The backpack is the most used mean of transporting school supplies among children and young people, and the weight and distribution of the load, in its inside, is often variable. The adverse consequences, resulting from these parameters, have raised a growing concern on the part of the scientific community, parents and teachers. To identify the kinetic parameters used to verify the effects of weight and load position, inside the backpack, in school aged children and young people.info:eu-repo/semantics/publishedVersio

Biomechanical assessment methods used in chronic stroke: A scoping review of non-linear approaches

Non-linear and dynamic systems analysis of human movement has recently become increasingly widespread with the intention of better reflecting how complexity affects the adaptability of motor systems, especially after a stroke. The main objective of this scoping review was to summarize the non-linear measures used in the analysis of kinetic, kinematic, and EMG data of human movement after stroke. PRISMA-ScR guidelines were followed, establishing the eligibility criteria, the population, the concept, and the contextual framework. The examined studies were published between 1 January 2013 and 12 April 2023, in English or Portuguese, and were indexed in the databases selected for this research: PubMed®, Web of Science®, Institute of Electrical and Electronics Engineers®, Science Direct® and Google Scholar®. In total, 14 of the 763 articles met the inclusion criteria. The non-linear measures identified included entropy (n = 11), fractal analysis (n = 1), the short-term local divergence exponent (n = 1), the maximum Floquet multiplier (n = 1), and the Lyapunov exponent (n = 1). These studies focused on different motor tasks: reaching to grasp (n = 2), reaching to point (n = 1), arm tracking (n = 2), elbow flexion (n = 5), elbow extension (n = 1), wrist and finger extension upward (lifting) (n = 1), knee extension (n = 1), and walking (n = 4). When studying the complexity of human movement in chronic post-stroke adults, entropy measures, particularly sample entropy, were preferred. Kinematic assessment was mainly performed using motion capture systems, with a focus on joint angles of the upper limbs.info:eu-repo/semantics/publishedVersio

O efeito dos centros de dia na progressão da demência e na sobrecarga do cuidador: um estudo retrospectivo

Introduction: The increasing aging of the population and consequent increase in the incidence of age-related diseases, arouses interest in the development of policies that help care for dementia. Dementia is characterized by cognitive impairment and activities of daily living and is one of the most disabling diseases in the world. These changes make the patient dependent on care in his daily routine, which is usually assumed by a relative. The Day Care Centre´s (DC) are structures developed in response to the aging of the population, with the purpose of promoting autonomy and independence of the elderly and can support the care of people with dementia. The present study aims to evaluate the retrospective analysis of data on cognitive screening (ACE-R and MMSE), functionality (DAD), behavior (ICF) and caregiver burden (Zarit Interview) of 105 patients diagnosed with dementia, followed in a hospital between 2008 and 2016. Data from the tests were collected at an initial and second evaluation, performed after an interval of 6 months to 2 years. We compared the results of three groups, divided into: they attended DC only in the second evaluation (G1), they attended DC in both evaluations (G2) and patients who did not attend DC (G3). Results: The group that did not attend the DC presented better results regarding the cognitive, functional and behavioral aspects, suggesting less progression of the disease in these aspects. Conclusion: Considering that there are other studies that have identified positive contributions of DC in dementia care, the results highlight the importance of the adaptation of the DC to the care of elderly people with dementia diagnosis.Introdução: O aumento do envelhecimento da população e consequente aumento da incidência de doenças relacionadas a idade desperta o interesse no desenvolvimento de políticas que auxiliem no cuidado em demência. A demência é caracterizada por alterações cognitivas e alteração das atividades de vida diária, e é uma das doenças mais incapacitantes do mundo. Estas alterações tornam o doente dependente de cuidados em sua rotina diária, que é normalmente assumido por um familiar. Os Centros de Dia (CD) são estruturas desenvolvidas em resposta ao envelhecimento da população, com o objetivo de promover a autonomia e independência do idoso, e pode servir de apoio no cuidado de pessoas com demência.  O presente estudo tem por objetivo avaliar a influência dos CD na progressão da demência e sobrecarga do cuidador. Metodologia: Análise retrospectiva de dados das avaliações de rastreio cognitivo (ACE-R e MMSE), funcionalidade (DAD), comportamento (ICF) e sobrecarga do cuidador (Entrevista Zarit) de 105 doentes diagnosticados com demência, acompanhados num hospital entre os anos de 2008 e 2016. Foram recolhidos os dados dos testes em um momento inicial e em uma segunda avaliação, realizada após um intervalo de 6 meses a 2 anos. Foram comparados os resultados de 3 grupos, divididos em: doentes que frequentavam CD apenas na segunda avaliação (G1), doentes que estavam em CD nos dois momentos de avaliação (G2) e doentes que não frequentaram CD (G3).  Resultados: O grupo que não frequentou os CD apresentou melhores resultados no que se refere aos aspectos cognitivos, funcionais e comportamentais, sugerindo menor progressão da doença nestes aspectos.  Conclusão: Considerando que há outros estudos que identificaram contribuições positivas dos CD no cuidado em demência, os resultados destacam a importância da adequação dos CD ao cuidado de idosos com diagnóstico demência

