Development and validation of a multicompound LLE–LC–MS/MS method for biomonitoring of hazardous medicinal products in urine of exposed workers

Antineoplastic drugs are carcinogens, mutagens, or teratogenic substances, which can pose serious risks to professionals. Concerns about chronic exposure to these hazardous medicinal products (HMPs) have led to their prominence in the EU strategic framework on health and safety at work 2021–2027. To estimate and mitigate human exposure to HMPs, regular monitoring programs and, consequently, reliable, sensitive, multicomponent methods are crucial. In this study, an unconventional liquid-liquid extraction coupled with liquid chromatography–tandem mass spectrometry analysis is proposed to simultaneously identify and quantify seven HMPs of high concern in urine: cyclophosphamide, etoposide, ifosfamide, paclitaxel, megestrol, mycophenolate mofetil, and tamoxifen, the last three for the first time. Recoveries of all drugs from urine samples were close to 100 %, and method detection limits (0.6–4.1 ng/L) were noticeably lower than most previously reported. This novel, non-invasive method for biomonitoring is thus suitable to unequivocally identify the target drugs at the expected trace levels in urine and to infer about workers' exposure. The method contributes to the conception of regular monitoring programs for antineoplastic drugs, in line with recommendations under EU Directive 2004/37/EC. This is especially relevant in Portugal, where neither analytical methods nor exposure data exist due to lack of formal surveillance. © 2024 The AuthorsThis work was financially supported by: national funds through FCT/MCTES (PIDDAC) – LEPABE, UIDB/00511/2020 (DOI: 10.54499/UIDB/00511/2020) and UIDP/00511/2020 (DOI: 10.54499/UIDP/00511/2020), LSRE-LCM, UIDB/50020/2020 (DOI: 10.54499/UIDB/50020/2020) and UIDP/50020/2020 (DOI: 10.54499/UIDP/50020/2020), and ALiCE, LA/P/0045/2020 (DOI: 10.54499/LA/P/0045/2020); FCT – Fundação para a Ciência e a Tecnologia, I.P. through the projects with references UIDB/04750/2020 and LA/P/0064/2020 and DOI identifiers https://doi.org/10.54499/UIDB/04750/2020 and https://doi.org/10.54499/LA/P/0064/2020. Maria Francisca Portilha-Cunha is grateful to FCT for her Ph.D. grant (2021.05219.BD). ARLR acknowledges the FCT funding received under the Scientific Employment Stimulus-Individual Call (2022.00184.CEECIND/CP1733/CT0001, DOI: 10.54499/2022.00184.CEECIND/CP1733/CT0001)

An Improved LC-MS/MS Method for the Analysis of Thirteen Cytostatics on Workplace Surfaces

This research was funded by Project POCI-01-0145-FEDER-031297 (CytoStraTech).—funded by FEDER funds through COMPETE2020—Programa Operacional Competitividade e Internacionalização (POCI) and by national funds (PIDDAC) through FCT/MCTES; Base Funding—UIDB/00511/2020 of the LEPABE—Laboratory for Process Engineering, Environment, Biotechnology and Energy; and UIDB/50020/2020 of the Associate Laboratory LSRE-LCM—funded by national funds through FCT/MCTES (PIDDAC). The APC was funded by Project POCI-01-0145-FEDER-031297 (CytoStraTech)

Antineoplastic drugs in healthcare settings: Occupational exposure and risk graduation

