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- Tackling fungal contamination for safer farmingPublication . Gomes, Bianca; Dias, Marta; Cervantes, Renata; Pena, Pedro; Twarużek, Magdalena; Kosicki, Robert; Viegas, Susana; Viegas, CarlaBiosafety measures are essential for maintaining animal health and workplace safety in poultry production. Poultry farm environments favor fungal growth, yet information on fungal contamination and associated health risks remains scarce. This study aimed to assess fungal and mycotoxin contamination in poultry pavilions (PP) during the poultries' growth cycle. Sampling was conducted during winter in 14 PP, Portugal, using electrostatic dust cloths (EDC) and conventional microbiological methods to quantify fungal densities (CFU/m²/day). Isolation, identification, and determination of major mycotoxins (aflatoxins; ochratoxin A, fumonisins, and zearalenone) were performed using HPLC. Results showed higher fungal loads during the 3rd week, 2.96x102 CFU.m-2.day—1) aligning with existing literature. Regarding fungal diversity, clinically and toxicologically relevant species belonging to Aspergillus sp. and Penicillium sp. were frequently identified. To consider the prevalence of the Aspergillus section Fumigati species included in the critical priority group by the WHO priority list (2022). Regarding mycotoxins, fumonisions (B1 and B2) classified as possibly carcinogenic (IARC, group 2B) were prevalent (57% and 40% respectively). Aflatoxins, ochratoxin A, and zealenone were not found. This study evidence that PP are contaminated with mycotoxigenic fungi and mycotoxins. The identification of clinically relevant fungal species and mycotoxins even after sanitary measures highlights gaps in biosafety protocols. Given the presence of at least two mycotoxins, further studies are needed to determine their cumulative effects and develop mitigation strategies. Integrating a One Health approach is critical for reducing fungal exposure and promoting safer farming.
- From farm to food: the overlooked impact of mycotoxins in poultry feedPublication . Gomes, Bianca; Dias, Marta; Cervantes, Renata; Pena, Pedro; Twarużek, Magdalena; Kosicki, Robert; Viegas, Susana; Viegas, CarlaThe occurrence of mycotoxins in poultry feeds is a primary problem worldwide due to their carcinogenic, mutagenic, and reprotoxic effects. This secondary metabolite generated by fungi can compromise animals' health and productivity. Monitoring mycotoxin exposure is crucial, as fungi are not reliable indicators of mycotoxin presence. This is partly because mycotoxins can remain in the environment long after the fungi have been eliminated, and not all fungal species generate mycotoxins. Besides, the potential transfer of these toxins to poultry products, such as meat and eggs consumed by humans, underscores the importance of effective mitigation strategies. This study aimed to identify prevalent fungi and mycotoxins in poultry feed. Composite samples of animal feed (n=29) were collected inside poultry pavilions. Classical methodologies were employed to assess fungal contamination (inoculation in DG18, 27º C, during 5-7 days), and fungal densities (CFU.g-1) were calculated. Isolation, identification, and determination of major mycotoxins (aflatoxins; ochratoxin A, fumonisins, and zearalenone) were performed using HPLC. Clinical and toxicological relevant species belonging to Penicillium, Mucor, and Aspergillus genera were found. Aspergillus species from the Fumigati section (WHO 2022 priority list) were also detected. Regarding mycotoxins, fumonisions classified as possibly carcinogenic (IARC, group 2B) and zearalenone (IARC, group 3B) were prevalent, ochratoxin-A (IARC, group 2B) was found in 2 samples in lower values (
- MRSA environmental surveillance: the need for standardized protocolsPublication . Pena, Pedro; Cervantes, Renata; Viegas, CarlaMethicillin-resistant Staphylococcus aureus (MRSA) is a major cause of infections, with airborne transmission playing a crucial role in its environmental spread. While healthcare settings remain high-risk areas, the increasing presence of community-associated MRSA (CA-MRSA) and livestock-associated MRSA (LA-MRSA) in diverse environments raises new public health concerns. This systematic review assessed MRSA contamination in different environmental reservoirs, focusing on transmission pathways and sampling methodologies. A literature search was conducted using databases such as PubMed, Scopus, and Web of Science, identifying 95 studies that reported MRSA detection through environmental sampling. MRSA was detected in healthcare settings (N=19), aquatic environments (N=13), wastewater treatment plants (N=5), public and occupational settings (N=11), and farms/veterinary hospitals (N=27). The growing presence in public and agricultural environments highlights the need for broader surveillance beyond hospitals. A review of sampling methods showed substantial variability. Active air sampling (27 studies, 28%) included impaction, filtration, and impinger techniques with diverse culture media and filter types. Passive sampling (84 studies, 88%) was more common, using settled dust, electrostatic dust cloths, settle plates, dust wipes, and swabs. The lack of standardized protocols complicates data comparability and limits risk assessment accuracy. The widespread detection of MRSA across environments underscores the importance of airborne transmission. While healthcare settings remain hotspots, increasing contamination in public and agricultural areas demands harmonized surveillance protocols. Standardizing air sampling techniques, culture media, and resistance profiling is essential for effective monitoring. A One Health approach integrating human, animal, and environmental interactions is crucial to mitigating airborne MRSA transmission and antimicrobial resistance risks. Future research should prioritize standardized methodologies to enhance global monitoring and control efforts.
