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The development of sustainable shellfish aquaculture is highly dependent on the provision of reliable monitoring and predictive information on the occurrence of harmful algal blooms (HABs). The Portuguese HAB early warning system and shellfish closures presented here is a prototype, developed in the ASIMUTH project. It relies on weekly monitoring data composed of observations of HAB species and toxin concentrations within shellfish, and ocean circulation forecasts generated by an operational oceanographic model. The shellfish harvesting areas comprise coastal areas, estuaries + rías and coastal lagoons. The weekly bulletin characterizes the current shellfish closure situation and next week's forecasts for potentially impacted areas. The period analyzed ranged from 27 July 2013 to 17 March 2014, and describes the first skill assessment of the warning system. The forecast accuracy was evaluated, considering the number of forecasts that were verified to be correct the following week (85%) as well as the number of events not forecasted (false negatives, 12%) and those expected but did not occur (false positives, 3%). Variations were most visible in the first weeks of bulletin implementation and during autumn–winter months. The complementary use of field data, remote sensing and operational models led to more accurate predictions of blooms and range of the event. [ABSTRACT FROM AUTHOR]

Cohesive sediment dynamics in estuarine systems is a major issue in water quality and engineering problems. Numerical models can help to assess the complex dynamics of cohesive sediments, integrating the information collected in monitoring studies. Following a numerical approach we investigated the main factors that influence the cohesive sediment dynamics in an estuarine system composed of large mudflats (Tagus estuary, Portugal). After a spin up period of the bottom layer and considering the combined effect of waves and currents on the bottom shear stress, the dynamics of cohesive sediment during the fortnightly and daily erosion–sedimentation cycle was properly reproduced by the model. The results of cohesive suspended sediments were validated with data from sixteen monitoring stations located along the estuary and turbidity data measured by two multiparametric probes. The hydrodynamics were previously validated by harmonic analysis and with ADCP data. Although tidal currents are the major cause of cohesive sediment erosion, the results suggest that wind waves also play an important role. The simulated sediment mass involved in the fortnightly tidal cycle was in the same order of magnitude of the annual load from the rivers, as observed in previous studies based on field data. [ABSTRACT FROM AUTHOR]

Abstract: The relative impacts of tidal (neap, spring) and river discharge (including a flood event) forcing upon water and sediment circulation have been examined at the rock-bound Guadiana estuary. Near-bed and vertical profiles of current, salinity, turbidity, plus surface suspended sediment concentrations (SSC, at some stations only), were collected at the lower and central/upper estuary during tidal and fortnightly cycles. In addition, vertical salinity and turbidity profiles were collected around high and low water along the estuary. Tidal asymmetry produced faster currents on the ebb than on the flood, especially at the mouth. This pattern of seaward current dominance was enhanced with increasing river flow, due to horizontal advection that was confined within the narrow estuarine channel. The freshwater inputs and, at a degree less, the tidal range controlled the vertical mixing and stratification importance. Well-mixed (spring) and partially stratified (neap) conditions alternated during periods of low river flows, with significant intratidal variations induced by tidal straining (especially at the partially stratified estuary). Highly stratified conditions developed with increasing river discharge. Intratidal variability in the pycnocline depth and thickness resulted from current shear during the ebb. A salt wedge with tidal motion was observed at the lower estuary during the flood event. Depending on the intensity of turbulent mixing, the residual water circulation was dominantly controlled either by tidal asymmetry or gravitational circulation. The SSC was governed by cyclical local processes (resuspension, deposition, mixing, advection) driven by the neap-spring fluctuations in tidal current velocities. More, intratidal variability in stratification indicated the significance of tidal pumping at the partially and highly stratified estuary. The estuary turbidity maximum (ETM) was enhanced with increasing current velocities, and displaced downstream during periods of high river discharge. During the flood event, the ETM was expelled out of the estuary, and the SSC along the estuary was controlled by the sediment load from the drainage basin. Under these highly variable river flow conditions, our observations suggest that sand is exported to the nearshore over the long-term (>years). [Copyright &y& Elsevier]

The article studies acute ascending aortic dissection during pregnancy by researchers from Lisbon, Portugal. Although acute aortic dissection is a very rare case, it is a life-threatening emergency for both the mother and the fetus when it occurs, usually during the during the third trimester or puerperium. The condition necessitates a high index of clinical suspicion and an immediate multidisciplinary approach.

