Nutritional risk and morbidity and mortality in intensive care unit patients with Coronavirus disease 2019.

INTRODUCTION: The Coronavirus disease 2019 (COVID-19) spread rapidly, with 37 million cases and more than 699,000 deaths. Among intensive care unit (ICU) patients with COVID-19, a high incidence of acute kidney injury (AKI) has been observed, ranging from 50 to 80%; furthermore, 85.9% were calculated to have high nutritional risk, which doubled their odds of death. The aim of the present study was to evaluate possible associations between nutritional risk, acute kidney injury, and morbidity and mortality in patients with COVID-19 admitted to an ICU. METHODS: Retrospective cohort study of adult and older-adult patients hospitalized for >24 h in an ICU. The exposure was diagnosis of COVID-19, while the outcomes were mortality, acute kidney injury, dialysis, mechanical ventilation, and vasopressor use. The association of nutritional risk with outcomes was evaluated. The sample consisted of two secondary datasets. Individuals aged <18 years, those with dialytic chronic kidney disease, pregnant women, and those diagnosed with brain death were excluded. RESULTS: The sample consisted of 192 patients: 101 in the exposure group (positive for COVID-19) and 91 in the control group (no COVID-19 diagnosis). The COVID-19 and non-COVID-19 groups differed significantly in the variables weight, body mass index (BMI), nutritional risk, mNUTRIC-S score, and length of ICU stay. Our results suggest that the optimal mNUTRIC-S score cutoff to predict nutritional risk is <5 points. CONCLUSION: COVID-19 has a significant impact on patients' kidney function, increasing the incidence of AKI and the likelihood of death. Nutritional risk is a major factor in the mortality of patients with COVID-19. Therefore, use of the mNUTRIC-S scale could contribute to assessment of prognosis in this patient population.

Accuracy of Thermographic Imaging in the Early Detection of Pressure Injury: A Systematic Review.

OBJECTIVE: To verify the accuracy of thermographic images in the early detection of pressure injury (PI) in adult patients. DATA SOURCES: Between March 2021 and May 2022, researchers searched 18 databases for relevant articles using nine keywords. In total, 755 studies were evaluated. STUDY SELECTION: Eight studies were included in the review. Studies were included if they evaluated individuals older than 18 years who were admitted to any healthcare setting; were published in English, Spanish, or Portuguese; examined the accuracy of thermal imaging in the early detection of PI, including suspected stage 1 PI or deep tissue injury; and they compared the region of interest to another area or control group, or to the Braden Scale or Norton Scale. Animal studies and reviews, studies with contact infrared thermography, and those including stages 2, 3, 4, and unstageable PIs were excluded. DATA EXTRACTION: Researchers examined sample characteristics and assessment measures related to image capture, including environmental, individual, and technical factors. DATA SYNTHESIS: Across the included studies, sample sizes ranged from 67 to 349 participants, and patients were followed up for periods ranging from a single assessment up to 14 days, or until the appearance of a PI, discharge, or death. Evaluation with the infrared thermography identified temperature differentials between regions of interest and/or in comparison with risk assessment scales. CONCLUSIONS: Evidence on the accuracy of thermographic imaging in the early detection of PI is limited.

Impact of Nutrition on the Prevention and Treatment of Pressure Injuries in Critically Ill Patients: An Integrative Review.

OBJECTIVE: To review the main scientific evidence on nutrition in the prevention and treatment of pressure injuries (PIs) in critically ill adult patients. DATA SOURCES: The searches were carried out in several scientific databases, namely, Scientific Electronic Library Online (SciELO), Public MEDLINE (PubMed), Latin American and Caribbean Literature in Health Sciences (LILACS), and Web of Science. The MeSH terms used were "pressure injury", "nutrition", and "intensive care". STUDY SELECTION: Studies published between January 1, 2005, and July 1, 2020, were included. Seven studies met the eligibility criteria and were included in this review. The searches were carried out in August 2020. The authors selected studies available in Portuguese, English, and Spanish. DATA EXTRACTION: Two independent researchers conducted the searches and read the article titles and abstracts. The studies that met the inclusion criteria were fully evaluated. Disagreements between reviewers were resolved by consensus, and when there was no consensus, a senior researcher was consulted. Data extraction was performed using a standardized form. DATA SYNTHESIS: Level-of-evidence analysis according to the type of study followed the classification proposed by the Oxford Center Evidence-Based Medicine. The evidence available on the use of standard enteral nutrition therapy and enteral nutrition therapy enriched with hyperprotein and hypercaloric nutrition supplements as well as the addition of zinc, eicosapentaenoic acid, γ-linolenic acid, and vitamins (A, C, D, and E) is limited in terms of supporting a specific nutrition support modality in the prevention and treatment of PI in the intensive care population. CONCLUSIONS: Malnutrition negatively impacts both the prevention and healing of PIs. The evidence available on the use of standard enteral nutrition therapy versus enrichment with nutrition supplements is too limited to support a specific nutrition modality in the prevention and treatment of PI in the intensive care population.

