The anti-candidal activity of Pelargonium graveolens essential oils against clinical isolates of Candida albicans

Objectives: Candida albicans as important opportunistic dimorphic fungi can cause the life threatening infections in humans. In this study, we evaluated the anticandidal activities of six samples of Pelargonium graveolens essential oils against 31 clinical isolates of C.albicans. Materials and methods: The anti-candidal activity was performed by disc diffusion and micro-broth dilution assays. The chemical compositions of essential oils were analyzed by Gas Chromatography (GC) apparatus. Results: P. graveolens essential oil samples with citronellol (7.7-43.7%) and geraniol (19.3-48.5%) showed the same anti-candidal activity in two different methods. There is no significant difference between the inhibition zone diameters (19.3-24.1 mm), and the MIC and MFC values (1.06-1.48 and 1.5-1.72 µl/ml) of essential oil samples with different percent of citronellol and geraniol. Conclusion: Therefore, P.graveolens essential oils can be used as anti-candidal agent for further studies.

Objetivos: Candida albicans es un importante hongo dimórfico oportunista que puede llegar a amenazar la vida de pacientes con inmunosupresión. En este estudio se evaluaron las actividades anti-Candida de seis muestras de aceites esenciales de Pelargonium graveolens contra 31 aislamientos clínicos de C. albicans. Materiales y métodos: La actividad anti-Candida se realizó por difusión en disco y ensayos de dilución micro-caldo. La composición química de los aceites esenciales se analizó mediante cromatografía de gases. Resultados: Las muestras de aceite esencial de P. graveolens con citronelol (7,7 a 43,7%) y geraniol (19,3 a 48,5%) mostraron la actividad anti-Candida en dos métodos diferentes. No hubo ninguna diferencia significativa entre los diámetros de la zona de inhibición (19,3-24,1 mm), y valores de MFC (1,06 a 1,48 y de 1,5 a 1,72 l / ml) de muestras de aceites esenciales con diferentes porcentajes de citronelol y geraniol. Conclusión: Los aceites esenciales de P.graveolens se pueden utilizar como agentes anti-Candida para estudios adicionales.

Frecuencia de los diagnósticos de enfermería en el primer ingreso del paciente con un trasplante renal reciente / Frequency of nursing diagnoses on the first admission of the patient with a recent renal transplant

La insuficiencia renal crónica es un problema de salud cuya prevalencia ha ido en aumento y que conlleva serias implicaciones para el paciente. El trasplante renal mejora la calidad de vida de estos pacientes pero les obliga a modificar hábitos en su vida diaria. La enfermería busca el compromiso del paciente con su autocuidado para evitar el rechazo del órgano trasplantado y para ello es importante sistematizar el trabajo a través de planes de cuidados adecuados a la situación de cada paciente y a sus necesidades. Se trata de un estudio descriptivo retrospectivo cuyo objetivo fue conocer los diagnósticos de enfermería (DxE) más frecuentes en el primer ingreso postrasplante, así como el motivo por el que ingresan, y se realizó sobre todos aquellos pacientes que recibieron un trasplante renal, en el Hospital Clínico San Carlos de Madrid, durante el periodo 2010 a 2014. Durante este periodo se realizaron 331 trasplantes, de los cuales ingresaron durante el año postraplante el 50.8% (167). En el primer ingreso tras el trasplante renal se asignaron una mediana de 4 DxE (RI=2-7) por paciente, siendo los más frecuentes Riesgo de Infección con un 25,1% (83), Dolor agudo con un 11,8% (39) y Conocimientos deficientes con un 10,3% (34). Conocer los DxE más frecuentes nos permite establecer planes de cuidados que mejoren la calidad asistencial e intentar prevenir posibles complicaciones del trasplante que perjudican la calidad de vida del paciente. Esto nos ayudará a reducir costes en el tratamiento, y lo que es más importante, a aumentar la satisfacción del paciente y su seguridad, al mismo tiempo que le ayudamos a recuperar su salud (AU)