Can ocean warming alter sub-lethal effects of antiepileptic and antihistaminic pharmaceuticals in marine bivalves?

The negative effects induced in marine organisms by Climate Change related abiotic factors consequences, namely ocean warming, are well-known. However, few works studied the combined impacts of ocean warming and contaminants, as pharmaceutical drugs. Carbamazepine (CBZ) and cetirizine (CTZ) occur in the marine environment, showing negative effects in marine organisms. This study aimed to evaluate the impacts of ocean warming on the effects of CBZ and CTZ, when acting individually and combined (drug vs drug), in the edible clam Ruditapes philippinarum. For that, drugs concentration, bioconcentration factors and biochemical parameters, related with clam's metabolic capacity and oxidative stress, were evaluated after 28 days exposure to environmentally relevant scenarios of these stressors. The results showed limited impacts of the drugs (single and combined) at control and warming condition. Indeed, it appeared that warming improved the oxidative status of contaminated clams (higher reduced to oxidized glutathione ratio, lower lipid peroxidation and protein carbonylation levels), especially when both drugs were combined. This may result from clam's defence mechanisms activation and reduced metabolic capacity that, respectively, increased elimination and limited production of reactive oxygen species. At low stress levels, defence mechanisms were not activated which resulted into oxidative stress. The present findings highlighted that under higher stress levels clams may be able to activate defence strategies that were sufficient to avoid cellular damages and loss of redox homeostasis. Nevertheless, low concentrations were tested in the present study and the observed responses may greatly change under increased pollution levels or temperatures. Further research on this topic is needed since marine heat waves are increasing in frequency and intensity and pollution levels of some pharmaceuticals are also increasing in coastal systems.publishe

Clinical measures for tone assessment in adults with central nervous system disorders—A scoping review in a rehabilitation context

Assessment of muscle tone in a clinical setting is important for the physiotherapist to better analyse and establish appropriate treatments for CNS disorders. This study aims to review and summarise how to assess changes in tone in the context of adult rehabilitation. Secondarily, this study aimed to identify the central nervous system disorders, the respective variable/concept under study, and the testing procedures employed. PRISMA-ScR guidelines were followed using the “population”, “concept”, and “context” to define the eligibility criteria and to delineate the research question. PubMed®, Science Direct®, Web of Science™, and Google Scholar® databases were used to search the literature. The search included studies published between 2011 and March 2023 in Portuguese, English, French, and Spanish that assessed an adult population (>19 years) with CNS injury. Review articles, qualitative studies, conference proceedings, letters to the editor, and editorials were excluded. Initially, 1519 references were identified, of which eight met the eligibility criteria. The measurement instruments included the Modified Ashworth Scale (n = 5), the Modified Modified Ashworth Scale (n = 3), the BioTone™ system (n = 2), the Montreal Spasticity Measurement (n = 1), and the Tone Evaluation Scale (n = 1). The health conditions considered included stroke sequelae (n = 7), multiple sclerosis (n = 4), spinal cord injuries (n = 4), cerebral palsy (n = 2), brain tumour (n = 2), and traumatic brain injuries (n = 3). The concepts of spasticity (n = 7) and muscle tone (n = 2) were explored. Considering the variables spasticity and muscle tone in different CNS disorders, mainly stroke, subjective instruments were preferred compared to objective ones, with the Modified Ashworth Scale being highlighted.info:eu-repo/semantics/publishedVersio

