Antibodies anti-rFilF protein has anti-biofilm activity against carbapenem-resistant Acinetobacter baumannii.

Acinetobacter baumannii is an opportunistic bacterium that causes infection in several sites. Carbapenem-resistant A. baumannii strains (CRAb) lead the World Health Organization's list of 12 pathogens considered a priority for developing new antimicrobials. The pathogenicity of A. baumannii is related to the different virulence factors employed in the colonization of biotic and abiotic surfaces, biofilm formation and multidrug resistance. We analyze the outer membrane protein FilF from A. baumannii in silico and produce it in recombinant form (rFilF). rFilF protein was successfully expressed in Escherichia coli BL21 Star in an insoluble form. Immunization with rFilF induced significant anti-rFilF IgG antibody production in mice, detected by indirect enzyme-linked immunosorbent assay, since the first evaluation until 49th. On the last experimentation day, the predominant immunoglobulin found was IgG1 followed by IgG2a, IgG2b, IgM, IgG3, and IgA. We observe that interleukins 4 and 10 show significant production after the 28th day of experimentation in mice immunized with rFilF. Anti-rFilF pAbs were able to inhibit biofilm formation in nine CRAb strains evaluated, and in the standard strain ATCC® 19606. These results demonstrate the anti-biofilm activity of anti-rFilF antibodies, promising in the development of a non-antibiotic approach based on the control of CRAb strains.

Long-Term Mortality and Health-Related Quality of Life After Continuous Versus Intermittent Renal Replacement Therapy in ICU Survivors: A Secondary Analysis of the Quality of Life After ICU Study.

Purpose: We assessed long-term outcomes in intensive care unit (ICU) survivors with acute kidney injury (AKI) submitted to intermittent or continuous renal replacement therapy (RRT) for comparisons between groups. Methods: The multicenter prospective cohort study included 195 adult ICU survivors with an ICU stay >72 h in 10 ICUs that had at least one episode of AKI treated with intermittent RRT (IRRT) or continuous RRT (CRRT) during ICU stay. The main outcomes were mortality and health-related quality of life (HRQoL). Hospital readmissions and physical dependence were also assessed. Results: Regarding RRT, 83 (42.6%) patients received IRRT and 112 (57.4%) received CRRT. Despite the similarity regarding sociodemographic characteristics, pre-ICU state of health and type of admission between groups, the risk of death (23.5% vs 42.7%; P < .001), the prevalence of sepsis (60.7%) and acute respiratory distress syndrome (17%) were higher at ICU admission among CRRT patients. The severity of critical illness was higher among CRRT patients, regarding the need for mechanical ventilation (75.0% vs 50.6%, P = .002) and vasopressors (91.1% vs 63.9%, P < .001). One year after ICU discharge, 67 of 195 ICU survivors died (34.4%) and, after adjustment for confounders, there were no significant differences in mortality when comparing IRRT and CRTT patients (34.9% vs 33.9%; P = .590), on HRQoL in both physical (41.9% vs 42.2%; P = .926) and mental dimensions (57.6% vs 56.6%; P = .340), and on the number of hospital readmissions and physical dependence. Conclusions: Our study suggests that among ICU survivors RRT modality (IRRT vs CRRT) in the ICU does not impact long-term outcomes after ICU discharge.

Multicenter evaluation of BioFire JI panel related to improved microbiological diagnostics on acute osteoarticular infections.

Microbiological diagnosis of osteoarticular infections (OI) is crucial for a successful treatment. A prospective multicenter study including 262 synovial fluids with suspicion of acute OI was performed between July 2021 and October of 2022. BioFire Joint Infection Panel multiplex-PCR test was performed and results were compared with conventional cultures of synovial fluid specimens. In total, 136 microorganisms were detected, and fourteen samples were positive for more than one microorganism. In monomicrobial infections (n = 87) agreement with culture was 69%. In 26 samples, the multiplex PCR yield an additional positive result when culture result was negative. It helped in the detection of fastidious microorganisms as K. kingae and N. gonorrhoeae. This multiplex PCR has proven to be a useful technique that can be used for patients with high suspicion of acute OI in a rapid and automated manner.

Predictors of early and long-term mortality after ICU discharge in critically ill COVID-19 patients: A prospective cohort study.

