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

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

EFEITO ANTIOXIDANTE DE LIPOSSOMAS CONTENDO CREATINA NO PROCESSO DE ISQUEMIA/REPERFUSÃO CEREBRAL EM RATOS: DESENVOLVIMENTO, CARACTERIZAÇÃO E AVALIAÇÃO FARMACOLÓGICA

Made available in DSpace on 2018-06-27T18:56:03Z (GMT). No. of bitstreams: 3 Diego Becker Borin.pdf: 1553948 bytes, checksum: b94d052c85f74f3bcc5e4cadbcb71e67 (MD5) Diego Becker Borin.pdf.txt: 134530 bytes, checksum: f3ad94a2052d1806ff21e9c0ce7733fb (MD5) Diego Becker Borin.pdf.jpg: 3538 bytes, checksum: b4b8b2603cafaeb4736f56efe30f7f1d (MD5) Previous issue date: 2013-03-26Coordenação de Aperfeiçoamento de Pessoal de Nível SuperiorCreatine is a biomolecule endogenously synthesized from amino acids which can also be obtained through the diet. But it does not permeate easily through the blood-brain barrier (BBB), so the brain must supply their needs through the synthesis of creatine in the central nervous system (CNS) by itself. Creatine has a major role in maintaining stable levels of adenosine triphosphate (ATP) thus keeping the whole body in a proper condition. Neurodegenerative diseases leads to decreases in ATP levels, which compromises cellular metabolism, generating the increase of reactive species that could lead to neuronal cell death. Therefore, it becomes important to increase creatine levels in neurodegenerative diseases, so it could provide new alternative treatments for these diseases. This study aimed to develop and characterize liposomes with creatine, as well as investigate its protective effect in ischemia and reperfusion (I/R) brain model. Two methodologies were used for the preparation of liposomes, the lipid film hydration and ethanol injection. Due the best results were obtained by the ethanol injection method, this was chosen for the preparation of liposomes in in vivo tests. The rats were tested using I/R by clamping bilateral carotid arteries and different groups were treated with creatine (30 mg/kg) in free form (Liv+I/R) and liposomed (Lip+I/R) and compared with the control group and I/R. The animals motor activity, exploratory and memory abilities were evaluated through field tests and passive avoidance, 24 and 48 hours after I/R, respectively. After 72 hours, the animals were euthanized and the brains removed for biochemical determination of levels of reactive species and ascorbic acid (AA), and the biochemical breakdown activity of superoxide dismutase (SOD) and catalase (CAT). The suspensions of liposomes used for the in vivo treatment had homogenous average particle diameter (154 ± 6.9 nm), low polydispersity index (0.211 ± 0.019), pH near neutral (around 6.7), negative potential Zeta (-21 ± 1.8 mV) and association rate around 31%. The results of field tests have shown that I/R caused a change in exploratory activity of animals and increased oxidative stress in the brain of rats subjected to I/R. Liposomes creatine protected the change in exploratory activity and increased oxidative stress in rat cortex. Already in free form, creatine was not able to protect against these changes. With these results, we can conclude that the production of liposomes containing creatine technological feasibility presented, demonstrating the potential to increase the bioavailability of creatine into the CNS via the BBB.A creatina é uma biomolécula sintetizada endogenamente a partir de aminoácidos, que também pode ser obtida através da dieta. Porém, ela não permeia facilmente através da barreira hematoencefálica (BHE), assim o cérebro deve suprir suas necessidades através da síntese de creatina no próprio sistema nervoso central (SNC). A grande importância da creatina para o funcionamento correto do organismo está em manter estáveis os níveis de adenosina trifosfato (ATP). Doenças neurodegenerativas levam a déficits de ATP, o que compromete o metabolismo celular, gerando espécies reativas (ERs) capazes de levar as células neuronais à morte. Assim, torna-se importante aumentar os níveis de creatina em doenças neurodegenerativas, podendo gerar novas alternativas de tratamento para estas doenças. Desta forma, o presente trabalho teve como objetivo desenvolver e caracterizar lipossomas de creatina, bem como, investigar o seu efeito protetor em um modelo de isquemia e reperfusão (I/R) cerebral. Foram utilizadas duas metodologias para o preparo dos lipossomas, a hidratação do filme lipídico e a injeção de etanol. Devido aos melhores resultados obtidos pelo método de injeção de etanol, este foi escolhido para o preparo dos lipossomas a serem aplicados nos testes in vivo. Os ratos foram submetidos ao processo de I/R pelo clampeamento bilateral das artérias carótidas, sendo os diferentes grupos tratados com a creatina (30 mg/kg) na forma livre (Liv+I/R) e lipossomada (Lip+I/R), sendo comparados com os grupos controle e I/R. A atividade locomotora, exploratória e a memória dos animais foram avaliadas através dos testes de campo aberto e da esquiva passiva, 24 e 48 h após a I/R, respectivamente. Após 72 h, os animais foram eutanasiados e os cérebros removidos para as determinações bioquímicas dos níveis de ERs e ácido ascórbico (AA), e a atividade das enzimas superóxido dismutase (SOD) e catalase (CAT). As suspensões de lipossomas utilizadas para o tratamento in vivo apresentaram diâmetro médio de partícula homogêneo (154 ± 6,9 nm), com baixo índice de polidispersão (0,211 ± 0,019), pH próximo a neutralidade (em torno de 6,7), potencial Zeta negativo (-21 ± 1,8 mV) e taxa de associação em torno de 31%. Os resultados do teste de campo aberto demonstraram que a I/R causou alteração na atividade exploratória dos animais. Além disso, o estudo demonstrou aumento no estresse oxidativo no cérebro de ratos submetidos a I/R. Os lipossomas de creatina protegeram a alteração na atividade exploratória e o aumento do estresse oxidativo em córtex de ratos. Já a creatina na forma livre não foi capaz de proteger contra estas alterações. Através destes resultados, pode-se concluir que a produção de lipossomas contendo creatina apresentou viabilidade tecnológica, demonstrando potencial para aumentar a biodisponibilidade de creatina para o SNC através da BHE

