Prevention of ventilator-associated pneumonia

AbstractInvasive mechanical ventilation (IMV) represents a risk factor for the development of ventilator-associated pneumonia (VAP), which develops at least 48h after admission in patients ventilated through tracheostomy or endotracheal intubation. VAP is the most frequent intensive-care-unit (ICU)-acquired infection among patients receiving IMV. It contributes to an increase in hospital mortality, duration of MV and ICU and length of hospital stay. Therefore, it worsens the condition of the critical patient and increases the total cost of hospitalization. The introduction of preventive measures has become imperative, to ensure control and to reduce the incidence of VAP. Preventive measures focus on modifiable risk factors, mediated by non-pharmacological and pharmacological evidence based strategies recommended by guidelines. These measures are intended to reduce the risk associated with endotracheal intubation and to prevent microaspiration of pathogens to the lower airways

Medical Termination of Delayed Miscarriage: Four-Year Experience with an Outpatient Protocol

Purpose: To evaluate the efficacy of an outpatient protocol with vaginal misoprostol to treat delayed miscarriage. Methods: Retrospective analysis of prospectively collected data on women medically treated for missed abortion with an outpatient protocol. The inclusion criteria were: ultrasound-based diagnosis of missed abortion with less than 10 weeks; no heavy bleeding, infection, inflammatory bowel disease or misoprostol allergy; no more than 2 previous spontaneous abortions; the preference of the patient regarding the medical management. The protocol consisted of: 1) a single dose of 800 µg of misoprostol administered intravaginally at the emergency department, after which the patients were discharged home; 2) clinical and ultrasonographic evaluation 48 hours later – if the intrauterine gestational sac was still present, the application of 800 µg of vaginal misoprostol was repeated, and the patients were discharged home; 3) clinical and ultrasonography evaluation 7 days after the initiation of the protocol – if the intrauterine gestational sac was still present, surgical management was proposed. The protocol was introduced in January 2012. Every woman received oral analgesia and written general recommendations. We also gave them a paper form to be presented and filled out at each evaluation. Results: Complete miscarriage with misoprostol occurred in 340 women (90.2%). Surgery was performed in 37 (9.8%) patients, representing the global failure rate of the protocol. Miscarriage was completed after the first misoprostol administration in 208 (55.2%) women, with a success rate after the second administration of 78.1% (132/169). The average age of the women with complete resolution using misoprostol was superior to the average age of those who required surgery (33.99 years versus 31.74 years; p = 0.031). Based on the ultrasonographic findings in the first evaluation, the women diagnosed with fetal loss achieved greater success rates compared with those diagnosed with empty sac (p = 0.049). Conclusions: We conclude this is an effective and safe option in the majority of delayed miscarriage cases during the first trimester, reducing surgical procedures and their consequences

Developing scaffolds for tissue engineering using the Ca2+-induced cold gelation by an experimental design approach

The Ca2+-induced cold gelation technique was found suitable to prepare highly porous biodegradable scaffolds based on bovine serum albumin (BSA) and alpha-casein from bovine milk for tissue engineering. A 23 full factorial design was used to study the influence and impact of each factor on the several responses of the scaffolds. In vitro degradation (ID), swelling ratio (SR), porosity (PO), and pore size (PS) as well cytotoxicity (CT) were evaluated and shown to be dependent on the pH of sample preparation and on the amount of BSA and casein present, making these scaffolds tunable structures. Under optimized working conditions (4.19% of BSA, 0.69% of Casein, pH 7.07), the ID attained was 37.97%, the SR observed was 11.87, the PO was 82.11%, the PS measured was 180.63 μm at surface, and 175.91 μm at fracture, whereas maximum cell viability was 84% in comparison to controls. Moreover, the scaffold supported cell adhesion and proliferation. These results, consistent with the prediction by the experimental design approach, support the use of this methodology to develop tunable scaffolds for tissue engineering using the Ca2+-induced cold gelation.Contract grant sponsor: FEDER through POFC-COMPETE and by national funds from FCT; contract grant number: PEst-C/BIA/UI4050/201

Immobilization of proteases with a water soluble–insoluble reversible polymer for treatment of wool

A commercial protease, Esperase, was covalently linked to Eudragit S-100, a reversible soluble–insoluble polymer by carbodiimide coupling. When compared to the native enzyme, the immobilized form presented a lower specific activity towards high molecular weight substrates but a higher thermal stability at all temperatures tested. The optimum pH of the immobilized protease was shifted towards the alkaline side by about one pH unit while there was no change in optimum temperature between the free and immobilized protease. The immobilized protease exhibited a good storage stability and re-usability. Enzymatic treatment of wool using proteases has been investigated for wool shrink-resist finishing. It was found that using the immobilized protease in the enzymatic treatment of wool there was a reduction of weight and fibre tensile strength loss because the proteolytic attack is only limited to the cuticle surfaces of wool fibres. This novel approach is a promising alternative for wool shrink-resist finishing to replace the conventional chlorine treatments. This environmentally friendly bioprocess needs to be further characterized to a complete understanding and optimization

