Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

NMDA receptor subunits in the adult rat hippocampus undergo similar changes after 5 minutes in an open field and after LTP induction.

NMDA receptor subunits change during development and their synaptic expression is modified rapidly after synaptic plasticity induction in hippocampal slices. However, there is scarce information on subunits expression after synaptic plasticity induction or memory acquisition, particularly in adults. GluN1, GluN2A and GluN2B NMDA receptor subunits were assessed by western blot in 1) adult rats that had explored an open field (OF) for 5 minutes, a time sufficient to induce habituation, 2) mature rat hippocampal neuron cultures depolarized by KCl and 3) hippocampal slices from adult rats where long term potentiation (LTP) was induced by theta-burst stimulation (TBS). GluN1 and GluN2A, though not GluN2B, were significantly higher 70 minutes--but not 30 minutes--after a 5 minutes session in an OF. GluN1 and GluN2A total immunofluorescence and puncta in neurites increased in cultures, as evaluated 70 minutes after KCl stimulation. Similar changes were found in hippocampal slices 70 minutes after LTP induction. To start to explore underlying mechanisms, hippocampal slices were treated either with cycloheximide (a translation inhibitor) or actinomycin D (a transcription inhibitor) during electrophysiological assays. It was corroborated that translation was necessary for LTP induction and expression. The rise in GluN1 depends on transcription and translation, while the increase in GluN2A appears to mainly depend on translation, though a contribution of some remaining transcriptional activity during actinomycin D treatment could not be rouled out. LTP effective induction was required for the subunits to increase. Although in the three models same subunits suffered modifications in the same direction, within an apparently similar temporal course, further investigation is required to reveal if they are related processes and to find out whether they are causally related with synaptic plasticity, learning and memory

Epidemiological surveillance of leptospirosis in the interior of Buenos Aires province

El Departamento de Zoonosis Rurales (con cede en Azul) recibe muestras de pacientes humanos sospechosos de leptospirosis de 7/12 regiones sanitarias. Anualmente, aproximadamente 400 casos humanos sospechosos de leptospirosis (con sintomatología y epidemiología compatible) son notificados en el interior de la provincia. Los factores de riesgo se encuentran relacionados a las actividades ocupacionales, recreativas, y a una exposición domiciliaria; las personas expuestas a inundaciones presentan más riesgo de presentar la enfermedad. Además del diagnóstico humano de la enfermedad, se realizan actividades de vigilancia epidemiológica, que incluyen la detección, notificación, estudio, seguimiento de casos y defunciones. En el interior de la provincia de Buenos Aires se comprobó la circulación de L. interrogans del serogrupo Icterohaemorrhagiae serovares Copenhageni Fiocruz L1-130 y M20, y RGA (área peri-urbana y rural) y del serogrupo Canicola Hound Utrecht IV (área rural). En fauna silvestre las tasas de aislamientos variaron según la especie: R. norvegicus (44%), A. azarae (25%), C. chinga (14.3%), L. griseus (10%) y D. albiventris (2%). Los 41 aislamientos obtenidos en animales silvestres, ponen en manifiesto por un lado la circulación de diversos serogrupos de Leptospiras altamente patógenas en la región, y por el otro, la presencia de nuevos portadores que cumplirían un rol importante en la epidemiología de la enfermedad.The Department of Rural Zoonosis (with yields in Azul) receives samples of human patients suspected of leptospirosis of 7/12 health regions. Annually, approximately 400 suspected human cases of leptospirosis (with symptoms and compatible epidemiology) are reported within the province. Risk factors are related to occupational, recreational activities, and exposure to a home; people exposed to flooding have increased risk of developing the disease. In addition to human disease diagnosis, surveillance activities, including the identification, reporting, review, monitoring of cases and deaths are made. In the interior of Buenos Aires province, circulation of L. interrogans serogroup Icterohaemorrhagiae Copenhageni Fiocruz L1-130 and M20 was found, and RGA (peri-urban and rural areas) and serogroup canicola Hound Utrecht IV (rural area). In wildlife, isolates rates vary by species: R. norvegicus (44%), A. azarae (25%), C. chinga (14.3%), L. griseus (10%) and D. albiventris (2%). The 41 isolates obtained from wild animals, put one hand manifest circulation of highly pathogenic various serogroups of Leptospira in the region, and on the other, the presence of new carriers that would fulfill an important role in the epidemiology of the disease.Fil: Scialfa, Exequiel Alejandro. Provincia de Buenos Aires. Ministerio de Salud; ArgentinaFil: Gallicchio, Oscar. Provincia de Buenos Aires. Ministerio de Salud; ArgentinaFil: Grunne, Sylvia. Instituto Nacional de Tecnología Agropecuaria; ArgentinaFil: Recavarren, Mariana Ines. Instituto Analisis Clinicos Fares Taie; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Mar del Plata; ArgentinaFil: Rivero, Mariana Alejandra. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Mar del Plata; Argentina. Universidad Nacional del Centro de la Provincia de Buenos Aires. Facultad de Ciencias Veterinarias; ArgentinaFil: Quintana, Silvina. Instituto Analisis Clinicos Fares Taie; ArgentinaFil: Aguirre, Pablo. Provincia de Buenos Aires. Ministerio de Salud; ArgentinaFil: San Anton, Dario. Provincia de Buenos Aires. Ministerio de Salud; ArgentinaFil: Brihuega, Bibiana. Instituto Nacional de Tecnología Agropecuaria; Argentin