PRODUÇÃO DE LIPOSSOMAS DE CREATINA, AVALIAÇÃO DA TOXICIDADE E DE EFEITO NEUROPROTETOR EM MODELO ANIMAL DE NEURODEGENERAÇÃO

Submitted by MARCIA ROVADOSCHI ([email protected]) on 2018-08-20T12:27:29Z No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Tese_DiegoBeckerBorin.pdf: 7060697 bytes, checksum: bbf39761011feb8708ec27ab4968daed (MD5)Made available in DSpace on 2018-08-20T12:27:29Z (GMT). No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Tese_DiegoBeckerBorin.pdf: 7060697 bytes, checksum: bbf39761011feb8708ec27ab4968daed (MD5) Previous issue date: 2017-03-27The pathophysiology of neurodegenerative diseases is associated with neuronal loss or dysfunction, whose characteristics are determined due to cerebral area affected and progression of the disease. Creatine has physiological importance as energy buffer and storage having protective effects in animal models of neurodegenerative diseases. However, its permeability through the blood-brain barrier (BBB) is very low. The objective of this study is was developing a nanoliposome carrier to facilitate the delivery of creatine to the central nervous system (CNS), thus could potentiate the effects of creatine. In order to test the safety of liposomes toxicity, assays were performed in cell culture and in vivo, as well as analyzed in streptozotocin-induced (STZ) dementia model. The method of production of liposomes by ethanol injection, proved to be efficient, since particles with a polydispersion index (PDI) of 0,237, negative Zeta potential (-12.5 mV) and average size of 213 nm were obtained. The size was confirmed by transmission electron microscopy where spherical particles of 100-200 nm were observed. In in vitro toxicity assays, blank liposomes (without creatine - BL) as well as creatine liposomes (CrL) at concentrations of 0.02 and 0.2 mg/mL did not alter the viability of VERO cells cultured. It also did not alter viability of neural cells in hippocampal slices from adult rats. In toxicity assays in vivo, subchronic treatment with both liposomes did no changes hematological and biochemical markers in blood of young rats, but an increased in creatine concentrations were observed in the brains of CrL-treated animals was observed. In the animal model of STZ-induced dementia in adult mice, behavioral changes such as habituation memory deficit and long-term aversive memory were reversed by 21 days treatment with free creatine and CrL. The animals of the STZ groups did not present alterations in energetic metabolism enzymes in the hippocampus, but they showed a reduction in creatine levels in cerebral tissue, which was reversed by the treatment with free creatine and CrL. It is suggested from the results that CrL can be used safely, but further studies should be performed to verify its performance in other neurodegeneration models.A fisiopatologia de doenças neurodegenerativas está associada à perda ou disfunção neuronal, cujas características são determinadas pela região onde ocorre a perda e pela velocidade de progressão da doença. A creatina possui importância fisiológica como mecanismo de reserva e tampão energético tendo efeitos protetores em modelos animais de doenças neurodegenerativas, apesar de possuir baixa permeabilidade através da barreira hematoencefálica (BHE). Assim, o objetivo do presente estudo foi desenvolver um carreador lipossomado para facilitar a entrega de creatina ao sistema nervoso central (SNC), e assim potencializar os efeitos da creatina livre. Com a finalidade de testar a segurança dos lipossomas testes de toxicidade em cultura de células e in vivo foram realizados, assim como testes em um modelo