Antineoplastic drugs (ADs) are hazardous medicinal products highlighted in the EU strategic framework on health and safety at work 2021–2027. To minimize workers' chronic exposure in oncologic settings, regular monitoring programs for these drugs are crucial and mandatory in the EU (Directive 2004/37/EC). No surveillance exists in Portugal, thus we intended to assess environmental contamination and to perform occupational exposure and risk graduation in a Portuguese tertiary hospital. Wipe sampling and liquid chromatography–tandem mass spectrometry were employed to analyze thirteen drugs of concern (bicalutamide, capecitabine, cyclophosphamide, cyproterone, doxorubicin, etoposide, flutamide, ifosfamide, imatinib, megestrol, mycophenolate mofetil, paclitaxel, prednisone), eight for the first time worldwide, in 152 surface samples over three sampling campaigns. Surface contamination before general cleaning (worst-case scenario) was higher and more widespread in the pharmacy (84%–98 % positive samples) than in the day-care hospital (40%–72 %). No samples were found above the “action limit” (10000 pg/cm2), but concentrations were frequently above the “safe”/alert level (100 pg/cm2), particularly for cyclophosphamide and ifosfamide (largest campaign's 90th percentiles: 2197 pg/cm2 and 1898 pg/cm2). Despite the approach's nuances, the maximum daily dermal intake calculated (1.6 μg/day, considering a single genotoxic drug) was lower than the acceptable daily intake. This study provided knowledge regarding surface contamination in a European hospital, where occupational exposure to some ADs of concern cannot be ruled out and follow-up monitoring is recommended, even if workers seem unlikely to develop cancer from handling them. Furthermore, this work contributes to the implementation of regular environmental monitoring programs for ADs in Portugal, enhancing compliance with EU recommendations. © 2024 The AuthorsThis work was financially supported by: national funds through FCT/MCTES (PIDDAC) – LEPABE, UIDB/00511/2020 (DOI: 10.54499/UIDB/00511/2020) and UIDP/00511/2020 (DOI: 10.54499/UIDP/00511/2020), LSRE-LCM, UIDB/50020/2020 (DOI: 10.54499/UIDB/50020/2020) and UIDP/50020/2020 (DOI: 10.54499/UIDP/50020/2020), and ALiCE, LA/P/0045/2020 (DOI: 10.54499/LA/P/0045/2020); FCT – Fundação para a Ciência e a Tecnologia, I.P. through the projects with references UIDB/04750/2020 and LA/P/0064/2020 and DOI identifiers https://doi.org/10.54499/UIDB/04750/2020 and https://doi.org/10.54499/LA/P/0064/2020; and Project POCI-01-0145-FEDER-031297 (CytoStraTech)—funded by FEDER funds through COMPETE2020—Programa Operacional Competitividade e Internacionalização (POCI) and by national funds (PIDDAC) through FCT/MCTES. Maria Francisca Portilha-Cunha is grateful to FCT for her Ph.D. grant (2021.05219.BD). ARLR acknowledges the FCT funding received under the Scientific Employment Stimulus-Individual Call (2022.00184.CEECIND/CP1733/CT0001, DOI: 10.54499/2022.00184.CEECIND/CP1733/CT0001)

Nanofiltration combined with ozone-based processes for the removal of antineoplastic drugs from wastewater effluents

Over the past years, there has been an increasing concern about the occurrence of antineoplastic drugs in water bodies. The incomplete removal of these pharmaceuticals from wastewaters has been confirmed by several scientists, making it urgent to find a reliable technique or a combination of techniques capable to produce clean and safe water. In this work, the combination of nanofiltration and ozone (O3)-based processes (NF + O3, NF + O3/H2O2 and NF + O3/H2O2/UVA) was studied aiming to produce clean water from wastewater treatment plant (WWTP) secondary effluents to be safely discharged into water bodies, reused in daily practices such as aquaculture activities or for recharging aquifers used as abstraction sources for drinking water production. Nanofiltration was performed in a pilot-scale unit and O3-based processes in a continuous-flow column. The peroxone process (O3/H2O2) was considered the most promising technology to be coupled to nanofiltration, all the target pharmaceuticals being removed at an extent higher than 98% from WWTP secondary effluents, with a DOC reduction up to 92%. The applicability of the clean water stream for recharging aquifers used as abstraction sources for drinking water production was supported by a risk assessment approach, regarding the final concentrations of the target pharmaceuticals. Moreover, the toxicity of the nanofiltration retentate, a polluted stream generated from the nanofiltration system, was greatly decreased after the application of the peroxone process, which evidences the positive impact on the environment of implementing a NF + O3/H2O2 process