NMDAR subunits immunofluorescence in mature hipocampal neuron cultures stimulated by KCl.

<p><b><i>A.</i></b> Quantification of NMDAR subunit puncta at dendrites (n = 100 neurites/culture). A significant increase in GluN1 and GluN2A puncta was observed at 30 and 70 minutes after KCl stimulation (** p<0.05, *** p<0.001, Kruskal-Wallis test followed by Dunn’s Multiple Comparison Post-Test). <i>Insert on the top of each bar</i>: representative dendrite for each condition (bar: 2 µm). <b><i>B.</i></b> Total fluorescence quantification 30 and 70 minutes after KCl stimulation. There were significant increases in GluN1 and GluN2A 70 minutes after stimulation. There were no significant changes in GluN2B total immunofluorescence (* p<0.05, *** p<0.001, ONE WAY ANOVA, Dunnet Post-Test). <i>Right:</i> representative neurons for each condition.</p

NMDAR subunits modification in hippocampal slices after transcription or translation inhibition during LTP induction. <i>A.</i>

<p><i> Left:</i> Normalized slopes of evoked fEPSPs recorded as those in <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0055244#pone-0055244-g003" target="_blank">Figure 3</a>, corresponding to the first pulse of the paired stimulation applied before and after TBS (arrow). Plots represent the average of five independent experiments over 90 minutes of recording (n = 5 for each group). <i>Black line</i>: drug perfusion. <i>Insert on top</i>: average traces of 10 individual recordings from a control slice and slices treated with ActD or CHX (black: 5 minutes before TBS; grey: 5 last minutes of recording). <i>Right:</i> Bars represent averages of normalized first pulse slopes of the 5 last minutes of recording for each group. LTP induction was blocked by 40 µg/ml CHX treatment (* p<0.05, one sample t test) compared to basal transmission (line referred to 1 in the graph). <b><i>B.</i></b> NMDAR subunits were evaluated by WB in same slices that in <b>A.</b> CHX treatment blocked GluN1 and GluN2A increase, while 50 µg/ml ActD only blocked GluN1 increase (* p<0,05 ONE WAY ANOVA, Dunnet Post-Test; n = 5 for each group). <i>Insert on top:</i> (from left to right): Representative GluN1 and GluN2A WB bands of +TBS+LTP slices (control), CHX and ActD +TBS+LTP slices treated slices. <b><i>C.</i></b> Table indicates mean ± SEM for GluN1/GAPDH (first row) or GluN2A/GAPDH (second row) in +TBS-LTP slices (n = 6) and +TBS+LTP slices without any drug treatment (Control in <b>B,</b> n = 9), or treated with ActD (n = 5) or CHX (n = 5) (*** p<0.0001; ONE WAY ANOVA - Newman Keuls Test).</p

