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- Organic dust exposure in veterinary clinics: a case study of a small-animal practice in PortugalPublication . Viegas, Carla; Monteiro, Ana; Ribeiro, Edna; Caetano, Liliana Aranha; Carolino, Elisabete; Assunção, Ricardo; Viegas, SusanaLiterature about occupational health in small-animal veterinary practices is scarce, but most of it has recognised a number of risks to be considered, including organic dust exposure. The aim of this pilot study was to assess organic dust, bacterial, and fungal contamination in the indoor environment of a typical Portuguese veterinary clinic but also to screen for azoleresistant fungi. To complement these findings we also analysed workers’ nasal exudates for resistant bacteriota. Particles measurements included mass concentrations (PMC) of five particle sizes (PM0.5, PM1, PM2.5, PM5, PM10) and their counts (PNC). Indoor air samples were obtained from six locations as well as before and during cat dental cleaning and cultured on four media for bacterial and fungal assessment. An outdoor sample was also collected for reference Surface samples were taken from the same indoor locations using swabs and we also use electrostatic dust cloths as passive methods. PM10 showed the highest concentrations across the locations. Indoor air fungal loads ranged from 88 to 504 CFU m−3. The azole-resistant Aspergillus section Nigri was identified in one sample. Indoor air bacterial loads ranged from 84 to 328 CFU m-3. Nasopharyngeal findings in the 14 veterinary clinic workers showed a remarkably low prevalence of Staphylococcus aureus (7.1 %). Our results point to contamination with organic dusts above the WHO limits and to the need for better ventilation. Future studies should combine the same sampling protocol (active and passive methods) with molecular tools to obtain more accurate risk characterisation. In terms of prevention, animals should be caged in rooms separate from where procedures take place, and worker protection should be observed at all times.
- Assessment of azole resistance in clinical settings by passive samplingPublication . Aranha Caetano, Liliana; Almeida, Beatriz; Viegas, CarlaThe exposure to the fungal burden is an increased risk factor for the development of respiratory symptoms and fungal diseases. The emergence worldwide of azole resistance in fungal species is a major concern for public health. Clinical settings must provide a clean and safe environment to protect patients and staff from fungal diseases. The aim of this study was to assess the fungal burden and prevalence of azole resistance in clinical settings in Portugal using passive sampling methods. Ten Primary Health Care Centers were evaluated through passive sampling, including electrostatic dust cloths, heating ventilation, and air conditioning filters, and settled dust. All samples were plated onto Sabouraud dextrose agar media and screened for azole resistance using agar media supplemented with itraconazole, voriconazole and posaconazole through incubation at 27 °C, for 5 days. Fungal species were identified based on macro and micromorphology. Fungal load ranged from 348 to 424628 CFU·m−2 in EDC, 0 to 56500 CFU·m−2 in HVAC filter, and 2 to 514 CFU·g−1 in settled dust. EDC samples presented the highest fungal loads and wider diversity. Azole resistance was observed in all Primary Health Care Centers. Multi-azole resistance (fungal growth in two or more azoles) was observed in 90% units for Penicillium sp., C. sitophila, and Cladosporium sp. None of the samples containing Aspergillus sp. colonies presented resistance to the tested azoles. The knowledge of the fungal burden and prevalence of resistance to azole-based antifungal drugs in clinical environments will allow a better risk characterization regarding fungal burden.
- Aspergillus spp. prevalence in Primary Health Care Centres: assessment by a novel multi-approach sampling protocolPublication . Viegas, Carla; Almeida, Beatriz; Gomes, Anita Quintal; Carolino, Elisabete; Aranha Caetano, LilianaExposure to Aspergillus conidia may cause adverse effects on human health; however, no specific recommendations for routine assessments of Aspergillus in the clinical environment have been suggested so far. This study intended to determine the prevalence of Aspergillus in the clinical environment, focusing on ten Primary Health Care Centres (PHCC) through a novel multi-approach sampling protocol. Air and passive sampling, culture-based methods and a probe-based real-time assay for the detection of four clinically relevant Aspergillus sections were performed. Aspergillus spp. was observed in all PHCC, with highest prevalence on floor surface swabs (n=81) (18% on MEA; 6.94% on DG18). Regarding air samples (n=81), highest Aspergillus counts were found in the waiting room (94% MEA; 18% DG18), where Nigri was the most prevalent Aspergillus section. The use of a multi-approach sampling protocol to assess Aspergillus burden in the analyzed PHCC has greatly contributed to risk characterization, highlighting the need to implement corrective measures in order to avoid fungal presence in those settings.