Immature Platelet Fraction and Thrombin Generation: Preeclampsia Biomarkers / Fração de plaquetas imaturas e geração de trombina: Biomarcadores da pré-eclâmpsia

Abstract Preeclampsia, a human pregnancy syndrome, is characterized by elevated blood pressure and proteinuria after the 20th week of gestation. Its etiology remains unknown, and its pathophysiological mechanisms are related to placental hypoperfusion, endothelial dysfunction, inflammation, and coagulation cascade activation. Recently, the role of the complement system has been considered. This syndrome is one of the main causes of maternal and fetal mortality and morbidity. This article discusses the hypothesis of preeclampsia being triggered by the occurrence of inadequate implantation of the syncytiotrophoblast, associated with bleeding during the first stage of pregnancy and with augmented thrombin generation. Thrombin activates platelets, increasing the release of antiangiogenic factors and activating the complement system, inducing the membrane attack complex (C5b9). Immature platelet fraction and thrombin generation may be possible blood biomarkers to help the early diagnosis of preeclampsia.

Resumo A pré-eclâmpsia, uma síndrome da gestação humana, é caracterizada por elevação da pressão arterial e proteinúria patológica após a 20ª semana de gestação. Sua etiologia permanece desconhecida, e seus mecanismos fisiopatológicos estão relacionados à hipoperfusão placentária, disfunção endotelial, inflamação, e ativação da cascata de coagulação. Recentemente, o papel do sistema do complemento foi considerado. Essa síndrome é uma das principais causas de morbidade e mortalidade materna e fetal. Este artigo discute a hipótese de a pré-eclâmpsia ser desencadeada pela ocorrência da implantação inadequada do sinciciotrofoblasto, associada ao sangramento durante o primeiro trimestre da gravidez com aumento da geração de trombina. A trombina ativa plaquetas, aumentando a liberação de fatores antiangiogênicos na circulação e ativando o sistema do complemento, especialmente o complexo de ataque de membrana (C5b9). Portanto, a fração de plaquetas imaturas e a geração de trombina podem ser possíveis biomarcadores sanguíneos para auxílio no diagnóstico precoce da pré-eclâmpsia.

Immature Platelet Fraction and Thrombin Generation: Preeclampsia Biomarkers.

Preeclampsia, a human pregnancy syndrome, is characterized by elevated blood pressure and proteinuria after the 20th week of gestation. Its etiology remains unknown, and its pathophysiological mechanisms are related to placental hypoperfusion, endothelial dysfunction, inflammation, and coagulation cascade activation. Recently, the role of the complement system has been considered. This syndrome is one of the main causes of maternal and fetal mortality and morbidity. This article discusses the hypothesis of preeclampsia being triggered by the occurrence of inadequate implantation of the syncytiotrophoblast, associated with bleeding during the first stage of pregnancy and with augmented thrombin generation. Thrombin activates platelets, increasing the release of antiangiogenic factors and activating the complement system, inducing the membrane attack complex (C5b9). Immature platelet fraction and thrombin generation may be possible blood biomarkers to help the early diagnosis of preeclampsia.

A pré-eclâmpsia, uma síndrome da gestação humana, é caracterizada por elevação da pressão arterial e proteinúria patológica após a 20ª semana de gestação. Sua etiologia permanece desconhecida, e seus mecanismos fisiopatológicos estão relacionados à hipoperfusão placentária, disfunção endotelial, inflamação, e ativação da cascata de coagulação. Recentemente, o papel do sistema do complemento foi considerado. Essa síndrome é uma das principais causas de morbidade e mortalidade materna e fetal. Este artigo discute a hipótese de a pré-eclâmpsia ser desencadeada pela ocorrência da implantação inadequada do sinciciotrofoblasto, associada ao sangramento durante o primeiro trimestre da gravidez com aumento da geração de trombina. A trombina ativa plaquetas, aumentando a liberação de fatores antiangiogênicos na circulação e ativando o sistema do complemento, especialmente o complexo de ataque de membrana (C5b9). Portanto, a fração de plaquetas imaturas e a geração de trombina podem ser possíveis biomarcadores sanguíneos para auxílio no diagnóstico precoce da pré-eclâmpsia.

Efficacy and safety of neuromuscular electrical stimulation in the prevention of pressure injuries in critically ill patients: a randomized controlled trial.