Atenção ao idoso na estratégia de Saúde da Família: atuação do enfermeiro

Este estudo objetivou descrever a consulta de enfermagem ao idoso realizada na ESF; identificar possíveis dificuldades na atenção à saúde do idoso, bem como os cursos de qualificação profissional realizados e as necessidades de aprendizagem. Os dados foram coletados por meio da entrevista semiestruturada e submetidos à análise descritiva e temática. Foram entrevistadas 12 enfermeiras, a maioria estando na faixa etária de anos de formada (41%) em instituição particular (75%). Emergiram duas categorias temáticas: consulta de enfermagem ao idoso na ESF e qualificação profissional para a atenção à saúde do idoso. Foi considerado como desafio na realização da consulta de enfermagem a obtenção de dados fidedignos, a resolutividade e o apoio familiar. Os cursos para qualificar a atenção ao idoso ocorreram durante o período de graduação, destacando a falta de oportunidade, a pouca oferta e a necessidade de se aprofundar sobre o processo de envelhecimento.Este estudio tuvo como objetivo describir la consulta de enfermería realizada por el anciano en la ESF; identificar posibles dificultades en la atención a la salud del anciano, así como los cursos de calificación profesional realizados y las necesidades de aprendizaje. Los datos fueron recogidos a través de la entrevista semiestructurada y sometidos al análisis descriptivo temático. Fueron entrevistadas doce enfermeras, estando la mayoría situadas en la faja etaria de 23 a 28 años (66%), con 1-2 años de graduadas (41%) en instituciones particulares (75%). Emergieron dos categorías temáticas: consulta de enfermería del anciano en la ESF y calificación profesional para la atención de la salud del anciano. Fue considerado como desafío en la realización de la consulta de enfermería la obtención de datos fidedignos, la resolutividad y el apoyo familiar. Los cursos para calificar la atención al anciano, tuvieron lugar durante el período de graduación, destacándose la falta de oportunidad, la poca oferta y la necesidad de profundizar sobre el proceso de envejecimiento.This study aimed to describe the nursing consultation for the elderly provided at the Family Health Strategy (ESF, acronym in Portuguese); identify possible difficulties in delivering health care to the elderly, as well as the professional qualification courses performed and the learning needs. Data were collected through semi-structured interviews and submitted to descriptive and thematic analysis. Interviews were performed with 12 nurses, most with ages between years since graduation (41%) in private institutions (75%). Two thematic categories emerged from the analysis: nursing consultation for the elderly performed at ESF and professional qualification in health care for the elderly. Obtaining reliable data in the nursing consultation, resolution and family support were considered as challenges. The courses to qualify professionals for elderly care occurred during their graduation course, highlighting the lack of opportunity, the short supply and the need for deeper studies about the aging process

Maternal ability to take care of children exposed to HIV

OBJECTIVE: to assess the ability of mothers to take care of children exposed to HIV, using the Assessment Scale of Care Skills for Children Exposed to HIV at Birth and to check the association between the scale dimensions and maternal characteristics. METHOD: this cross-sectional study involved 62 HIV+ mothers whose children of up to one year old had been exposed to the virus at birth. The Assessment Scale of Care Skills for Children Exposed to HIV at Birth consists of 52 items and five dimensions, indicating high, moderate or low care ability. RESULTS: 72.7% of the mothers appropriately offered zidovudine syrup; 86.0% were highly skilled to prepare and administer milk formula; 44.4% were moderately able to prepare and administer complementary feeding; 76.5% revealed high ability to administer prophylactic treatment against pneumonia and 95.3% demonstrated high abilities for clinical monitoring and immunization. Significant associations were found between some maternal variables and the scale dimensions. CONCLUSION: the scale permits the assessment of maternal care delivery to these children and the accomplishment of specific child health interventions

Estresse e Burnout entre residentes multiprofissionais

OBJECTIVE: To identify associations between high-stress and burnout syndrome in multidisciplinary residents from a federal university in Rio Grande do Sul, Brazil. METHOD: This is an analytical, cross-sectional and quantitative study. A socio-demographic questionnaire, the Work Stress Scale and the Maslach Burnout Inventory-Health Services Survey (MBI-HSS) were applied to 37 residents between April and June 2011. P-valuesOBJETIVO: Identificar la asociación entre alto estrés y Burnout en residentes Multiprofesionales de una universidad federal de Rio Grande do Sul. MÉTODO: se trata de un estudio analítico, transversal, cuantitativo. Se aplicaron un formulario de datos socio-demográficos, la Escala de Estrés en el Trabajo y el Maslach Burnout Inventory- Health Services en 37 residentes entre Abril y Junio de 2011. Valores de pOBJETIVO: identificar a associação entre alto estresse e Burnout em residentes multiprofissionais de uma universidade federal do Rio Grande do Sul. MÉTODO: trata-se de estudo analítico, transversal, quantitativo. Aplicaram-se um formulário de dados socio demográficos, a Escala de Estresse no Trabalho e o Maslach Burnout Inventory-Human Services Survey (MBI-HSS) em 37 residentes entre abril e junho de 2011. Valores de