Characterization of antibiotic resistance mechanisms in gram negative bacteria isolated from animals and food products of animal origin

Tese de Doutoramento em Ciências Veterinárias. Especialidade de Sanidade AnimalABSTRACT - Antibiotics were a truly innovative option in medical therapy for the treatment of diseases caused by microbial agents, having largely contributed for the decrease levels of human and animal morbidity and mortality. Therefore, the overuse and misuse of these drugs in human clinical therapy and in the veterinary medicine, including animal production, contributed for the emergence and dissemination of antibiotic resistant microorganisms, which are a serious threat to human and animal health, and to the ecosystem. The aim of the present thesis was to search the main acquired antibiotic resistance mechanisms to β-lactams, fluoroquinolones and polymixins in Gram negative bacteria recovered from different animal species and matrices, and to investigate the most important mobile genetic elements involved in the dissemination. Thus, the studies concerning antibiotic susceptibility and molecular characterization were performed in collections of bacterial isolates belonging to Enterobacteriaceae family (mainly Escherichia coli and Salmonella enterica). Both bacterial species were associated to antibiotic resistant determinants of clinical relevance in human and veterinary medicine, namely, blaCTX-M-1, blaCTX-M-14, blaCTX-M-15, blaCTXM- 32, blaCMY-2, qnrS1, aac(6’)-Ib-cr, mcr-1. The diversity of detected mobile genetic elements, e.g., IncI1, IncF and IncX4 plasmids, insertion sequences ISEcp1, as well as integrons of class 1 and 2, suggest their involvement in the dissemination of resistance genes interspecies, and movement within the bacterial cell. Genomic analysis of two isolates (Morganella morganii and Salmonella Enteritidis), highlighted the potencial of omic technologies, as an additional tool to the phenotypic and genotypic characterization of antibiotic resistance. The results obtained throughout this thesis highlight the importance of the different animal species as reservoirs of antibiotic resistant bacteria. In addition, it was reinforced the need of a permanent research and monitoring of antibiotic resistance in the different ecological niches, and the use of genomic approaches, which had an important role in the understanding of the complex problem represented by the dynamic of antibiotic resistance.RESUMO - Os antibióticos constituíram uma opção verdadeiramente inovadora na terapêutica medicamentosa para o tratamento de doenças provocadas por agentes microbianos, tendo contribuído largamente para a diminuição das taxas de morbilidade e mortalidade humana e animal. Porém, a utilização abusiva e inadequada destes fármacos na prática clínica humana e na medicina veterinária, incluindo a produção animal, contribuiu para a emergência e disseminação de microrganismos resistentes, os quais constituem uma grave ameaça à saúde humana e animal, e para o ecossistema. A presente dissertação teve como objetivo central investigar os principais mecanismos de resistência adquirida aos antibióticos β-lactâmicos, fluoroquinolonas e polimixinas em bactérias de Gram negativo isoladas de diferentes espécies animais e matrizes, bem como os principais elementos genéticos móveis responsáveis pela sua disseminação. Assim, os estudos de suscetibilidade aos antibióticos e caracterização molecular foram realizados em coleções de estirpes bacterianas pertencentes à família Enterobacteriaceae (maioritariamente Escherichia coli e Salmonella enterica). Ambas as espécies bacterianas estavam associadas a determinantes de resistência de relevância clínica humana e veterinária, nomeadamente blaCTX-M-1, blaCTX-M-14, blaCTX-M-15, blaCTX-M-32, blaCMY-2, qnrS1, aac(6’)-Ib-cr, mcr-1. A diversidade de elementos genéticos móveis detetados, e.g. plasmídeos IncI1, IncF e IncX4, sequências de inserção ISEcp1, bem como integrões de classes 1 e 2, sugere o seu envolvimento na disseminação de genes de resistência aos antibióticos entre espécies, tal como a sua movimentação dentro da própria bactéria. A análise do genoma de duas estirpes (Morganella morganii e Salmonella Enteritidis) realçou o potencial das tecnologias ómicas, como ferramenta adicional na caracterização fenotípica e genotípica da resistência aos antibióticos. Os resultados obtidos salientam a importância que as várias espécies animais representam como reservatórios de bactérias resistentes aos antibióticos. Foi igualmente reforçada a necessidade de uma permanente investigação e monitorização da resistência aos antibióticos nos vários nichos ecológicos, e do uso de abordagens genómicas, as quais tiveram um papel importante na compreensão do complexo problema que representa a dinâmica da resistência aos antibióticos.N/

Foster care process: challenges and coping of youth and families

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Anal canal adenocarcinoma locally treated with abdominoperineal resection after chemoradiotherapy: case report and review of literature