Introduction Rivastigmine is the only approved transdermal therapy for Alzheimer’s disease (AD). Reduced drug concentration variability compared to oral formulations may improve tolerability and optimize treatment effectiveness. Objectives The EXEPT study evaluated patient compliance, caregiver treatment preference and clinical outcomes in patients with mild to moderate AD initiating oral monotherapy (OM) or transdermal monotherapy (TM) with approved AD drugs. Methods EXEPT was a Portuguese observational multicentre trial that prospectively evaluated two cohorts of patients over 6 months (± 3 months): OM and TM, to which patients were assigned according to clinical criteria. Endpoints included patient compliance (evaluated by caregivers on a 0-10 scale), caregiver treatment preference and change in Mental State Examination (MMSE) and Neuropsychiatric Inventory domains scores. Results Eighteen investigators recruited 190 patients (63.5% female, mean age 75.99 [± 7.67]), of which 69.5% were initiated on TM. Patient compliance at study end was significantly higher in the TM group (9.4 versus 8.6 points, p<0.001); 95.3% of caregivers in TM cohort preferred this formulation. MMSE increased by a median of 2.0 points in both cohorts (p<0.001 versus baseline) but no difference was observed between groups (p=0.790). A higher proportion of patients on TM showed reduced agitation/aggression (30.9% versus 15.4%, p=0.035); after controlling for baseline MMSE and use of antipsychotics this difference remained significant (OR=2.795; p=0.030). Conclusions Transdermal rivastigmine was associated with higher compliance and caregiver preference and reduced agitation/aggression compared to OM. These findings may impact treatment decisions in AD patients with agitation and aggression and high caregiver burden. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the use of external cephalic version (ECV) in Portuguese public hospitals with maternity services, as well as exploring the main motives for not offering the technique., Methods: A cross-sectional observational study was conducted involving an online survey with 34 questions, accessed via an email addressed to all Heads of Department of Portuguese state-owned hospitals with maternity services. In centers where the technique was performed, information was requested on success rates, contraindications for the procedure, and practical aspects related to its use. In centers where ECV was not offered, the underlying reasons for this were queried., Results: Answers were received from 41 out of the 43 state hospitals with maternity services (95.3%). Sixteen hospitals perform the technique (39%), with reported annual numbers ranging from 3 to 51, and success rates ranging from 25% to 85% (12 respondents). The main reasons for not offering the technique were lack of experience and lack of conditions to perform it safely. Most centers (87.8%) reported that they would welcome hands-on training in ECV., Conclusion: ECV is used in a minority of Portuguese state-owned hospitals. Efforts are needed to achieve a wider implementation of the technique, with a particular focus on simulation-based training., (© 2022 International Federation of Gynecology and Obstetrics.)