- Comparative study on the quality of life of lower-limb amputees between Portugal and SpainPublication . Matos, José Pedro; Gomes, Ana; Moreira, Carlota; Costa, Catarina; Mendes, TâniaBackground: Characterising the perception of unilateral lower limb amputees and increasing information and data on their rehabilitation will help to fill the information gap, contributing to the making of new studies with greater scientific and methodological rigour. This knowledge will make it possible to optimise rehabilitation and rationalise costs, enabling the creation of health policies that are appropriate to needs. Aim of the study: To compare the perception of unilateral lower limb amputees on the quality/functionality of life with the prosthesis in Portugal and Spain.
- Establishment of a standardized biological sample collection protocol for OPMDsPublication . Jiaao, Yu; Ladeira, Carina; Van Dis, Vera; Costea, Daniela Elena; Villar, Stephanie; Kozlakidis, ZisisThere has been a growing number of clinical studies on OPMDs in recent years, reflecting increasing interest in this field. Among these studies, EU countries have the second-highest number of publications after China. According to a meta-analysis, the prevalence of OPMDs is approximately 3.07%. While surgical diagnosis remains the gold standard, there is currently no standardized protocol for the surgical biopsy of oral lesions. To reach a protocol compendium for the collection of oral biological samples, a literature review on clinical studies with detailed methodologies of surgical biopsy of OPMDs in clinical settings was performed.
- Global and European Union oral cancer characterization from Global Burden of Disease 2019: what data show us?Publication . Clemente, Marta; Ladeira, CarinaBackground: Lip and oral cavity cancer is a growing public health concern globally. In 2019, cancer accounted for 10 million deaths worldwide, with lip and oral cavity cancer responsible for approximately 200,000 of these deaths. The type of cancer significantly impacts both mortality and morbidity, with survivors often experiencing substantial reductions in quality of life. This study aims to characterize global and European Union trends of lip and oral cavity cancer, using data from the Global Burden of Disease 2019, providing insights for oral cancer prevention strategies.
- Blood molecular profile to predict genotoxicity from exposure to antineoplastic drugs: a comparison with cytokinesis-block micronucleus assay resultsPublication . Ladeira, Carina; Araújo, Rúben; Ramalhete, Luís; Teixeira, Hélder; Calado, Cecília R. C.Genotoxicity is an important information that should be included in human biomonitoring programs design. Cytogenetic methods are usually laborious and time-consuming; therefore, the development of new molecular methods is an added value. This study aimed to evaluate if the molecular profile of previously frozen whole blood acquired by Fourier Transform Infrared (FTIR) spectroscopy allows for to assessment of genotoxicity in occupational exposure to antineoplastic drugs in hospital professionals, as obtained by the lymphocyte cytokinesis block micronucleus (CBMN) assay.
- The outcomes of empowering individuals after total knee arthroplasty: a randomized controlled trialPublication . Gomes, Anabela; Cunha, Gilda; Eiras, Margarida; Correia, AnabelaBackground: The rehabilitation of individuals after total knee arthroplasty is essential to optimize outcomes. The number of surgeries has been increasing significantly worldwide, overburdening healthcare systems with rising associated costs. Purpose: This study aims to demonstrate the effectiveness and cost-effectiveness of a rehabilitation plan consisting of two weekly physiotherapy sessions, supplemented by a home exercise program, in individuals over 65 years of age undergoing primary Total Knee Arthroplasty, compared to conventional rehabilitation with three weekly sessions. Methods: A single-centre randomized experimental study with intervention evaluated the efficiency and cost of two rehabilitation plans for individuals aged 65 and over who underwent primary Total Knee Arthroplasty and were referred for outpatient physiotherapy in the period from September 27 to December 31, 2022. Twenty-four Individuals were randomly assigned to two groups: the experimental group (15 individuals), which received face-to-face physiotherapy twice per week, supplemented by a home exercise program, and the control group (9 individuals), which received face-to-face physiotherapy three times per week without additional exercises. Both groups received treatment for 5 weeks and were assessed at the beginning and the end of the 5-week treatment period. The effectiveness of the interventions was measured through the assessment of pain and functionality using the Oxford Knee Score (scored from 12 to 60 points), active range of movement measured in degrees with a goniometer, and muscle strength evaluated by the number of repetitions in the 30-second chair stand test. The economic evaluation was conducted from the hospital’s perspective, using cost-effectiveness analysis, with the incremental cost-effectiveness ratio calculated to compare the costs of the two rehabilitation plans. Results: There were no significant differences between the groups in the initial assessment. After the 5-week treatment, both groups demonstrated improvements in all effectiveness indicators, with the experimental group achieving better outcomes. However, no statistical significance was found in the comparisons between the two groups (p > 0.05 for all indicators). The resulting incremental cost-effectiveness ratio of -3.71€/effectiveness unit was favorable to the experimental group. Conclusion(s): The rehabilitation plan of the experimental group emerged as the cost-effective alternative compared to the control group, highlighting a potential strategy for optimizing health resources in the hospital department where the study was conducted. No participant expressed any concerns about the home treatment. Implications: The empowerment of individuals through the teaching of home exercises is a useful tool for individuals following total knee arthroplasty, providing the same health benefits at a lower cost to the hospital. It also reduces the need for hospital visits, resulting in economic savings for individuals and families, as well as a reduction in environmental footprint.
