Sepsis Associated Delirium

Sepsis is a potentially life-threatening condition caused by a systemic dysregulated host response to infection. The brain is particularly susceptible to the effects of sepsis with clinical manifestations ranging from mild confusion to a deep comatose state. Sepsis-associated delirium (SAD) is a cerebral manifestation commonly occurring in patients with sepsis and is thought to occur due to a combination of neuroinflammation and disturbances in cerebral perfusion, the blood brain barrier (BBB) and neurotransmission. The neurological impairment associated with SAD can persist for months or even longer, after the initial septic episode has subsided which may impair the rehabilitation potential of sepsis survivors. Early identification and treatment of the underlying sepsis is key in the management of SAD as once present it can be difficult to control. Through the regular use of validated screening tools for delirium, cases of SAD can be identified early; this allows potentially aggravating factors to be addressed promptly. The usefulness of biomarkers, neuroimaging and electroencephalopathy (EEG) in the diagnosis of SAD remains controversial. The Society of Critical Care Medicine (SCCM) guidelines advise against the use of medications to treat delirium unless distressing symptoms are present or it is hindering the patient's ability to wean from organ support.publishersversionpublishe

Self-harm as a predisposition for suicide attempts: A study of adolescents' deliberate self-harm, suicidal ideation, and suicide attempts

The aim of this study was to analyze the predictive risk factors for self-harm in adolescents with and without suicidal ideation. 600 adolescents answered a questionnaire about self-harm and suicidal behaviors. A logistic regression analysis was conducted. Over half of the individuals with deliberate self-harm (DSH) presented significant suicide risk. There was a direct association between DSH and suicide attempts, with almost the totality of the adolescents with suicide attempts also reporting DSH. According to the prediction model, suicidal ideation and diversity of DSH behaviors are significant predictors of suicide attempts, with an augmentation in the diversity of DSH behaviors and suicidal ideation predicting suicide attempts. Depression and anxiety appeared also as significant predictors of suicide attempts in adolescent self-harmers. Considering that the majority of the sample was not from a clinical setting, an alarming finding was that one third of the total sample was at suicide risk. These results place DSH as a key variable for early intervention.info:eu-repo/semantics/acceptedVersio

What every intensivist needs to know about subsyndromal delirium in the intensive care unit

publishersversionpublishe

A Percepção do Enfermeiro Sobre Cuidados a Pacientes Oncológicos

Cancer is characterized as a disease that affects different ethnicities, gender and socioeconomic status. The incidence of cancer is increasing, and, according to national and international estimates, the numbers will continue increasing. Based on this finding, the nurse must be prepared to develop a care plan for cancer patients according to the biological, social and emotional needs resulting from the diagnosis, treatment and survival. The study aims to know the nurse's perception about the nursing care to the patient with cancer. It is a descriptive exploratory study with qualitative methodological approach of data carried out with twelve nurses who developed assistance activities with patients with cancer of a school hospital in the State of São Paulo, Brazil. The data were collected using a semi-structured interview. The data were organized around two main themes: the perception and the dimensions of the care and the oncology patient care. The results revealed that, for nurses, assistance is directed to issues such as the care during treatment, administration of chemotherapy, pain relief and emotional dimensions of patient interaction with cancer, in terminality process and death. We conclude that the oncological patient care requires specialized and humanized knowledge of the entire multidisciplinary team involved in this process.O câncer se caracteriza como uma doença que acomete diferentes etnias, sexo e nível socioeconômico. A incidência de câncer está cada vez maior, e, segundo estimativas nacionais e internacionais, os números continuarão aumentando. Diante dessa constatação, o enfermeiro deve estar preparado para desenvolver um plano de cuidados a pacientes oncológicos atendendo às necessidades biológicas, sociais e emocionais decorrentes do diagnóstico, tratamento e sobrevivência. O estudo tem por objetivo conhecer a percepção do enfermeiro acerca do cuidar de enfermagem ao paciente com câncer. É um estudo de natureza descritiva com abordagem metodológica qualitativa dos dados, realizado com 12 enfermeiros que desenvolviam atividades assistenciais a pacientes com câncer de um hospital escola do interior do estado de São Paulo. Os dados foram coletados com base em uma entrevista semiestruturada. Os dados foram organizados ao redor de dois temas principais: a percepção e as dimensões do cuidar e os cuidados ao paciente oncológico. Os resultados revelaram que, para os enfermeiros, a assistência é direcionada a questões como os cuidados durante o tratamento, administração de quimioterápicos, alívio da dor e as dimensões emocionais da convivência ao paciente com câncer, no processo de terminalidade e morte. Concluímos que o cuidar do paciente oncológico requer conhecimento especializado e humanizado de toda a equipe multiprofissional envolvida neste processo

Projeto Flórida: (im)possibilidades para o devir-criança

Este texto faz uma reflexão sobre a experiência da infância no filme Projeto Flórida (2017), do diretor Sean Baker, cuja história envolve uma menina de seis anos e sua jovem mãe, que moram em um hotel de beira de estrada próximo ao parque da Disney. Ancora-se na abordagem metodológica da etnografia de tela,a partir das simbologias presentes na narrativa que suscitam uma estética da realidade versus fantasia vivenciada pela personagem Moonee e outras crianças amigas. Problematiza, a partir dos conceitos de devir criança, de impossibilidades e gênero, a presença ou a ausência dos afetos, das redes de solidariedade e de proteção, da amizade, dos brincares e do exercício da maternidade

Health Care Worker Immune Status and Risk Perception of Acquisition of Vaccine Preventable Diseases

