Changes in the quality of life of adults with an ostomy during the first year after surgery as part of the Best Practice Spotlight Organisation® Programme.

The aim was to analyse changes in the perceived quality of life of patients with an ostomy during the first year after surgery at two or three follow-ups. This is a prospective study of a cohort of 55 patients who were ostomised between June 2021 and September 2022 and cared for under the recommendations set out in the Registered Nurses' Association of Ontario® best practice guideline Supporting Adults Who Anticipate or Live with an Ostomy as part of the Best Practice Spotlight Organisation® (BPSO®) programme. The Stoma Quality of Life tool was used. A univariate analysis was performed to identify variables associated with a non-improvement in quality of life. Variables showing p < 0.1 were included in a multivariate model. Patients with an ostomy exhibited a moderate-to-good perception of quality of life in both the personal and social dimensions, with no worsening over the first year. Being female (OR = 10.32) and being younger (OR = 0.89) were associated with a higher risk of no improvement in quality of life. The most frequent complications were urinary leakage (p = 0.027) and dermatitis (p = 0.052) at first follow-up; and parastomal hernia (p = 0.009) and prolapse (p = 0.05) at third follow-up. However, they did not lead to a worsening of quality of life, suggesting that these patients were adequately supported under the BPSO® programme.

Auranofin coated catheters inhibit bacterial and fungal biofilms in a murine subcutaneous model.

Microbe entry through catheter ports can lead to biofilm accumulation and complications from catheter-related bloodstream infection and ultimately require antimicrobial treatment and catheter replacement. Although strides have been made with microbial prevention by applying standardized antiseptic techniques during catheter implantation, both bacterial and fungal microbes can present health risks to already sick individuals. To reduce microbial adhesion, murine and human catheters were coated with polyurethane and auranofin using a dip coating method and compared to non-coated materials. Upon passage of fluid through the coated material in vitro, flow dynamics were not impacted. The unique antimicrobial properties of the coating material auranofin has shown inhibitory activity against bacteria such as Staphylococcus aureus and fungi such as Candida albicans. Auranofin coating on catheters at 10mg/mL reduced C. albicans accumulation in vitro from 2.0 x 108 to 7.8 x 105 CFU for mouse catheters and from 1.6 x 107 to 2.8 x 106 for human catheters, showing an impact to mature biofilms. Assessment of a dual microbe biofilm on auranofin-coated catheters resulted in a 2-log reduction in S. aureus and a 3-log reduction in C. albicans compared to uncoated catheters. In vivo assessment in a murine subcutaneous model demonstrated that catheters coated with 10 mg/mL auranofin reduced independent S. aureus and C. albicans accumulation by 4-log and 1-log, respectively, compared to non-coated catheters. In conclusion, the auranofin-coated catheters demonstrate proficiency at inhibiting multiple pathogens by decreasing S. aureus and C. albicans biofilm accumulation.

Nurses' evidence-based practice competence and hospital practice environment after specific training under the Best Practice Spotlight Organization® Programme. A cross sectional study.

BACKGROUND: Barriers to implementing training strategies for the improvement of evidence-based practice competence of nurses in hospital practice environments still persist. OBJECTIVE: The aim of the study was to evaluate the impact of a specific training within the framework of the Best Practice Spotlight Organization® programme, on nurses' evidence-based practice competence and the practice environment in two hospitals. DESIGN: This is a observational cross-sectional study assessing evidence-based practice competence and perceptions of Practice Environments. PARTICIPANTS: The study sample were 204 nurses working at medical and surgical inpatient units at two hospitals involved in the Best Practice Spotlight Organization® programme. METHODS: The study was conducted from February 2020 to May 2020. Three questionnaires were used to collect data: a sociodemographic/occupational questionnaire, a questionnaire exploring evidence-based practice skills, and a questionnaire exploring nurses' perceptions of their hospital practice environments. RESULTS: A total of 204 nurses participated. They were classified into two groups: those who had received specific training within the framework of the programme, called trained-champions (n = 66), and those who had not yet received training, control group (n = 138). The trained-champions exhibited better evidence-based practice competence values than the control group in all dimensions (p < 0.001), with a higher difference in means in the "Utilisation" dimension (-0.80; CI:-0.99,-0.60) and the "Knowledge" dimension (-0.63; CI:-0.88,-0.38). Trained-champions also had a more positive perception of the practice environments than the controls in all dimensions (p ≤ 0.001). The largest differences in means were in the "Participation" dimension (-0.48; CI:-0.66,-0.31) and in the "Leadership" dimension (-0.41; CI:-0.59,-0.23). CONCLUSIONS: Specific EBP training within the framework of the Best Practice Spotlight Organization® programme has succeeded in nurses (trained-champions) obtaining better EBP competence than others without this training. This could have contributed to increase nurses' abilities to integrate evidence into decision making in their clinical practice, while positively influencing them to perceive their PEs more favorably.

