Gender perspective in the implementation of hygiene in cardiology intensive care.

INTRODUCTION: Hygiene in critical patients is an essential daily care, provided under safe conditions, to promote comfort and maintain the integrity of skin and mucous membranes, however, it can generate feelings of dependence and vulnerability in patients. The aim of this post hoc study is to know the differences in satisfaction and lived experience regarding bed hygiene in an intensive care unit according to biological sex and gender perspective. METHODS: Observational, descriptive and prospective study in which an ad hoc questionnaire was administered to 148 conscious and oriented patients of legal age. The questionnaire was completed 24-48 hours after admission to the unit, once the initial bed hygiene had been performed. RESULTS: Males experienced conformism (51%), embarrassment (31%) and relief (9%); Women felt conformism (35.4%), embarrassment (18.8%) and relief (29.2%) (p < 0.05). Women experienced a feeling of cleanliness in 89.1% compared to 56.1% of men (p < 0.05). Men were offered to wash their genitals in 72.9% compared to 35.7% of women (p < 0.05). 34.3% of men would prefer a family member to assist them during hygiene (62.9% by their wives), compared to 27.1% of women who would prefer a family member (84.6% by their daughters). CONCLUSION: Women tolerate bed hygiene better than men and appreciate more the feeling of cleanliness. Women are identified as caregivers, both professionally and in the family, and patients prefer them to collaborate in the performance of hygiene, being wives preferred by men and daughters preferred by women.

Mitral valve-in-valve implantation: A case report.

INTRODUCTION: Mitral valve-in-valve implantation is a new therapeutic tool in the field of structural interventional cardiology for patients with bioprosthetic dysfunction due to severe mitral valve regurgitation and high surgical risk. The objective was to develop an individualised nursing care plan for a patient undergoing this procedure; the first case in our centre. CASE DESCRIPTION: A 75-year-old woman, independent for activities of daily living, with a history of chronic renal failure and biological mitral valve replacement due to rheumatic valve disease. She was admitted to the acute cardiac care unit for severe symptomatic mitral valve regurgitations secondary to mitral bioprosthesis dysfunction. Heart surgery was ruled out due to comorbidities and high surgical risk, and the patient underwent percutaneous mitral valve-in-valve implantation. The implantation was successful. ASSESSMENT: The nursing assessment followed Marjory Gordon's conceptual model identifying the following impaired patterns: pattern 2: bilateral malleolar oedema without pitting; pattern 3: urinary catheter and intravenous diuretic use; pattern 4: dyspnoea on moderate exertion, dry nocturnal cough, orthopnoea and respiratory disturbances, and activity intolerance; pattern 5: need for pharmacological assistance for a good night's rest. DIAGNOSES: The following nursing diagnoses were established using the NANDA taxonomy: Excess fluid volume; ineffective breathing pattern; Activity intolerance and problem collaborating: Hypotension and anaemia secondary to deep thigh haematoma. PLANNING: The following objectives were set based on the NOC taxonomy: Fluid balance; Respiratory status: ventilation; Cardiopulmonary status and the following NIC interventions: Hypervolaemia management; Respiratory monitoring and oxygen therapy; Vital sign monitoring and heart care. DISCUSSION: Nursing interventions aimed at monitoring haemodynamic status, fluid restriction together with the efficacy of diuretic treatment achieved a negative water balance which contributed to fluid depletion improving respiratory symptoms, enabling implantation under better conditions. CONCLUSIONS: Technological progress in the health sciences, and in the field of acute cardiology in particular, directly calls for training, revision and updating of critical care nursing. Given this dynamic and continually evolving process, the specialist intensive care nurse, the inclusion of the cardiovascular nurse specialist in multidisciplinary teams such as the heart team, and expanding the consultation of the haemodynamic nurse are urgently required to ensure optimal nursing care, safety, and care quality.

Valve in valve mitral: a propósito de un caso / Mitral valve-in-valve implantation: A case report

Introducción: El implante valve in valve mitral es una nueva herramienta terapéutica que ha surgido recientemente en el campo del intervencionismo estructural en cardiología para pacientes con disfunción bioprotésica por insuficiencia mitral severa y alto riesgo quirúrgico. El objetivo es elaborar un plan de cuidados enfermero individualizado destinado a una paciente que se somete a este procedimiento, siendo el primer caso en nuestro centro. Descripción del caso: Mujer de 75años, independiente para las actividades de la vida diaria, con antecedentes de insuficiencia renal crónica y recambio valvular mitral biológico por valvulopatía reumática. Ingresada en la unidad de cuidados cardiológicos agudos por insuficiencia mitral severa sintomática secundaria a disfunción de la bioprótesis mitral. Descartada para cirugía cardíaca por comorbilidades y alto riesgo quirúrgico, se procedió al valve in valve mitral percutáneo, siendo exitoso su implante. Valoración: La valoración enfermera se realizó siguiendo el modelo conceptual de Marjory Gordon, donde se identificaron los siguientes patrones alterados: patrón2: edemas maleolares bilaterales sin fovea; patrón3: sondaje vesical y uso de diurético intravenoso; patrón4: disnea a moderados esfuerzos, tos seca nocturna, ortopnea y alteraciones respiratorias e intolerancia a la actividad; patrón5: necesidad de ayuda farmacológica para el buen descanso nocturno. Diagnósticos: Mediante la taxonomía NANDA se establecieron los diagnósticos enfermeros: Exceso de volumen de líquidos; Patrón respiratorio ineficaz; Intolerancia a la actividad y el problema de colaboración: Hipotensión y anemización secundaria al hematoma profundo en muslo.(AU)

