Exposure assessment in one central hospital: A multi-approach protocol to achieve an accurate risk characterization.

The bioburden in a Hospital building originates not only from patients, visitors and staff, but is also disseminated by several indoor hospital characteristics and outdoor environmental sources. This study intends to assess the exposure to bioburden in one central Hospital with a multi-approach protocol using active and passive sampling methods. The microbial contamination was also characterized through molecular tools for toxigenic species, antifungal resistance and mycotoxins and endotoxins profile. Two cytotoxicity assays (MTT and resazurin) were conducted with two cell lines (Calu-3 and THP-1), and in vitro pro-inflammatory potential was assessed in THP-1 cell line. Out of the 15 sampling locations 33.3% did not comply with Portuguese legislation regarding bacterial contamination, whereas concerning fungal contamination 60% presented I/O > 1. Toxigenic fungal species were observed in 27% of the sampled rooms (4 out of 15) and qPCR analysis successfully amplified DNA from the Aspergillus sections Flavi and Fumigati, although mycotoxins were not detected. Growth of distinct fungal species was observed on Sabouraud dextrose agar with triazole drugs, such as Aspergillus section Versicolores on 1 mg/L VORI. The highest concentrations of endotoxins were found in settled dust samples and ranged from 5.72 to 23.0 EU.mg-1. While a considerable cytotoxic effect (cell viability < 30%) was observed in one HVAC filter sample with Calu-3 cell line, it was not observed with THP-1 cell line. In air samples a medium cytotoxic effect (61-68% cell viability) was observed in 3 out of 15 samples. The cytokine responses produced a more potent average cell response (46.8 ± 12.3 ρg/mL IL-1ß; 90.8 ± 58.5 ρg/mL TNF-α) on passive samples than air samples (25.5 ± 5.2 ρg/mL IL-1ß and of 19.4 ± 5.2 ρg/mL TNF-α). A multi-approach regarding parameters to assess, sampling and analysis methods should be followed to characterize the biorburden in the Hospital indoor environment. This study supports the importance of considering exposure to complex mixtures in indoor environments.

Assessment of indoor air exposure at residential homes: Inhalation dose and lung deposition of PM10, PM2.5 and ultrafine particles among newborn children and their mothers.

Accurate assessment of particulate matter (PM) dose and respiratory deposition is essential to better understand the risks of exposure to PM and, consequently, to develop the respective risk-control strategies. In homes, this is especially relevant in regards to ultrafine particles (UFP; <0.1 µm) which origin in these environments is mostly due to indoor sources. Thus, this study aimed to estimate inhalation doses for different PM mass/number size fractions (i.e., PM10, PM2.5 and UFP) in indoor air of residential homes and to quantify the deposition (total, regional and lobar) in human respiratory tract for both newborn children and mothers. Indoor real-time measurements of PM10, PM2.5 and UFP were conducted in 65 residential homes situated in Oporto metropolitan area (Portugal). Inhalation doses were estimated based on the physical characteristics of individual subjects and their activity patterns. The multi-path particle dosimetry model was used to quantify age-specific depositions in human respiratory tract. The results showed that 3-month old infants exhibited 4-fold higher inhalation doses than their mothers. PM10 were primarily deposited in the head region (87%), while PM2.5 and UFP depositions mainly occurred in the pulmonary area (39% and 43%, respectively). Subject age affected the pulmonary region and the total lung deposition; higher deposition being observed among the newborns. Similarly, lower lobes (left lobe: 37% and right lobe: 30%) received higher PM deposition than upper and middle lobes; right lobes lung are prone to be more susceptible to respiratory problems, since asymmetric deposition was observed. Considering that PM-related diseases occur at specific sites of respiratory system, quantification of site-specific particle deposition should be predicted in order to better evidence the respective health outcomes resulting from inhaled PM.

Frailty syndrome, biomarkers and environmental factors - A pilot study.

