The effects of using heel protectors on the prevention of heel pressure injuries and plantar flexion contractures.

BACKGROUND: Immobilization in the intensive care unit can lead to pressure injuries and plantar flexion contractures. AIM: This study was conducted to evaluate the effectiveness of heel protectors applied for the prevention of heel pressure injuries and plantar flexion contractures in intensive care units. METHODOLOGY: This study was conducted as a randomized controlled trial in two adult intensive care units of a teaching and research hospital. The study sample consisted of 84 patients admitted to intensive care units between January 2022 and December 2022. Patients who had been in the intensive care unit for at least 5 days, scored 16 or less on the Braden Pressure Ulcer Risk Assessment Scale and scored 4 or more on the Ramsey Sedation Scale, were included in the study. Heel protector boots were applied to the heels of the patients in the intervention group, while standard positioning with a pillow and ROM exercises were continued in the control group. A sociodemographic data form, the Ramsey Sedation Scale and the Braden Pressure Ulcer Risk Assessment Scale were used to collect data. While pressure injuries were evaluated with the International NPUAP-EPUAP Pressure Ulcer Classification System, goniometric measurements were made to evaluate joint ROM. RESULTS: In the intervention group, heel pressure injuries did not develop during the study, whereas five patients in the control group developed heel pressure injuries. The risk of pressure injury development that was seen in the control group was 1.7 times higher compared with the risk for the intervention group (log 95% CI: 0.91-2.59). There were significant differences between the right foot (99%; F = 99.229; p = .000) and left foot (99%; F = 100.519; p = .000) in range of motion measurement values of the patients in the intervention group according to the measurement times. According to the results of the multiple comparison test (Bonferroni) performed to determine the range of motion measurement periods showing significant differences, it was observed that each measurement for both feet yielded lower results than the previous measurement (seven measurements from day 1 to day 13). CONCLUSION: The use of heel protector boots was found to be effective in preventing the development of heel pressure injuries and plantar flexion contractures in intensive care unit patients. RELEVANCE FOR CLINICAL PRACTICE: This study provides evidence that intensive care nurses can use heel protector boots to prevent the development of heel pressure injuries and plantar flexion contractures.

Engineering Acetobacterium woodii for the production of isopropanol and acetone from carbon dioxide and hydrogen.

The capability of four genetically modified Acetobacterium woodii strains for improved production of acetone from CO2 and hydrogen was tested. The acetone biosynthesis pathway was constructed by combining genes from Clostridium acetobutylicum and Clostridium aceticum. Expression of acetone production genes was demonstrated in all strains. In bioreactors with continuous gas supply, all produced acetic acid, acetone, and, surprisingly, isopropanol. The production of isopropanol was caused by an endogenous secondary alcohol dehydrogenase (SADH) activity at low gas-feeding rate. Although high amounts of the natural end product acetic acid of A. woodii were formed,14.5 mM isopropanol and 7.6 mM acetone were also detected, showing that this is a promising approach for the production of new solvents from C1 gases. The highest acetic acid, acetone, and isopropanol production was detected in the recombinant A. woodii [pJIR750_ac1t1] strain, with final concentrations of 438 mM acetic acid, 7.6 mM acetone, and 14.5 mM isopropanol. The engineered strain A. woodii [pJIR750_ac1t1] was found to be the most promising strain for acetone production from a gas mixture of CO2 and H2 and the formation of isopropanol in A. woodii was shown for the first time.

Autotrophic (C1-gas) versus heterotrophic (fructose) accumulation of acetic acid and ethanol in Clostridium aceticum.

The influence of the carbon source on the metabolism and growth of Clostridium aceticum was investigated, supplying either CO or fructose as sole carbon source. The acid and solvent production patterns were determined under either autotrophic or heterotrophic conditions, elucidating the effect of pH on the substrate's bioconversion pattern. The highest maximum specific growth rate was observed with CO, under the organism's optimal growth conditions, reaching 0.052 h-1 and an acetic acid concentration of 18 g·L-1. The production of 4.4 g·L-1 ethanol was also possible, after medium acidification, during CO bioconversion. Conversely, formic acid inhibition was observed during fructose fermentation under optimal growth conditions. In the latter experiments, it was not possible to stimulate solvent production when growing C. aceticum on fructose, despite applying the same medium acidification strategy as with CO, showing the selective effect of the carbon source (autotrophic vs heterotrophic) on the metabolic pattern and solventogenesis.

The Quality of Life, Depression Levels and Coping Styles of Patients on Kidney Transplant Waiting List.

This study aims to understand the coping strategies, depression levels, sociodemographic characteristics of Turkish patients with hemodialysis, and the other factors explain quality of life levels. This research is a cross-sectional study. The convenience sampling consisted of 292 patients with hemodialysis. The data were collected using the brief COPE, QOL, Beck Depression Inventory and sociodemographic form. According to the research results, patients show mild (score range 10-16) depression symptoms. One of the most important findings of this study is that the coping strategies and level of depression with chronic kidney patients accounted for a significant amount of variance in their quality of life. The relationship between emotion-focused coping strategy and quality of life was not statistically significant. In addition, high level of depression in chronic renal failure patients significantly reduce the quality of life. As a result of the study, the relationship between the high quality of life of patients who use problem-focused coping strategy more intensively and patients with low depression levels was determined. The findings point to the importance of taking individual coping strategies into account when evaluating the impact of a disease on psychosocial wellbeing. Delineation of coping strategies might be useful for identifying patients in need of particular counseling and support. These patients should have frequent contact with a multidisciplinary team of health care givers, possibly allowing for early diagnosis and prompt treatment. Results suggest targeted interventions to stimulate future research regarding the psychological care of patients with chronic kidney disease.

Familial Mediterranean Fever with Neonatal Onset: Case Report.

Familial Mediterranean fever (FMF) is an autosomal recessively inherited disorder characterized by recurrent fever and attacks of abdominal pain, chest pain, and joint pain. Attacks of recurrent fever and serositis are encountered clinically. Attacks may present either with only one symptom or many simultaneous symptoms. Although most of the patients are diagnosed clinically above the age of 2, those cases who are diagnosed before 2 years of age and with clinical course of isolated fever are believed to have a more serious course and tend to develop amyloidosis. In this article, a case who was admitted first on the 22nd day of life and later diagnosed to have FMF with recurrent attacks of isolated fever and no other focus is presented. We emphasize that FMF may present as early as in the first month of life, and it should be considered in cases presenting with fever of unknown origin and misdiagnosed to have late neonatal sepsis or occult bacteremia at this age group.

Solventogenesis in Clostridium aceticum producing high concentrations of ethanol from syngas.

The ethanol production capability of Clostridium aceticum was investigated and optimized, in order to evaluate the ability of that organism to produce high concentrations of fuel-ethanol. The results showed that C. aceticum can produce significant amounts of ethanol when a natural pH drop occurs in the fermentation broth as a consequence of acetic acid production in a first stage. Applying different pH-regulating strategies allowed to optimize ethanol production, which proved to be more efficient in case of natural acidification due to acetic acid, reaching up to 5.6 g/L ethanol, compared to artificial pH adjustment through the addition of hydrogen chloride. Playing with the pH value and the bioreactor operating conditions showed that, under specific conditions, C. aceticum is able to perform the reverse reaction as well and convert ethanol, produced at low pH, back to acetic acid, impeding, under those specific conditions, further accumulation of ethanol in the fermentation broth.