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- Community surveillance of Staphylococcus aureus and presumptive MRSA nasal colonization in rural Portugal: The BI-STAPH Project—Phase 2: FundãoPublication . Costa, Rodrigo; Cordero, Ainhoa Ferreira; Ferreira, Francisco; Metello, João; Santos, Carina; Belo, João; Coelho, Patricia; Mateus, Sónia; Castelo Branco, Miguel; Rodrigues, FranciscoStaphylococcus aureus is one of the leading causes of both community- and healthcareassociated infections. Nasal colonization constitutes the primary reservoir for subsequent infection and transmission, while methicillin-resistant Staphylococcus aureus (MRSA) remains a major public health concern because of its resistance to multiple antimicrobial agents. However, data regarding community nasal colonization in rural Portuguese populations remain scarce. The BI-STAPH Project was established to address this knowledge gap through systematic surveillance of rural communities in inland Portugal. To estimate the prevalence of presumptive nasal colonization by Staphylococcus aureus and MRSA among adults living in the municipality of Fundão, Portugal, and to explore potential associations between colonization and demographic, behavioural, occupational, and environmental characteristics. A prospective community-based cross-sectional study was conducted as the second phase of the BI-STAPH Project. A total of 200 adults were recruited from different parishes of the municipality of Fundão. Bilateral nasal swabs were collected and processed using standardized microbiological methods for the presumptive identification of S. aureus. Presumptive MRSA isolates were investigated using a PBP2′ latex agglutination assay. Sociodemographic and exposure-related information was obtained through structured questionnaires. Associations between presumptive colonization and participant characteristics were evaluated using Pearson’s chi-square or Fisher’s exact tests, as appropriate. Presumptive S. aureus nasal colonization was identified in 56 of 200 participants, corresponding to a prevalence of 28.0% (95% CI: 21.8–34.2%). No presumptive MRSA-positive isolates were identified, corresponding to an observed prevalence of 0% (95% CI: 0.0–1.8%). Colonization prevalence was 29.5% among females and 26.8% among males, and ranged from 25.8% to 31.1% across age groups; neither sex nor age was significantly associated with colonization. Participants reporting daily animal cont act had a colonization prevalenceof 32.3%, compared with 20.5% among those without animal contact, but this difference was not statistically significant (p = 0.075). Overall, no statistically significant associations were identified between presumptive S. aureus colonization and the demographic, behavioural, occupational, or environmental variables evaluated. Presumptive S. aureus nasal colonization was common among adults living in the rural municipality of Fundão, Portugal, whereas no presumptive MRSA-positive isolates were identified in this study population. No statistically significant associations were observed between colonization and the characteristics evaluated. These findings expand the epidemiological evidence generated by the BI-STAPH Project and support continued community-based surveillance of S. aureus in rural Portugal. Future multicentre studies incorporating molecular confirmation, antimicrobial susceptibility testing, and larger populations will be important to better characterize circulating strains and transmission patterns within a One Health framework.
- Determinants of multidrug resistance among gram-positive uropathogens in Central Portugal: A 5 year retrospective studyPublication . Adnan, Muhammad; Patricia Coelho; Mateus, Sónia; Castelo Branco, Miguel; Rodrigues, FranciscoUrinary tract infections (UTIs) are among the most common bacterial infections worldwide. Although Gram-negative bacteria predominate, Gram-positive cocci (GPC) are increasingly recognized as significant uropathogens. This retrospective study analyzed 655 patients with culture-confirmed GPC UTIs in a hospital in Central Portugal (2018–2022) to identify predictors of multidrug resistance (MDR). MDR was defined as resistance to three or more antimicrobial classes. The overall MDR prevalence was 83.7%, with Enterococcus spp. showing the highest MDR prevalence (98.2%). Multivariate analysis identified older age as na independent predictor of MDR, whereas Staphylococcus and Streptococcus species were associated with significantly lower odds compared to Enterococcus. A temporal increase in MDR risk was observed in 2021 and 2022. Despite the high overall resistance rates observed, oxazolidinones and cyclic lipopeptides retained near-complete activity against all GPC isolates, reinforcing their role as last-line therapeutic options.