BACKGROUND: Pressure injuries (PIs), especially in the sacral region are frequent, costly, and increase morbidity and mortality of patients in an intensive care unit (ICU). These injuries can occur as a result of prolonged pressure and/or shear forces. Neuromuscular electrical stimulation (NMES) can increase muscle mass and improve local circulation, potentially reducing the incidence of PI. METHODS: We performed a randomized controlled trial to assess the efficacy and safety of NMES in preventing PI in critically ill patients. We included patients with a period of less than 48 h in the ICU, aged ≥ 18 years. Participants were randomly selected (1:1 ratio) to receive NMES and usual care (NMES group) or only usual care (control group-CG) until discharge, death, or onset of a PI. To assess the effectiveness of NMES, we calculated the relative risk (RR) and number needed to treat (NNT). We assessed the muscle thickness of the gluteus maximus by ultrasonography. To assess safety, we analyzed the effects of NMES on vital signs and checked for the presence of skin burns in the stimulated areas. Clinical outcomes were assessed by time on mechanical ventilation, ICU mortality rate, and length of stay in the ICU. RESULTS: We enrolled 149 participants, 76 in the NMES group. PIs were present in 26 (35.6%) patients in the CG and 4 (5.3%) in the NMES group (p ˂ 0.001). The NMES group had an RR = 0.15 (95% CI 0.05-0.40) to develop a PI, NNT = 3.3 (95% CI 2.3-5.9). Moreover, the NMES group presented a shorter length of stay in the ICU: Δ = - 1.8 ± 1.2 days, p = 0.04. There was no significant difference in gluteus maximus thickness between groups (CG: Δ = - 0.37 ± 1.2 cm vs. NMES group: Δ = 0 ± 0.98 cm, p = 0.33). NMES did not promote deleterious changes in vital signs and we did not detect skin burns. CONCLUSIONS: NMES is an effective and safe therapy for the prevention of PI in critically ill patients and may reduce length of stay in the ICU. Trial registration RBR-8nt9m4. Registered prospectively on July 20th, 2018, https://ensaiosclinicos.gov.br/rg/RBR-8nt9m4.

Does COVID-19 infection increase the risk of pressure injury in critically ill patients?: A narrative review.

ABSTRACT: Patients with severe COVID-19 may have endothelial dysfunction and a hypercoagulable state that can cause skin damage. In the presence of external pressure on the tissues, the local inflammatory process regulated by inflammatory cytokines can increase and prolong itself, contributing to the formation of pressure injury (PI). PI is defined as localized damage to the skin or underlying tissues. It usually occurs as a result of intense and/or prolonged pressure in combination with shear. The aim of the study is to perform a narrative review on the physiological evidence of increased risk in the development of PI in critically ill patients with COVID-19.In patients with severe COVID-19 a pattern of tissue damage consistent with complement-mediated microvascular injury was found in the lungs and skin of critically ill COVID-19 patients, suggesting sustained systemic activation of complement pathways. Theoretically, the same thrombogenic vascular changes related to COVID-19 that occur in the skin also occur in the underlying tissues, making patients less tolerant to the harmful effects of pressure and shear. Unlike the syndromes typical of acute respiratory illnesses and other pathologies that commonly lead to intensive care unit admission, COVID-19 and systemic viral spread show that local and systemic factors overlap. This fact may be justified by current epidemiological data showing that the prevalence of PI among intensive care unit patients with COVID-19 was 3 times higher than in those without COVID-19. This narrative review presents physiological evidence to suggesting an increased risk of developing PI in critically ill patients with COVID-19.

The Quality of Mobile Apps Used for the Identification of Pressure Ulcers in Adults: Systematic Survey and Review of Apps in App Stores.