Background: Primary adenocarcinoma of the anal canal is rare, representing less than 20% of anal canal cancers. Given the limited data regarding treatment and outcomes, the management of this type of cancer is focused on a combined modality therapy involving radical surgery and neoadjuvant/adjuvant chemoradiotherapy. Case study: A 74-year-old woman presented with pruritus and anal pain with 6 months duration. MRI showed a semi-concentric mass in anal canal posterior wall. After an incisional biopsy that revealed an adenocarcinoma, the patient underwent neoadjuvant chemoradiotherapy followed by laparoscopic abdominoperineal resection. Conclusion: There is limited research into anal adenocarcinoma since the rarity of this condition. The prognosis of anal adenocarcinoma is poor and the management remains controversial. Therapy strategies are not well established, however, general agreement states that a combined multimodality (combination of radical surgical resection and pre or postoperative chemoradiotherapy) achieves the best outcome

O papel do bibliotecário do ensino superior no e-learning durante a pandemia COVID-19

A pandemia COVID-19 foi responsável por muitas mudanças nos processos de ensino e aprendizagem nas Instituições de Ensino Superior. As bibliotecas de ensino superior têm um papel importante na transmissão de conhecimentos aos seus utilizadores e na assistência aos mesmos através dos seus recursos. Devido ao encerramento de todas as atividades educativas, as bibliotecas tiveram de transferir e mobilizar os seus serviços presenciais para serviços online. O objetivo geral deste trabalho é compreender o papel dos bibliotecários do ensino superior português no e-learning durante a pandemia COVID-19. Os objetivos específicos são: descrever as experiências de e-learning que os bibliotecários tinham antes e durante a pandemia, identificar as oportunidades e os desafios que foram trazidos pela COVID-19, analisar o interesse e a atitude dos bibliotecários em relação ao e-learning e sugerir recomendações de apoio ao e-learning. Os participantes da pesquisa são bibliotecários de vinte instituições portuguesas de ensino superior universitário e politécnico, uma instituição por cada distrito e por cada região autónoma. Os bibliotecários tiveram de repensar as suas práticas e as formas de ensino, o que exigiu que fossem mais criativos no seu modo de ensinar. Os inquiridos reportaram que a pandemia deu um impulso para que fossem desenvolvidos programas de formação online, tirando partido dos serviços e dos recursos já disponíveis no período pré-pandemia. Com base nas experiências relatadas pelos bibliotecários, podemos concluir que a pandemia impulsionou o desenvolvimento e a implementação de sistemas de apoio ao e-learning nas bibliotecas do ensino superior. Para que os bibliotecários possam utilizar estas ferramentas no ensino online, necessitam de formação sobre como utilizá-las eficazmente. A colaboração entre o bibliotecário e o pessoal académico é fundamental para o sucesso do ensino, para uma melhor aprendizagem e para desenvolver serviços que satisfaçam as exigências de ensino da comunidade académica. Para tal, é fundamental tornar presente a biblioteca nas plataformas de aprendizagem do campus e construir alianças com os agentes ou intervenientes envolvidos no e-learning.COVID-19 pandemic was responsible for bringing about many changes in the teaching and learning processes of Higher Education Institutions. Academic libraries play an important role in imparting knowledge to their users and in assisting them through the provision of resources. As a result of the closure of all educational activities, libraries were obliged to migrate their in-person services to online ones. The overall objective of this study is to understand the role of Portuguese higher education librarians in e-learning during the COVID-19 pandemic. Specifically, describing the e-learning experiences of librarians before and during the pandemic, identifying the opportunities and challenges brought by COVID-19, analysing librarians' interests and attitudes toward e-learning, as well as suggesting recommendations on how to better support the e-learning. Librarians from twenty Portuguese universities and polytechnic higher education institutions, participated in the research, with one institution per district and per autonomous region. Some respondents stated that they experienced the need to rethink their practices and ways of teaching, which required them to be more creative in the way they teach. Others described how the pandemic gave them an impetus to develop online training programs, whilst taking advantage of the services and resources that were already at their disposal. Based on the experiences reported by librarians, we can conclude that the pandemic acted as a driver for the development and implementation of e-learning support systems in university libraries. To ensure that librarians can use these tools for online teaching, there is a need for them to be trained in how to use them effectively. A good level of collaboration between the librarian and faculty is key to achieving successful teaching, better learning, discovering the needs of library users, and developing services to satisfy the teaching demands of the academic community. It is essential to turn present the library in the campus learning platforms and that alliances be forged with e-learning agents and stakeholders

O papel do bibliotecário do ensino superior no e-learning durante a pandemia COVID-19