Tuberculose Infantil — Anos 90. Revisão Casuística de 5 Anos

É apresentada a revisão de 204 casos de tuberculose doença diagnosticados e tratados no Hospital de D. Estefânia num período de 5 anos (1990-1994). Refira-se, nos casos estudados (204), a maior percentagem de crianças no grupo etário dos 5 aos 14 anos (67%), uma incidência de 32% para a raça negra e um predomínio nas classes sociais mais desfavorecidas, contribuindo o concelho da Amadora com a maior percentagem de casos. A inoculação prévia de BCG observou-se em 80% dos casos. As formas mediastino-pulmonares verificaram-se em 91% das crianças, tendo ocorrido complicações em 23%. A complicação mais frequente foi o derrame pleural. A tuberculose extrapulmonar observou-se em 9% das formas de tuberculose doença, sendo a meningite a mais frequente. A identificação da fonte de contágio foi possível em 42% dos casos e a pesquisa de BK positiva em 23%. Considerando o grupo racial como factor de variabilidade, verificou-se uma maior frequência de complicações na raça negra (29%) do que na raça branca (17%). Salienta-se a alta prevalência de tuberculose em Portugal e a sua incidência preferencial nas classes sociais mais desfavorecidas e nas zonas habitacionais urbanas mais degradadas

The scope of preserved procedural memory in amnesia

The finding that patients with amnesia retain the ability to learn certain procedural skills has provided compelling evidence of multiple memory systems in the human brain, but the scope, defining features and ecological significance of the preserved mnemonic abilities have not yet been explored. Here, we tested the hypothesis that subjects with amnesia would be able to learn and retain a broad range of procedural skills, by examining their acquisition and retention performance on five novel experimental tasks. The tasks are based on real-world activities and encompass a broad range of perceptual–motor demands: (i) the weaving task involves weaving pieces of fabric from woollen strings, using a manual weaver’s loom; (ii) the geometric figures task consists of tracing geometric figures with a stylus as they move horizontally across a touch screen monitor; (iii) the control stick task involves tracking a sequence of visual target locations using a joystick control; (iv) the pouring task consists of pouring 200 ml of water from a watering can into a series of graduated cylinders, from a point 20 cm above the cylinders; and (v) the spatial sequence task involves learning an ordered sequence of pushing five spatially distributed buttons without visual guidance. Ten chronic and stable amnesic subjects (nine with bilateral medial temporal lobe damage due to herpes simplex encephalitis or anoxia, and one with thalamic stroke) and 25 matching normal comparison subjects were tested on three occasions: initial learning at time 1; retention at time 2 (24 h later); and retention at time 3 (2 months later). Despite impaired declarative memory for the tasks, the amnesic subjects demonstrated acquisition and retention of the five skills; their learning slopes over repeated trials were comparable with those of comparison subjects. These findings indicate that preserved learning of complex perceptual–motor skills in patients with amnesia is a robust phenomenon, and that it can be demonstrated across a variety of conditions and perceptual– motor demands. The comparability of the tasks employed in this study with real-world activities highlights the potential application of this memory dissociation in the rehabilitation of patients with amnesi

Shock Following Subcutaneous Injections of Polymethylmethacrylate

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Functionalization of bacterial cellulose nonwoven by poly(fluorophenol) to improve its hydrophobicity and durability

The present study aims to improve the hydrophobicity and durability of bacterial cellulose (BC) nonwoven by functionalization with poly(fluorophenol). To this end, laccase was first entrapped onto BC and then used to polymerize the fluorophenol {4-[4-(trifluoromethyl) phenoxy] phenol} in-situ. The polymerization of fluorophenol by laccase was confirmed through 1H NMR and MALDI-TOF analyses. The effect of poly(fluorophenol) on BC nonwoven was determined by evaluation of the surface hydrophobicity and olephobicity properties such as water contact angle (WCA), oil contact angle (OCA), surface energy and water/oil absorption time. After BC functionalization with poly(fluorophenol) (20 mM), the WCA increased from 54.5 ± 1.2° to 120 ± 1.5° while the surface energy decreased (11.58 ± 1.4 mN/m). The OCA was also increased from 46.5 ± 2.5° to 87 ± 2° along to the decrease of surface energy (8.7 ± 1.5°). X-ray photoelectron spectroscopy (XPS) analysis confirmed an increase in the fluorine content in BC from 5.27 to 17.57%. The findings confirmed the polymerization of fluorophenol by laccase and its entrapment onto a BC nanofiber structure. The durability of the functionalization with poly(fluorophenol) was confirmed by evaluating the washing fastness, tensile strength after washing and dimensional stability. The results indicate that the functionalized BC nonwoven had higher tensile strength (×10 times) and better dimensional stability (30%) than the non-functionalized BC nonwoven material.This work was supported by the Portuguese Foundationfor Science and Technology (FCT) under the scope of thestrategic funding of UID/BIO/04469/2019 unit and Bio-TecNorteoperation (NORTE-01-0145-FEDER-000004). This work wasalso supported by the National Research Foundation of Korea(NRF) grant funded by the Korea government (MSIT) (No. NRF-2019R1A2C1009217).info:eu-repo/semantics/publishedVersio