BACKGROUND: The increasing global use of smartphones has contributed to the growing use of apps for various health conditions, showing promising results. Through mobile apps, it is possible to perform chronological and iconographic follow-up of wounds, such as pressure ulcers, using a simple and practical tool. However, numerous surveys have pointed out issues related to the functionality, design, safety, and veracity of app information. OBJECTIVE: The objective of this study was to perform a systematic review of published studies regarding mobile apps and a systematic survey in app stores looking for apps developed to identify, evaluate, treat, and/or prevent pressure ulcers in adults, and to evaluate those apps based on software quality characteristics. METHODS: This review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The main bibliographic databases were searched between January 1, 2007 and October 15, 2018, and an app survey was performed in app stores. The selected studies were evaluated according to software quality characteristics by the International Organization for Standardization/International Electrotechnical Commission (ie, ISO/IEC 25010:2011) that involve functionality, efficiency, compatibility, usability, reliability, safety, maintenance, and portability. RESULTS: The search in databases and web-based app stores returned a total of 2075 studies. After removal of duplicates and screening of titles and abstracts, 48 complete articles were evaluated for eligibility, and among these, six were included for qualitative synthesis. CONCLUSIONS: In this review, it was observed that all studies involved the initial phase of app development or improvement, and therefore, the apps still need to be evaluated using different software quality characteristics, so that in the future, a gold standard can be approached. Therefore, the prescription of an app for the identification, evaluation, treatment, and/or prevention of pressure ulcers in adults is currently limited. However, the evaluated studies provided important insights for future research. It is of utmost importance that future surveys develop apps jointly with users, using collaborative and cocreative processes and assess patients in real-world situations across different service settings, and they should consider different ethnicities, so that apps are useful to end users, such as patients, family members, health professionals, and students, in the health area. In addition, it is necessary for studies to describe the methodological course of app development in a clear and objective way in order to ensure reproducibility of the study and to offer inputs to allow future research to approach the development of ideal apps that are geared to positively impact the health of end users. TRIAL REGISTRATION: PROSPERO CRD42018114137; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=114137.

Cinesioterapia e eletroestimulação na incontinência urinária feminina / Kinesiotherapy and electrostimulation in female urinary incontinence / Cinesiterapia y electroestimulación en la incontinencia urinaria femenina

A incontinência urinária é definida como qualquer perda urinária involuntária e constitui um problema social e higiênico. O objetivo do estudo foi analisar a eficácia de tratamento fisioterapêutico na reeducação da musculatura do assoalho pélvico de mulheres com incontinência urinária por meio da cinesioterapia versus eletroestimulação. Trata-se de estudo quase experimental realizado na clínica FisioUNISC entre outubro de 2007 e maio de 2008. O estudo avaliou a força de contração da musculatura perineal em 36 mulheres por intermédio do perineômetro digital, do teste do absorvente e do questionário de qualidade de vida - King's Health Questionnaire (KHQ). A terapêutica foi constituída de dois grupos distintos: o primeiro realizava a cinesioterapia; o segundo, a eletroestimulação. Cada grupo concretizou 20 sessões de tratamento, realizado três vezes por semana. Mediante o teste do absorvente, constatou-se a redução na perda de urina e o consecutivo progresso da força de contração vaginal nos dois grupos investigados, com a cinesioterapia exprimindo melhor resultado. O KHQ evidenciou resultados similares, com melhora na pontuação para os dois grupos, destacando maior pontuação no grupo da cinesioterapia. Os resultados mostraram melhora do quadro de incontinência urinária com os dois tratamentos, contudo a cinesioterapia se mostrou a opção mais efetiva. [AU]

Urinary incontinence is defined as any involuntary urinary loss and is a social and hygienic problem. The objective of this study was to analyze the effectiveness of physiotherapeutic treatment in reeducating the pelvic floor musculature of women with urinary incontinence through kinesiotherapy versus electrostimulation. It is a quasi-experimental study conducted at the FisioUNISC clinic between October 2007 and May 2008. The study assessed the strength of perineal musculature contraction in 36 women, using digital perineometer, pad test and the King's Health Questionnaire (KHQ). Therapy was applied to two distinct groups: the first one was subjected to kinesiotherapy while the second one to electrostimulation. Each group completed 20 treatment sessions three times a week. Reduced urine loss and subsequent progression of vaginal contraction strength in the two investigated groups were observed by means of the pad test, with kinesiotherapy expressing better results. The KHQ showed similar results, with improved scores for both groups and higher scores in the kinesiotherapy group. The results showed improvement in urinary incontinence with both treatments; however, kinesiotherapy was the most effective option. [AU]

La incontinencia urinaria es definida como cualquier pérdida urinaria involuntaria y constituye un problema social e higiénico. El objetivo del estudio fue analizar la eficacia del tratamiento fisioterapéutico en la reeducación de la musculatura del suelo pélvico de mujeres con incontinencia urinaria por medio de la cinesiterapia versus electroestimulación. Se trata de un estudio casi experimental realizado en la clínica FisioUNISC entre octubre de 2007 y mayo de 2008. El estudio evaluó la fuerza de contracción de la musculatura perineal en 36 mujeres por intermedio del perineómetro digital, del test de la compresa y del cuestionario de calidad de vida - King's Health Questionnaire (KHQ). La terapéutica fue constituida por dos grupos distintos: el primero realizaba la cinesiterapia; el segundo, la electroestimulación. Cada grupo llevó a cabo 20 sesiones de tratamiento, realizado tres veces por semana. Mediante el test de la compresa, se constató la reducción en la pérdida de orina y el consecutivo progreso de la fuerza de contracción vaginal en los dos grupos investigados, manifestando con la cinesiterapia mejor resultado. El KHQ evidenció resultados semejantes, con la mejora en la puntuación para los dos grupos, destacando mayor puntuación en el grupo de la cinesiterapia. Los resultados mostraron mejora del cuadro de incontinencia urinaria con los dos tratamientos, no obstante la cinesiterapia se mostró la opción más efectiva. [AU]