- Discrepancies between screening sonography and ultrasound in emergency department: A case reportPublication . Miravent, Sérgio; Figueiredo, Teresa; Donchenko, Inna; Cruz, Gualter; Almeida, Rui Pedro de; Lobo, ManuelIntroduction: This case report presents a discrepancy in sonographic findings between a screening sonography performed by a Sonographer in the Basic Emergency Service (BES) and a subsequent ultrasound performed by a Radiologist physician in a Referral Hospital (RH). The aim of this report is to discuss the possible reasons for the discrepancy and its implications for patient care. Case Presentation: A patient with a history of epigastric pain and vomiting underwent screening sonography in a BES, which suggested Intrahepatic Biliary Dilatation Duct (IHBD) and main pancreatic duct dilatation. The patient was subsequently referred to the RH for further evaluation. However, the Radiologist in the RH did not confirm any of the initial suspicions from BES through a normal ultrasound procedure. The discrepancy raises questions regarding the quality of the screening ultrasound, misinterpretation of the BES images, or the potential for ambiguity in the point of care ultrasound (POCUS) exam. Conclusion: The differences in sonographic findings between BES and RH, in this case, suggest that the improvement of the patient's clinical condition and therapeutic interventions may have contributed to the discrepancy. Further investigation and standardization of POCUS training and interpretation may improve diagnostic accuracy and patient outcomes.
- Effectiveness of ultrasound screening in right upper quadrant pain: A comparative study in a basic emergency servicePublication . Miravent, Sérgio; Figueiredo, Teresa; Jiménez, Carmen; Almeida, Rui Pedro de; Lobo, ManuelBackground and Aims: The use of ultrasound screening is primarily facilitated by point‐of‐care ultrasound (POCUS) and its integration into healthcare systems is a result of the versatility of this imaging technique. This study intends to compare the accuracy and pertinence of sonographic findings obtained by a sonographer in a Basic Emergency Service (BES) with that of radiologists at referral hospital (RH) in Portugal. Methods: Twenty patients with right upper quadrant (RUQ) pain and suspected cholecystitis or biliary pathology underwent sonography screening using POCUS in the BES. They were then forwarded to the RH where a radiologist performed a conventional ultrasound exam on the same patients. The results of both exams were compared to determine if the findings obtained in the BES were confirmed by the radiologist in the RH. Results: In our sample, 60% of cases were related to biliary pathology, 20% were liver‐related, 10% had hepatopancreatic biliary etiology, and 10% had unknown etiology. A strong association between the sonographic findings in the BES and the RH was found in the variables “Sonographic Murphy sign” (V = 0.859; p = 0.001), “Cholelithiasis/Gallbladder sludge” (V = 0.840; p = 0.001), and “Intrahepatic biliary tract dilatation” (V = 0.717; p = 0.006). Adequate measures of agreement between the findings of the radiographer and radiologist were obtained for the “Sonographic Murphy sign” (k = 0.664; p = 0.001) and the presence of “Cholelithiasis/Gallbladder sludge” (k = 0.712; p = 0.000). Conclusion: Major biliary abnormalities were detected in patients with RUQ pain in BES using sonography. The correlation between the sonographic findings obtained by the sonographers at BES and those obtained by radiologists at the RH in Portugal was strong, showing that POCUS screening could be extended to other similar settings; however, more studies are needed.
- Effects of multicomponent exercise on immunity, antibodies, and physical activity in older adults after COVID-19 vaccination: An RCT-feasibility studyPublication . Ferreira, Bruna Maria Palotino; Furtado, Guilherme Eustáquio; Gomes, Antonio Felipe Souza; Amaral, Jônatas Bussador do; Rodrigues, Francisco; Silva, Albená Nunes; RossiMarcelo; Bachi, André Luís Lacerda; Oliveira, Juliana da Silva; Santos, Clarice Alves dos; Vasconcelos, SauloBackground Immunosenescence contributes to reduced vaccine responsiveness and chronic low-grade inflammation in olderadults. Although regular physical exercise has been associated with improved immune function, evidence regarding thefeasibility and immunological effects of multicomponent exercise training (MET) following COVID-19 vaccinationremains limited. This pilot randomized feasibility trial aimed to assess the feasibility of implementing a 10-week METprogram and to explore its effects on functional fitness, physical activity, anthropometric measures, lipid profile, andimmuno-inflammatory markers in community-dwelling older adults after COVID-19 vaccination. Methods Twenty-three community-dwelling older adults (≥60 years) completed this randomized pilot feasibility trial and wereallocated to either a MET group (n = 10) or a Behavior Change Program (BCP) group (n = 13). Both interventions lasted10 weeks. Pre- and post-intervention assessments included functional fitness (Short Physical Performance Battery),physical activity levels, anthropometric measures, lipid and protein profiles, immunoglobulins (IgA, IgM, IgG), andcytokines (IL-2, IL-6, IL-10, TNF-α, and IFN-γ). Results The intervention proved feasible, with satisfactory adherence among participants completing the program and noexercise-related adverse events. The MET group demonstrated significant improvements in functional fitness (p =0.002; d = 1.90). Although physical activity levels showed a positive trend, changes did not reach statistical significance.Significant reductions in IL-2, IL-6, and TNF-α were observed following MET (all p ≤ 0.05), whereas the BCP groupexhibited increased IL-6 concentrations together with higher IL-2/IL-10 and IL-6/IL-10 ratios, suggesting a shift towarda more pro-inflammatory profile. Moderate-to-large effect sizes were also observed for improvements in selected lipidparameters, although most biochemical changes were not statistically significant. Conclusions This pilot feasibility trial demonstrated that a 10-week multicomponent exercise program can be safely implementedin community-dwelling older adults following COVID-19 vaccination and provides preliminary evidence of beneficialeffects on functional fitness and selected immuno-inflammatory markers. Given the small sample size, these findingsshould be interpreted cautiously and confirmed in adequately powered randomized controlled trials.