[Rupture of umbilical cord chorioangioma, intraamniotic hemorrhage and fetal death: report of a case and review of the literature]. / Rotura de corioangioma de cordón umbilical, hemorragia intraamniótica y muerte fetal: reporte de un caso y revisión de la bibliografía.

The umbilical cord is exposed to a great variety of injuries and events throughout the pregnancy whose origin may be either structural, mechanical, hamartomatous or infectious (1). Some of these alterations unquestionably interfere directly with the fetoplacental circulation either blocking it or creating severe haemorrhage as a result of laceration or tumor rupture. True tumors of the umbilical cord interfere directly with the fetal development. Two true tumors of the umbilical cord are described in this paper: chorangioma and teratoma. Chorangioma is a benign tumor, but has a very high rate of rate of perinatal mortality. Its frequency is rare, reporting in literature it presence of 1:3500 pregnancies. Our objective was to review world-wide literature and to report a case of fetal death by chorangioma of umbilical cord.

Advances in Biomaterials for the Prevention and Disruption of Candida Biofilms.

Candida species can readily colonize a multitude of indwelling devices, leading to biofilm formation. These three-dimensional, surface-associated Candida communities employ a multitude of sophisticated mechanisms to evade treatment, leading to persistent and recurrent infections with high mortality rates. Further complicating matters, the current arsenal of antifungal therapeutics that are effective against biofilms is extremely limited. Antifungal biomaterials are gaining interest as an effective strategy for combating Candida biofilm infections. In this review, we explore biomaterials developed to prevent Candida biofilm formation and those that treat existing biofilms. Surface functionalization of devices employing clinically utilized antifungals, other antifungal molecules, and antifungal polymers has been extremely effective at preventing fungi attachment, which is the first step of biofilm formation. Several mechanisms can lead to this attachment inhibition, including contact killing and release-based killing of surrounding planktonic cells. Eliminating mature biofilms is arguably much more difficult than prevention. Nanoparticles have shown the most promise in disrupting existing biofilms, with the potential to penetrate the dense fungal biofilm matrix and locally target fungal cells. We will describe recent advances in both surface functionalization and nanoparticle therapeutics for the treatment of Candida biofilms.

Anidulafungin liposome nanoparticles exhibit antifungal activity against planktonic and biofilm Candida albicans.

Fungal infections can cause significant patient morbidity and mortality. Nanoparticle therapeutics have the potential to improve treatment of these infections. Here we report the development of liposomal nanoparticles incorporating anidulafungin, a potent antifungal, with the goal of increasing its solubility and aiding in localization to fungi. Liposomes were fabricated with three concentrations of anidulafungin yielding monodisperse ~100 nm unilamellar vesicles. All three formulations inhibited planktonic Candida albicans growth at a minimum inhibitory concentration equivalent to free drug. All three formulations also disrupted preformed C. albicans biofilms, reducing fungal burden by as much as 99%, exhibiting superior biofilm disruption compared with free drug. Liposome formulations tested in vivo in C. albicans infected Galleria mellonella wax moth larvae demonstrated increased survival compared to free drug equivalents, leading to a survival of 33 to 67% of larvae over 7 days depending on the liposome utilized compared with only 25% survival of larvae administered free drug. Liposomal formulations along with free anidulafungin did not cause red blood cell lysis. Ultimately, the liposome formulations reported here increased anidulafungin solubility, displayed promising efficacy against planktonic and biofilm C. albicans, and improved the survival of C. albicans-infected G. mellonella compared to free anidulafungin.

Auranofin Releasing Antibacterial and Antibiofilm Polyurethane Intravascular Catheter Coatings.