Introduction: Mitral valve-in-valve implantation is a new therapeutic tool in the field of structural interventional cardiology for patients with bioprosthetic dysfunction due to severe mitral valve regurgitation and high surgical risk. The objective was to develop an individualised nursing care plan for a patient undergoing this procedure; the first case in our centre. Case description: A 75-year-old woman, independent for activities of daily living, with a history of chronic renal failure and biological mitral valve replacement due to rheumatic valve disease. She was admitted to the acute cardiac care unit for severe symptomatic mitral valve regurgitations secondary to mitral bioprosthesis dysfunction. Heart surgery was ruled out due to comorbidities and high surgical risk, and the patient underwent percutaneous mitral valve-in-valve implantation. The implantation was successful. Assessment: The nursing assessment followed Marjory Gordon's conceptual model identifying the following impaired patterns: pattern2: bilateral malleolar oedema without pitting; pattern3: urinary catheter and intravenous diuretic use; pattern4: dyspnoea on moderate exertion, dry nocturnal cough, orthopnoea and respiratory disturbances, and activity intolerance; pattern5: need for pharmacological assistance for a good night's rest.Diagnoses: The following nursing diagnoses were established using the NANDA taxonomy: Excess fluid volume; Ineffective breathing pattern; Activity intolerance and problem collaborating; Hypotension and anaemia secondary to deep thigh haematoma.(AU)

Diversity of endosymbiotic Nostoc in Gunnera magellanica from Tierra del Fuego, Chile [corrected].

Global warming is causing ice retreat in glaciers worldwide, most visibly over the last few decades in some areas of the planet. One of the most affected areas is the region of Tierra del Fuego (southern South America). Vascular plant recolonisation of recently deglaciated areas in this region is initiated by Gunnera magellanica, which forms symbiotic associations with the cyanobacterial genus Nostoc, a trait that likely confers advantages in this colonisation process. This symbiotic association in the genus Gunnera is notable as it represents the only known symbiotic relationship between angiosperms and cyanobacteria. The aim of this work was to study the genetic diversity of the Nostoc symbionts in Gunnera at three different, nested scale levels: specimen, population and region. Three different genomic regions were examined in the study: a fragment of the small subunit ribosomal RNA gene (16S), the RuBisCO large subunit gene coupled with its promoter sequence and a chaperon-like protein (rbcLX) and the ribosomal internal transcribed spacer (ITS) region. The identity of Nostoc as the symbiont was confirmed in all the infected rhizome tissue analysed. Strains isolated in the present study were closely related to strains known to form symbioses with other organisms, such as lichen-forming fungi or bryophytes. We found 12 unique haplotypes in the 16S rRNA (small subunit) region analysis, 19 unique haplotypes in the ITS region analysis and 57 in the RuBisCO proteins region (rbcLX). No genetic variability was found among Nostoc symbionts within a single host plant while Nostoc populations among different host plants within a given sampling site revealed major differences. Noteworthy, interpopulation variation was also shown between recently deglaciated soils and more ancient ones, between eastern and western sites and between northern and southern slopes of Cordillera Darwin. The cell structure of the symbiotic relationship was observed with low-temperature scanning electron microscopy, showing changes in morphology of both cyanobiont cells (differentiate more heterocysts) and plant cells (increased size). Developmental stages of the symbiosis, including cell walls and membranes and EPS matrix states, were also observed.

Towards a more realistic picture of in situ biocide actions: combining physiological and microscopy techniques.

In this study, we combined chlorophyll a fluorescence (ChlaF) measurements, using pulse-amplitude-modulate (PAM) equipment, with scanning electron microscopy in backscattered electron mode (SEM-BSE) and transmission electron microscopy (TEM) images to evaluate the actions of Koretrel at lower concentrations on Verrucaria nigrescens colonising a dolostone. ChlaF measurements are good indicators of the damaging effects of biocides. However, these indicators only provide an incomplete view of the mechanism of biocides used to control biodeterioration agents. The death of the V. nigrescens photobiont at two biocide concentrations was revealed by PAM, SEM-BSE and TEM. Once Koretrel was applied, the Fv/Fm ratios markedly fell in the first few hours after the 1.5% treatment, and ratios for the 3% dilution remained close to zero throughout the study. The algal zone shows the plasmolysed appearance of the photobiont cells, and important aspects related to the action of the biocide on free and lichenised fungi were also detected using SEM-BSE. Many of the mycobiont cells had only their cell walls preserved; although, some fungal hyphae in lichen thalli and some microorganisms in endolithic clusters maintained lipid storage in their cytoplasm. These results indicated that the combination of physiological and microscopy techniques improves the assessment of biocide action in situ and this will help to optimize protocols in order to reduce the emission of these compounds to the environment.