Universidade Federal de São Paulo, São Paulo, BrazilUniversidade Federal de São Paulo, São Paulo, BrazilWeb of Scienc

Health Care Workers Occupational Accidents in a Brazilian Hospital

Universidade Federal de São Paulo, São Paulo, BrazilUniversidade Federal de São Paulo, São Paulo, BrazilWeb of Scienc

Subsyndromal delirium in critically ill patients: cognitive and functional long-term outcomes

© 2023 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).Subsyndromal delirium (SSD) in the Intensive Care Unit (ICU) is associated with an increased morbidity with unknown post-discharge functional and cognitive outcomes. We performed a prospective multicenter study to analyze the mental status of patients during their first 72 h after ICU admission and its trajectory, with follow-ups at 3 and 6 months after hospital discharge. Amongst the 106 included patients, SSD occurred in 24.5% (n = 26) and was associated with the duration of mechanical ventilation (p = 0.003) and the length of the ICU stay (p = 0.002). After the initial 72 h, most of the SSD patients (30.8%) improved and no longer had SSD; 19.2% continued to experience SSD and one patient (3.8%) progressed to delirium. The post-hospital discharge survival rate for the SSD patients was 100% at 3 months and 87.5% at 6 months. At admission, 96.2% of the SSD patients were fully independent in daily living activities, 66.7% at 3-month follow-up, and 100% at 6-month follow-up. Most SSD patients demonstrated a cognitive decline from admission to 3-month follow-up and improved at 6 months (IQCODE-SF: admission 3.13, p < 0.001; 3 months 3.41, p = 0.019; 6 months 3.19, p = 0.194). We concluded that early SSD is associated with worse outcomes, mainly a transitory cognitive decline after hospital discharge at 3 months, with an improvement at 6 months. This highlights the need to prevent and identify this condition during ICU stays.info:eu-repo/semantics/publishedVersio

Polymer-cementitious composites containing recycled rubber particles

Waste from scrap tires is one of the most environmentally harmful waste since it leads to significant soil and air pollution. This work investigates the effect of recycled rubber particles incorporation into cementitious composites modified with epoxy polymer. A Design of Experiment (DoE) was conducted to identify the effect of epoxy polymer inclusion (35 and 50?wt%), rubber inclusion (10, 15 and 20?wt%) and rubber particle size (coarse and fine particles) factors on the bulk density, mechanical strength and stiffness of the composites. Third-order interaction effects were obtained, except for density which was affected by two second-order interactions. Larger epoxy polymer and rubber amounts decreased the bulk density of the composites. Epoxy polymer contributes to cement hydration, even without water content. Higher incorporation of coarse rubber particles leads to reduced mechanical performance. In general, lower amounts of epoxy polymer and finer rubber aggregates provide superior mechanical strength and modulus. The use of epoxy polymer also enhances the adhesion between cement and rubber aggregates. This rubber polymer-cementitious composite achieved promising results, being a feasible alternative to reuse end-of-life rubber tyres into structural applications

ANISERP: a new serpin from the parasite Anisakis simplex

Background: Serine proteinase inhibitors (serpins) finely regulate serine proteinase activity via a suicide substrate-like inhibitory mechanism. In parasitic nematodes, some serpins interact with host physiological processes; however, little is known about these essential molecules in Anisakis. This article reports the gene sequencing, cloning, expression and preliminary biochemical and bioinformatically-based structural characterization of a new Anisakis serpin (ANISERP). Methods: The full AniSerp gene was cloned by specific RACE-PCR after screening an Anisakis simplex (L3) cDNA library. For biochemical assays, the AniSerp gene was subcloned into both prokaryotic and eukaryotic vectors, and the recombinant proteins were purified. The inhibitory properties of the proteins were tested in classical biochemical assays using human serine peptidases and AMC substrates. Immunolocalization of ANISERP, theoretical structural analysis and bioinformatically-based structural modelling of the ANISERP protein were also conducted. Results: The AniSerp gene was found to have 1194 nucleotides, coding for a protein of 397 amino acid residues plus a putative N-terminal signal peptide. It showed significant similarity to other nematode, arthropod and mammalian serpins. The recombinant ANISERP expressed in the prokaryotic and eukaryotic systems inhibited the human serine proteases thrombin, trypsin and cathepsin G in a concentration-dependent manner. No inhibitory activity against Factor Xa, Factor XIa, Factor XIIa, elastase, plasmin or chymotrypsin was observed. ANISERP also acted on the cysteine protease cathepsin L. ANISERP was mainly localized in the nematode pseudocoelomic fluid, somatic muscle cell bodies and intestinal cells. The findings of molecular dynamics studies suggest that ANISERP inhibits thrombin via a suicide substrate-like inhibitory mechanism, similar to the mechanism of action of mammalian coagulation inhibitors. In contrast to findings concerning human antithrombin III, heparin had no effect on ANISERP anticoagulant inhibitory activity. Conclusions: Our findings suggest that ANISERP is an internal Anisakis regulatory serpin and that the inhibitory activity against thrombin depends on a suicide substrate-like inhibitory mechanism, similar to that described for human antithrombin (AT)-III. The fact that heparin does not modulate the anticoagulant activity of ANISERP might be explained by the absence in the latter of five of the six positively charged residues usually seen at the AT-III-heparin binding site.We thank Biomol-Informatics SL (http://www.biomol-informatics.com/) for bioinformatic consultation. We also thank Juan Francisco Alcaide and Julia Medrano for their invaluable help in the ANISERP patenting process. We thank Dr Raúl Iglesias (Laboratorio de Parasitología, Facultad de Biología, Universidad de Vigo) for his helpful comments on the interpretation of the IHQ studies