Intravascular catheter related bloodstream infections (CRBSIs) are a leading cause of hospital-acquired infections worldwide, resulting not only in the burden of cost and morbidity for patients but also in the over-consumption of medical resources for hospitals and health care organizations. In this study, a novel auranofin releasing antibacterial and antibiofilm polyurethane (PU) catheter coating was developed and investigated for future use in preventing CRBSIs. Auranofin is an antirheumatic drug with recently identified antimicrobial properties. The drug carrier, PU, acts as a barrier surrounding the antibacterial agent, auranofin, to extend the drug release profile and improve its long-term antibacterial and antibiofilm efficacy and potentially the length of catheter implantation within a patient. The PU+auranofin coatings developed here were found to be highly stretchable (exhibiting ~500% percent elongation), which is important for the compliance of the material on a flexible catheter. PU+auranofin coated catheters were able to inhibit the growth of methicillin-resistant Staphylococcus aureus (MRSA) for 8 to 26 days depending on the specific drug concentration utilized during the dip coating process. The PU+auranofin coated catheters were also able to completely inhibit MRSA biofilm formation in vitro, an effect that was not observed with auranofin or PU alone. Lastly, these coatings were found to be hemocompatible with human erythrocytes and maintain liver cell viability.

What is the best position to place and re-evaluate an unconscious but normally breathing victim? A randomised controlled human simulation trial on children.

BACKGROUND: Current resuscitation guidelines endorse placing the unconscious and normally breathing victims in the recovery position (RP), but this technique might hinder breathing evaluation. AIM: To compare breathing evaluation and cardiac arrest detection: placing the victim in RP and checking breathing regularly, placing the victim in RP while re-evaluating breathing every minute, and placing the victim on his back, maintaining an open airway with the head-tilt-chin-lift technique and continuously checking breathing. METHODS: Schoolchildren aged 10-12 with no previous cardiopulmonary resuscitation (CPR) training, from three different primary schools were randomly allocated into groups to receive a CPR course involving one of the three strategies. Then a human simulation took place. RESULT: 192 schoolchildren (64 per group) were randomly selected and received one of the courses. 182 participants who correctly assessed the victim were compared: 16 (26.2%) out of the 59 participants using RP and checking breathing regularly detected cardiac arrest before the end of the simulation, compared to 41 (67.20%) out of 61 using RP re-evaluating breathing every minute, and 56 (90.3%) out of 62 using head-tilt-chin-lift. Statistically significant differences were found between the RP groups (p < 0.001; OR = 5.766) as well as between the Head-tilt-chin-lift and both RP groups (p < 0.001; OR = 21.094), (p = 0.002; OR = 4.553). CONCLUSION: The strategy involving head-tilt-chin-lift significantly increased the likelihood of detecting cardiac arrest. Re-evaluating every minute when the RP was used significantly increased the likelihood of detecting cardiac arrest.

Biodiversity recovery of Neotropical secondary forests.

Old-growth tropical forests harbor an immense diversity of tree species but are rapidly being cleared, while secondary forests that regrow on abandoned agricultural lands increase in extent. We assess how tree species richness and composition recover during secondary succession across gradients in environmental conditions and anthropogenic disturbance in an unprecedented multisite analysis for the Neotropics. Secondary forests recover remarkably fast in species richness but slowly in species composition. Secondary forests take a median time of five decades to recover the species richness of old-growth forest (80% recovery after 20 years) based on rarefaction analysis. Full recovery of species composition takes centuries (only 34% recovery after 20 years). A dual strategy that maintains both old-growth forests and species-rich secondary forests is therefore crucial for biodiversity conservation in human-modified tropical landscapes.

Dengue y factores teratogénicos. Reporte de un paciente / Dengue and Teratogenic Factors. Report of a Patient

Se reportó un caso de aborto espontáneo producido entre la décima y oncena semanas de gestación en una gestante durante la epidemia de dengue que afectó la ciudad de Holguín, en el año 2015. El objetivo fue realizar el análisis de los factores teratogénicos que incidieron en el fracaso gestacional. La transmisión transplacentaria de la infección por el virus dengue al embriofeto, que provocó alteraciones en el proceso metabólico del desarrollo embriofetal fue el factor teratogénico primario, potencializados en forma sinérgica por la prolongada exposición febril que afectó la gestante, con la formación de un hematoma retroplacentario y la producción secundaria de un grado variable de insuficiencia placentaria, que ulteriormente condujo al desprendimiento placentario abortivo. La terapéutica farmacológica empleada (dipirona, gravinol, omeprazol, difenhidramina y benadrilina) por la insuficiente actividad enzimática microsómica y citosólica, característica en este estadio del desarrollo de la concepción, suele haber interrumpido o dificultado la actividad farmacocinética embriofetal, que actuó en calidad de coteratógeno en este estadio del desarrollo e incidió en el desarrollo de la concepción para producir el aborto espontáneo.