BACKGROUND: To mitigate mortality among critically ill COVID-19 patients, both during their Intensive Care Unit (ICU) stay and following ICU discharge, it is crucial to measure its frequency, identify predictors and to establish an appropriate post-ICU follow-up strategy. METHODS: In this multicentre, prospective cohort study, we included 586 critically ill COVID-19 patients. RESULTS: We observed an overall ICU mortality of 20.1% [95%CI: 17.1% to 23.6%] (118/586) and an overall hospital mortality of 25.4% [95%CI: 22.1% to 29.1%] (149/586). For ICU survivors, 30 days (early) post-ICU mortality was 5.3% [95%CI: 3.6% to 7.8%] (25/468) and one-year (late) post-ICU mortality was 7.9% [95%CI: 5.8% to 10.8%] (37/468). Pre-existing conditions/comorbidities were identified as the main independent predictors of mortality after ICU discharge: hypertension and heart failure were independent predictors of early mortality; and hypertension, chronic kidney disease, chronic obstructive pulmonary disease and cancer were independent predictors of late mortality. CONCLUSION: Early and late post-ICU mortality exhibited an initial surge (in the first 30 days post-ICU) followed by a subsequent decline over time. Close monitoring of critically ill COVID-19 post-ICU survivors, especially those with pre-existing conditions, is crucial to prevent adverse outcomes, reduce mortality and to establish an appropriate follow-up strategy.

Estrategias de afrontamiento centradas en las emociones de enfermeros de un hospital de Corrientes en el año 2022 / Coping strategies focused on emotions in nurses from a hospital in Corrientes in the year 2022

Introducción: el personal de enfermería enfrenta a diario jornadas extendidas de trabajo, tiene muchos pacientes a su cargo, dificultades en las relaciones interpersonales, que podrían desencadenar en estrés, para lo cual el individuo desarrolla un proceso de adaptación o desequilibrio y es por esta razón la importancia de contar con estrategias para afrontar las situaciones. Objetivos: el objetivo de este estudio fue analizar las estrategias de afrontamiento ante situaciones de estrés utilizadas por los profesionales de enfermería de un Hospital Público de la ciudad de Corrientes capital, así como su asociación con variables socio demográficas. Metodología: estudio de tipo cuantitativo, descriptivo, transversal y observacional. La población incluyó enfermeros de un hospital público de la ciudad de Corrientes en el período 2022. Se consideró como criterios de inclusión personal de enfermería que cumpla funciones asistenciales y su tiempo de labor fuera de 1 año o más; como criterios de exclusión, personal que tuviera dos o más puestos de trabajo y de criterios de eliminación aquellos enfermeros que no se encuentren presentes al momento de la encuesta. El cálculo del tamaño muestral se realizó a través del método probabilístico aleatorio simple resultando de éste 120 profesionales de enfermería. Para la recolección de datos, se aplicó una encuesta adaptada del cuestionario Ways of Coping Questionnaire de Lazarus y Folkman. Resultados: se evidenció que la estrategia de afrontamiento más utilizada por los enfermeros fue la reinterpretación positiva. Conclusión: a través de este estudio se logró reconocer las estrategias de afrontamiento que el personal de enfermería utilizó al momento de enfrentar situaciones o experiencias estresantes[AU]

Introduction: nursing staff face extended work days daily, have many patients under their care, difficulties in interpersonal relationships, which could trigger stress, for which the individual develops a process of adaptation or imbalance and it is for this reason the importance of having strategies to deal with situations. Objectives: the objective of this study was to analyze coping strategies in stressful situations used by nursing professionals from a Public Hospital in the capital city of Corrientes, as well as their association with sociodemographic variables. Methodology: quantitative, descriptive, cross-sectional and observational study. The population included nurses from a public hospital in the city of Corrientes in the period 2022. Inclusion criteria were considered nursing personnel who perform care functions and their time of work was 1 year or more; as exclusion criteria, personnel who had two or more jobs and as elimination criteria those nurses who were not present at the time of the survey. The calculation of the sample size was carried out through the simple random probabilistic method, resulting in 120 nursing professionals. For data collection, a survey adapted from the Ways of Coping Questionnaire by Lazarus and Folkman was applied. Results: it was evidenced that the coping strategy most used by nurses was positive reinterpretation. Conclusion: through this study, it was possible to recognize the coping strategies that the nursing staff used when facing stressful situations or experiences[AU]

