Programa de reeducação funcional respiratória no doente crítico submetido a ventilação não invasiva / Respiratory functional re-education program in the critically ill patient submitted to non-invasive ventilation

Em Portugal verifica-se uma tendência para o aumento das doenças do foro respiratório, que com frequência conduz a internamento numa unidade de cuidados intensivos, onde a ventilação não invasiva é uma terapia adjuvante da mecânica ventilatória amplamente utilizada e permite tratar a insuficiência respiratória aguda, crónica ou crónica agudizada, evitando a entubação endotraqueal. O Enfermeiro Especialista em Enfermagem de Reabilitação, pelas suas competências, tem um papel primordial e adjuvante na melhoria da função respiratória, sendo a reeducação funcional respiratória uma importante forma de atuação, embora ainda exista pouca evidência sobre os benefícios desta intervenção especializada em Enfermagem de Reabilitação nestes contextos. Objetivos: Avaliar os efeitos de um programa de reeducação funcional respiratória na SaO2, PaO2, PaO2/FiO2, PaCO2 e pH em doentes submetidos a ventilação não invasiva numa unidade de cuidados intensivos do grande Porto. Metodologia: Estudo quantitativo, de natureza quase-experimental com uma amostragem não probabilística acidental de 30 doentes e um total de 65 sessões. Foram definidos critérios de inclusão e exclusão. Instrumentos de colheita de dados: questionário sociodemográfico e clínico e uma grelha de observação, que foram elaborados para o efeito. A colheita de dados ocorreu entre julho de 2019 e fevereiro de 2020. Resultados: A aplicação do programa de reeducação funcional respiratória pelo Enfermeiro Especialista em Enfermagem de Reabilitação aos doentes permitiu confirmar as hipóteses que demonstram os efeitos do programa na melhoria da PaO2, PaO2/FiO2, PaCO2 e pH verificando-se diferenças estatisticamente significativas entre os momentos pré e pós-sessão. Relativamente à SaO2 embora se tenha verificado melhoria nos seus valores pós- sessão, não foram encontradas diferenças estatisticamente significativas, pelo que esta hipótese não foi confirmada. Conclusões: Os resultados evidenciam uma melhoria significativa nos valores gasimétricos PaO2, PaO2/FiO2, PaCO2 e pH pelo que podemos comprovar que a reeducação funcional respiratória aplicada ao doente crítico pelo Enfermeiro Especialista em Enfermagem de Reabilitação é eficaz e constitui uma mais valia no processo de transição da estabilização e recuperação da função respiratória do doente e consequentemente na sua qualidade de vida.

n Portugal there is a tendency to increase the number of respiratory diseases, often conducted to an intensive care unit, where noninvasive ventilation is an adjunct therapy to the ventilatory mechanics and widely used for acute, chronic and acute on chronic respiratory failure and aims to prevent endotracheal intubation. The Specialist Nurse in Rehabilitation Nursing, due to his skills, has a primary and adjuvant role in improving respiratory function with respiratory functional re-education being an important form of action, although there is still the least amount of impact on the benefits of respiratory rehabilitation in these contexts. Objectives: To analyze the effects of a respiratory functional re-education program on SaO2, PaO2, PaO2/FiO2, PaCO2 and pH in patients under noninvasive ventilation at an intensive care unit of the greater Porto. Methodology: Quantitative study, of an almost-experimental nature, with an accidental non-probabilistic sampling of 30 patients and a total of 65 sessions. Inclusion and exclusion restrictions have been included. Data collection instruments: sociodemographic and clinical questionnaire and an observation grid, which were designed for this purpose. Data were collected between July 2019 and February 2020. Results: The application of the respiratory functional re-education program by the Specialist Nurse in Rehabilitation Nursing in the patients confirmed the hypotheses that demonstrate the effects of the improvement of PaO2, PaO2/FiO2, PaCO2 and pH checking statistically significant differences between the pre and post-session moments. Regarding SaO2, although there was an improvement in its post-session values, no statistically significant differences were found, so this hypothesis was not confirmed. Conclusions: The results show a significant improvement in the gasometric values PaO2, PaO2/FiO2, PaCO2 and pH so it is possible to prove that the respiratory functional re-education program apllied to the critical patient by the Reabilitation Nurse is effective and constitutes an asset in the process of transition from stabilization and recovery of the patient`s respiratory function and consequently in his quality of life.

Microbiota fingerprints within the oral cavity of cetaceans as indicators for population biomonitoring.