A case of spontaneous abortion occurred between the tenth and eleventh weeks of gestation in a pregnant woman during the dengue epidemic that affected the city of Holguín in 2015. The objective of this was to analyze of the teratogenic factors that affected the gestational failure. The transplacental transmission of dengue virus infection to embryofeto, which caused alterations in the metabolic process of the embryofoetal development, was the primary teratogenic factor, together with the prolonged febrile exposure that affected the pregnant woman, with the formation of a retroplacental hematoma, and secondary variable degree of placental insufficiency, causing the abortion. Dipyrone, gravinol, omeprazole, diphenhydramine and benadryline were the pharmacological therapy used, due to the insufficient microsomal and cytosolic enzymatic activity, characteristic at this stage of conception development, has usually interrupted or hindered the embryofoetal pharmacokinetic activity, acting as coteratogen, influenced in the development of conception to produce embryolethal effects, producing the spontaneous abortion.

Rabdomioma cardíaco / Cardiac rhabdomyoma

El rabdomioma es un tumor benigno cardíaco primario. Se describe un recién nacido de 4 días de edad, producto de parto eutócico a las 40 semanas de edad gestacional y buen peso al nacer, nacido vía transpelviana sin morbilidad perinatal, test de Apgar 9/9, que a las pocas horas de vida se le ausculta soplo cardiaco de intensidad III/VI, sin otros signos clínicos. La evaluación ecocardiográfica reveló masa tumoral pediculada con características obstructivas del tractus de salida del ventrículo izquierdo, que genera gradiente a ese nivel de alrededor de 80 mmHg. Se realizó exéresis del tumor de base ancha, aspecto nacarado y superficie lisa a través de aortotomía oblicua, con circulación extracorpórea. El curso posoperatorio fue sin complicaciones. El paciente evoluciona sin residuos ni secuelas a los 12 meses de seguimiento.

Rhabdomyoma is a primary cardiac benign tumor. This report described a 4 days-old newborn born to eutocic delivery at 40 weeks of gestational age and good birthweight. He was born through transpelvic route with no perinatal morbidity, Apgar test of 9/9, but few hours after birth, he was detected an intensity II/IV cardiac murmur with no other clinical signs. The echocardiographic results showed pedicled tumor mass with obstructive characteristics of the outlet tract of the left ventricle, thus generating around 80 mmHg gradient at that level. This wide-base, pearly and flat surface tumor was excised by means of oblique aortotomy using extracorporeal circulation. The postoperative phase was uncomplicated. The patient recovers with neither residues nor sequelae after 12 months of follow/up.

Cuban Meningococcal BC Vaccine: Experiences & Contributions from 20 Years of Application.

This paper reviews 20 years of experience and scientific contributions of the Cuban meningococcal BC vaccine (VA-MENGOC-BC®) obtained by the Finlay Institute in Havana, Cuba. The vaccine is the first of its type in the world that is safe, effective, and commercially available for preventing meningococcal disease caused by serogroup B meningococcus; it is also effective against serogroup C. VA-MENGOC-BC® has shown satisfactory results, with no serious adverse events, after application of approximately 55 million doses in some 15 countries. Also included is background information on meningococcal disease, as well as the main characteristics of VA-MENGOC-BC®, the strategy used for controlling meningococcal disease and its prevention in Cuba, and a summary of the main scientific results obtained in basic research, development, clinical evaluation, and post-marketing results (safety, efficacy-effectiveness, post-vaccination adverse events, etc.) in Cuba and elsewhere.

Agenesia Traqueal: presentación de un caso / Tracheal agenesis: presentation of a case

Se presentó un paciente que nace severamente deprimido por parto natural, a las 35,4 semanas, con peso de 2 620 g. Inmediatamente se comenzaron medidas de reanimación, con bolsa, pero al no mejorar se decide intubación traqueal. Se planteó malformación de vías respiratorias por imposibilidad de lograrlo; al intentar traqueotomía, la tráquea está ausente, planteándose el diagnóstico de agenesia traqueal. A pesar de las medidas terapéuticas tomadas, el paciente fallece 8 horas después del nacimiento. En el estudio patológico se comprobó la presencia de agenesia traqueal tipo II, de acuerdo a la clasificación de Floyd...