Efeitos dos lasers Hélio-Neônio (HeNe) e Arseneto de Gálio (AsGa) associados à educação em saúde com foco na promoção da saúde de portadores de úlcera por pressão / Effects of Helium-Neon (HeNe) and Gallium Arsenide (GaAs) lasers associated with prevention guidelines and treatment of pressure ulcers

Introdução: As úlceras por pressão são áreas localizadas de morte celular que se desenvolvem quando o tecido mole é comprimido entre uma proeminência óssea e uma superfície dura por um período de tempo prolongado. As úlceras são de difícil cicatrização, sendo responsáveis por um alto índice de orbidade. A laserterapia de baixa intensidade vem sendo empregada como um recurso fisioterápico capaz de apresentar resposta efetiva na cicatrização de tecidos. Objetivos: Comparar a ação dos lasers Hélio-Neônio e Arseneto de Gálio no processo cicatricial de úlceras por pressão e desenvolver um trabalho com medidas de prevenção como tratamento. Métodos: Foram tratados um usuário com o laser Hélio-Neônio e dois com o laser Arseneto de Gálio, selecionados aleatoriamente, além de ter sido realizado um trabalho preventivo com esses sujeitos. Resultados: Os dois tipos de laser demonstraram resultados eficazes na cicatrização dos processos ulcerativos. Conclusão: Usuários que, juntamente com a laserterapia, seguiram corretamente as medidas preventivas obtiveram melhores resultados do que aqueles que não seguiram corretamente as orientações. (AU)

Introduction: The pressure ulcers are located areas of cellular tissue death, that develop themselves when the soft tissue is compressed, between a bone proeminence and a hard surface, for a long period of time. The ulcers are of hard scarring and, responsible by a high index of morbidity, generating a difficult handling situation and high economic costs for the health agencies. In this context appears the low intensity laser therapy that is being used as afhysiotherapic resource capable to present effective reply in the tissue scarring. Objectives: To compare the action of HeNe and AsGa laser in the scarring process of pressure ulcers, as well as evaluating the effect of prevention measures in the treatment. Methods: There had been treated four users on the HeNe laser and two users on the AsGa laser, aleatory chosen, and also had been done a prevention work with the users. Results: Both types of laser had demonstrated positive results in the healing of these ulcerative processes. Conclusion: The users who, with the laser therapy, had also followed prevention measures correctly, they had gotten better results than those who had not followed the orientations correctly. (AU)

Experimental study with nursing staff related to the knowledge about pressure ulcers.

Objective: to compare the scores of knowledge in teams participating or not participating in educational interventions about pressure ulcers. Method: a quantitative study with experimental design. Data were collected through a validated questionnaire. The study included 71 individuals, including nurses and nursing technicians from three intensive care units, divided into intervention group and control group. Data analysis considered the scores of the groups in the moment before and after intervention. To check the average rate of correct answers, we calculated the mean and standard deviation. We carried out the Mann-Whitney test for analysis of two independent samples, and the Wilcoxon test for related samples. Results: The mean percentage of correct answers, at the baseline was 74.1% (SD = 26.4) in the intervention group and 76.0% (SD = 22.9) in the control group and post time -intervention, was 87.8% (SD = 18.8) in the group receiving educational intervention, considering that in the control group it was 79.1% (SD = 22.2). The group that participated in educational interventions did not reach the proper average of 90% correct answers for the test. Conclusion: educational interventions on staging, evaluation and prevention of pressure ulcers contributed significantly to the increase of correct responses score in the knowledge test of the intervention group and improved their knowledge on the subject.

Experimental study with nursing staff related to the knowledge about pressure ulcers / Estudo experimental com equipes de Enfermagem acerca do conhecimento sobre úlceras por pressão / Estudio experimental con el personal de enfermería sobre el conocimiento acerca de las úlceras por presión