Introdução: a equipe de enfermagem enfrenta diariamente jorna-das de trabalho extensas, tem muitos pacientes sob seus cuidados, dificuldades no relacionamento interpessoal, podendo desenca-dear estresse, para o qual o indivíduo desenvolve um processo de adaptação ou desequilíbrio e por isso a importância de se ter estra-tégias para lidar com as situações. Objetivos: o objetivo deste estudo foi analisar as estratégias de enfrentamento em situações estressan-tes utilizadas por profissionais de enfermagem de um Hospital Pú-blico da capital Corrientes, bem como sua associação com variáveis sociodemográficas. Metodologia: estudo quantitativo, descritivo, transversal e observacional. A população incluiu enfermeiros de um hospital público da cidade de Corrientes no período de 2022. Os critérios de inclusão foram considerados pessoal de enfermagem que desempenha funções assistenciais e seu tempo de trabalho foi de 1 ano ou mais; como critérios de exclusão, pessoal que exercesse dois ou mais vínculos empregatícios e como critérios de eliminação os enfermeiros que não estivessem presentes no momento da pes-quisa. O cálculo do tamanho da amostra foi realizado pelo método probabilístico aleatório simples, resultando em 120 profissionais de enfermagem. Para a coleta de dados, foi aplicado um questionário adaptado do Questionário de Modos de Enfrentamento de Lazarus e Folkman. Resultados: evidenciou-se que a estratégia de enfrenta-mento mais utilizada pelos enfermeiros foi a reinterpretação posi-tiva. Conclusão: Por meio deste estudo, foi possível reconhecer as estratégias de enfrentamento que a equipe de enfermagem utiliza diante de situações ou experiências estressantes[AU]

Antibacterial and antibiofilm activity of 1-thiocarbamoyl-3,5-diaryl-4,5-dihydro-1H pyrazoles and thiazoles in multidrug-resistant pathogens.

To find novel antibiotic drugs, six 1-thiocarbamoyl-3,5-diaryl-4,5-dihydro-1H derivatives named 1b, 1d (pyrazoles), 2a, 2b, 2c, and 2d (thiazoles) were evaluated in silico and in vitro. The in silico analyses were based on ADME pharmacokinetic parameters (absorption, distribution, metabolism, and excretion). The in vitro antibacterial activity was evaluated in Gram-positive and Gram-negative species (Staphylococcus aureus ATCC® 25904, Staphylococcus epidermidis ATCC® 35984, Klebsiella pneumoniae ATCC® 700603, and Acinetobacter baumannii ATCC® 19606), by determination of minimal inhibitory concentration (MIC), minimal bactericidal concentration (MBC), kinetics curve, and antibiofilm assays. As results, the azoles have activity against the Gram-negative species K. pneumoniae ATCC® 700603 and A. baumannii ATCC® 19606. No antibacterial activity was observed for the Gram-positive bacteria evaluated. Thus, the azoles were evaluated against clinical isolates of K. pneumoniae carbapenemase (KPC) and A. baumannii multidrug-resistant (Ab-MDR). All azoles have antibacterial activity against Ab-MDR isolates (Gram-negative) with MIC values between 512 µg/mL and 1,024 µg/mL. Against KPC isolates the azoles 1b, 1d, and 2d present antibacterial activity (MIC = 1,024 µg/mL). In the kinetics curve assay, the 1b and 1d pyrazoles reduced significantly viable cells of Ab-MDR isolates and additionally inhibited 86.6 to 95.8% of the biofilm formation. The in silico results indicate high possibility to permeate the blood-brain barrier (2b) and was predict human gastrointestinal absorption (all evaluated azoles). Considering that the research and development of new antibiotics is a priority for drug-resistant pathogens, our study revealed the antibacterial and antibiofilm activity of novel azoles against K. pneumoniae and A. baumannii pathogens.

Time Series of Counts under Censoring: A Bayesian Approach.

Censored data are frequently found in diverse fields including environmental monitoring, medicine, economics and social sciences. Censoring occurs when observations are available only for a restricted range, e.g., due to a detection limit. Ignoring censoring produces biased estimates and unreliable statistical inference. The aim of this work is to contribute to the modelling of time series of counts under censoring using convolution closed infinitely divisible (CCID) models. The emphasis is on estimation and inference problems, using Bayesian approaches with Approximate Bayesian Computation (ABC) and Gibbs sampler with Data Augmentation (GDA) algorithms.

Randomized clinical study of injectable dextrin-based hydrogel as a carrier of a synthetic bone substitute.

