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

Протимікробна активність структурно-метаболітних комплексів L. rhamnosus GG і S. boulardii щодо S. aureus AТСС 25923, E. coli ATCC 25922, Р. аеruginosa ATCC 27853

 The aim of the work – to determine the sensitivity of reference strains to structural-metabolic complexes of both Lactobacillus rhamnosus GG alone and in combination with Saccharomyces boulardii to justify the possibility of developing antimicrobial drugs with polyfunctional activity.Materials and methods. Proprietary structural-metabolic complexes of lactobacteria and lactobacteria with saccharomycetes were obtained without the use of culture media. Minimum inhibitory concentrations (MICs) and minimum bactericidal concentrations (MBCs) were determined by the serial dilution micromethod in a culture medium in a 96-well plate. To estimate the MIC, the optical density of the samples was spectrophotometrically measured using a Lisa ScanTM EM analyzer (Erba Mannheim, Czech Republic), and broth was plated on a solid culture medium for the MBC estimation. The concentrations of the test substances ranged from 1.10 to 0.02 mg/ml by the total protein. The test cultures were reference strains of S. aureus ATCC 25923, E. coli ATCC 25922, P. aeroginosa ATCC 27853.Results. The antimicrobial effect was found to be in direct proportion to the exposure time, concentration and activity of structural-metabolic complexes of lactobacteria and lactobacteria with saccharomycetes. The MBC of lactobacteria filtrates for S. aureus ATCC 25923, E. coli ATCC 25922, P. aeruginosa ATCC 27853 was 0.27 mg/ml by protein, and lactobacteria and saccharomycetes – 0.21 mg/ml by protein. The structural-metabolitic complex of Lactobacillus with a concentration of 0.14 mg/ml by protein also presented bactericidal effect on the culture of P. aeruginosa ATCC 27853. The lowest tested concentrations of the studied Lactobacillus rhamnosus GG (0.03 mg/ml by protein) filtrates and combinations with Saccharomyces boulardii (0.02 mg/ml by protein) caused a decrease in the optical density of the reference strains of S. aureus ATCC 25923, E. coli ATCC 25922, P. aeruginosa ATCC 27853 by 77.16–82.30 %, 51.25 – 52.78 %, 31.43–31.58 % (P ≤ 0.01), respectively. The MICs values corresponded to the MBCs.Conclusions. As a result of the studies, the sensitivity of S. aureus ATCC 25923, E. coli ATCC 25922, and P. aeruginosa ATCC 27853strains to both structural-metabolic complexes of lactobacteria and saccharomycetes was determined. The obtained minimum inhibitory/bactericidal concentrations of the studied filtrates of L. rhamnosus GG and S. boulardii will be useful in the development of promising antimicrobial agents for alternative or add-on therapies of diseases having various origins. Цель работы – определить чувствительность референтных штаммов к структурно-метаболитным комплексам отдельно Lactobacillus rhamnosus GG и в комбинации с Saccharomyces boulardii для обоснования возможности создания противомикробных препаратов с полифункциональной активностью.Материалы и методы. Структурно-метаболитные комплексы лактобактерий и лактобактерий и сахаромицетов получали авторским способом без использования питательных сред. Минимальные ингибирующие концентрации (МИК) и минимальные бактерицидные концентрации (МБцК) определяли микрометодом серийных разведений в жидкой питательной среде в 96-луночном планшете. Для установления МИК спектрофотометрически измеряли оптическую плотность образцов с помощью анализатора «Lisa Scanтм EM» (Erba Mannheim, Чешская Республика), а для МБцК делали высев на твердую питательную среду. Концентрации исследуемых веществ находились в диапазоне от 1,10 до 0,02 мг/мл по общему белку. Тест-культурами были референтные штаммы S. aureus AТСС 25923, E. coli ATCC 25922, Р. аеruginosa ATCC 27853.