- Um olhar interdisciplinar sobre os suplementos alimentares: reconfiguração dos papéis profissionais no contexto das novas tendências de consumo terapêuticoPublication . Raposo, Hélder António; Aranha Caetano, LilianaO actual protagonismo que os suplementos alimentares têm vindo a assumir no quadro de novas lógicas de oferta e de consumo de recursos terapêuticos, constitui um facto que é revelador da emergência de novos fenómenos que geram reconfigurações importantes ao nível da dimensão social de novas práticas em torno destes mesmos recursos, com implicações no papel dos profissionais de farmácia. Face a este novo quadro, em que novas realidades profissionais se desenham como resposta a estes fenómenos, o olhar interdisciplinar que aqui se desenvolve procura problematizar os novos papéis dos profissionais ao nível do aconselhamento e da educação para a saúde. Sustenta-se que esse objectivo dificilmente poderá ser mais do que um mero horizonte normativo, se não for capaz de integrar as abordagens de carácter sociológico sobre as importantes reconfigurações das dinâmicas de autonomia e reflexividade leiga que têm vindo a ocorrer em termos de gestão da saúde e de consumos terapêuticos. The current role that dietary supplements have been playing under new logic of supply and consumption of therapeutic resources, is a fact that reveals the emergence of new phenomena that generate major reconfigurations to the social dimension of new practices around these resources, with implications for the professional role of pharmacy practitioners. In this new framework, in which new realities are emerging as a professional response to these phenomena, the interdisciplinary outlook that we develop aims to raise some critical questions concerning the development of new roles in pharmacy practitioners in counseling and health education. We assert that this goal will scarcely be more than just a normative horizon, if unable to integrate the nature of sociological approaches on important reconfiguration of the dynamics of lay autonomy and reflexivity that have been occurring in terms of health management and therapeutic consumptions.
- Antifungal-resistant mucorales in different indoor environmentsPublication . Aranha Caetano, Liliana; Faria, Tiago; Springer, Jan; Loeffler, Juergen; Viegas, CarlaThis paper sought to address the prevalence of Mucorales in different indoor environments in Portugal. Environmental samples (183 in total) were collected at dwellings (n = 79) and workplaces (bakeries, swine farms, taxis, waste-sorting plants) (n = 93) by passive sampling using electrostatic dust collector (EDC), air-conditioning filters, litter, and/or raw materials. Samples were inoculated onto non-selective MEA and DG18 media and were screened for antifungal drug-resistance in azole-supplemented agar Sabouraud media. A probe-based Mucorales-specific real-time PCR assay (Muc18S) was used to detect Mucorales in complement to conventional culture-based methods. Mucorales order was found as more prevalent in air-conditioning filters from waste-sorting fork lifters (35.7%). Amongst Mucorales isolates able to grow in azole-supplemented media, 16 isolates of Mucor sp., Rhizopus sp. or Rhizomucor sp. were not susceptible to 1 mg/L voriconazole, and four isolates of Mucor sp. or Rhizopus sp. were not susceptible to 4 mg/L itraconazole. In conclusion, a combination of the culture-based and molecular methods proved to be reliable for Mucorales order identification in complex environmental samples.
- Effect of microbiome from waste sorting industry in THP-1 cell homeostasis and inflammatory responsesPublication . Viegas, Carla; Aranha Caetano, Liliana; Cox, Jennie; Korkalainen, Merja; Viegas, Susana; Reponen, TinnaOrganic dust and related microbial exposures are the main inducers of several respiratory symptoms and have been reported in diverse occupational settings. In vitro tests using relevant cell cultures can be useful for characterizing the toxicity of complex mixtures present in the air of occupational environments. In this study, cell viability was determined using the cell proliferation test WST-1 and inflammatory responses by ELISA assays measuring the production of proinflammatory cytokines TNFα and IL-1β. Human macrophages derived from THP-1 monocytic cells were exposed to extracts of 17 filters belonging to the filtration system from forklifts operating in one waste sorting industry located in the Lisbon region and one control filter. Additionally, bacterial and fungal diversity was assessed by RTL Genomics on an Illumina MiSeq with bacterial 16S 515F and 806R sequencing primers and fungal ITS1F and ITS2aR ribosomal DNA primers with 2x300bp chemistry. All filter samples were positive for microbial contamination, for both bacterial (350-1329 operational taxonomic units [OTUs]) and fungal (157-650 OTUs) load. Three filter samples revealed only moderate cytotoxicity in vitro. On average, the reduction in cell viability was between 0-20%, and 35% at the highest. All filter samples caused in vitro proinflammatory effects, regarding the elicited TNFα and IL-1β levels. The highest inflammatory responses were observed in filter samples 1, 4 and 5. A moderate negative correlation was found between bacterial load (OTUs) and inflammatory response for both TNFα (r=-0.61; p=0.02) and IL-1β (r=-0.46; p=0.07). No significant correlation was found between fungal load and inflammatory response in vitro. In light of the results, we should consider that, besides microbiome, others pollutants such as dust, metabolites or particles are probably influencing the increased production of cytokines. These findings corroborate, once more, the importance of considering exposure to complex mixtures in occupational settings. More studies are needed to drive robust conclusions on the effects of exposure to complex mixtures in occupational settings, in order to better estimate health risks for workers.