OBJECTIVES: This study aimed to improve the performance and mode of administration of a glass-reinforced hydroxyapatite synthetic bone substitute, Bonelike by Biosckin® (BL®), by association with a dextrin-based hydrogel, DEXGEL, to achieve an injectable and moldable device named DEXGEL Bone. METHODS: Twelve participants requiring pre-molar tooth extraction and implant placement were enrolled in this study. BL® granules (250-500 µm) were administered to 6 randomized participants whereas the other 6 received DEXGEL Bone. After 6 months, a bone biopsy of the grafted area was collected for histological and histomorphometric evaluation, prior to implant placement. The performance of DEXGEL Bone and BL® treatments on alveolar preservation were further analyzed by computed tomography and Hounsfield density analysis. Primary implant stability was analyzed by implant stability coefficient technique. RESULTS: The healing of defects was free of any local or systemic complications. Both treatments showed good osseointegration with no signs of adverse reaction. DEXGEL Bone exhibited increased granule resorption (p = 0.029) accompanied by a tendency for more new bone ingrowth (although not statistically significant) compared to the BL® group. The addition of DEXGEL to BL® granules did not compromise bone volume or density, being even beneficial for implant primary stability (p = 0.017). CONCLUSIONS: The hydrogel-reinforced biomaterial exhibited an easier handling, a better defect filling, and benefits in implant stability. CLINICAL RELEVANCE: This study validates DEXGEL Bone safety and performance as an injectable carrier of granular bone substitutes for alveolar ridge preservation. TRIAL REGISTRATION: European Databank on Medical Devices (EUDAMED) No. CIV-PT-18-01-02,705; Registo Nacional de Estudos Clínicos, RNEC, No. 30122.

Construção de curso sobre Mini-CEX na modalidade de ensino a distância para preceptores de residência médica / Construction of a course on Mini-CEX in the distance learning modality for medical residence preceptors

Resumo Introdução: A avaliação é primordial no processo de ensino-aprendizagem do médico residente. O Mini-CEX é considerado um instrumento apropriado para realizar uma avaliação formativa, permitindo um feedback educacional estruturado. Nesse contexto, os preceptores de residência precisam estar em contínuo processo de capacitação para melhor direcionar os seus residentes, e uma forma viável de capacitação é por meio do ensino a distância (EaD). Objetivo: Este estudo teve como objetivos desenvolver e validar um curso na modalidade de EaD sobre Mini-CEX para preceptores da residência em mastologia. Método: Trata-se de desenvolvimento e validação de um produto técnico-educacional no formato de curso de capacitação e na modalidade de EaD. No processo de validação de conteúdo do produto, utilizou-se a técnica de grupo de consenso. A validação semântica foi realizada através de questionário de validação aplicado aos preceptores envolvidos na residência em mastologia. Resultado: Foi elaborado e validado um curso autoinstrucional e sem mediação, com carga horária total de duas horas. O curso teve aprovação do público-alvo por apresentar um escore médio global de 98% de satisfação e um alfa de Cronbach igual a 0,8. Conclusão: O curso desenvolvido e validado sobre Mini-CEX apresenta-se como opção relevante para a formação de preceptores de residência médica em mastologia, podendo se estender para qualquer serviço de residência médica. Ressalta-se que o curso na modalidade de EaD favorece a adesão do público-alvo apresentando um formato acessível para fortalecer o conhecimento sobre o tema, além de incentivar os preceptores a utilizar a ferramenta de avaliação educacional.

Abstract Introduction: Assessment is paramount in the resident physician's teaching-learning process. The Mini-CEX is considered an appropriate instrument to carry out formative assessment, allowing structured educational feedback. In this context, residency preceptors need to undergo a continuous training process to better prepare their residents, and a viable form of training is using Distance Education (EaD). Objective: To develop and validate a Distance Education (EaD) course on Mini-CEX for residency preceptors in Mastology. Method: Development and validation of a technical-educational product, in the format of a training course and in the Distance Education modality (EaD). The consensus group technique was used in the product content validation process. Semantic validation was carried out through a validation questionnaire applied to the preceptors involved in the residency program in Mastology. Results: A self-instructional and unmediated course was designed and validated, with a total workload of 02 (two) hours. The course was approved by the target audience, as it had an overall average score of 98% satisfaction and a Cronbach's alpha equal to 0.8. Conclusions: The course developed and validated on Mini-CEX presents itself as a relevant option for the training of medical residency preceptors in Mastology and can be extended to any medical residency service. It should be noted that the Distance Education (EaD) course favors the adherence of the target audience, with an accessible format to strengthen knowledge on the subject, in addition to encouraging preceptors to also use the educational evaluation.

Immune and spermatogenesis-related loci are involved in the development of extreme patterns of male infertility.

We conducted a genome-wide association study in a large population of infertile men due to unexplained spermatogenic failure (SPGF). More than seven million genetic variants were analysed in 1,274 SPGF cases and 1,951 unaffected controls from two independent European cohorts. Two genomic regions were associated with the most severe histological pattern of SPGF, defined by Sertoli cell-only (SCO) phenotype, namely the MHC class II gene HLA-DRB1 (rs1136759, P = 1.32E-08, OR = 1.80) and an upstream locus of VRK1 (rs115054029, P = 4.24E-08, OR = 3.14), which encodes a protein kinase involved in the regulation of spermatogenesis. The SCO-associated rs1136759 allele (G) determines a serine in the position 13 of the HLA-DRß1 molecule located in the antigen-binding pocket. Overall, our data support the notion of unexplained SPGF as a complex trait influenced by common variation in the genome, with the SCO phenotype likely representing an immune-mediated condition.

