A Comparison of Two Multi-Layer Sacral Foam Dressings for the Prevention of Hospital-Acquired Pressure Injuries.

Hospital-acquired pressure injuries (HAPIs) represent a significant detriment to patient health by increasing mortality risk, negatively impacting quality of life, and increasing risk of complications such as infection. Prophylactic use of sacral foam dressings is known to decrease the occurrence of HAPIs in various patient populations. This retrospective study compared the effect of two multi-layer sacral foam dressings on HAPI incidence in patients admitted to a short-term, acute care hospital during the years 2015 (dressing one: Mepilex® Border Protect sacral dressing [Mölnlycke Healthcare AB, Göteborg, Sweden]) and 2017 (dressing two: Optifoam® Gentle LQ silicone faced foam < border sacral dressing [Medline Industries, LP, Northfield, Illinois]). Patient medical charts were examined for full sample (n=297) and subsample (n=284) analysis, respectively. The HAPI incidence for dressing two was found to be significantly less than dressing one (full sample: 5.12% compared to 10.79% [p=0.0001], and subsample: 4.07% compared to 9.31% [p=0.0001]). The incidence rate ratio (IRR) for dressing two was 0.39 for the full sample and 0.35 for the subsample, indicating that compared to dressing one, the HAPI count was approximately 40% lower for dressing two for the full sample and approximately 35% lower for dressing two for the subsample. These results demonstrate that dressing two performed better than dressing one in HAPI prevention. The results of this study may inform clinicians in their choice of prophylactic dressings.

Potentiation of the synergistic activities of chitinases ChiA, ChiB and ChiC from Serratia marcescens CFFSUR-B2 by chitobiase (Chb) and chitin binding protein (CBP).

With the goal of understanding the chitinolytic mechanism of the potential biological control strain Serratia marcescens CFFSUR-B2, genes encoding chitinases ChiA, ChiB and ChiC, chitobiase (Chb) and chitin binding protein (CBP) were cloned, the protein products overexpressed in Escherichia coli as 6His-Sumo fusion proteins and purified by affinity chromatography. Following affinity tag removal, the chitinolytic activity of the recombinant proteins was evaluated individually and in combination using colloidal chitin as substrate. ChiB and ChiC were highly active while ChiA was inactive. Reactions containing both ChiB and ChiC showed significantly increased N-acetylglucosamine trimer and dimer formation, but decreased monomer formation, compared to reactions with either enzyme alone. This suggests that while both ChiB and ChiC have a general affinity for the same substrate, they attack different sites and together degrade chitin more efficiently than either enzyme separately. Chb and CBP in combination with ChiB and ChiC (individually or together) increased their chitinase activity. We report for the first time the potentiating effect of Chb on the activity of the chitinases and the synergistic activity of a mixture of all five proteins (the three chitinases, Chb and CBP). These results contribute to our understanding of the mechanism of action of the chitinases produced by strain CFFSUR-B2 and provide a molecular basis for its high potential as a biocontrol agent against fungal pathogens.

Prevalence and Predictors of Important Telaprevir Drug Interactions Among Patients Coinfected With Hepatitis C and Human Immunodeficiency Virus.

Background: Among patients with HIV and hepatitis C (HCV) coinfection, drug-drug interactions involving nonstructural protein 3/4 (NS3/4A) serine protease inhibitors for HCV infection are an important concern because these drugs affect cytochrome P450 metabolism and p-glycoprotein transporters. Objectives: The primary objective was to determine the prevalence of clinically significant drug-drug interactions (CSDDIs) in HIV/HCV coinfected patients if telaprevir-based HCV therapy is added to patients' medication regimens. Secondary objectives were to identify antiretroviral therapy (ART) regimens associated with the lowest risk of CSDDI and determine the clinical risk factors. Methods: A cross-sectional study was performed among adult HIV/HCV coinfected patients. Demographics, comorbidities, social history, and medication lists were extracted from medical records. For each patient, CSDDIs were identified by entering all medications and pegylated interferon, ribavirin, and telaprevir into Lexi-Interact drug interaction software. The number and nature of CSDDIs were recorded before and after addition of telaprevir-based therapy. Results: There were 335 patients included. Prior to the addition of telaprevir-based HCV therapy, there was a high frequency (82.1%) of any CSDDI. After the addition of telaprevir-based HCV therapy, the frequency of any CSDDI increased to 97% (P < .001). Contraindicated interactions rose from 20.0% to 38.2% of patients after addition of telaprevir-based therapy. Use of ≥10 non-HIV medications, dyslipidemia, and HIV protease inhibitors were independently associated with the occurrence of a contraindicated interaction. Conclusions: Clinicians considering initiating telaprevir in HIV/HCV coinfected patients should be vigilant of drug-drug interactions, particularly among patients with dyslipidemia, those using ≥10 non-HIV medications, and those using HIV protease inhibitors.