Urban green spaces (UGS) deliver a wide range of regulating, provisioning and cultural ecosystem services (CES), relevant to support the achievement of some United Nations Sustainable Development Goals (e.g., Goal 11: sustainable cities and communities, and Goal 3: good health and well-being). However, knowledge of preferences and uses of UGS by urban dwellers is still lacking. This study assesses the CES perceived by different users in five distinct urban parks located in Coimbra, Portugal: Manuel Braga (secular park), Botanical garden, Choupal national forest, Mondego green park (large area placed next to the river), and Vale das Flores (linear park located in a residential area). A questionnaire survey was performed in each park to investigate the activities performed and their relevance for the users, users' motivations to develop the activities on that specific UGS, the perceived benefits regarding physical and emotional well-being and social interactions, and users' perception about disservices. The results showed that walking, meeting people, practicing and doing activities with children are the activities performed by most users and are perceived as beneficial for physical and emotional well-being. Multifunctionality is a characteristic of all parks and highly appreciated by the users. Significant differences in socio-demographic characteristics of the users and motivations are recorded between parks. The tranquillity of space and landscape beauty are the main motivations to use Manuel Braga Park and the Botanical garden. Distance to the park and transportation means are particularly important for Botanical garden and Vale das Flores park users. Age group and average monthly income were associated in both Choupal national forest, Mondego green park and Vale das Flores park, denoting that older and wealthier users are more able to enjoy these parks. Users' problems or ecosystem disservices were not identified, although plagues (e.g., mosquitoes) and dangerous animals recorded average concerns in the Choupal national forest and in the Vale das Flores and Mondego green parks. This work's findings can help decision-makers better understand users' needs and expectations, thus improving UGS design and management to attract more citizens., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021 The Authors. Published by Elsevier B.V. All rights reserved.)

Radiological monitoring is fundamental for compliance with radiological protection policies in the aftermath of radiological events, such as nuclear accidents, terrorism, and out-of-commission uranium mines. An effective strategy for radiation monitoring is to use radiation detectors coupled with Unmanned Aerial Vehicles (UAVs), enabling for quicker surveillance of large areas without involving the need of human presence in the target area. The main aim of this study was to formulate the parameters for a UAV flight strategy in preparation for future field measurements using Geiger-Muller Counters (GMC) and Cadmium Zinc Telluride (CZT) spectrometers. As a proof of concept, the prepared flight strategy will be used to survey out-of-commission uranium mines in northern Portugal. Procedures to assure the calibration of the CZT and verification of the GMCs were conducted, as well as a sensitivity analysis of the sensors considering different acquisition times, distance to source, and detector response time. This article reports specific parameters, such as UAV distance to ground, time of exposition, speed, and the methodology to perform the identification and calculate the activity of possible radioactive sources. An effective flight strategy is also presented, aiming to use radiation detectors coupled with UAVs to undertake extensive monitoring of areas with enhanced levels of environmental radiation, which is of prime importance due to the lasting hazardous effects of enhanced environmental radiation in the nearby ecosystem and population.

Purpose: Glaucoma leads as the first cause of irreversible blindness. The number of patients will greatly increase in upcoming years and changes will have to be accomplished to cope with those numbers. As such, data are important to understand the effect of new policies introduced in glaucoma management. Only few countries have described their glaucoma surgical profile and, in Europe, only the United Kingdom described the last 15 years. The aim of this study is to assess the glaucoma surgical profile and its changes in mainland Portugal from 2000 to 2015., Methods: Retrospective database analysis of inpatient and surgical outpatients' episodes of all public hospitals in mainland Portugal was performed. The annual absolute numbers of ophthalmic procedures, as well as their surgical rate (per 100,000 inhabitants) were calculated., Results: Glaucoma patients undergoing glaucoma procedures were 67±14 years old and 50% were female. During the study period there was an increase in the number and surgical rate of glaucoma procedures. Trabeculectomy showed a stable surgical rate (7 per 100,000 inhabitants) despite a reduction in terms of relative weight among glaucoma procedures. At the same time, the surgical rate of glaucoma drainage devices and cyclophotoablation increased, while remaining stable for cyclocryoablation., Conclusions: In Portugal, trabeculectomy had a stable surgical rate throughout the study period, being the most performed glaucoma surgical procedure. Other surgeries, like glaucoma drainage devices and cyclophotoablation are gaining ground among glaucoma specialists. Our results match what has been published by other countries worldwide and can be used to achieve a better health planning.