Intramacrophage potential of a tetrahydropyridine: A promising compound in combating Mycobacterium tuberculosis.

Due to several obstacles in treating tuberculosis (TB), the search for new therapeutic alternatives remains a global priority. The nitrogenous heterocyclic compounds are promising in searching for new anti-Mycobacterium tuberculosis molecules, and our previous results highlight the potential of tetrahydropyridines. After exploring the antimycobacterial potential and putative mechanism of action of a tetrahydropyridine derivative (NUNL02), we seek to measure the oxidative stress caused by NUNL02 inside the extracellular replicating M. tuberculosis since it could be the reason for the NUNL02 bactericidal effect against replicating and starved M. tuberculosis; and to evaluate the anti-M. tuberculosis activity of NUNL02 against the intracellular bacillus (even combined with an anti-TB drug) to explore the potential of this tetrahydropyridine as a promising adjuvant for TB therapy. Briefly, we assessed the activity of NUNL02 against the H37Rv strain and evaluated the combination of NUNL02 and rifampicin (RIF), at previously defined subinhibitory concentrations, against intramacrophage M. tuberculosis. NUNL02, in addition to promote the oxidative stress inside the extracellular replicating M. tuberculosis as a possible indirect mechanism of action, also presented bactericidal potential as promising as RIF against intracellular bacilli. Thus, our findings reinforce NUNL02 as a promising scaffold for the development of new options for TB.

Injectable hydrogel as a carrier of vancomycin and a cathelicidin-derived peptide for osteomyelitis treatment.

A local drug delivery system that attempts to find a suitable balance between antimicrobial and regenerative actions was developed for osteomyelitis treatment (OM). This system combines the angiogenic and immunomodulatory peptide LLKKK18 (LL18) and vancomycin hydrochloride (VH), loaded into an injectable oxidized dextrin (ODEX)-based hydrogel (HG). In vitro cytotoxicity was analyzed in MC3T3-E1 pre-osteoblasts and erythrocytes. The kinetics of LL18 release was studied. Antimicrobial activity was assessed in vitro against a clinical Methicillin-Resistant Staphylococcus aureus (MRSA) strain. A rat model of acute OM was developed by direct inoculation into a tibia defect, concomitantly with the implantation of the drug-loaded HG. The local bioburden was quantified and damage in surrounding tissues was examined histologically. In vitro, ODEX-based HG displayed a safe hemolytic profile. Half of LL18 (53%) is released during the swelling phase at physiological pH, then being gradually released until complete HG degradation. LL18-loaded HG at 300 µM was the most effective peptide formulation in decreasing in vivo infection among concentrations ranging from 86 to 429 µM. The histopathological scores observed in vivo varied with the LL18 concentration in a dose-dependent manner. VH at 28 mM completely eradicated bacteria, although with substantial tissue injury. We have found that sub-millimolar doses of VH combined with LL18 at 300 µM may suffice to eradicate the infection, with reduced tissue damage. We propose an easy-to-handle, shape-fitting HG formulation with the potential to treat MRSA-infected bone with low VH doses associated with LL18.

Sedation, analgesia, and delirium management in Portugal: a survey and point prevalence study. / Abordagem da sedação, da analgesia e do delirium em Portugal: inquérito nacional e estudo de prevalência.

OBJECTIVE: To establish current Portuguese critical care practices regarding analgesia, sedation, and delirium based on a comparison between the activities reported and daily clinical practice. METHODS: A national survey was conducted among physicians invited to report their practice toward analgesia, sedation, and delirium in intensive care units. A point prevalence study was performed to analyze daily practices. RESULTS: A total of 117 physicians answered the survey, and 192 patients were included in the point prevalence study. Survey and point prevalence studies reflect a high sedation assessment (92%; 88.5%), with the Richmond Agitated Sedation Scale being the most reported and used scale (41.7%; 58.2%) and propofol being the most reported and used medication (91.4%; 58.6%). Midazolam prescribing was reported by 68.4% of responders, but a point prevalence study revealed a use of 27.6%.Although 46.4% of responders reported oversedation, this was actually documented in 32% of the patients. The survey reports the daily assessment of pain (92%) using standardized scales (71%). The same was identified in the point prevalence study, with 91.1% of analgesia assessment mainly with the Behavioral Pain Scale. In the survey, opioids were reported as the first analgesic. In clinical practice, acetaminophen was the first option (34.6%), followed by opioids. Delirium assessment was reported by 70% of physicians but was performed in less than 10% of the patients. CONCLUSION: The results from the survey did not accurately reflect the common practices in Portuguese intensive care units, as reported in the point prevalence study. Efforts should be made specifically to avoid oversedation and to promote delirium assessment.