ABSTRACT Objective: to compare the scores of knowledge in teams participating or not participating in educational interventions about pressure ulcers. Method: a quantitative study with experimental design. Data were collected through a validated questionnaire. The study included 71 individuals, including nurses and nursing technicians from three intensive care units, divided into intervention group and control group. Data analysis considered the scores of the groups in the moment before and after intervention. To check the average rate of correct answers, we calculated the mean and standard deviation. We carried out the Mann-Whitney test for analysis of two independent samples, and the Wilcoxon test for related samples. Results: The mean percentage of correct answers, at the baseline was 74.1% (SD = 26.4) in the intervention group and 76.0% (SD = 22.9) in the control group and post time -intervention, was 87.8% (SD = 18.8) in the group receiving educational intervention, considering that in the control group it was 79.1% (SD = 22.2). The group that participated in educational interventions did not reach the proper average of 90% correct answers for the test. Conclusion: educational interventions on staging, evaluation and prevention of pressure ulcers contributed significantly to the increase of correct responses score in the knowledge test of the intervention group and improved their knowledge on the subject.

resumo Objetivo: comparar os escores de conhecimento sobre úlcera por pressão das equipes que participaram ou não de intervenções educativas. Método: estudo quantitativo com delineamento experimental. Os dados foram coletados por meio de questionário validado. Participaram deste estudo 71 pessoas, dentre enfermeiros e técnicos de Enfermagem de três unidades de terapia intensiva, divididos em grupo-intervenção e grupo-controle. A análise dos dados considerou os escores dos grupos no momento pré e pós-intervenção. Para verificar o escore médio de acertos, foram calculados a média e o desvio-padrão. Foi realizado o Teste de Mann-Whitney, para análise de duas amostras independentes, e o Teste de Wilcoxon, para amostras relacionadas. Resultados: a porcentagem média de acertos, no momento inicial, foi de 74,1% (dp=26,4) no grupo-intervenção e 76,0% (dp=22,9) no grupo-controle e, no momento pós-intervenção, foi de 87,8% (dp=18,8) no grupo que recebeu intervenção educativa, considerando-se que no grupo-controle foi de 79,1% (dp=22,2). O grupo que participou de intervenções educativas não atingiu a média adequada de 90% de acertos para o teste. Conclusão: as intervenções educativas sobre estadiamento, avaliação e prevenção da úlcera por pressão contribuíram significativamente para o aumento do escore de acertos no teste de conhecimento do grupo-intervenção e melhoraram o conhecimento sobre o tema.

RESUMEN Objetivo: comparar las puntuaciones de los conocimientos acerca de las úlceras por presión de los equipos que han participado o no de intervenciones educativas. Método: estudio cuantitativo con diseño experimental. Los datos fueron recolectados a través de cuestionario validado. En el estudio participaron 71 personas, incluyendo enfermeras y técnicos de enfermeria de tres unidades de cuidados intensivos, divididos en grupo de intervención y grupo control. El análisis de los datos consideró las puntuaciones de los grupos antes y después de la intervención. Para comprobar la tasa media de respuestas correctas, se calculó la media y el desvio estándar (DE). La prueba de Mann-Whitney fue realizada para el análisis de dos muestras independientes y la prueba de Wilcoxon para muestras relacionadas. Resultados: la media del porcentaje de respuestas correctas, al inicio del estudio fue de 74,1% (DE = 26,4) en el grupo de intervención y 76,0% (DE = 22,9) en el grupo de control y en el tiempo post-intervención, fue del 87,8% (DE = 18,8) en el grupo que recibió la intervención educativa, teniendo en cuenta que en el grupo control fue de 79,1% (DE = 22,2). El grupo que participó en las intervenciones educativas no llegó a la media apropiada de 90% de respuestas correctas de la prueba. Conclusión: las intervenciones educativas en la estadificación, evaluación y prevención de las úlceras por presión contribuyeron significativamente al aumento de puntuación de aciertos en la prueba de conocimiento en el grupo de intervención y mejoraron su conocimiento sobre el tema.

Outcome of patients with severe PH due to lung disease with and without targeted therapy.

INTRODUCTION: Pulmonary hypertension (PH) can occur in patients with lung disease and worsen prognosis. Endothelin receptor antagonists, phosphodiesterase 5-inhibitors, and prostacyclin analogs, referred to as targeted therapy, have not been shown in a limited number of controlled clinical studies to improve exercise capacity in these patients. Possibly targeted therapy could be of benefit in patients with severe PH due to lung disease, but this subgroup is not well studied. AIMS: To analyze influence of PH severity and use of targeted therapy on exercise capacity and survival in patients with PH due to lung disease. METHODS: Consecutive patients with PH (mean pulmonary artery pressure ≥25 mmHg at rest) due to lung disease diagnosed by right heart catheterization between 1/2005 and 9/2011 were retrospectively included. Severe PH was defined as mean pulmonary artery pressure ≥35 mmHg. Patients were followed until 4/2012 for exercise capacity, survival, and targeted therapy use. RESULTS: Patients with severe PH (n = 40) received significantly more often targeted therapy compared to the 32 patients with less severe PH (65% vs. 25%, P = 0.001). Survival was not significantly different between these groups (P = 0.310). Patients on targeted therapy were older, more often female, and had worse hemodynamic impairment, but significantly higher estimated 1-, 3-, and 5-year survival rates compared to untreated patients (97%, 81%, and 75% vs. 83%, 54%, and 19%, respectively; P = 0.002). This effect was mainly driven by the patients with severe PH, in whom the survival advantage was statistically significant on subgroup analysis (HR 0.182, P = 0.002). Exercise capacity was not significantly altered in any patient group. CONCLUSION: Patients with severe PH due to lung disease may have a survival benefit from targeted therapy compared to untreated patients with less severe PH. Prospective clinical trials utilizing targeted therapy and long-term endpoints are justified in this patient group.