The composition of mammalian microbiota has been related with the host health status. In this study, we assessed the oral microbiome of 3 cetacean species most commonly found stranded in Iberian Atlantic waters (Delphinus delphis, Stenella coeruleoalba and Phocoena phocoena), using 16S rDNA-amplicon metabarcoding. All oral microbiomes were dominated by Proteobacteria, Firmicutes, Bacteroidetes and Fusobacteria bacteria, which were also predominant in the oral cavity of Tursiops truncatus. A Constrained Canonical Analysis (CCA) showed that the major factors shaping the composition of 38 oral microbiomes (p-value < 0.05) were: (i) animal species and (ii) age class, segregating adults and juveniles. The correlation analysis also grouped the microbiomes by animal stranding location and health status. Similar discriminatory patterns were detected using the data from a previous study on Tursiops truncatus, indicating that this correlation approach may facilitate data comparisons between different studies on several cetacean species. This study identified a total of 15 bacterial genera and 27 OTUs discriminating between the observed CCA groups, which can be further explored as microbiota fingerprints to develop (i) specific diagnostic assays for cetacean population conservation and (ii) bio-monitoring approaches to assess the health of marine ecosystems from the Iberian Atlantic basin, using cetaceans as bioindicators.

The microbiome of a striped dolphin (Stenella coeruleoalba) stranded in Portugal.

Infectious diseases with epizootic consequences have not been fully studied in marine mammals. Presently, the unprecedented depth of sequencing, made available by high-throughput approaches, allows detailed comparisons of the microbiome in health and disease. This is the first report of the striped dolphin microbiome in different body sites. Samples from one striped female edematous dolphin were acquired from a variety of body niches, including the blowhole, oral cavity, oral mucosa, tongue, stomach, intestines and genital mucosa. Detailed 16S rRNA analysis of over half a million sequences identified 235 OTUs. Beta diversity analyses indicated that microbial communities vary in structure and cluster by sample origin. Pathogenic, Gram-negative, facultative and obligate anaerobic taxa were significantly detected, including Cetobacterium, Fusobacterium and Ureaplasma. Phocoenobacter and Arcobacter dominated the oral-type samples, while Cardiobacteriaceae and Vibrio were associated with the blowhole and Photobacterium were abundant in the gut. We report for the first time the association of Epulopiscium with a marine mammal gut. The striped dolphin microbiota shows variation in structure and diversity according to the organ type. The high dominance of Gram-negative anaerobic pathogens evidences a cetacean microbiome affected by human-related bacteria.

Integration host factor is essential for the optimal expression of the styABCD operon in Pseudomonas fluorescens ST.

The StyS/StyR two-component regulatory system of Pseudomonas fluorescens ST controls the expression of the styABCD operon coding for the styrene degradation upper pathway. In a previous work we showed that the promoter of the catabolic operon (PstyA) is induced by styrene and repressed to differing extents by organic acids or carbohydrates. In order to study the mechanisms controlling the expression of this operon, we performed a functional analysis on 5' deletions of PstyA by the use of a promoter-probe system. These studies demonstrated that a palindromic region (sty box), located from nucleotides -52 to -37 with respect to the transcriptional start point is essential for PstyA activity. Moreover, additional regulatory regions involved in the modulation of PstyA activity were found along the promoter sequence. In particular, deletion of a putative StyR binding site, homologous to the 3' half of the sty box and located upstream of this box, resulted in 65% reduction of the induction level of the reporter gene. Additionally, we performed bandshift assays with a DNA probe corresponding to PstyA and protein crude extracts from P. fluorescens ST, using specific DNA fragments as competitors. In these experiments we demonstrated that IHF binds an AT-rich region located upstream of the sty box. On the basis of this finding, coupled with the results obtained with PstyA functional analysis, we suggest that the role of the IHF-mediated DNA bend is to bring closer, in an overlapping position, the upstream StyR putative binding site and the downstream sty box, and that the formed complex enhances transcription.

Occurrence and properties of glutathione S-transferases in phenol-degrading Pseudomonas strains.

Pseudomonas sp. strains, able to degrade aromatic compounds such as phenol, were chosen to investigate the occurrence and characteristics of glutathione S-transferases (GSTs). Affinity chromatography purification showed the presence of at least one GST in each studied strain. The purified proteins exhibited a great variety in the N-terminal sequences and different enzyme activities with the standard GST substrates tested. Two Pseudomonas strains, M1 and CF600, were chosen to investigate the GST activities under different growth conditions. Therefore, cells were grown either on phenol or on different nonaromatic carbon sources in the presence and absence of increasing phenol concentrations. In strain M1 a strong correlation between the activities of the catechol 1,2-dioxygenase and GST was observed in all the tested conditions. Moreover, growth on different organic acids also affected GST activity levels, with a negative correlation with the specific growth rate determined by each substrate. These results suggest a possible function of GST as a response to specific metabolic conditions determined by phenol toxicity and/or catabolism and the metabolic status of the cells. The same experiments performed with the CF600 strain did not show induction of GST activity in any of the tested conditions, indicating that GST_CF600 probably has a different role in cell metabolism. Native gel electrophoresis gave indications that GST dimerization could be an important process in the modulation of GST activity.