- Exercise training characteristics and psycho-bio-chemical outcomes in individuals with addictive behaviours: A scoping reviewPublication . Furtado, Guilherme Eustáquio; Marques, Maria Inês; Sampaio, António Rodrigues; Duarte, Daniel; Ramos, Susana; Carballera, Eduardo; Sevilla-Sanchez, Marta; Eduardo, Edson; Mateus, Sónia; Patricia Coelho; Rodrigues, FranciscoAddictive behaviours are associated with substantial neurobiological, psychological, and behavioural impairments. Exercise training has emerged as a potential complementary strategy in addiction treatment; however, the characteristics of exercise interventions and their associated outcomes remain insufficiently characterized. This scoping review (ScR) was conducted according to the Joanna Briggs Institute methodology and reported in accordance with the PRISMA-ScR guidelines. Searches were conducted across three electronic databases for studies published between January 2015 and March 2025. Eligible studies investigated structured exercise training interventions in individuals with substance-related or behavioural addictions. Data were extracted regarding study characteristics, addiction type, exercise modality, FITT parameters, and neurobiological, biochemical, psychological, behavioural, and addiction-related outcomes. Five human intervention studies met the inclusion criteria, all addressing substance-related addictions, including alcohol use disorder, methamphetamine use disorder, and polysubstance dependence. Three studies evaluated acute exercise interventions, whereas two investigated structured exercise programmes lasting 8–12 weeks. Aerobic exercise was the most frequently investigated modality, although combined aerobic and resistance training, yoga, cycling, soccer-based exercise, circuit training, and functional exercise were also identified. Exercise intensity ranged from moderate to vigorous, with substantial variability in frequency, session duration, intervention period, and reporting of progression, supervision, and adherence. Reported outcomes included dopamine-related measures, mood, anxiety, depressive symptoms, self-esteem, affect, and craving. The available evidence suggests potentially relevant effects of exercise across neurobiological, psychological, and addiction-related domains, but the limited number and heterogeneity of studies preclude conclusions regarding the effectiveness of specific exercise prescriptions. The current evidence base on structured exercise training in addictive behaviours remains limited and heterogeneous and is restricted, among the eligible intervention studies identified, to substance-related addictions. Exercise may represent a promising complementary approach, but evidence is insuficiente to establish optimal exercise modalities, FITT prescriptions, or sustained clinical benefits. Future research should prioritize adequately powered longitudinal randomized controlled trials, standardized reporting of exercise prescription and adherence, and comprehensive assessment of clinically relevant addiction-related outcomes.
- Point of care prehospital ultrasound in basic emergency services in PortugalPublication . Miravent, Sérgio; Lobo, Manuel; Almeida, Rui Pedro deBackground and Aims: The Point of Care Ultrasound and Point‐of‐Care Ultrasound in Resource‐Limited Settings are differentiated diagnostic methods using ultrasound, essential in urgent patients screening, allowing better guidance in the diagnostic process and therapeutic approach. This study intends to observe the impact of these techniques in two Basic Emergency Services (SUB) in Portugal. Methods: A longitudinal study was carried out in two remote locations in Portugal (SUB N and SUB S). Data were collected by trained radiographers in each location, and a total of 972 exams were considered. Imaging findings were documented by exam type, the exam normality and the resolution after exam. χ 2 and Cramer's V tests were performed to check significant correlations between the variables. Results: Regarding the type of echographic findings, 289 (29.7%) were considered normal, 628 (64.6%) were classified as abnormal and 55 (5.7%) were considered inconclusive. As for the type of resolution, 58% had local resolution, 24% were referred to a hospital emergency service and 18% referred to ambulatory care. Regarding the Location versus Resolution after exam versus Findings variables, it was verified a stronger statistically significant association for the exams considered “Abnormal” (Cramer´s V = 0.414; p < 0.001). In the variables Location versus Findings versus Resolution after exam, it was verified a stronger statistical significance for “Referral to Ambulatory” (Cramer V = 0.443; p < 0.001) although Referral for Hospital (Cramer V = 0.252; p = 0.003) or Local Resolution (Cramer V = 0.252; p < 0.001) also had a moderate association strength. Conclusion: Ultrasonography is a useful diagnostic tool for patients screening, having an influence on patient management in remote settings. Given the limited literature in Portugal about this matter, further research and literature will be needed to support and complement the results of this study.