- Bioburden in health care centers: is the compliance with Portuguese legislation enough to prevent and control infection?Publication . Viegas, Carla; Almeida, Beatriz; Monteiro, Ana; Aranha Caetano, Liliana; Carolino, Elisabete; Gomes, Anita Quintal; Twarużek, Magdalena; Kosicki, Robert; Marchand, Geneviéve; Viegas, SusanaThis study intends to assess the bioburden in ten Portuguese health care centers (PHCC) with a multi-approach protocol using active (air sampling by impaction and impinger) and passive (surface swabs and air-conditioning filters) sampling methods, and compare the results with compliance levels of IAQ Portuguese legislation for the assessment of bioburden. The fungal burden in the PHCC was also characterized through molecular detection of toxigenic species, antifungal resistance and mycotoxins profile. Concerning legal compliance criteria for bacteriota the first criteria [indoor] + 350 CFU. m−3 < [outdoor] was not compiled in all PHCC analyzed. Regarding fungal load, 60% did not comply with the quantitative guideline (I/O < 1). Growth of four fungal genera (Chrysosporium, Cladosporium, Mucor, and Penicillium) was observed in HVAC filter samples collected from 6 out of 10 assessed PHCC when using azole-supplemented SDA media. Overall, Aspergillus/Penicillium/Paecilomyces levels were above the detection limits, except in one PHCC. The presence of mycotoxins was found both in air and HVAC filter samples. From the air samples analyzed, nine were contaminated (ng/ml) with 1–5 different mycotoxins within the same sample, whereas in HVAC filters, four samples contained 1 or 2 mycotoxins in the same filter. Overall, it was possible to conclude that Portuguese legislation is not enough to ensure IAQ in health care settings. The multi-approach sampling protocol used in this study allowed to unveil a more real scenario regarding exposure to bioburden. Detection of mycotoxins reinforces the relevance of studying mycotoxins in the clinical environment.
- EXPOsE: avaliação da exposição a micobiota resistente a antifúngicosPublication . Caetano, Liliana Aranha; Viegas, CarlaMicrobiota in clinical environments: poor hospital indoor air quality (IAQ) may lead to hospital-acquired infections, sick hospital syndrome, and various occupational hazards; microbiological IAQ monitoring and control in hospitals is currently a necessary and integral part of prevention strategies against hospital-acquired infections; implementation of sampling and analysis methods should be adapted to the hospital environment; bacterial, viral and fungal infections are frequently acquired via inhalation, among them pulmonary aspergillosis and pneumocystosis still represent high disease burden; a large number of fungal species can cause severe infections, especially among immunocompromised individuals; most important fungi related with fungal exposure: Cladosporium, Alternaria, Stachybotris, Penicillium, Aspergillus.
- Worker’s nasal swab: a tool for occupational exposure assessment to bioburden?Publication . Viegas, Carla; Santos, V.; Moreira, R.; Faria, Tiago; Ribeiro, Edna; Caetano, Liliana Aranha; Viegas, SusanaThe nose cavity is the primary portal of entry for inspired air and the first region of the respiratory tract to be in contst with bioaerosols. Nasal swab allows measurement of bioburden presence in the nose cavity and the collection is easy and painless. We intended to identify scientific papers reporting this tool as a surrogate to access exposure to microbiologic agents in occupational environments. Literature research was performed using scientific and academic databases. In 5 from 11 articles studied only one parameter was analysed, being the most common Methicillin-resistant S. aureus. Sevem studies applied cutured based-methods coupled with molecular tolls essay. Findings from two studies coroborate the use of nasal swab as a tool to complement the occupational exposure assessements, since was found association between the nasal swabs results and the occupational microbiota also assessed. Nasal swabs analyses should comprehend culture based-methods and molecular tools assay.
- Consumo de substâncias psicoactivas na população estudantil da Escola Superior de Tecnologia da Saúde de LisboaPublication . Grilo, S.; Reis, P.; Aranha Caetano, Liliana; Raposo, Hélder António; Graça, AnabelaO consumo de substâncias psicoactivas por estudantes do ensino superior tem sido objecto de estudo nos últimos anos em Portugal. Ao actuarem no Sistema Nervoso Central, produzindo alterações comportamentais, cognitivas, de consciência e de humor, as substâncias psicoactivas podem comprometer a capacidade de aprendizagem e futuro desempenho profissional. As prevalências de consumo em estudantes das áreas específicas da saúde (Medicina, Enfermagem, Farmácia) têm sido amplamente estudadas e caracterizadas. Considera-se que estes constituem um grupo vulnerável ao consumo de substâncias psicoactivas devido, em parte, ao esforço intelectual intenso, stress, ansiedade, insónias e depressão a que estão frequentemente sujeitos. Desconhecem-se dados específicos sobre o consumo de substâncias psicoactivas nos estudantes das Tecnologias de Saúde.