Chronic kidney failure is a health problem whose prevalence has increased and has serious implications for the patient. Renal transplantation improves the quality of life of these patients but it forces them to modify habits in their daily life. The nurse seeks the commitment of the patient with their self-care to avoid rejection of the transplanted organ and for this it is important to systematize the work through plans of care appropriate to the situation of each patient and their needs. A retrospective descriptive study was carried out. The aim was to know the most frequent nursing diagnoses (NxD) in the first post-transplant admission, as well as the reason for the admission. All patients who received a kidney transplant at the Hospital Clínico San Carlos of Madrid, during the period 2010 to 2014, were included. During this period, 331 transplants were performed, of which 50.8% (167) were admitted during the post-transplant year. In the first admission after kidney transplantation, a median of 4 NxD (RI = 2-7) per patient was assigned, being the most frequent ‘Infection Risk’ with 25.1% (83), ‘Acute Pain’ with 11.8% (39) and ‘Poor Knowledge’ with 10.3% (34). Knowing the most frequent NxD, allows establishing plans of care that improve the quality of care and try to prevent possible complications of transplantation that affect the quality of life of the patient. This fact will help reduce costs in treatment, and more importantly, increase patient satisfaction and safety, while at the same time recover their health (AU)

Cardiac Transplant Postoperative Management and Care.

Heart failure impacts a multitude of individuals each year. Treatment is based on the progression of the disease and severity of symptoms. Cardiac transplant is the gold standard treatment of advanced heart failure, although the availability of organs limits the number of transplants received each year. Postoperative care and monitoring for cardiac transplant is complex and requires specialized nurses and providers at transplant centers for successful outcomes. This article outlines cardiac transplant from preoperative care through transplant, as well as posttransplant monitoring and care including discharge. Special attention is focused on management in the intensive care unit setting and potential complications that can occur in the immediate postoperative period. Interventions for potential complications are also highlighted.

Immunosuppression in Solid-Organ Transplantation: Essentials and Practical Tips.

A multidisciplinary team approach is essential for successful management of patients with solid-organ transplant. Transplant nursing encompasses care and support of transplant recipients as well as caregivers and organ donors through all phases of transplantation, from pretransplant evaluation to posttransplant recovery and maintenance. The field of solid-organ transplantation has advanced rapidly, and new treatments continue to emerge. Nurses who are responsible for the care of transplant recipients should have a knowledge base in transplant immunology and pharmacology. This review discusses mechanism of action, indication, side effects, and drug interactions of commonly used immunosuppressive medications in solid-organ transplantation. Nonoral routes of drug administration, therapeutic drug monitoring, and patient monitoring strategies are also included as practical tips for bedside nurses who are responsible for delivery of direct patient care and education of patients and their caregivers. This review focuses on the following medications: antithymocyte globulins, basiliximab, alemtuzumab, corticosteroids, tacrolimus, cyclosporine, azathioprine, mycophenolate mofetil/mycophenolate sodium, sirolimus, everolimus, belatacept, intravenous immunoglobulin, and rituximab.

Estratégias implementadas pelo enfermeiro para aprendizagem do transplantado renal em imunossupressão / Estrategias implementadas por enfermeros para el aprendizaje en inmunosupresión para trasplantados renales / Strategies implemented by nurses for learning kidney transplant immunosuppression

RESUMO Descrever a vivência da enfermagem na implementação de estratégias de aprendizagem em imunossupressão para transplantados renais. Caracteriza-se como um estudo qualitativo, descritivo, que utiliza o referencial teórico da pesquisa convergente assistencial, realizado em uma unidade de transplante renal. Para a obtenção dos dados, utilizou-se de entrevistas e oficinas temáticas. Foram desenvolvidas estratégias de aprendizagem para três oficinas com grupos de transplantados renais: pacientes sem déficit cognitivo - estratégia discursiva, com recursos visuais; pacientes com déficit cognitivo - estratégia do discurso repetitivo com recursos visuais; pacientes com déficit visual - recursos auditivos e táteis. As estratégias adotadas para os transplantados na oficina com déficit cognitivo e visual requisitaram adaptações, mas na alta hospitalar os pacientes demonstraram capacidade para o autocuidado e a apreensão dos imunossupressores. A vivência possibilitou ao enfermeiro o planejamento, a implementação e a utilização de estratégias de aprendizagem que favoreceram a emancipação do autocuidado, influenciando na adesão ao tratamento e na qualidade de vida do transplantado.