Результаты. Установлена прямопропорциональная зависимость противомикробного эффекта от продолжительности экспозиции, концентрации и активности структурно-метаболитных комплексов лактобактерий и лактобактерий и сахаромицетов. Минимальная бактерицидная концентрация фильтратов лактобактерий для S. aureus AТСС 25923, E. coli ATCC 25922, Р. аеruginosa ATCC 27853 составила 0,27 мг/мл белка, а лактобактерий и сахаромицетов – 0,21 мг/мл белка. Структурно-метаболитный комплекс Lactobacillus с концентрацией 0,14 мг/мл белка также бактерицидно действовал на культуру Р. аеruginosa ATCC 27853. Наименьшие испытуемые концентрации исследуемых фильтратов Lactobacillus rhamnosus GG (0,03 мг/мл белка) и комбинации с Saccharomyces boulardii (0,02 мг/мл белка) вызывали снижение оптической плотности референтных штаммов S. aureus AТСС 25923, E. coli ATCC 25922, Р. аеruginosa ATCC 27853 на 77,16–82,30 %, 51,25–52,78 %, 31,43–31,58 % (р ≤ 0,01) соответственно. Минимальные бактерицидные концентрации соответствовали минимальным ингибирующим концентрациям.Выводы. В результате исследований определена чувствительность штаммов S. aureus AТСС 25923, E. coli ATCC 25922, Р. аеruginosa ATCC 27853 к обоим структурно-метаболитным комплексам лактобактерий и сахаромицетов. Полученные минимальные ингибирующие/бактерицидные концентрации исследуемых фильтратов L. rhamnosus GG и S. boulardii пригодятся при создании перспективных противомикробных препаратов для альтернативной или дополнительной терапии при заболеваниях различного генеза.Мета роботи – визначити чутливість референтних штамів до структурно-метаболітних комплексів окремо Lactobacillus rhamnosus GG і в комбінації з Saccharomyces boulardii  для обґрунтування можливості створення протимікробних препаратів із поліфункціональною активністю.Матеріали та методи. Структурно-метаболітні комплекси лактобактерій і лактобактерій і сахароміцетів одержували авторським способом без використання живильних середовищ. Мінімальні інгібувальні концентрації (МІК) і мінімальні бактерицидні концентрації (МБцК) визначали мікрометодом серійних розведень у рідкому живильному середовищі в 96-лунковому планшеті. Для встановлення МІК спектрофотометрично вимірювали оптичну щільність зразків за допомогою аналізатора «Lisa Scanтм EM» (Erba Mannheim, Чеська Республіка), а для МБцК робили висів на тверде живильне середовище. Концентрації досліджуваних речовин перебували в діапазоні від 1,10 до 0,02 мг/мл за загальним білком. Тест-культурами були референтні штами S. aureus AТСС 25923, E. coli ATCC 25922, Р. аеruginosa ATCC 27853.Результати. Встановлена прямопропорційна залежність протимікробного ефекту від тривалості експозиції, концентрації та активності структурно-метаболітних комплексів лактобактерій, лактобактерій і сахароміцетів. Мінімальна бактерицидна концентрація фільтратів лактобактерій для S. aureus AТСС 25923, E. coli ATCC 25922, Р. аеruginosa ATCC 27853 становила 0,27 мг/мл білка, а лактобактерій і сахароміцетів – 0,21 мг/мл білка. Структурно-метаболітний комплекс Lactobacillus із концентрацією 0,14 мг/мл білка також бактерицидно діяв на культуру Р. аеruginosa ATCC 27853. Найменші випробувані концентрації дослідних фільтратів Lactobacillus rhamnosus GG (0,03 мг/мл білка) та комбінації з Saccharomyces boulardii (0,02 мг/мл білка) викликали зниження оптичної щільності референтних штамів S. aureus AТСС 25923, E. coli ATCC 25922, Р. аеruginosa ATCC 27853 на 77,16–82,30 %, 51,25–52,78 %, 31,43–31,58 % (р ≤ 0,01) відповідно. Мінімальні бактерицидні концентрації відповідали мінімальним інгібувальним концентраціям.Висновки. У результаті досліджень визначили чутливість штамів S. aureus AТСС 25923, E. coli ATCC 25922, Р. аеruginosa ATCC 27853 до обох структурно-метаболітних комплексів лактобактерій і сахароміцетів. Отримані мінімальні інгібувальні/бактерицидні концентрації дослідних фільтратів L. rhamnosus GG і S. boulardii стануть у нагоді для створення перспективних протимікробних препаратів для альтернативної або додаткової терапії при захворюваннях різного генезу