OBJETIVO: Determinar as práticas atuais de cuidados intensivos em Portugal quanto à analgesia, à sedação e ao delirium, com base em uma comparação entre as atividades relatadas e a prática clínica diária. MÉTODOS: Inquérito nacional em que os médicos foram convidados a relatar sua prática em relação à analgesia, à sedação e ao delirium em unidades de terapia intensiva. Para analisar a prática diária, realizou-se um estudo de prevalência pontual. RESULTADOS: Responderam ao inquérito 117 médicos, e 192 pacientes foram incluídos no estudo de prevalência pontual. O inquérito e o estudo de prevalência mostraram uma avaliação generalizada do nível de sedação (92%; 88,5%). A Escala de Agitação e Sedação de Richmond foi a mais reportada e utilizada (41,7%; 58,2%), e o propofol foi o medicamento mais reportado e utilizado (91,4%; 58,6%). A prescrição de midazolam foi relatada por 68,4% dos respondentes, mas o estudo de prevalência pontual revelou a sua utilização em 27,6%.Embora 46,4% dos respondentes tenham relatado excesso de sedação, na realidade foi documentado em 32% dos pacientes. O inquérito relatou avaliação diária de dor (92%) com uso de escalas padronizadas (71%). Identificou-se resultado semelhante no estudo de prevalência pontual, com 91,1% de avaliação da analgesia feita principalmente com a Escala Comportamental de Dor. No inquérito, os opioides foram relatados como analgésicos de primeira linha. Na prática clínica, o paracetamol foi a primeira opção (34,6%), seguido de opioides. A avaliação do delirium foi relatada por 70% dos médicos, embora tenha sido realizada em menos de 10% dos pacientes. CONCLUSÃO: Os resultados do inquérito não refletiram com precisão as práticas habituais nas unidades de terapia intensiva portuguesas, tal como relatado no estudo de prevalência pontual. Devem ser feitos esforços principalmente para evitar o excesso de sedação e promover a avaliação do delirium.

Effects of Coir-Based Growing Medium with Municipal Solid Waste Compost or Biochar on Plant Growth, Mineral Nutrition, and Accumulation of Phytochemicals in Spinach.

The use of municipal solid waste compost (MSW) and biochar, two renewable resources with a low carbon footprint as components of substrates, may be an alternative to reducing peat and coir usage. The aim of this study was to assess the suitability of selectively collected MSW and biochar as components of the coir-based substrate to spinach grown. An experiment was carried out to evaluate five substrates, coir and four coir-based blends (coir + biochar + perlite, coir + municipal waste compost + perlite, coir + biochar + pine bark, and coir + biochar + pine bark) with 12% (v/v) MSW or biochar and 10% (v/v) perlite or pine bark. Spinach seedlings were transplanted into Styrofoam planting boxes filled with the substrate. Each planting box was irrigated daily by drip with a complete nutrient solution. Plants grown with MSW had a higher content of calcium. Shoot Mn increased in the biochar-containing mixes. The shoot dry weight of the plants grown in the different blends was higher than those grown in coir. Fresh yield was higher in mixes with MSW and perlite (3 kg/m2) or pine bark (2.87 kg/m2). Total phenols and DPPH antioxidant activity were not affected by the substrates. However, shoot ascorbate (AsA) content was higher or equal to those plants grown in coir. MSW and biochar are alternatives to reduce the use of coir and peat.

Common Variation in the PIN1 Locus Increases the Genetic Risk to Suffer from Sertoli Cell-Only Syndrome.

We aimed to analyze the role of the common genetic variants located in the PIN1 locus, a relevant prolyl isomerase required to control the proliferation of spermatogonial stem cells and the integrity of the blood-testis barrier, in the genetic risk of developing male infertility due to a severe spermatogenic failure (SPGF). Genotyping was performed using TaqMan genotyping assays for three PIN1 taggers (rs2287839, rs2233678 and rs62105751). The study cohort included 715 males diagnosed with SPGF and classified as suffering from non-obstructive azoospermia (NOA, n = 505) or severe oligospermia (SO, n = 210), and 1058 controls from the Iberian Peninsula. The allelic frequency differences between cases and controls were analyzed by the means of logistic regression models. A subtype specific genetic association with the subset of NOA patients classified as suffering from the Sertoli cell-only (SCO) syndrome was observed with the minor alleles showing strong risk effects for this subset (ORaddrs2287839 = 1.85 (1.17-2.93), ORaddrs2233678 = 1.62 (1.11-2.36), ORaddrs62105751 = 1.43 (1.06-1.93)). The causal variants were predicted to affect the binding of key transcription factors and to produce an altered PIN1 gene expression and isoform balance. In conclusion, common non-coding single-nucleotide polymorphisms located in PIN1 increase the genetic risk to develop SCO.