RESUMEN Describir la experiencia de la enfermería en la implementación de estrategias de aprendizaje en inmunosupresión para trasplantados renales. Se caracteriza como un estudio cualitativo y descriptivo que utiliza el marco teórico de la investigación convergente asistencial, realizado en una unidad de trasplante de riñón. Para obtener los datos, se utilizaron entrevistas y talleres temáticos. Las estrategias de aprendizaje se desarrollaron en el transcurso de tres talleres con grupos de trasplantados renales: pacientes sin deterioro cognitivo - estrategia discursiva, con efectos visuales; pacientes con deterioro cognitivo - estrategia de discurso repetitivo, con efectos visuales; pacientes con deterioros visuales - recursos auditivos y táctiles. Las estrategias adoptadas para los trasplantados en el taller con deterioro cognitivo y visual requirieron adaptaciones, pero en el alta hospitalaria los pacientes demostraron capacidad para el autocuidado y la adquisición de los inmunosupresores. La experiencia permitió que el enfermo planifique, implemente y utilice estrategias de aprendizaje que favorecieron la emancipación del autocuidado, influyendo en la adhesión al tratamiento y en la calidad de vida del trasplantado.

ABSTRACT To describe an experience by nurses in the implementation of learning strategies in immunosuppression for kidney transplants. Characterized as a qualitative, descriptive study using the theoretical framework of convergent care research, performed in a kidney transplant unit. To obtain the data, we used interviews and thematic workshops. Learning strategies were developed for three workshops with groups of kidney transplant patients: patients without cognitive impairment - discursive strategy, with visuals; patients with cognitive impairment - repetitive speech strategy, with visuals; patients with visual deficits - auditory and tactile resources. The strategies adopted for the transplant with cognitive and visual impairment ordered adaptations, although at discharge patients demonstrated capacity for self-care and acquisition of immunosuppressive drugs. The experience made it possible for nurse planning, implementation and use of learning strategies that favored the emancipation of selfcare, influencing treatment adherence and quality of life of the transplant patient.

Adesão à terapia imunossupressora em receptores de transplante renal / Adherence to immunosuppressive therapy adherence in kidney transplant recipients

Kidney transplantation has advantages over other forms of kidney replacement therapies (hemodialysis and peritoneal dialysis) because it improves quality of life and increases the survival rate of recipients. However, adherence to immunosuppressive therapy after transplantation is an indispensable condition for the renal graft survival. Assessment of the adherence to immunosuppressive therapy in kidney transplant patients from a teaching hospital in São Luís -Maranhão, Brazil. Cross-sectional study of 151 kidney transplants with follow-up in the renal transplant clinic. Adherence to immunosuppressive was assessed by the self-report method Immunosuppressive Therapy Adherence Scale (ITAS): there was (60.3%) percentage of nonadherence of the transplant patients. The variables that were statistically significant with nonadherence were: being transplanted with a living donor (p=0.03), type of immunosuppressant used (p=0.04) and serum creatinine (p=0.04). We found a high rate of nonadherence to immunosuppressive therapy by the self-report method in renal transplant recipientsin an outpatient follow-up. This result becomes an important risk factor for adverse clinical outcomes, such as rejection and failure of the kidney graft

O transplante renal apresenta vantagens sobre as outras formas de terapias renais substitutivas (hemodiálise e diálise peritoneal), visto que melhora a qualidade de vida e aumenta a sobrevida dos receptores. Contudo, a adesão à terapia imunossupressora, após o transplante, é uma condição indispensável para a sobrevida do enxerto renal. Avaliar a adesão à terapia imunossupressora em transplantados renais de um hospital de ensino na cidade de São Luís ­Maranhão. Estudo transversal, cujos dados foram coletados no período de maio de 2012 a abril de 2013 com aplicação de instrumentos junto a 151 transplantadosrenais acompanhados no ambulatório de Transplante renal. A adesão aos imunossupressores foi avaliada pelo método autorrelato com a Escala de Aderência à Terapia Imunossupressora (ITAS). Encontrou-se um percentual de não adesão de (60,3%) dos transplantados. As variáveis que tiveram significância estatística com a não adesão foram: ter sido transplantado com doador vivo (p= 0,03), tipo de imunossupressor usado (p=0,04) e creatinina sérica (p=0,04). Houve uma taxa elevada de não adesão à terapia imunossupressora pelo autorrelato em receptores de transplante renal no seguimento ambulatorial. Tal resultado torna-se um importante fator de risco para desfechos clínicos negativos, como rejeição e falência do enxerto renal.