- Contribution to physiotherapy to value-based healthcare: a systematic reviewPublication . Correia, AnabelaBackground: Value-based healthcare focuses on finding a balance between the quality of care and the costs involved. It does not imply cost-cutting, but rather providing necessary care while avoiding unnecessary or ineffective procedures. Physiotherapy seeks to deliver optimal patient outcomes by enhancing the relationship between achieved benefits and incurred costs, aligning with the principles of value-based healthcare. Purpose: This study aims to understand how physiotherapy contributes to increasing the value of healthcare services. Methods: A systematic search was conducted in the Scopus, Web of Science, and PubMed databases without time restrictions, using the keywords in both Portuguese and English: value-based care, physiotherapy (or physical therapy), and rehabilitation. The search was limited to peer-reviewed articles and conference presentations. Eligible studies were those that described new value-based healthcare models incorporating physiotherapy, either as a standalone intervention or within a multidisciplinary team, across any type of pathology. Studies that described value-based healthcare models without the inclusion of physiotherapy, those analysing only conventional care models, descriptive or review articles, and other types of studies were excluded. The review protocol was registered in INPLASY under the number 6629. Results: Out of 211 articles, after removing duplicates (104) and applying the eligibility criteria, fourteen articles were selected. All selected studies focused on individuals with musculoskeletal disorders. Of these, eight examined the reorganization of care models for patients undergoing hip or knee arthroplasty, four evaluated telerehabilitation programs, one assessed direct access to physiotherapy, and another examined the integration of a physiotherapist in orthopedic emergency care. Various assessment tools were used, including length of hospital stay, intervention costs, hospital readmissions, discharge destination, pain, adherence, disability, patient satisfaction, and quality of life. Most of the studies reported positive outcomes from the inclusion of physiotherapy. Conclusions: Incorporating physiotherapy into healthcare model reorganization, namely with early intervention in individuals who have undergone orthopedic surgery, and adopting new technologies, represents promising approaches to creating value in healthcare. However, it is important to note that value can only be measured by balancing costs with health outcomes. Implications: Physiotherapy, when aligned with the principles of value-based healthcare, contributes to improving health outcomes by balancing quality and costs. The reorganization of healthcare models, especially in orthopedic surgeries, and the use of telerehabilitation stand out as promising strategies. Studies show that the inclusion of physiotherapy reduces hospital stays, readmissions, and pain, while increasing patient satisfaction and quality of life. Integration into multidisciplinary teams optimizes service efficiency. However, physiotherapists need to acquire knowledge in healthcare management and service organization to further enhance the value they bring to patient care.
- Cirurgia de nistagmo para correção da posição da cabeça: a propósito de 2 casos clínicosPublication . Lino, Pedro Miguel; Bastos, Mariana; Teixeira, Filipa; Capelas, Inês; Macedo, Dina; Mota, Armandina; Lázaro, Tiago; Silva, LauraO nistagmo congénito é uma alteração do movimento ocular caracterizado por oscilações involuntárias. Pacientes com nistagmo congénito frequentemente viram a cabeça para colocar os olhos numa direção de fixação com o menor nistagmo, conhecida como "zona nula“ ou “posição de bloqueio”. Crianças com nistagmo congénito tendem a preferir olhar na direção da zona nula para alcançar a acuidade visual (AV) ideal. Quando a zona nula está localizada de forma excêntrica em relação ao olhar primário, é frequentemente adotada uma postura compensatória da cabeça. A correção cirúrgica desta postura compensatória envolve cirurgia nos músculos extraoculares de cada olho, com o objetivo de mover a zona nula excêntrica para a posição primária do olhar, mas tal cirurgia é provavelmente realizada por uma minoria de oftalmologistas. O objetivo deste trabalho é apresentar a gestão cirúrgica e funcional de dois pacientes jovens com nistagmo congénito e posição anómala da cabeça (PAC), resultando num bom e estável resultado estético e funcional, com melhoria na acuidade visual.