Production of prodigiosin and chitinases by tropical Serratia marcescens strains with potential to control plant pathogens.

The potential of three Serratia marcescens strains (CFFSUR-B2, CFFSUR-B3 and CFFSUR-B4) isolated from tropical regions in Mexico to inhibit the mycelial growth and conidial germination of Colletotrichum gloeosporioides, causal agent of fruit anthracnose, was evaluated. The ability of these strains to produce prodigiosin and chitinases when cultivated in oil seed-based media (peanut, sesame, soybean and castor bean) and in Luria-Bertani medium was determined. All of the strains exhibited similar fungal antagonistic activities and inhibited myceliar growth by more than 40% while inhibiting conidial germination by 81-89% (P = 0.01). The highest level of prodigiosin (40 µg/ml) was produced in the peanut-based medium while growth in soybean-based medium allowed the highest production of chitinases (56 units/ml), independent of the strain used. Strain CFFSUR-B2 grown in peanut medium was used to evaluate the effect of inoculum density and initial pH on metabolite production. The amount of prodigiosin produced increased with greater inoculum densities, with an initial density of 1 × 10(12) resulting in the highest production (60 µg/ml). Prodigiosin production was not affected by pH. The strains studied have the advantage of being adapted to tropical climates and are able to produce chitinases in the absence of chitin induction in vitro. These characteristics suggest their potential as biocontrol agents for fungal pathogens in tropical regions of the world.

Preemptive antiretroviral therapy modifications for the management of potential clinically significant drug interactions with direct acting hepatitis C therapies.

We report a case series of HIV/HCV co-infected patients who underwent preemptive antiretroviral therapy modifications to manage clinically significant drug interactions with HCV therapy. Among the 15 patients reviewed, all changed to a raltegravir-based regimen and none experienced a loss of virologic suppression or increase in HIV-RNA.

Sensibilidad ética en estudiantes versus profesionales de enfermería / Ethical sensitivity in nursing students and professionals / Sensibilidade ética em estudantes e profissionais de enfermagem

RESUMEN Objetivo: comparar la sensibilidad ética de estudiantes de una universidad privada del estado de Puebla versus profesionales de enfermería adscritos a instituciones de salud. Método: comparativo, prospectivo y de corte transversal, en 217participantes divididos en 109 para estudiantes y 108 para profesionales. Se aplicó el instrumento de sensibilidad ética. Se aplico estadística descriptiva y ANOVA de un factor. Resultados:la sensibilidad etica de las enfermeras y enfermeros en general es alta (= 73.14 ±15.38); Sin embargo, en relación al grado académico el promedio de la sensibilidad ética fue más alto en la licenciatura en enfermería (= 74.41 ±14.47) y posgrado en enfermería (= 73.77 ±11.57) en comparación el postécnico en enfermería (= 69.78 ±18.22). Al realizar el análisis de varianza de la ANOVA de un factor,se muestra que no existe diferencia entre el grado académico y la sensibilidad ética (F= 1.865, p = .167). Conclusión: la sensibilidad ética en estudiantes como profesionales de enfermería es alta y no cambia a pesar de que estén en ámbitos hospitalarios o universitarios, por lo que en la profesión de enfermería existen valores consistentes en sus diferentes ámbitos.

ABSTRACTObjective:to compare the ethical sensitivity of students from a Public University of the state of Puebla versus nursing professionals assigned to health institutions. Method:comparative, prospective, cross-sectional, in 217 participants divided into 109 for students and 108 for professionals. The instrument of ethical sensitivity was applied. Descriptive statistics and one-way ANOVA were applied. Results:the Ethical Sensitivity of Nurses in general is high (X̅= 73.14 ±15.38); However, in relation to the academic degree, the average ethical sensitivity was higher in the undergraduate nursing (X̅= 74.41 ±14.47) and postgraduate in nursing (X̅= 73.77 ±11.57) compared to the post-technical in nursing (X̅= 69.78 ±18.22). When performing the one-way ANOVA analysis of variance, it is shown that there is no difference between academic grade and ethical sensitivity (F = 1.865, p = .167). Conclusion: the ethical sensitivity in students as nursing professionalsis high and does not change even though they are in hospital or university settings, so that in the nursing profession there are consistent values in its different fields.