Preparing for a face transplant: development of a comprehensive nursing educational program.

To date, more than 30 face transplants have been performed worldwide. This innovative procedure has restored the functional and aesthetic aspects of the face in patients with cancer, congenital, and trauma-related deformities where the results of traditional reconstructive surgery have been deficient. The importance of nursing involvement in the care of these patients is undeniable; however, little has been published about how to properly prepare a nursing department to undertake such an important role. Although the care of patients undergoing face transplants has many similarities to the care of patients undergoing traditional head and neck flap procedures, patients undergoing face transplant provide unique challenges, including immunosuppression, allograft rejection, communication impairment, and psychosocial needs. Staff at New York University's Langone Medical Center have devised a specific plan of action to properly inform, educate, and prepare the nursing staff for this exciting endeavor.

How to implement immunoadsorption in a polyvalent dialysis unit: a review.

BACKGROUND: Many kidney-transplant candidates have anti-HLA alloantibodies (HLAi): these make transplantation difficult, even from a living kidney (LK) donor, because of the presence of donor-specific anti-HLA alloantibodies. Due to the shortage of deceased kidney donors, the number of LK transplants is increasing, but is potentially limited by ABO incompatibility (ABOi). OBJECTIVES: To make ABOi and/or HLAi patients suitable for kidney transplantation they need to be desensitised: this strategy is mainly based on rituximab therapy combined with either plasmapheresis (PP) or immunoadsorption (IA). IA can be more efficient than PP because greater plasma volumes can be treated within a single session than a PP session (>4 vs. 1.5-2). IA can be specific (ABOi setting) or non-specific (HLAi). DESIGN: We describe how we designed and implemented a desensitisation programme based on IA. This was started in the first trimester of 2010 within the Acute Polyvalent Haemodialysis and Apheresis Unit in Toulouse University Hospital, France. So far, we have performed >200 IA sessions with good results. RESULTS: The IA sessions were associated with a net body-weight gain of ∼1 kg. Normally, IA is performed first and then haemodialysis on the same or next day; however, we have been able to, for the first time, couple IA with haemodialysis. Moreover, we can now carry out this procedure 24 hours a day, seven days a week. CONCLUSION: This procedure has improved patient care and reduced costs. The IA desensitisation programme has enabled successful transplantation in 24 patients to date.

An Overview of Transplant Immunosuppression--History, Principles, and Current Practices in Kidney Transplantation.

From the historical first transplant in 1954 to the current transplant era, tremendous strides have been made in transplant immunology and immunosuppression. The most common immunosuppressive regimens use a combination of agents with differing modes of action to maximize efficacy and minimize the toxicities associated with each class of agent. The general categories of immunosuppressives are glucocorticoids, antimetabolites, calcineurin inhibitors, anti-lymphocyte antibody therapies (monoclonal and polyclonal), costimulation blockers, and mTOR inhibitors. This article reviews immunosuppressant medications, their actions, and significant side effects; discusses clinical management issues of immunosuppression; and describes future directions for the development of immunosuppressive medications.

Infecciones asociadas a la atención de salud en un Hospital de Oncología Brasileño: análisis de cinco años / Healthcare-Associated Infections at a Brazilian Cancer Hospital: five years of anales

Estudio epidemiológico retrospectivo realizado en 2009 a fin de analizar las tasas de infección asociada a los cuidados en la salud, en pacientes oncológicos, por topografía, letalidad y mortalidad de 2004 a 2008. Los datos se recogieron de registros archivados en el Servicio de Control de Infección Hospitalaria (SCIH) de la institución. Los aspectos éticos fueron observados. Referente a la tasa de infección asociada a los cuidados en salud se observó que ocurrió el 8,24% (5.821) de episodios en el período. Estas tasas presentaron variación del 6,51% (1,017) en 2004 al 10,82% (1.790) en 2007 y desvío estándar = (± 1,91). Referente al número de pacientes con infección se encontró el 5,75% (4.064) variando del 4,89% (765) en 2004 al 7,47% (1237) en 2007. Las topografías más acometidas fueron las de sitio quirúrgico con el 26,11%, corriente sanguínea con el 24,11% y el tracto respiratorio con el 18,50%. La tasa de letalidad y mortalidad asociadas a la infección fueron el 23,86% y el 1,37% de óbitos respectivamente. Se considera necesaria la evaluación de los múltiples factores involucrados en ese proceso para que la institución desarrolle estrategias de prevención y control de las infecciones y pueda intervenir en tiempo hábil (AU)