Frailty is an age-related syndrome expected to increase over the next decades. This syndrome has been identified to be the most common condition leading to disability, institutionalisation and death in the elderly. The aim of this pilot study is to investigate a possible link between frailty status, biomarkers and environmental exposures. A group of 71 older adults (≥65 years old) was engaged in this study. The study population was classified as 45.1% robust, 45.1% pre-frail and 9.8% frail. A significant higher prevalence of second-hand smokers was found in the pre-frail group when compared to robust. Furthermore, a higher prevalence of robust individuals was found among those consuming home-produced vegetables and water from well/springs. Significant differences were found between data collected in a lifetime exposure questionnaire (LTEQ) and the levels of genotoxicity endpoints and the mercury levels analysed regarding some exposure-related parameters, namely, smoking habits, intake of home-produced vegetables and the use of pesticides in agriculture. Understanding if the way we live(d) or worked can impact the way we age are important questions to be explored. Data obtained in this pilot study encourage further studies on this matter, exploring the role of exposures history and its impact on health.

Pré-eclâmpsia e mortalidade materna: relação entre fatores de risco, diagnóstico precoce e prevenção / Pre-eclampsia and maternal mortality: relationship between risk factors, early diagnosis and prevention / Pre-eclampsia y mortalidad materna: relación entre factores de riesgo, diagnóstico precoz y prevención

Objetivo: Discorrer sobre doenças hipertensivas na gestação e discutir os seus fatores de risco, diagnóstico e prevenção. Revisão bibliográfica: A morte materna caracteriza-se pelo óbito por complicações geradas ou agravadas pela gravidez durante a gestação, parto e puerpério. Dentre as causas destas complicações, a hipertensão gestacional está entre as principais, mesmo sendo potencialmente evitável. Estudos apontam uma associação significativa de baixo nível socioeconômico, idade materna, idade gestacional precoce e doenças crônicas prévias com desfechos maternos desfavoráveis. Apesar de não existirem medidas protetoras bem delimitadas, pesquisas apontam que a prevenção pode ser proporcionada pelo uso de aspirina, pela suplementação de cálcio e pelo acompanhamento contínuo da gestação. Quando não evitadas, as desordens hipertensivas demandam um diagnóstico precoce, o qual pode ser feito por meio de exames específicos, como a dosagem de metaloprotease ADAM12-S, e permite que intervenções obstétricas sejam tomadas para evitar desfechos maternos desfavoráveis. Idealmente, essas intervenções devem ser tomadas no cenário de um sistema de saúde capacitado, o que muitas vezes não é garantido. Considerações finais: Foi constatado que existem múltiplos indicadores para estabelecer fatores de risco, diagnóstico precoce e prevenção. Entretanto, mais estudos devem ser encorajados visando a criação de protocolos consolidados no manejo de grávidas hipertensas. (AU)

Objective: To discuss hypertensive diseases during pregnancy and discuss their risk factors, diagnosis and prevention. Bibliographic review: Maternal death is characterized by death from complications generated or aggravated by pregnancy during the period that includes pregnancy, childbirth and puerperium. Among the causes of these complications, gestational hypertension is among the main ones, even though it is potentially preventable. Studies show a significant association of low socioeconomic status, maternal age, early gestational age and previous chronic diseases with unfavorable maternal outcomes. Although, there are no well-defined protective measures, research indicates that prevention can be provided by the use of aspirin, calcium supplementation and continuous monitoring of pregnancy. When not avoided, hypertensive disorders require an early diagnosis, which can be done through specific tests, such as the measurement of metalloprotease ADAM12-S, and allows obstetric interventions to be taken to avoid severe maternal conditions. Ideally, these interventions should be taken in the context of an empowered health system, which is often not guaranteed. Final considerations: It was found that there are multiple indicators to establish risk factors, early diagnosis and prevention. However, further studies should be encouraged aiming at the creation of consolidated protocols in the management of hypertensive pregnant women.

Objetivo: Discutir las enfermedades hipertensivas en el embarazo y discutir sus factores de riesgo, diagnóstico y prevención. Revisión bibliográfica: La muerte materna se caracteriza por la muerte por complicaciones generadas o agravadas por el embarazo durante el embarazo, parto y puerperio. Entre las causas de estas complicaciones, la hipertensión gestacional se encuentra entre las principales, aunque es potencialmente prevenible. Los estudios apuntan a una asociación significativa de bajo nivel socioeconómico, edad materna, edad gestacional temprana y enfermedades crónicas previas con resultados maternos desfavorables. Si bien no existen medidas de protección bien definidas, las investigaciones indican que la prevención puede brindarse mediante el uso de aspirina, suplementos de calcio y monitoreo continuo del embarazo. Cuando no se evitan, los trastornos hipertensivos exigen un diagnóstico temprano, que puede realizarse a través de pruebas específicas, como la dosificación de la metaloproteasa ADAM12-S, y permite realizar intervenciones obstétricas para evitar desenlaces maternos desfavorables. Idealmente, estas intervenciones deberían llevarse a cabo en el contexto de un sistema de salud empoderado, que a menudo no está garantizado. Consideraciones finales: Fue encontrado que existen múltiples indicadores para establecer factores de riesgo, diagnóstico precoz y prevención. Sin embargo, se deben incentivar más estudios con el fin de crear protocolos consolidados para el manejo de la gestante hipertensa.

