Percorrer por autor "Guerreiro, Daniela"
A mostrar 1 - 10 de 12
Resultados por página
Opções de ordenação
- Can chlorhexidine gluconate baths reduce fungal colonisation in intensive care unit patients?Publication . Nascimento, Teresa; Inácio, João; Guerreiro, Daniela; Patrício, Patrícia; Proença, Luís; Toscano, Cristina; Diaz, Priscila; Barroso, HelenaBackground: Chlorhexidine Gluconate (CHG) bathing is widely used in Intensive Care Units (ICUs) to reduce bacterial colonisation, yet its efficacy against fungal skin colonisation, particularly Candida spp., is not well understood. This study aimed to evaluate the impact of daily CHG bathing on Candida colonisation among ICU patients. Methods: From 2020 to 2022, axillary/inguinal swabs were collected from 675 ICU patients across three units on admission (Day 1, D1), Day 5 (D5) and Day 8 (D8). Patients received daily CHG bathing (either 2% impregnated wipes or 4% liquid solution) from D1 to D5, followed by soap-and-water bathing from Day 6 to D8. Standard and molecular microbiological methods were used to identify fungal species, and colony-forming units (CFUs) were quantified. Colonisation rates and fungal burden were compared across time points and bathing protocols. Results: A total of 988 swabs from 675 patients were collected, 675 on D1, 203 on D5 and 110 on D8. CHG bathing had no significant impact on Candida burden at individual time points, (D1, p = 0.223; D5, p = 0.939 and D8, p = 0.669). No significant differences in colonisation or fungal burden were observed between the use of 4% CHG solution and 2% CHG-impregnated wipes upon ICU admission. However, in the subgroup of 89 patients monitored longitudinally, a transient reduction in colonisation was observed during the CHG bathing period (D1–D5), followed by a significant increase during the soap-and-water period (D6–D8) (p = 0.005; between periods: p < 0.001). Among the 329 positive swabs, 274 yielded > 100 CFU/ml. High colony counts of C. albicans (> 1000 CFU/mL) were observed, with no significant association between colonisation levels and specific Candida species (p = 0.940). Conclusions: CHG bathing demonstrated only a limited and transient impact on Candida colonisation in ICU patients. Colonisation rates rebounded after cessation of CHG use, suggesting ongoing acquisition during ICU stay. These findings highlight the need for additional or alternative infection control measures targeting fungal pathogens in critical care settings.
- Enhancing ICU Candida spp. surveillance : a cost-effective approach focused on Candida auris detectionPublication . Nascimento, Teresa; Inácio, João; Guerreiro, Daniela; Diaz, Priscila; Patrício, Patrícia; Proença, Luís; Toscano, Cristina; Barroso, HelenaIntroduction: Candida auris is an emerging pathogen that represents a worldwide health problem due to its global expansion, multidrug resistance, and difficult laboratory identification. Among the risk factors for colonization/infection by C. auris, a stay in an intensive care unit (ICU) stands out. This prospective multicenter study aimed to monitor the trend of the local epidemiology of Candida spp. and unveil the prevalence of C. auris. Methods: From 2020 to 2022, axillar/inguinal swabs were collected from adult patients at three points: upon admission (D1) and on the fifth (D5) and eighth (D8) days of their ICU stay. We employed culture-based screening methods combined with molecular techniques to identify Candida spp. down to the species level. Specific screening for Candida auris was conducted using a real-time PCR assay in combination with an improved selective culture medium, mannitol salt agar auris (MSAA). To validate the effectiveness of MSAA, a collection of reference C. auris strains representing the four major geographical clades was used. Results: We enrolled 675 patients, and 355 Candida isolates were retrieved from the 988 swab samples collected. From those, 185/355 (52.1%) were identified as C. albicans and 170/355 (47.9%) as non-albicans Candida (NAC). MSAA medium showed a specificity of 94.8%, albeit C. auris was not detected in this cohort. The dynamics of Candida spp. colonization by ICU were significant at the three collection points. Upon admission, C. albicans was associated with the Beatriz Ângelo Hospital ICU (p=0.003) and C. tropicalis with the general Hospital Professor Doutor Fernando Fonseca (FFH) ICU (p=0.006). C. parapsilosis and C. lusitaniae were associated with FFH ICUs, with the general ICU at D5 (p=0.047) and surgical ICU at D8 (p=0.012). The dynamics of NAC colonization by ICU were significantly different at D1 (p=0.011), D5 (p=0.047), and D8 (p=0.012). Conclusion: We developed and implemented a screening protocol for C. auris while uncovering the colonization patterns of Candida in the ICU. Our findings contribute to the optimization of overall patient management, ensuring that ICU protocols are resilient and adaptive to emerging fungal threats.