Retrospective epidemiological study, carried out in 2009, to analyze healthcare-associated infection rates in cancer patients, according to infection site, lethality and data were collected from records filed at the institution’s Hospital Infection Control Service (SCIH), between 2004 and 2008. The project was submitted and approved by the Research Ethics Committee. Regarding the healthcare infection rate, it was observed that 8.24% (5,821) of episodes occurred during the period. These rates ranged from 6.51% (1,017) in 2004 to 10.82% (1,790) in 2007, with a standard deviation of ± 1.91. Regarding the number of patients with infection, a rate of 5.75% (4.064) was found, ranging from 4.89% (765) in 2004 to 7.47% (1,237) in 2007. The most affected sites were surgical site (26.11%), bloodstream (24.11%) and respiratory tract (18.50%). Infection associated lethality and mortality rates corresponded to 23.86% and 1.37% of deaths, respectively. The multiple factors involved in this process need to be assessed, so that the institution can develop infection prevention and control strategies and can intervene timely (AU)

Emerging immunology of stem cell transplantation.

OBJECTIVES: To review critical areas of recent advances in immunology related to hematopoietic stem cell transplantation (SCT) and developing science that hopefully will be translated into improvements in patient care. DATA SOURCES: Review of literature and electronic data. CONCLUSION: An overwhelming amount of diverse information related to the science of immunology and hematopoietic SCT is available. Hot topics of clinical focus appear to be in the area of donor selection and human leukocyte antigen testing, cellular functioning as it relates to immune modulation, immune reconstitution, and the source of stem cells. IMPLICATIONS FOR NURSING PRACTICE: The concept of immunity introduced over 200 years ago has evolved into everyday language in hematopoietic SCT. Nurses are challenged to keep their knowledge current with recent advances and the integration of immunotherapy into traditional care.

Management of the patient undergoing lung transplantation: an intensive care perspective.

The postoperative management of a patient undergoing lung transplantation involves many components of care. These components include ventilatory and hemodynamic management, immunosuppression, wound care, rehabilitation, infection control and treatment, and early detection of rejection.

The role of the nurse post-renal transplantation.

The previous article explored the role of the nurse pre-renal transplantation, which addressed the physical, psychological and educational support that the patient and family members require prior to this life-changing surgery. The following article explores the continual role of the nurse in caring for and educating the patient post-renal transplantation. Renal transplantation is considered the optimal treatment of choice for patients with end-stage renal failure (ESRF) and who are receiving dialysis. The nurse plays a pivotal role in assisting the patient in facing the many challenges that are associated post-renal transplantation, including the complications and the long-term physical and psychosocial implications.

Hematopoietic stem cell transplantation: implications for critical care nurses.

Hematopoietic stem cell transplantation (HSCT) is being used increasingly in the treatment of malignant and nonmalignant diseases. The treatment modality has been proven effective but is not without risks. Studies consistently have identified the need for advanced supportive care (e.g., multiple organ dysfunction, vasopressor use, mechanical ventilation) as a negative prognostic indicator in patients who have received HSCT. Among patients who have received HSCT, 15%-40% require critical care monitoring or advanced support. Nurses on intensive care units can positively impact outcomes for transplant recipients when they possess the specialized skills to recognize and promptly intervene when transplant-related complications arise. This article will provide a basic overview of the HSCT process and outline the complications that may necessitate transfer to a higher level of care for specialized skills and equipment in the intensive care setting.

Pediatric cardiac transplants: a clinical update.

In the last 10 years more than 2,600 pediatric patients have received heart transplants. The survival rate at 10 years is 65% (Blume, 2003). There have been profound improvements in the survival and quality of life associated with pediatric heart transplants. Due to the increase in survival and quality of life, it is becoming more common for nurses to care for these unique patients. Nurses need to be aware of the complex management of pediatric heart transplant patients to aid in their care of these patients. This paper will discuss the transplant process, medications, common complications, and psychosocial impact associated with pediatric heart transplants to better prepare nurses involved in the care of pediatric cardiac transplant patients.