We present the case of a patient, who was born severely depressed by natural birth, at 35,4 week, weighting 2 620 g. Immediately he was given reanimation, with bag, but when there was not an improvement, we decided the tracheal intubation. We supposed the malformation of the respiratory ways when the intubation was impossible; when we tried to make a tracheotomy, we did not find the trachea, arriving to the diagnosis of tracheal agenesis. In spite of the taken therapeutic measures, the patient died 8 hours after birth. In the pathologic study we stated type II tracheal agenesis, according to Floyd's classification...

Insuficiencia Renal Aguda en el recién nacido / Renal Acute Insufficiency in newborns

La insuficiencia renal aguda neonatal se define como el trastorno abrupto y grave de la función renal, manifestada por caída del filtrado glomerular y de la función tubular y eventualmente de la producción de orina; se debe sospechar cuando el valor de creatinina plasmática neonatal no disminuye a niveles inferiores a los maternos, aumenta alrededor de 0,2-0,3 mg/dl/día o supera el valor de 1,5 mg/dl independientemente del valor de la diuresis. Su diagnóstico y tratamiento deben efectuarse simultáneamente para corregir el defecto de modo que se limite el compromiso de la función renal.

The neonatal renal acute insufficiency is defined as an abrupt and serious disorder of the renal function, characterized by the fall of the glomerular filtration and of the tubular functioning and, eventually, of the urine production; it should be suspected when the neonatal plasmatic creatinine value does not descend to levels, lower than maternal, increases around 0,2-0,3 mg/dl/day, or surpasses the 1,5 mg/dl value, independently of the diuresis value. The diagnosis and treatment should be simultaneously, to correct the problem in a way limiting the renal function compromise.

Intramyocardial gene transfer of vascular endothelial growth factor 121 improves myocardial perfusion and function in the ischemic porcine heart

Vascular endothelial growth factor (VEGF) is an endothelial cell-specific mitogen that is angiogenic in vitro and in vivo. Several studies report on gene transfer of VEGF121 to promote angiogenesis in the ischemic myocardium of animals and patients. We hypothesized that intramyocardial administration of naked plasmid DNA encoding VEGF121 could improve myocardial perfusion and function in a porcine model of myocardial ischemia. Yorkshire swine underwent thoracotomy and placement of an ameroid constrictor on the circumflex coronary artery. Four weeks later, pVEGF121 plasmid was administered into the ischemic myocardium. Four weeks after gene transfer, SPECT imaging demonstrated significant reduction in the ischemic area in pVEGF121-treated animals compared with controls. In the pVEGF121 group, most of the animals evolved from light ischemia to a normal perfusion. In contrast, control animals exhibited similar or impaired ischemic conditions. Our results indicate that intramyocardial gene transfer of VEGF121 as naked plasmid DNA results in significant improvement in myocardial perfusion and function.

Aloinmunización eritrocitaria en embarazadas Rho (D) negativas: comparación de 3 métodos de detección de anticuerpos antieritrocitarios / Erytrocytic alloimmunization in negative Rho (D) negative pregnant women: comparison of three methods for the detection of antierythrocytic antibodies

Se estudió la frecuencia de aloinmunización contra antígenos eritrocitarios en 300 embarazadas Rho (D) negativas, mediante el empleo de 3 métodos de identificación de anticuerpos antieritrocitarios: prueba de polietilenglicol-antiglobulina, prueba de antiglobulina indirecta y prueba de enzima. las frecuencias de aloinmunización encontradas con el uso de las técnicas anteriores fueronde 4,6 2 y 1,6 % respectivamente. Se identificaron 16 aloanticuerpos: 14 de especificidad anti D (Rho), 1 de especificidad anti C (rh') y otro anti E (rh''): La prueba de polietilenglicol antiglobulina detectó 16 anticuerpos, 6 la de antiglobulina indirecta y 5 la de enzima. Se encontró que el antecedente de transfusiones de sangre fue más frecuente en el grupo inmunizado que en el no inmunizado

Anemia hemolítica por primaquina y exanguineotransfusión / Haemolytic anemia due to primoquine and exanguineotransfusion

Partiendo de la experiencia de la atención a 90 pacientes con el diagnóstico de anemia hemolítica por primaquina se decide hacer exanguineotransfusión a los que presenten igualdad de condiciones clínicas y humorales que aquellos que fueron a la insuficiencia renal aguda con requerimientos hemodialíticos; la evolución de los tres primeros enfermos es satisfactoria en sólo 48 horas, contrariamente a los pacientes anteriores que necesitaron tratamiento hemodialítico con prolongación de su estadia en cuidados intensivos. Se concluye la efectividad de este proceder en este tipo de pacientes