RESUMOObjetivo:comparar a sensibilidade ética de estudantes de uma universidade privada do estado de Puebla com profissionais de enfermagem designados a instituições de saúde. Método:comparativo, prospectivo y transversal, com 217 participantes divididos em 109 estudantes e 108 profissionais. Foi aplicado o instrumento de sensibilidade ética. Estatísticas descritivas e ANOVA de uma via foram aplicadas. Resultados:a sensibilidade ética dos enfermeiros em geral é alta (X̅= 73,14 ±15,38), porém, em relação ao grau acadêmico, a média da sensibilidade ética foi maior na graduação em enfermagem (X̅= 74,41 ±14,47) e na pós-graduação em enfermagem (X̅= 73,77 ±11,57) em comparação àpós-técnica em enfermagem (X̅= 69,78±18,22). Ao realizar a análise de variância ANOVA de um fator, émostrado que não hádiferença entre a nota acadêmica e a sensibilidade ética (F = 1,865, p = 0,167). Conclusão:a sensibilidade ética dos estudantes como profissionais de enfermagem é elevada e não se altera mesmo estando em ambientes hospitalares ou universitários, de modo que na profissão de enfermagem existem valores consistentes em suas diferentes áreas.

Prevalence of drug-drug interactions upon addition of simeprevir- or sofosbuvir-containing treatment to medication profiles of patients with HIV and hepatitis C coinfection.

The objectives were to (1) compare the frequency of contraindicated drug-drug interactions (XDDI) when simeprevir (SIM)- and sofosbuvir (SOF)-containing regimens are theoretically added to a patient's medication profile; (2) identify which hepatitis C (HCV) regimen is associated with the lowest frequency of XDDIs within different types of antiretroviral treatment (ART) regimens; and (3) determine the risk factors for XDDIs with each regimen. A cross-sectional study was performed among adult HIV/HCV-coinfected patients. Demographics, comorbidities, and medication lists were collected from medical records. Medication lists were entered into Lexi-Interact drug interaction software and XDDI before/after the addition of SIM- and SOF-containing therapy was documented. Classification and regression tree (CART) analyses identified breakpoints in continuous variables. Before the addition of any HCV therapy, XDDIs were present in 20% of the 335 included patients. After the addition of SIM-containing therapy, the frequency of XDDIs significantly increased to 88.4% (p<0.001). After adding SOF-containing therapy, the prevalence of XDDIs increased to 24.5% (p<0.001). The prevalence of XDDIs was significantly lower for SOF-containing HCV therapy within various types of ART regimens. Use of ≥7 non-HIV medications (CART breakpoint) was the only variable to predict XDDIs before the addition of any HCV therapy. Similarly, this was the only variable to predict XDDIs after the addition of SOF-containing therapy (PR: 4.80; 95% CI: 2.57-8.96, p<0.001). Variables independently associated with XDDIs after the addition of SIM-containing therapy were NNRTI regimen (prevalence ratio, PR: 1.62; 95% confidence interval, CI: 1.38-1.91, p<0.001), PI regimen (PR: 1.64; 95% CI: 1.40-1.93, p<0.001), and ≥7 non-HIV medications (PR: 1.06; 95% CI: 1.00-1.14, p=0.09). The addition of SOF-containing therapy was associated with a lower prevalence of XDDI than SIM-containing therapy.

The Use of a Pure Native Collagen Dressing for Wound Bed Preparation Prior to Use of a Living Bi-layered Skin Substitute.

Management of chronic wounds in the outpatient setting is quite challenging. The extensive co-morbid medical problems of the chronically ill patient along with the complexities of the wound bed and its biochemical environment has led to a plethora of patients with poor wound healing. This ever increasing population is a challenge for the wound care practitioner and cost to the health care system and patient. Increased wound chronicity has promulgated the use of advanced wound care products, including Living Skin Substitutes (LSS), in an attempt to obtain wound closure, and ultimately both physiological and functional healing.(1-3) In the outpatient setting, it is evident that the efficacy of the LSS varies widely depending on the patient type with some patients responding quite favorably while others who do not achieve healing despite repeated applications of LSS. This case series demonstrates that a systematic method of wound bed preparation prior to the application of LSS improved healing outcomes. The entire wound bed preparation protocol included autolytic, non-selective, and sharp-selective debridement, if deemed appropriate, followed by the weekly application of a pure native collagen. The wound bed preparation protocol was completed prior to LSS application. This case series presents evidence supporting the application of a 100% native collagen dressing to wound bed prior to the final step of LSS utilization.