Prevalence, severity, and characteristics of medical device related pressure injuries in adult intensive care patients: A prospective observational study.

This study was intended to determine the characteristics of Medical Related Pressure Injury (MDRPI) in adult intensive care patients. MDRIs are recognized as significant and complex health problems among hospitalized patients. Underestimated true scale of the problem is evident because the systematic clinical evaluation of MDRPI occurrence is not part of routine skin assessment among intensive care patients. A prospective approach was used to obtain data of MDRPIs with two weeks follow up to monitor the prevention and treatment strategies. Participants were 329 adult patients from three large referral and teaching centres in Jordan. Data were collected using a screening form that included demographic and clinical characteristics, and a list of medical devices. The primary outcome for this study was MDRPI and defined as a pressure injury (PI) found on the skin or mucous membrane with a medical device in use at the location of the injury (EPUAP, 2019). The patients with MDRPI were followed up for 2 weeks for prevention and treatment strategies. Prevalence of MDRPI was 5.01% (15/299) with 41 injuries, 27/41 (65.8%) were skin injuries and 14/41(34.2%) were mucosal. Most mucous membrane MDRPIs were at mouth/lips and caused by ET tube and meatal orifice caused by foley catheter. Skin MDRPIs were at the nose and caused by NG tube and hands by peripheral intravenous line and arms caused by blood pressure cuff. Inadequate prevention was provided on daily care as only 177 prevention and treatment interventions were provided over 2 weeks for 15 patients. As a growing problem among Jordanian adults in intensive care, MDRPI required the need for effective prevention. About one-thirds of MDRPIs were mucosal, a finding not previously reported, indicating the need to include mucous membrane assessment with skin assessment when a medical device such as NG and ET tubes or foley catheters are in use. Prevention and treatment interventions provided to patients with MDRPIs were not systematic and based on routine care with no clear guidelines. A consensus has yet to be reached suggesting the need to establish effective prevention strategies for medical device-related pressure injuries. Future research is recommended to follow up MDRPI prevention and treatment strategies among patients in ICU. We suggest to continue studying the prevalence of MDRPIs and monitoring the location, prevention and treatment of both skin and mucosal MDRPIs.

A single oral dose of celecoxib-loaded solid lipid nanoparticles for treatment of different developmental stages of experimental schistosomiasis mansoni.

Schistosomiasis, a neglected tropical parasitic disease, is associated with severe pathology, mortality and economic loss. The treatment and control of schistosomiasis depends mainly on a single dose of praziquantel (PZQ). Drug repurposing and nanomedicine attract great attention to improve anti-schistosomal therapy. Previously, we reported that celecoxib (CELE), the non-steroidal anti-inflammatory drug, showed potent anti-schistosomal efficacy in an oral dose of 20 mg/kg/day for five days against different developmental stages of Schistosoma mansoni (S. mansoni) infection in mice. The aim of the current study was to shorten the duration of CELE treatment to reach an effective single oral dose against different developmental stages of S. mansoni infection using solid lipid nanoparticles (SLNs) as nano-carriers. The latter enhance the solubility, bioavailability and drug delivery and hence can decrease the frequency of administration which is of great clinical value. CELE-loaded SLNs showed good colloidal properties, high entrapment efficiency and drug loading, sustained biphasic release pattern with excellent storage stability. The used regimen was efficient against different developmental stages of S. mansoni infection with the most pronounced effect against the juvenile stage where the worm load, the hepatic egg count and the intestinal egg count were reduced by 86.39%, 91.45% and 90.11%, respectively. Meanwhile, when targeting the invasive and the adult stages, it induced reduction in the worm load by 73.55% and 78.22%, the hepatic egg count by 69.99% and 75.39% and the intestinal egg count by 77.57% and 79.89%, respectively. Additionally, CELE-loaded SLNs caused extensive tegumental damage of adult worms and marked improvement in the liver pathology.

Effect of celecoxib against different developmental stages of experimental Schistosoma mansoni infection.

Due to the high prevalence of schistosomiasis and the wide use of praziquantel solely for mass drug administration to control the disease, there is a great concern about the potential emergence of reduced susceptibility strains. This, together with the concern that praziquantel is ineffective against juvenile worms highlight the importance of developing an alternative anti-schistosomal drug. Using nonsteroidal anti-inflammatory drugs against schistosome infection is considerable. The present study evaluated the effect of oral administration of five days celecoxib regimen (20 mg/kg/day) against different developmental stages of Schistosoma mansoni infection. This regimen induced significant reduction in worm burden, tissue egg count, individual female fecundity and the mean percentage of immature and mature eggs with increased mean percentage of dead eggs. More importantly, celecoxib was more potent than praziquantel in all these parasitological parameters (except in the worm burden when given against the adult stage where the difference was statistically non-significant). Scanning and transmission electron microscopy of the adult worms revealed severe tegumental damage, laceration of the muscular layers and oedema of the syncytial layer. There was disruption of the testicular, ovarian and vitelline glandular tissues with signs of apoptosis and abnormalities of the spermatozoa and the oocytes. Additionally, celecoxib induced reduction in the number and the size of the hepatic granulomata and also amelioration of the hepatic tissue pathology.