Purpose: To determine the frequency of epiretinal membranes (ERM) in eyes with primary open-angle glaucoma subjected to trabeculectomy., Methods: We conducted a retrospective study on patients subjected to trabeculectomy with at least a 6-month follow-up. Ophthalmologic examination and spectral-domain optical coherence tomography (SD-OCT) were analyzed. Eyes with previous surgical or laser treatments or other pathologies (other than glaucoma and ERM) were excluded., Results: A total of 50 eyes (40 patients) were included in this study. The mean follow-up time after surgery was 27.8 months. After surgery, 9 eyes (18%) had preretinal macular fibrosis and 19 eyes (38%) had cellophane macular reflex. Of the 16 eyes with a preoperative macular SD-OCT, 3 (18.8%) developed ERM and 4 (25%) progressed from cellophane macular reflex to preretinal macular fibrosis, after surgery. The ERM frequency did not differ significantly between eyes subjected to trabeculectomy with or without the use of antimetabolites (P=0.08), or between eyes subjected to simple or combined surgery (phacotrabeculectomy) (P=0.09)., Conclusion: Trabeculectomy may predispose one to the appearance and progression of ERM. Further studies are needed to clarify this intriguing relation.

Fifty-four healthy dogs were screened in Portugal for the presence of nasal methicillin-resistant Staphylococcus aureus (MRSA) carriage. Sixteen MRSA isolates (one/sample) were recovered from nasal samples of dogs, and they were typed by molecular methods (S. aureus protein A [spa]-, multilocus sequence typing-, staphylococcal cassette chromosome mec-typing). MRSA isolates were investigated for their susceptibility to antimicrobial agents by disk-diffusion test. The presence of resistance genes and of the Panton-Valentine leukocidin gene (lukF-lukS) was analyzed by PCR. Four different spa-types were identified among our MRSA isolates (t032, t432, t747, and t4726), with t032 as the most frequently detected. The sequence-type ST22 was identified in four tested MRSA isolates with different spa-types. All 16 isolates presented the staphylococcal cassette chromosome mec type IV. Most of MRSA isolates were resistant to ciprofloxacin, erythromycin, and clindamycin (94%-100%), and no resistance was identified to chloramphenicol, mupirocin, and trimethoprim-sulfametoxazole. The ermC and tetM resistance genes were detected in all MRSA isolates. The amino acid changes Ser84Leu in GyrA protein and Ser80Phe in GrlA protein were the most prevalent ones in our MRSA isolates. None of the MRSA strains carried the lukF-lukS genes. The results presented in this study indicate that healthy dogs may be a reservoir of MRSA that could be transmitted to humans by direct contact.

Extended-spectrum beta-lactamase-containing Escherichia coli isolates were detected in 32 of 119 fecal samples (26.9%) from birds of prey at Serra da Estrela, and these isolates contained the following beta-lactamases: CTX-M-1 (n = 13), CTX-M-1 plus TEM-1 (n = 14), CTX-M-1 plus TEM-20 (n = 1), SHV-5 (n = 1), SHV-5 plus TEM-1 (n = 2), and TEM-20 (n = 1).

ESBL-producing E. coli isolates have been isolated from eight of seventy seven faecal samples (10.4%) of wild boars in Portugal. The ESBL types identified by PCR and sequencing were bla(CTX-M-1) (6 isolates) and bla(CTX-M-1) + bla(TEM1-b) (2 isolates). Further resistance genes detected included tet (A) or tet (B) (in three tetracycline-resistant isolates), aad A (in three streptomycin-resistant isolates), cml A (in one chloramphenicol-resistant isolate), sul 1 and/or sul 2 and/or sul 3 (in all sulfonamide-resistant isolates). The intI 1 gene encoding class 1 integrase was detected in all ESBL-producing E. coli isolates. One isolate also carried the intI 2 gene, encoding class 2 integrase. The ESBL-producing E. coli isolates could be assigned to phylogenetic groups B1 (3 isolates), B2 (3 isolates) or A (2 isolates). Amino acid change in GyrA protein (Ser83Leu or Asp87Tyr) was detected in three nalidixic acid-resistant and ciprofloxacin-susceptible isolates. Two amino acid changes in GyrA (Ser83Leu + Asp87Asn) and one in ParC (Ser80Ile) were identified in two nalidixic acid- and ciprofloxacin-resistant isolates. As evidenced by this study wild boars could be a reservoir of antimicrobial resistance genes.