Rede de atenção oncológica: como a estratégia saúde da família se percebe na assistência ao paciente com câncer / Oncology care network: how family health strategy is perceived in patient / Red de atención oncológica: como la estrategia de salud de la familia se percibe en la atención al paciente con cáncer

Introdução: A susceptibilidade genética aliada ao envelhecimento populacional, o estilo de vida, o meio ambiente eo processo de industrialização determinam o risco de adoecimento por câncer, segunda causa de morte na população brasileira. A Política Nacional de Atenção Oncológica desenvolvida pelo Instituto Nacional de Câncer José Alencar Gomes da Silva (INCA) prevê participação em todos os níveis de atenção à saúde e articulação intersetorial (tripartite). Objetivo: Analisar a percepção dos integrantes de equipes da Estratégia Saúde da Família do Município do Rio de Janeiro sobre sua inserção na Rede de Atenção oncológica, identificando dificuldades e facilidades no processo de trabalho. Método: Estudo qualitativo no qual realizaram-se entrevistas semiestruturadas, seguindo roteiro temático sobre o trabalho dos profissionais do Programa Saúde da Família, da Área Programática 5.2, capacitados pelo projeto Unidos pela Cura, que estimula a detecção precoce do câncer infantojuvenil, baseadas em seu movimento para acompanharem seus pacientes portadores de câncer e suas dificuldades no dia a dia. Resultado: Os participantes referiram descompasso entre a Atenção Básica e o INCA; dúvidas quanto ao processo de acompanhamento; e falta de acesso à informação sobre quem contatar. Conclusão: A proposta da Rede requer planejamento de ações estratégicasalinhadas ao princípio da integralidade do Sistema Único de Saúde (SUS) e da linha de cuidado. Para que a AtençãoBásica se defina como parte importante da linha do cuidado do câncer, há necessidade de educação permanente,educação continuada e organização de níveis de atenção articulados com a Rede de Atenção Oncológica

Glycosaminoglycan binding facilitates entry of a bacterial pathogen into central nervous systems.

Certain microbes invade brain microvascular endothelial cells (BMECs) to breach the blood-brain barrier (BBB) and establish central nervous system (CNS) infection. Here we use the leading meningitis pathogen group B Streptococcus (GBS) together with insect and mammalian infection models to probe a potential role of glycosaminoglycan (GAG) interactions in the pathogenesis of CNS entry. Site-directed mutagenesis of a GAG-binding domain of the surface GBS alpha C protein impeded GBS penetration of the Drosophila BBB in vivo and diminished GBS adherence to and invasion of human BMECs in vitro. Conversely, genetic impairment of GAG expression in flies or mice reduced GBS dissemination into the brain. These complementary approaches identify a role for bacterial-GAG interactions in the pathogenesis of CNS infection. Our results also highlight how the simpler yet genetically conserved Drosophila GAG pathways can provide a model organism to screen candidate molecules that can interrupt pathogen-GAG interactions for future therapeutic applications.

Host and pathogen glycosaminoglycan-binding proteins modulate antimicrobial peptide responses in Drosophila melanogaster.