Abordagem da sedação, da analgesia e do delirium em Portugal: inquérito nacional e estudo de prevalência / Sedation, analgesia, and delirium management in Portugal: a survey and point prevalence study

RESUMO Objetivo: Determinar as práticas atuais de cuidados intensivos em Portugal quanto à analgesia, à sedação e ao delirium, com base em uma comparação entre as atividades relatadas e a prática clínica diária. Métodos: Inquérito nacional em que os médicos foram convidados a relatar sua prática em relação à analgesia, à sedação e ao delirium em unidades de terapia intensiva. Para analisar a prática diária, realizou-se um estudo de prevalência pontual. Resultados: Responderam ao inquérito 117 médicos, e 192 pacientes foram incluídos no estudo de prevalência pontual. O inquérito e o estudo de prevalência mostraram uma avaliação generalizada do nível de sedação (92%; 88,5%). A Escala de Agitação e Sedação de Richmond foi a mais reportada e utilizada (41,7%; 58,2%), e o propofol foi o medicamento mais reportado e utilizado (91,4%; 58,6%). A prescrição de midazolam foi relatada por 68,4% dos respondentes, mas o estudo de prevalência pontual revelou a sua utilização em 27,6%. Embora 46,4% dos respondentes tenham relatado excesso de sedação, na realidade foi documentado em 32% dos pacientes. O inquérito relatou avaliação diária de dor (92%) com uso de escalas padronizadas (71%). Identificou-se resultado semelhante no estudo de prevalência pontual, com 91,1% de avaliação da analgesia feita principalmente com a Escala Comportamental de Dor. No inquérito, os opioides foram relatados como analgésicos de primeira linha. Na prática clínica, o paracetamol foi a primeira opção (34,6%), seguido de opioides. A avaliação do delirium foi relatada por 70% dos médicos, embora tenha sido realizada em menos de 10% dos pacientes. Conclusão: Os resultados do inquérito não refletiram com precisão as práticas habituais nas unidades de terapia intensiva portuguesas, tal como relatado no estudo de prevalência pontual. Devem ser feitos esforços principalmente para evitar o excesso de sedação e promover a avaliação do delirium.

ABSTRACT Objective: To establish current Portuguese critical care practices regarding analgesia, sedation, and delirium based on a comparison between the activities reported and daily clinical practice. Methods: A national survey was conducted among physicians invited to report their practice toward analgesia, sedation, and delirium in intensive care units. A point prevalence study was performed to analyze daily practices. Results: A total of 117 physicians answered the survey, and 192 patients were included in the point prevalence study. Survey and point prevalence studies reflect a high sedation assessment (92%; 88.5%), with the Richmond Agitated Sedation Scale being the most reported and used scale (41.7%; 58.2%) and propofol being the most reported and used medication (91.4%; 58.6%). Midazolam prescribing was reported by 68.4% of responders, but a point prevalence study revealed a use of 27.6%. Although 46.4% of responders reported oversedation, this was actually documented in 32% of the patients. The survey reports the daily assessment of pain (92%) using standardized scales (71%). The same was identified in the point prevalence study, with 91.1% of analgesia assessment mainly with the Behavioral Pain Scale. In the survey, opioids were reported as the first analgesic. In clinical practice, acetaminophen was the first option (34.6%), followed by opioids. Delirium assessment was reported by 70% of physicians but was performed in less than 10% of the patients. Conclusion: The results from the survey did not accurately reflect the common practices in Portuguese intensive care units, as reported in the point prevalence study. Efforts should be made specifically to avoid oversedation and to promote delirium assessment.