Prevalência de lesões ateroscleróticas na artéria torácica interna esquerda, evidenciadas pelos achados de angiografia seletiva / Prevalenve of atherosclerotic lesions in the left internal thoracic artery, evidenced by selective angiographic findings

Background: By observing the high prevalence of failures in the surgical treatment of myocardial revascularization (MR), with the use of the Left Internal Thoracic Artery (LITA) as a graft, evidenced by the international literature, it was sought to demonstrate the prevalence of lesions that would not allow the use of LITA as a graft in myocardial revascularization surgery, with possible alteration in the surgical management performed by the cardiac surgeon, and reduction of the morbimortality of these patients. Objectives: To evaluate the prevalence of atherosclerotic lesions of the LITA, through selective preoperative angiography, in patients submitted to coronary angiography and indicated for myocardial revascularization. We also analyzed other lesions that made the use of LITA unfeasible as a main graft in cases of myocardial revascularization surgery (MRS). Methods: This was a cross-sectional, prevalence study that evaluated, through selective angiography, the LITA of 39 patients with a median age of 63 years, submitted to coronary angiography, with indication of Coronary Artery Bypass Graft (CABG). Categorical variables were compared by chi-square test and Fisher's exact test. The single continuous variable, age, was tested for normality by the Kolmogorov-Smirnov test, described in median (P25; P75) and the groups compared with the Mann-Whitney test. The level of statistical significance adopted was p < 0.05. The analyzes were performed in SPSS ® software version 20. Results: It was identified the presence of 7.7% of disorders in the LITA that made it unfeasible to be used. In all of the patients there was no specific symptomatology evidencing the lesion. No variable was shown as a predictor for the occurrence of the outcomes. Conclusion: The prevalence of the lesions found in the study was significant, indicating that a preoperative evaluation of LITA could bring future benefits to the patients submitted to CABG

Fundamento: Pela observação da alta prevalência de falhas no tratamento cirúrgico da revascularização do miocárdio (RM), com o uso da Artéria Torácica Interna Esquerda (ATIE) como enxerto, evidenciadas pela literatura internacional, buscou-se demonstrar a prevalência de lesões que inviabilizem o uso da ATIE como enxerto na cirurgia de revascularização do miocárdio, com possível alteração na conduta cirúrgica tomada pelo cirurgião cardíaco, e redução da morbimortalidade destes pacientes. Objetivos: Avaliar a prevalência de lesões ateroscleróticas da ATIE, por meio da angiografia seletiva, pré - operatória, em pacientes submetidos à cinecoronariografia e com indicação de revascularização cirúrgica do miocárdio. Também foram analisadas outras lesões que inviabilizam o uso da ATIE como enxerto principal em casos de necessidade da cirurgia de revascularização do miocárdio (CRM). Métodos: Estudo analítico, transversal, de prevalência, que avaliou por meio da angiografia seletiva, a ATIE de 39 pacientes com mediana de idade de 63 anos, submetidos ao exame de cinecoronariografia, com indicação de CRM. As variáveis categóricas foram comparadas pelo teste do qui-quadrado e exato de Fisher. A única variável contínua, a idade, foi testada para normalidade pelo teste de Kolmogorov-Smirnov, descrita em mediana (P25; P75) e os grupos comparados com teste de Mann-Whitney. O nível de significância estatística adotado foi p < 0,05. As análises foram realizadas no software SPSS ® versão 20. Resultados: Foi identificada a presença de 7,7% de alterações na ATIE que inviabilizam sua utilização. Em todos os pacientes inexistiu a presença de qualquer sintomatologia especifica que evidencia a lesão. Nenhuma variável se mostrou como fator preditor para ocorrência dos desfechos. Conclusão: A prevalência das lesões encontradas no estudo mostrou-se significativa, indicando que uma avaliação pré-operatória de ATIE possa trazer benefícios futuros aos pacientes submetido à CRM