Medidas de avaliação motora em indivíduos após AVC nas fases aguda e sub-aguda – scoping review

As alterações biomecânicas nos indivíduos após Acidente Vascular Cerebral (AVC) podem ser avaliadas em contexto clínico, com recurso a testes e escalas validadas, ou em contexto laboratorial através de uma análise instrumentada quantitativa e objetiva. Identificar e sumariar os instrumentos de avaliação, e respetivas tarefas motoras, utilizados na análise do movimento humano, nas fases aguda e subaguda recente, após AVC. Seguiu-se o protocolo PRISMA Extension for Scoping Reviews(PRISMA-ScR) e a estratégia “população”, “conceito” e “contexto” (PCC), para a definição da questão de pesquisa nas bases de dados PubMed®, Science Direct®, Web of Science®e Google Scholar®. Incluíram-se estudos publicados entre 2018 e 2022, em português e inglês, que descrevessem os instrumentos de avaliação clínicos e laboratoriais utilizados, e a tarefa motora associada, em indivíduos >19 anos, considerando até 3 meses após AVC. Excluíram-se artigos de revisão, estudos qualitativos, conference proceedings, cartas ao editor e editoriais. Foram selecionados 302 artigos, dos quais 15 foram elegíveis. A marcha (n=9), o sit to stand(n=2) e funções relacionadas com o membro superior(n=4) foram avaliadas por diferentes instrumentos clínicos (Functional Ambulation Categories; Functional Independence Measure; Fulgl-Meyer Assessment;) e laboratoriais (sistemas de captura de imagem (VICON, EXFH20, GoPro Hero5); plataformas de forças AMTI INc e AccuGait®). O Functional Ambulation Categoriese a Fulgl-Meyer Assessmentforam os instrumentos mais aplicados na análise clínica e o sistema de captura de imagem VICON na análise cinemática quantitativa. A tarefa motora mais estudada foi a marcha. Dada a evolução da tecnologia na procura de soluções viáveis para a tomada de decisão em contexto de reabilitação, sugerem-se estudos que privilegiam a avaliação em contexto real.info:eu-repo/semantics/publishedVersio

As preferências ao nível do feedback durante a dinamização de aulas de hidroginástica

Os objetivos do estudo foram caraterizar as preferências dos participantes em aulas de hidroginástica ao nível do feedback. Cinquenta praticantes do género masculino e feminino de diferentes idades (x homens, y mulheres) (compreendidas entre os 25 e 78 anos) preencheram um questionário com o objetivo de serem aferidas as preferências relativamente ao feedback em aulas de hidroginástica. Verificou-se uma preferência pelo feedback direcionado à classe, durante a execução, sem contacto físico e com afetividade positiva, durante os exercícios em separado, com indicação de como devem ser realizados, de frente para a atividade e com especial atenção à res-piração. Compreender as preferências dos praticantes é fundamental no sentido de ser procurado pelos instrutoresThe objectives of the study were to characterize the preferences of participants in hydrogymnastics classes at the feedback level. Fifty male and female practitioners of different ages (25-78 years old) completed a questionnaire in order to assess preferences regarding feedback in hydrogymnastic classes. There was a preference for feedback directed to the class, during the execution, without physical contact and with positive affectivity, during the separate exercises, indicating how they should be performed, facing the activity and paying special attention to breathing. The understanding of preferences of the practitioners is crucial to meet what is most pleasing to those who practice this activity.info:eu-repo/semantics/publishedVersio