- Pre-hospital ultrasonography screening for biliary disease in remote settingsPublication . Miravent, Sérgio; Jimenez, Cármen; Lobo, Manuel; Figueiredo, Teresa; Almeida, Rui Pedro deScreening ultrasound, including Point of Care Ultrasonography (POCUS), is widely utilized for rapid clinical guidance in diverse healthcare settings. In this case report, a 34-year-old male with recurrent biliary colic symptoms underwent a Basic Emergency Service ultrasound, revealing a 13 mm gall bladder calculus and signs of inflammation, and was promptly referred to the hospital for further evaluation and treatment. Medical specialist confirmation at the hospital underscored the significance of early detection through POCUS. Despite inconclusive laboratory results, the detailed ultrasound assessment provided a comprehensive understanding, emphasizing the tool’s value in averting com plications. Thus, screening ultrasound played a pivotal role in justifying the hospital referral, showcasing its vital role in healthcare, especially in resource-limited settings. The judicious use of POCUS can lead to superior outcomes, avoiding unnecessary referrals for non-emergent cases
- Prevalence, determinants, and temporal dynamics of multidrug-resistant Gram-negative bacilli in urinary tract infection patients from Central Portugal (2018–2022)Publication . Adnan, Muhammad; Coelho, Patricia; Castelo-Branco, Miguel; Rodrigues, FranciscoBackground: Multidrug-resistant (MDR) Gram-negative bacilli (GNBs) significantly compromisse the effective management of urinary tract infections (UTIs) worldwide. As antimicrobial resistance varies across regions, locally tailored data are essential to guide empirical therapy. This study investigated the prevalence, determinants, and temporal dynamics of MDR GNBs in UTI patients from Central Portugal between 2018 and 2022. Methods:We conducted a retrospective observational study at a hospital center in Central Portugal, analyzing data from 2018 to 2022. Data from 5194 UTI patients with GNB-positive cultures were analyzed. Binary logistic regression was used to identify determinants of MDR GNBs, defined as resistance to ≥1 agent in ≥3 antibiotic classes. Results: The study population had a mean age of 64.5 ± 25.3 years, and females represented two-thirds of the sample (67.0%). The overall prevalence of MDR GNBs was 35.8%. Advanced age (≥75 years), male sex, and specific treatment contexts—particularly day treatment and laboratory-only cases—were independently associated with MDR. SBL-producing Enterobacterales and non-fermenting GNBs showed the highest risk levels. Conclusions: MDR GNBs are highly prevalent among UTI patients in Central Portugal, and their increasing trend—particularly in 2022—highlights an urgent need for strengthened surveillance and updated empirical treatment strategies. The observed temporal increase highlights the urgent need for strengthened regional surveillance and updated empirical treatment guidelines.
- Renal screening sonography. A comparative study in a Portuguese basic emergency servicePublication . Miravent, Sérgio; Jiménez, Carmen; Barbancho, Narciso; Lobo, Manuel; Figueiredo, Teresa; Gomes, Carla; Ratusneac, Ion; Gonçalves, João Mário; Hasnas, Corina; Almeida, Rui Pedro deIntroduction: This study intends to compare the accuracy and pertinence of sonographic findings obtained by a sonographer in a Basic Emergency Service (BES) with the imaging findings at the Referral Hospital (RH). Methods: Thirty-one patients suspected of having renal pathology underwent initial renal sonography screening with sonographer reporting at the BES and were subsequently referred to the RH for additional imaging examinations. The results of both examinations were compared to verify whether the findings from the BES were confirmed by the radiologist in the RH and to ensure that the patient referrals from BES to RH were appropriate. Results: In our sample, most patients (80%) exhibited varying degrees of pyelocaliceal distension, with nearly half (48%) presenting obstructions. A strong association between the sonographic findings in the BES and the RH was found in the variables “Dilatation of pyelocaliceal system” (V=0.895; p=0.000), “Simple cystic formation” (V=0.878; p=0.000), respectively. There was a statistically significant correlation between BES and RH findings, indicating a strong association between these two variables respectively (k=0.890; p=0.000) and (k=0.870; p=0.000). In this research, an achieved sensitivity of 96% and a specificity of 85% were demonstrated in the identification of pyelocaliceal dilatation. Conclusion: Renal sonographer reporting screening successfully detected abnormalities in the urinary system of patients suspected of having renal colic. The sonographic data obtained at the BES demonstrated a strong correlation with the additional imaging findings from the RH in Portugal. These results suggest that Radiographers/Sonographers can have an important role in the preliminary assessment of urgent renal pathology in remote areas, contributing to a correct referral and early treatment.