METHODS OF CONTROL DIPHTHERIA VACCINE SAFETY

Vaccination success depends not only on the timely coverage of threatened contingents, but also on the quality of vaccines. Every day, the requirements for security guarantees vaccines and their use guarantees of security increases. For the fast, reliable and independent scientific assessment of vaccine safety issues, WHO in 1999 created the Global Advisory Committee on Vaccine Safety. To enhance the capacity of pharmaceutical supervision in relation to vaccines in 2012 it was developed the Global Vaccine Safety Initiative. The main directions of the Global Vaccine Safety programs are considered in this review. It’s noted more strict requirements of Ukrainian pharmaceutical industry to produce public immunization drugs regulated Supplements to the State Pharmacopoeia of Ukraine, in comparison with other countries. This review considered diphtheria vaccine safety monitoring in the process of production according to the recommendations of the World Health Organization (WHO), described a subcutaneous method for determining the specific toxicity of the combined purified toxoid, characterized an intracutaneous method of determining of the presence of diphtheria toxin in each sample of the combined purified toxoid, that additionally used by some manufacturers. The definition of diphtheria toxin in dilutions of purified toxoid is presented. This review considered diphtheria vaccine safety monitoring in the process of production according to the recommendations of the World Health Organization (WHO), described a subcutaneous method for determining the specific toxicity of the combined purified toxoid, characterized an intracutaneous method of determining of the presence of diphtheria toxin in each sample of the combined purified toxoid, that additionally used by some manufacturers. The definition of diphtheria toxin in dilutions of purified toxoid is presented. As methods for determination of diphtheria toxin must be able to detect even a small amount of toxin it's examined the WHO's proposal to use an intradermal method on guinea pigs and tests on cell cultures. Attention is drawn to the fact that the determination of specific toxicity in cell culture can be carried out at presence of the approval of this method of a national control authority and sensitivity rates no less than in experiments on guinea pigs. The determining of specific toxicity of ready vaccine by subcutaneous method is described. The publication gave a test for elevated toxicity of the final product by intraperitoneal infection of mice and guinea pigs. It’s cited the WHO recommendations aimed at removing the possibility of recovery of the refined toxin toxicity. Checking vaccines toxicity, pyrogenicity, sterility, allergenicity, teratogenicity, mutagenicity and immunogenicity mainly performed on laboratory animals. The review examined the unreliability of animal experiments and the need to find alternative methods for determining the toxicity without their use particularly in light of the “3R”concept. Methods for determining diphtherial toxin using cell cultures is considered, namely, colony overlay test (COT), tests using a monolayer of HeLa cell culture, a culture of Vero cells (kidney cells of african green monkeys ), a culture of CHO cells (cells of Chinese hamster ovary), which are based on the toxin cytopathic effect on sensitive cell culture. Their advantages and disadvantages are listed. An alternative method for the quantitative detection of C. diphtheriae toxin using the polystyrene plate coated with monoclonal antibody to the part of the diphtheria toxin which defines its binding to the cell, is described. It’s regarded the cytotoxic effect of diphtheria toxin on cells of the immune system of mice and guinea pigs: splenocytes, adhesive phagocytes i B- lymphocytes

The study of the biological properties of probiotic lactobacillus spp. strains under aerobic and microaerophilic cultivation conditions

The biological properties (growth characteristics, adhesive activity and sensitivity to antimicrobial) of probiotic Lactobacillus strains were studied under different gas composition of incubation atmosphere. It was found that the number of viable lactobacilli cells in the one dose of investigated probiotic preparations was lower than it was claimed by the manufacturer. Gas composition of incubation atmosphere affects cell viability of probiotic strains. The number of colony forming units of lactobacilli under microaerophilic conditions increased in 1,19-1,33 times as compared with aerobic conditions. It was proved that adhesive activity of probiotic Lactobacillus strains and sensitivity to 2th, 3th, 4th generations of cephalosporins (cefuroxime, cefotaxime, cefepime) and tetracyclines (doxycycline) also increased under microaerophilic conditions. The changes of the biological properties of lactobacilli under different cultivation conditions require further study for optimization of correction of dysbiotic disorders

ОСНОВНІ ПОЛОЖЕННЯ РОЗРАХУНКУ ЗАХИСНИХ ФОРТИФІКАЦІЙНИХ СПОРУД

Розроблена методологія розрахунку та проектування залізобетонних елементів та конструкцій в умовах високошвидкісних ударних навантажень. Встановлені основні розрахункові залежності розрахунку захисних фортифікаційних споруд дії вогнепальної зброї