de demência induzido por estreptozotocina (STZ) para avaliar sua funcionalidade, também foi avaliada a concentração de creatina no SNC dos animais. O método de produção de lipossomas por meio da injeção de etanol demonstrou ser eficiente, pois foram obtidas partículas com índice de polidispersão (IPD) 0,237, potencial Zeta de -12,5 mV e tamanho médio de 213 nm. O tamanho foi confirmado por microscopia eletrônica de transmissão onde observou-se partículas esféricas de 100 a 200 nm. Nos testes de toxicidade in vitro, os lipossomas brancos (sem creatina - LB) bem como os lipossomas de creatina (LCr) nas concentrações de 0,02 e 0,2 mg/mL não alteraram a viabilidade de células em cultura da linhagem VERO, e tampouco de fatias da área cerebral hipocampo de ratos adultos. Nos testes de toxicidade in vivo, não foram observadas alterações com o tratamento subcrônico com ambos lipossomas em marcadores hematológicos e bioquímicos em ratos filhotes, porém foi observado um aumento nas concentrações de creatina no cérebro dos animais tratados com LCr. No modelo animal de demência induzido por STZ em camundongos adultos foram observadas alterações comportamentais como déficit de memória de habituação e aversiva de longo prazo ambas revertidas pelo tratamento de 21 dias com creatina livre e LCr. Os animais dos grupos STZ não apresentaram alterações em enzimas do metabolismo energético no hipocampo, porém apresentaram redução nos níveis de creatina, que foi revertido pelo tratamento com creatina livre e LCr. Sugere-se a partir dos resultados obtidos, que os LCr podem ser utilizados com segurança, porém mais estudos devem ser realizados para verificar seu desempenho em outros modelos de neurodegeneração

Parasporin A13-2 of Bacillus thuringiensis Isolates from the Papaloapan Region (Mexico) Induce a Cytotoxic Effect by Late Apoptosis against Breast Cancer Cells

The protein A13-2 was obtained from Bacillus thuringiensis strains isolated from the Papaloapan watershed region (Oaxaca, Mexico). The cytotoxic activity of parasporal inclusions was studied against breast cancer cell line (MCF-7) and normal cell (human peripheral blood mononuclear cells). The MTT, the formation of reactive species, nitric oxide, free cell DNA, and the type of death cellular were assessed. The protein A13-2 shows the highest cytotoxic activity against MCF-7 (13% cell viability at 6 µg/mL), the extracellular DNA increases, and it shows no stress for reactive species or nitric oxide. Besides, the A13-2 parasporin shows no toxicity to peripheral blood mononuclear cells, and it does not generate changes in nitric oxide levels or free cell DNA. Due to that, the cytotoxic effect of A13-2 was specific for MCF-7, and it does not affect normal cells. According to microscopy and flow cytometry, A13-2 parasporin leads to the death of MCF-7 cells by late apoptosis together with necrosis and without allowing the triggering of the survival mechanisms. When analyzed together, our results show for the first time that the A13-2 protein isolated from Mexican strains of B. thuringiensis preferentially kills MCF- 7 (cancer cells) over HEK 293 and PBMC cell lines (normal cells), thus representing a promising alternative for the treatment of cancer breast

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 (Intensive Care Medicine, (2021), 47, 2, (160-169), 10.1007/s00134-020-06234-9)

The original version of this article unfortunately contained a mistake. The members of the ESICM Trials Group Collaborators were not shown in the article but only in the ESM. The full list of collaborators is shown below. The original article has been corrected