- Exploring the skin mycobiome in intensive care patients : a pilot study on fungal diversity from axillary and groin swabsPublication . Nascimento, Teresa; Inácio, João; Guerreiro, Daniela; Patrício, Patrícia; Proença, Luís; Toscano, Cristina; Barroso, HelenaThe skin mycobiome is a largely unexplored component of the human microbiome, especially in critically ill patients. Fungal colonisation in the Intensive Care Unit (ICU) may be influenced by underlying comorbidities and hospital-related risk factors, potentially impacting patient outcomes. This pilot study aimed to characterize the diversity and abundance of skin fungi in ICU patients during their first week of hospitalization. A total of 35 ICU patients were recruited and divided into two groups: Group 1 (patients with 1–2 comorbidities and ICU risk factors) and Group 2 (patients with more than 2 comorbidities and ICU risk factors). Bilateral axillary-groin swabs were collected on admission day (D1) and after one week of ICU stay (D8) for fungal identification. Culture-based methods and MALDI-TOF MS were initially used, followed by Internal Transcribed Spacer 2 (ITS2) sequencing via the Illumina MiSeq platform for in-depth analysis of fungal communities. Fungal diversity and relative abundance were assessed using standard alpha and beta diversity metrics. Culture and MALDI-TOF MS identified only Candida spp., suggesting limited diversity. ITS2 sequencing revealed that Candida (69.3%) was the most prevalent genus, followed by Penicillium (10.3%) and Cladosporium (4.0%), with Malassezia being rare (0.7%). Diversity analysis indicated a relatively stable fungal community throughout the first week (ANOSIM, p = 0.499), with no significant changes in species richness or community structure. By Day 8, Candida spp. represented 79.9% and 78.9% of the mycobiome in Groups 1 and 2, respectively. Preliminary data suggest that the ICU skin mycobiome is dominated by Candida spp. and exhibits low fungal diversity. These findings provide foundational insight into the skin mycobiome of critically ill patients and underscore the need for further research to elucidate its clinical significance and potential role in patient management.
- Feasibility study of an intensive multi-strategy rehabilitation program for Parkinson diseasePublication . Domingos, Josefa M.; Caniça, Veronica; Godinho, Catarina; Pinho, Alice; Guerreiro, Daniela; Ferreira, Joaquim J.
- Insights into Candida colonization in intensive care unit patients : a prospective multicenter studyPublication . Nascimento, Teresa; Inácio, João; Guerreiro, Daniela; Patrício, Patrícia; Proença, Luís; Toscano, Cristina; Diaz, Priscila; Barroso, HelenaThe skin mycobiota plays a significant role in infection risk, pathogen transmission, and personalized medicine approaches in intensive care settings. This prospective multicenter study aimed to enhance our understanding of intensive care units’ (ICUs’) Candida colonization dynamics, identify modifiable risk factors, and assess their impact on survival risk. Specimens were taken from 675, 203, and 110 patients at the admission (D1), 5th (D5), and 8th (D8) days of ICU stay, respectively. The patient’s demographic and clinical data were collected. Candida isolates were identified by conventional culture-based microbiology combined with molecular approaches. Overall, colonization was 184/675 (27.3%), 87/203 (42.8%), and 58/110 (52.7%) on D1, D5, and D8, respectively. Candida colonization dynamics were significantly associated with ICU type (odds ratio (OR) = 2.03, 95% CI 1.22–3.39, p = 0.007), respiratory infection (OR = 1.74, 95% CI 1.17–2.58, p = 0.006), hemodialysis (OR = 2.19, 95% CI 1.17–4.10, p = 0.014), COVID-19 (OR = 0.37, 95% CI 0.14–0.99, p = 0.048), and with a poor 3-month outcome (p = 0.008). Skin Candida spp. colonization can be an early warning tool to generate valuable insights into the epidemiology, risk factors, and survival rates of critically ill patients, and should be considered for epidemiological surveillance.