Fatores preditivos e risco de queda nas pessoas idosas / Predictive factors and risk of fall in elderly people

Introdução: À medida que os anos passam, o risco de cair aumenta substancialmente e transforma a queda numa questão de saúde pública, não só, em virtude do aumento do número de idosos, na população mundial, como também na sua maior longevidade, sendo assim fundamental atuar rapidamente, para se poderem prevenir complicações e obter ganhos em saúde. A etiologia multifatorial das quedas torna complicada a sua prevenção, sendo por isso crucial, a identificação das pessoas com maior risco de cair, e os fatores que contribuem para tal. Objetivo: Analisar os fatores que concorrem para as quedas, nomeadamente no que se refere às características sociodemográficas, à condição de saúde e à perceção da pessoa idosa sobre a sua qualidade de vida. Metodologia: Trata-se de um estudo quantitativo, descritivo, exploratório e transversal, realizado numa unidade de saúde de uma região urbana, do norte de Portugal, no período de setembro de 2018 a julho de 2019, com a participação de 40 idosos, com idade mínima de 65 anos. Como instrumento de colheita de dados foi usado um formulário. Integrado no projeto Pt4Ageing, este estudo teve aprovação da Administração Regional de Saúde. Resultados: Dos 40 participantes do estudo, com uma idade média de 74,8 anos, 30% (n=12) tiveram quedas. Em relação ao sexo e idade das pessoas idosas que verbalizaram ter tido quedas nos últimos seis meses, 8 eram mulheres com idade média de 74,4 anos e 4 eram homens, com idade média de 78,3 anos. Em relação aos fatores sociodemográficos e à condição de saúde, confirmou-se associação significativa entre a ocorrência de quedas, o estado civil e a tensão arterial diastólica. A ocorrência de quedas é mais frequente nas pessoas idosas solteiras, divorciadas ou viúvas (p=0,018) e nos idosos com valores de tensão arterial diastólica inferiores (p=0,047). Também não se verificou associação significativa, no que se refere aos fatores relacionadas com as doenças, os sintomas, a medicação, a qualidade de vida e a ocorrência de quedas. Por outro lado, as pessoas idosas com dificuldade em andar (p=0,018), com desequilíbrios constantes (p=0,032) e com dor (p=0,02), apresentam perceção do risco de queda, evidenciando concomitantemente maior score na faceta Família/Vida Familiar (p=0,043). Conclusão: Apesar do tamanho da amostra ter limitado o aprofundamento da análise estatística, os resultados obtidos contribuem para a sistematização da intervenção do enfermeiro especialista em enfermagem de reabilitação, no âmbito da prevenção de quedas em idosos a viver no domicílio. A importância da consciencialização da pessoa idosa, a atuação precoce perante a dificuldade em andar e os desequilíbrios constantes, sendo áreas sensíveis à intervenção dos enfermeiros especialistas em enfermagem de reabilitação, tornar-se-ão extremamente relevantes para a prevenção de quedas

Introduction: As the years pass, the risk of falling increases substantially and turns falling into a public health issue, not only due to the increase in the number of elderly people in the world population, but also in its greater longevity, thus It is essential to act quickly to prevent complications and obtain health gains. The multifactorial etiology of falls makes its prevention complicated, and it is therefore crucial to identify people at greater risk of falling, and the factors that contribute to it. Objective: To analyse the factors that contribute to falls, namely about sociodemographic characteristics, health status and the elderly person's perception of their quality of life. Methodology: This is a quantitative, descriptive, exploratory, and cross-sectional study, carried out in a health unit in an urban region, north of Portugal, from September 2018 to July 2019, with the participation of 40 elderly people, with Minimum age of 65 years. As a data collection instrument, a form was used. As part of the Pt4Ageing project, this study was approved by the Regional Health Administration. Results: Of the 40 study participants, with a mean age of 74.8 years, 30% (n=12) had falls. Regarding the gender and age of the elderly people who reported having had falls in the last six months, 8 were women with an average age of 74.4 years and 4 were men, with an average age of 78.3 years. Regarding sociodemographic factors and health status, a significant association was confirmed between the occurrence of falls, marital status and diastolic blood pressure. The occurrence of falls is more frequent in single, divorced or widowed elderly people (p=0.018) and in elderly people with lower diastolic blood pressure values (p=0.047). There was also no significant association about factors related to diseases, symptoms, medication, quality of life and the occurrence of falls. On the other hand, elderly people with difficulty walking (p=0.018), with constant imbalances (p=0.032) and with pain (p=0.02), present a perception of the risk of falling, showing concomitantly a higher score in the Family facet /Family Life (p=0.043). Conclusion: Despite the sample size having limited the depth of statistical analysis, the results obtained contribute to the systematization of the intervention of specialist nurses in rehabilitation nursing, in the context of preventing falls in elderly people living at home. The importance of raising awareness among the elderly, acting early in the face of difficulty in walking and constant imbalances, which are areas that are sensitive to the intervention of specialist nurses in rehabilitation nursing, will become extremely relevant for the prevention of falls.