A pandemia COVID-19 foi responsável por muitas mudanças nos processos de ensino e aprendizagem nas Instituições de Ensino Superior. Devido ao encerramento de todas as atividades educativas, as bibliotecas do ensino superior tiveram de transferir e mobilizar os seus serviços presenciais para o ambiente online. O objetivo geral deste trabalho é compreender o papel dos bibliotecários do ensino superior português na utilização do e-learning durante a pandemia COVID-19. Os objetivos específicos são: descrever as experiências de e-learning que os bibliotecários tinham antes e durante a pandemia, identificar as oportunidades e os desafios que foram trazidos pela COVID-19, analisar o interesse e a atitude dos bibliotecários em relação ao e-learning e sugerir recomendações de apoio ao e-learning. Os participantes da pesquisa são bibliotecários (n=20) de 20 instituições portuguesas de ensino superior universitário e politécnico, uma instituição por cada distrito e por cada região autónoma. Os bibliotecários tiveram de repensar as suas práticas e as formas de ensino, o que exigiu que fossem mais criativos no seu modo de ensinar. Os inquiridos reportaram que a pandemia impulsionou o desenvolvimento de programas de formação online, tirando partido dos serviços e dos recursos já disponíveis no período pré-pandemia. Conclui-se que a pandemia acelerou a implementação de sistemas de apoio ao e-learning nas bibliotecas do ensino superior. Contudo, para que os bibliotecários possam utilizar estas ferramentas no ensino online, necessitam de formação sobre como utilizá-las eficazmente. A colaboração entre o bibliotecário e o pessoal académico é fundamental para o sucesso do ensino, para uma melhor aprendizagem e para desenvolver serviços que satisfaçam as exigências de ensino da comunidade académica. Para tal, é fundamental tornar presente a biblioteca nas plataformas de aprendizagem do campus e construir alianças com os agentes ou intervenientes envolvidos no e-learning.info:eu-repo/semantics/publishedVersio

Severe imported malaria in an intensive care unit: a review of 59 cases

<p>Abstract</p> <p>Background</p> <p>In view of the close relationship of Portugal with African countries, particularly former Portuguese colonies, the diagnosis of malaria is not a rare thing. When a traveller returns ill from endemic areas, malaria should be the number one suspect. World Health Organization treatment guidelines recommend that adults with severe malaria should be admitted to an intensive care unit (ICU).</p> <p>Methods</p> <p>Severe cases of malaria in patients admitted to an ICU were reviewed retrospectively (1990-2011) and identification of variables associated with in-ICU mortality performed. Malaria prediction score (MPS), malaria score for adults (MSA), simplified acute physiology score (SAPSII) and a score based on WHO's malaria severe criteria were applied. Statistical analysis was performed using StataV12.</p> <p>Results</p> <p>Fifty nine patients were included in the study, all but three were adults; 47 (79,6%) were male; parasitaemia on admission, quantified in 48/59 (81.3%) patients, was equal or greater than 2% in 47 of them (97.9%); the most common complications were thrombocytopaenia in 54 (91.5%) patients, associated with disseminated intravascular coagulation (DIC) in seven (11.8%), renal failure in 31 (52.5%) patients, 18 of which (30.5%) oliguric, shock in 29 (49.1%) patients, liver dysfunction in 27 (45.7%) patients, acidaemia in 23 (38.9%) patients, cerebral dysfunction in 22 (37.2%) patients, 11 of whom with unrousable coma, pulmonary oedema/ARDS in 22 (37.2%) patients, hypoglycaemia in 18 (30.5%) patients; 29 (49.1%) patients presented five or more dysfunctions. The case fatality rate was 15.2%. Comparing the four scores, the SAPS II and the WHO score were the most sensitive to death prediction. In the univariate analysis, death was associated with the SAPS II score, cerebral malaria, acute renal and respiratory failure, DIC, spontaneous bleeding, acidosis and hypoglycaemia. Age, partial immunity to malaria, delay in malaria diagnosis and the level of parasitaemia were not associated with death in this cohort.</p> <p>Conclusion</p> <p>Severe malaria cases should be continued monitored in the ICUs. SAPS II and the WHO score are good predictors of mortality in malaria patients, but other specific scores deserve to be studied prospectively.</p