NMDAR subunits changes after OF habituation. <i>A.</i>

<p>Habituation to the OF of rats exposed to a 5 minutes OF session (n = 16). Graphs show number of crossings (left panel) and rearings (right panel) <i>per</i> minute (bars indicates median with interquartile ranges). Crossings decreased significantly after 3 minutes, while rearings were only significantly decreased in the fifth minute. *** p<0.0001, ** p<0.01 by Friedman test followed by Dunn’s Multiple Comparison Test. <b><i>B.</i></b> Total crossings from rats exposed to the OF for 1 or 5 minutes (Training) and tested for STM 40 minutes later (n = 12) or LTM 24 h later (n = 16). There were significant differences in total number of crossings in the second session compared to the first, only in rats which spent 5 minutes in the OF in the training session, for STM (* p<0.05) as well as for LTM (*** p<0.0001) (Mann Whitney test). <b><i>C.</i></b> NMDAR subunits in the hippocampus of rats after OF exposure. Four groups of rats were analyzed: rats as in <b><i>A,</i></b> which were sacrificed at 0, 30 and 70 minutes after the task (5′-0′, 5′–30′ and 5′–70′ groups); and rats exposed for 1 minute to the OF, sacrificed 70 minutes later (1′–70′ group). WB analysis showed about a one fold increase in GluN1 and GluN2A level for <i>5′–70′</i> group, in 3 independent experiments (* p<0.05, ONE WAY ANOVA, Newman-Keuls Multiple Comparison Post-Test). <i>Insert on top:</i> representative WB bands for GluN1, GluN2A and GluN2B NMDAR subunits and GAPDH (internal control). <b><i>D</i></b>. NMDAR subunits analysis in the hippocampus of rats after two OF sessions. 4 groups of rats were analyzed: rats exposed to the OF 5 minutes and sacrificed immediately (5′-0′), 70 minutes (5′–70′), 24 h later (5′–24 h), or tested in the OF and sacrificed 70 minutes later (70′ postest-TE). * p<0.05 ONE WAY ANOVA, Dunnett’s Post-Test. <i>Insert on top:</i> representative WB bands for GluN1 and GluN2A NMDAR subunits and GAPDH (internal control).</p

NMDAR subunits change after LTP induction and expression.

<p><b><i>A.</i></b> Evoked fEPSPs normalized slopes from fresh hippocampal slices corresponding to the first pulse of paired stimulation, before and after TBS (arrow). Plots represent the average of three independent experiments over 90 minutes of recording (n = 6 for each group). <i>Insert on top:</i> average traces of 10 individual recordings from a +TBS+LTP and a +TBS-LTP slices (black: 5 minutes before TBS; grey: 5 last minutes of recording). <b><i>B.</i></b> WB band densities quantification of samples from same slices that in <b>A.</b> A significant increase was only observed for +TBS+LTP slices (** p<0.01; *** p<0.001 ONE WAY ANOVA, Dunnet Post-Test; n = 6 for each group). <i>Insert on top:</i> (from left to right): representative GluN1 and GAPDH WB bands from: a −TBS slice, a +TBS-LTP slice and a +TBS+LTP slice. <b><i>C.</i></b> Evoked fEPSPs slopes corresponding to the first pulse of the paired stimulation before and after TBS (arrow). Plots represent the average of fEPSPs slopes over 50 and 90 minutes of recording, respectively (n = 6 for each group). <i>Right</i>: average traces of 10 individual recordings from a LTP-slice after 30 and 70 minutes TBS (black: 5 minutes before TBS; grey: 5 last minutes of recording). <b><i>D.</i></b> NMDAR subunits quantification by WB. Samples analyzed: slices used in <b>C</b>. (processed 30 or 70 minutes after TBS) and in −TBS slices (Control). Analysis of WB bands showed a significant increase in GluN1 and GluN2A level for the 70 minutes group in three independent experiments (* p<0,05; *** p<0,001 ONE WAY ANOVA-Dunnet Test). <i>Insert on top:</i> Representative WB bands for GluN1, GluN2A and GluN2B NMDAR subunits and GAPDH (internal control).</p

Teorías y Sistemas Psicológicos - PS04 201601

El curso de Teorías y Sistemas Psicológicos es un curso de especialidad de la carrera de Psicología, de carácter teórico, dirigido a estudiantes de primer ciclo, que busca desarrollar la competencia general de pensamiento crítico y la competencia específica de fundamento teórico conceptual