- Ketogenic diet and neuroinflammation : implications for neuroimmunometabolism and therapeutic approaches to refractory epilepsyPublication . Guerreiro, Daniela; Almeida, Anabela; Ramalho, RenataRefractory epilepsy, characterized by seizures that do not respond to standard antiseizure medications, remains a significant clinical challenge. The central role of the immune system on the occurrence of epileptic disorders has been long studied, but recent perspectives on immunometabolism and neuroinflammation are reshaping scientific knowledge. The ketogenic diet and its variants have been considered an important medical nutrition therapy for refractory epilepsy and may have a potential modulation effect on the immune system, specifically, on the metabolism of immune cells. In this comprehensive review, we gathered current evidence-based practice, ketogenic diet variants and interventional ongoing clinical trials addressing the role of the ketogenic diet in epilepsy. We also discussed in detail the ketogenic diet metabolism and its anticonvulsant mechanisms, and the potential role of this diet on neuroinflammation and neuroimmunometabolism, highlighting Th17/Treg homeostasis as one of the most interesting aspects of ketogenic diet immune modulation in refractory epilepsy, deserving consideration in future clinical trials.
- Massive testing Is important to control a SARS-CoV-2 outbreakPublication . Guerreiro, Daniela; Costa, Ana Luísa; Nascimento, Teresa; Ribeiro, Ana Clara; Proença, Luís; Mendes, José João; Barroso, HelenaAt the end of September 2020, an outbreak of SARS-CoV-2 occurred at a university student’s residence. A rapid response, with massive testing, using both RT-PCR and antigen rapid testing, helped to control the spread of the virus, showing the importance of tracking the infection. Testing for antibodies one month after the outbreak showed that the permanence of students with no infection in the same building was not a preponderant factor to develop an immune response.
- Non-surgical periodontal therapy’s influence on alpha-synuclein and inflammatory marker levels : a pilot studyPublication . Lyra, Patrícia; Botelho, João; Rota, Sílvia; Poplawska-Domaszewicz, Karolina; Machado, Vanessa; Guerreiro, Daniela; Proença, Luís; Barroso, Helena; Mendes, José João; Chaudhuri, Kallol RayBackground: Microbial dysbiosis may contribute to alpha-synuclein (α-Syn) homeostasis disruption, yet the burden of inflammatory periodontal infection and its treatment have never been studied in this regard. We aimed to compare the cytokine and α-Syn levels in the saliva and blood of patients with periodontitis who underwent non-surgical periodontal therapy (NSPT) and those of their healthy counterparts. Methods: Periodontal examination and saliva and blood sample collection were carried out in incoming patients at a university clinic. The periodontitis group (PG) received NSPT. The sample collection and periodontal observation were repeated 30 days after. IL-6, IL1-β and total α-Syn were quantified using immunoassay methods. The periodontal inflamed surface area (PISA) was calculated as a proxy for periodontal inflammation. Results: Eleven participants formed the PG, and there were fifteen healthy controls (HC). At baseline, no correlation between salivary and plasma α-Syn was found. The salivary α-Syn levels revealed a tendency to decrease 30 days after, particularly in the PD cases. The variation in PISA and α-Syn showed significant correlation. Salivary α-Syn correlated negatively with salivary IL-6 levels at both timepoints in the total sample (rho = −0.394 and rho = −0.451) and in the HC (rho = −0.632 and rho = −0.561). Variations in plasma IL-6 and α-Syn were negatively correlated (rho = −0.518) in the healthy participants. Baseline plasma IL1-β negatively correlated with plasmatic α-Syn at 30 days in the HC (rho = −0.581). Conclusions: Salivary and plasma α-Syn bioavailability operate independently, and periodontal diagnosis was not a confounding factor. Salivary α-Syn levels were significantly affected by NSPT, contrary to plasma levels. These results should be confirmed in future larger and prospective studies.
- Objective structured clinical/practical examination (OSC/PE) in pharmaceutical sciences education : a pilot studyPublication . Cavaco-Silva, Patrícia; Ribeiro, Ana Clara; Figueiredo, Alexandra; Guerreiro, Daniela; Torres, Edite Oliveira; Costa, Isabela Margarida; Couvaneiro, João; Aguiar, João Pedro; Inez, Raquel; Branco, Vasco; Fernandes, A.I.
- Objective Structured Clinical/Practical Examination (OSC/PE) in Pharmaceutical Sciences Education: a pilot studyPublication . Cavaco-Silva, Patrícia; Ribeiro, Ana Clara; Figueiredo, Alexandra; Guerreiro, Daniela; Torres, Edite Oliveira; Costa, Isabela Margarida; Couvaneiro, João; Aguiar, João Pedro; Inez, Raquel; Branco, Vasco; Fernandes, Ana Isabel