EDUCAÇÃO AMBIENTAL: DA TEORIA À PRÁTICA, EM BUSCA DA SENSIBILIZAÇÃO E CONSCIENTIZAÇÃO AMBIENTAL

A educação ambiental deve ser um processo educativo, permanente e contínuo nos dias atuais, com oobjetivo de apontar caminhos para manutenção dos recursos naturais e a qualidade de vida dapopulação. Nesse sentido, acredita-se que a escola é um veículo com grandes poderes de transmissãode pensamento e construção do conhecimento. Para tal, a Escola Municipal de Ensino FundamentalSenador Darcy Ribeiro do Município de Capão do Leão-RS, foi escolhida por se tratar de uma escolacom alunos na faixa etária de 6 a 12 anos, sendo muitos deles vulneráveis ambientalmente, decorrentesdos riscos a que estão submetidos em função dos preconceitos e/ou desigualdade econômica e socialna sociedade. Nesse contexto, a proposta teve como objetivos: desenvolver atividades teorico-práticas,visando o desenvolvimento da consciência e sensibilização ambiental; estimular a percepção daimportância nas transformações causadas pelo homem no meio em que vivem e as interferênciascausadas à natureza, promover a oralidade e a socialização do conhecimento. Metodologicamente, aproposta foi conduzida em duas fases: na primeira fase, foram feitas consultas bibliográficas sobre oassunto e posteriormente, foram planejadas e executadas as atividades práticas, no intuito deconscientizar e sensibilizar o público alvo da pesquisa. Como resultados obteve-se a estruturação dahorta agroecológica, minhocário, bem como, gincana com o tema ‘lixo’, visitas à Parques e fundaçõesambientais, filmes e produção de textos. Pode-se perceber entre o as crianças, além da afinidade comas atividades por elas executadas, uma efetiva mudança de comportamento, o aumento da autoestima,respeito e a valorização como ser humano

Understanding the role of extracurricular activities in socioemotional development and its impact on young people digital involvement: an exploratory study

Young people spend a significant amount of time online, which brings both risks and opportunities (e.g., Hamilton et al., 2021). Since not all risks lead to actual harm, the aim is to identify key protective factors in order to empower young people in their use of technology (e.g., Campos et al., 2021). Recently, studies focused on the impact of young people's use of digital media have emphasised the importance of the socioemotional skills of the person behind the device (e.g., Odgers & Jensen, 2020). Contexts such as extracurricular activities can take on particular importance because of the role they play in young people's socioemotional development (e.g., Collaborative for Academic, Social, and Emotional Learning [CASEL], 2015, 2022; Fredricks & Eccles, 2006), as described earlier, and it is important to understand how and why this happens.info:eu-repo/semantics/publishedVersio

Sural nerve involvement in experimental hypertension: morphology and morphometry in male and female normotensive Wistar-Kyoto (WKY) and spontaneously hypertensive rats (SHR)

<p>Abstract</p> <p>Background</p> <p>The sural nerve has been widely investigated in experimental models of neuropathies but information about its involvement in hypertension was not yet explored. The aim of the present study was to compare the morphological and morphometric aspects of different segments of the sural nerve in male and female spontaneously hypertensive (SHR) and normotensive Wistar-Kyoto (WKY) rats. Rats aged 20 weeks (N = 6 in each group) were investigated. After arterial pressure and heart rate recordings in anesthetized animals, right and left sural nerves were removed and prepared for epoxy resin embedding and light microscopy. Morphometric analysis was performed with the aid of computer software, and took into consideration the fascicle area and diameter, as well as myelinated fiber number, density, area and diameter.</p> <p>Results</p> <p>Significant differences were observed for the myelinated fiber number and density, comparing different genders of WKY and SHR. Also, significant differences for the morphological (thickening of the endoneural blood vessel walls and lumen reduction) and morphometric (myelinated fibers diameter and G ratio) parameters of myelinated fibers were identified. Morphological exam of the myelinated fibers suggested the presence of a neuropathy due to hypertension in both SHR genders.</p> <p>Conclusions</p> <p>These results indicate that hypertension altered important morphometric parameters related to nerve conduction of sural nerve in hypertensive animals. Moreover the comparison between males and females of WKY and SHR allows the conclusion that the morphological and morphometric parameters of sural nerve are not gender related. The morphometric approach confirmed the presence of neuropathy, mainly associated to the small myelinated fibers. In conclusion, the present study collected evidences that the high blood pressure in SHR is affecting the sural nerve myelinated fibers.</p

The who-when-why triangle of complementary and alternative medicine use among Portuguese IBD patients

Background: The use of complementary and alternative medicines is increasing among chronic patients, particularly those afflicted with inflammatory bowel diseases. Aim: This study aimed to address the prevalence of complementary and alternative medicines use among Portuguese inflammatory bowel diseases' patients. Methods: Patients were invited to fill an anonymous questionnaire concerning the use of complementary and alternative medicines. Results: Thirty-one per cent of the patients reported having used complementary and alternative medicines in the past, whereas 12% were using them by the time the questionnaire was administered. Fifty-nine per cent of the users did not share this information with their physician, whereas 14% and 8% discontinued their medication and periodical examination, respectively. Steroids prescription (OR = 2.880) and a higher instruction level (OR = 3.669) were predictors of complementary and alternative medicines use in this cohort. Conclusions: Roughly a third of Portuguese IBD patients had used CAM. Steroid treatment and an academic degree are associated with CAM use. Given the potential side effects and interactions, patient information about the benefits and limitations of conventional and complementary treatments should be reinforced. (C) 2017 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.GEDII (Portuguese IBD Study Group)info:eu-repo/semantics/publishedVersio