During group B streptococcal infection, the alpha C protein (ACP) on the bacterial surface binds to host cell surface heparan sulfate proteoglycans (HSPGs) and facilitates entry of bacteria into human epithelial cells. Previous studies in a Drosophila melanogaster model showed that binding of ACP to the sulfated polysaccharide chains (glycosaminoglycans) of HSPGs promotes host death and is associated with higher bacterial burdens. We hypothesized that ACP-glycosaminoglycan binding might determine infection outcome by altering host responses to infection, such as expression of antimicrobial peptides. As glycosaminoglycans/HSPGs also interact with a number of endogenous secreted signaling molecules in Drosophila, we examined the effects of host and pathogen glycosaminoglycan/HSPG-binding structures in host survival of infection and antimicrobial peptide expression. Strikingly, host survival after infection with wild-type streptococci was enhanced among flies overexpressing the endogenous glycosaminoglycan/HSPG-binding morphogen Decapentaplegic-a transforming growth factor ß-like Drosophila homolog of mammalian bone morphogenetic proteins-but not by flies overexpressing a mutant, non-glycosaminoglycan-binding Decapentaplegic, or the other endogenous glycosaminoglycan/HSPG-binding morphogens, Hedgehog and Wingless. While ACP-glycosaminoglycan binding was associated with enhanced transcription of peptidoglycan recognition proteins and antimicrobial peptides, Decapentaplegic overexpression suppressed transcription of these genes during streptococcal infection. Further, the glycosaminoglycan-binding domain of ACP competed with Decapentaplegic for binding to the soluble glycosaminoglycan heparin in an in vitro assay. These data suggest that, in addition to promoting bacterial entry into host cells, ACP competes with Decapentaplegic for binding to glycosaminoglycans/HSPGs during infection and that these bacterial and endogenous glycosaminoglycan-binding structures determine host survival and regulate antimicrobial peptide transcription.

Host glycosaminoglycan confers susceptibility to bacterial infection in Drosophila melanogaster.

Many pathogens engage host cell surface glycosaminoglycans, but redundancy in pathogen adhesins and host glycosaminoglycan-anchoring proteins (heparan sulfate proteoglycans) has limited the understanding of the importance of glycosaminoglycan binding during infection. The alpha C protein of group B streptococcus, a virulence determinant for this neonatal human pathogen, binds to host glycosaminoglycan and mediates the entry of bacteria into human cells. We studied alpha C protein-glycosaminoglycan binding in Drosophila melanogaster, whose glycosaminoglycan repertoire resembles that of humans but whose genome includes only three characterized membrane heparan sulfate proteoglycan genes. The knockdown of glycosaminoglycan polymerases or of heparan sulfate proteoglycans reduced the cellular binding of alpha C protein. The interruption of alpha C protein-glycosaminoglycan binding was associated with longer host survival and a lower bacterial burden. These data indicate that the glycosaminoglycan-alpha C protein interaction involves multiple heparan sulfate proteoglycans and impairs bacterial killing. Host glycosaminoglycans, anchored by multiple proteoglycans, thereby determine susceptibility to infection. Because there is homology between Drosophila and human glycosaminoglycan/proteoglycan structures and many pathogens express glycosaminoglycan-binding structures, our data suggest that interfering with glycosaminoglycan binding may protect against infections in humans.

Clonally expanded mitochondrial DNA mutations in epileptic individuals with mutated DNA polymerase gamma.

The instability of the mitochondrial genome in individuals harboring pathogenic mutations in the catalytic subunit of mitochondrial DNA (mtDNA) polymerase gamma (POLG) is well recognized, but the underlying molecular mechanisms remain to be elucidated. In 5 pediatric patients with severe myoclonic epilepsy and valproic acid-induced liver failure, we identified 1 novel and 4 previously described pathogenic mutations in the linker region of this enzyme. Although muscle biopsies in these patients showed unremarkable histologic features, postmortem liver tissue available from 1 individual exhibited large cytochrome c oxidase-negative areas. These cytochrome c oxidase-negative areas contained 4-fold less mtDNA than cytochrome c oxidase-positive areas. Decreased copy numbers of mtDNA were observed not only in the liver, skeletal muscle, and brain but also in blood samples from all patients. There were also patient-specific patterns of multiple mtDNA deletions in different tissues, and in 2 patients, there were clonally expanded mtDNA point mutations. The low amount of deleted mtDNA molecules makes it unlikely that the deletions contribute significantly to the general biochemical defect. The clonal expansion of a few individual-specific deletions and point mutations indicates an accelerated segregation of early mtDNA mutations that likely are a consequence of low mtDNA copy numbers. Moreover, these results suggest a potential diagnostic approach for identifying mtDNA depletion in patients.

Apraxia of lid opening mimicking ptosis in compound heterozygosity for A467T and W748S POLG1 mutations.

Patients harboring A467T and W748S POLG1 mutations present with a broad variety of neurological phenotypes, including cerebellar ataxia, progressive external ophthalmoplegia (PEO), myoclonus, epilepsy, and peripheral neuropathy. With exception of ataxia and myoclonus, movement disorders are not typical features of POLG1 associated disorders. We report on two affected siblings compound heterozygous for A467T and W748S mutations, one suffering from choreoathetosis and apraxia of lid opening due to focal eyelid dystonia that mimicked progression of ptosis, resulting in functional blindness. So far, focal dystonia has not been reported in POLG1 mutation carriers, and should be considered when investigating patients with PEO and ptosis. Further studies on POLG1 mutations in focal dystonia are warranted.