This study evaluated T cell immune responses to purified protein derivative (PPD) and Mycobacterium tuberculosis (Mtb) in health care workers who remained free of active tuberculosis (HCWs w/o TB), health care workers who went on to develop active TB (HCWs w/TB), non-health care workers who were TB free (Non-HCWs) and tuberculosis patients presenting with minimal (Min TB) or advanced (Adv TB) disease. Peripheral blood mononuclear cells (PBMC) were stimulated with Mtb and PPD and the expression of T cell activation markers CD25+ and HLA-DR+, intracellular IL-4 and IFN-gamma production and cytotoxic responses were evaluated. PBMC from HCWs who developed TB showed decreased percentages of cells expressing CD8+CD25+ in comparison to HCWs who remained healthy. HCWs who developed TB showed increased gammadelta TCR+ cell cytotoxicity and decreased CD3+gammadelta TCR- cell cytotoxicity in comparison to HCWs who remained healthy. PBMC from TB patients with advanced disease showed decreased percentages of CD25+CD4+ and CD25+CD8+ T cells that were associated with increased IL-4 production in CD8+ and gammadelta TCR+ phenotypes, in comparison with TB patients presenting minimal disease. TB patients with advanced disease showed increased gammadelta TCR+ cytotoxicity and reduced CD3+gammadelta TCR- cell cytotoxicity. Our results suggest that HCWs who developed TB show an early compensatory mechanism involving an increase in lytic responses of gammadelta TCR+ cells which did not prevent TB.

Castromil is one of the gold mining areas in Portugal that has been abandoned since 1940. This area, which was first mined in Roman times, is located within a Hercynian granite body near the contact with Silurian metasediments. Gold is essentially disseminated along veins in the silicified granite, running NW-SE, related with a shear zone and frequently associated with sulphides (arsenopyrite and basically pyrite). In paragenetic terms, three stages of mineralization are considered: ferro-arseniferous (quartz + arsenopyrite I + pyrite I + pyrrhotite + bismuth), zinciferous (sphalerite + chalcopyrite), and remobilization (arsenopyrite II + galena + gold). Due to the lack of laws and environmental education, Castromil is today a gold mining heritage site where we can detect the consequences of an incautious exploration (tailings, wells and adits located in the old explored zone) and where a residential area is located. In order to characterize the actual state of the old mining area the trace metal contamination of soils and waters by mining activities was investigated. In the studied area 106 soil samples, 15 waters and 20 plants were sampled and analysed. The soil samples were analysed for 32 elements by ICP-AES. Waters were analysed by ionic chromatography and ICP-MS for major and trace elements. Plants were analysed for As, Fe and Pb by AAS. The results are discussed taking into account the risk-based standards for soils and groundwater's (target and intervention values) proposed by Swartjes (1999). The results show elevated concentration of As and Pb which were found in soils collected from agricultural areas. Foodstuff plants species collected in the Castromil agricultural area show high concentrations of As in the leaves (cabbage and lettuce) and in the tubers (potatoes). Groundwaters in the mining area contain high concentrations of As that exceeds the intervention values. The area must to be subject to a remediation process, considering the actual risks to humans and ecosystems and the risks due to contaminant migration.

The aim of this study was to obtain an estimate of the frequency of the delta F508 mutation in the Portuguese population, and of the tightness of its association with specific haplotypes. Furthermore, the genotype/clinical phenotype relationship and the feasibility of prenatal diagnosis were also investigated. The analysis of 42 cystic fibrosis (CF) families revealed that (1) 52% of CF chromosomes carry the deletion of codon 508; (2) there seems to be a positive correlation between the occurrence of the delta F508 mutation and the severity of the disease; and (3) fully informative prenatal diagnosis can be offered in 76% of at-risk pregnancies by using both genomic and allele specific oligonucleotide probes.