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

Impact of physicochemical parameters of the digestive tract on Cryptosporidium parvum infection

International audienceCryptosporidium parvum is responsible for a zoonotic disease affecting both human health and livestock. The parasite infects its host through the oral route and develops in ileal epithelial cells, leading to acute and sometimes lethal diarrhoea. The severity of cryptosporidiosis is closely related to the immune status of its host, young ruminants, infants, and immunocompromised individuals being more susceptible. Other non-immune-related factors, such as digestive physicochemical properties, can also vary widely with age but their contribution to infection establishment in young individuals has never been investigated. In vitro digestion models have been designed and validated to study the fate of orally ingested substances while closely mimicking the physiological processes occurring during digestion. Among the available systems, the dynamic and multicompartmental TNO gastrointestinal model (TIM-1) is currently the most complete simulator of the human upper gastrointestinal tract. The TIM-1 was used for a comparative study of C. parvum infection under adult and young children (from 6 months to 2 years) digestive conditions. The TIM-1 was programmed to reproduce both physicochemical digestive conditions upon simulated ingestion of a glass of mineral water, which was experimentally contaminated with C. parvum oocysts. The parasite excystation kinetics throughout the course of the in vitro digestion was determined by flow cytometry analysis. Parasite invasion ability was assessed after reinoculation of sporozoites collected from the TIM-1 onto HCT-8 cells. A luciferase reporter gene assay was also used to follow sporozoite activity throughout the digestive process. Our data show that the parasite excystation rate is almost maximal in the duodenal compartment, one hour after the beginning of digestion in the TIM-1. However, a higher number of parasites reaches the distal ileal compartment while protected in their oocyst shell upon simulation of child compared to adult digestive conditions. This suggests that a lower amount of sporozoites is released in the small intestine in children, nevertheless, the luciferase activity expressed by these free stages in the ileal compartment is significantly higher in children compared to adults. Invasion assay performed on HCT-8 cells suggests that only sporozoites collected in the ileum after three hours of digestion are able to invade host cells.Our study is the first one exploring the impact of different digestive conditions on Cryptosporidium using a sophisticated gastrointestinal model. A global transcriptome analysis by RNA-Seq is also being performed on samples collected during in vitro digestion to identify parasite genes that are differentially expressed under child and adult digestive conditions

Impact of physicochemical parameters of child or adult digestive tract on Cryptosporidium parvum infection

National audienceCryptosporidium parvum is responsible for a zoonotic disease affecting both human health and livestock. The parasite infects its host through the oral route and develops in ileal epithelial cells, leading to acute and sometimes lethal diarrhoea. The severity of cryptosporidiosis is closely related to the immune status of its host, young ruminants, infants, and immunocompromised individuals being more susceptible. Other non-immune-related factors, such as digestive physicochemical properties, can also vary widely with age but their contribution to infection establishment in young individuals has never been investigated. In vitro digestion models have been designed and validated to study the fate of orally ingested substances while closely mimicking the physiological processes occurring during digestion. Among the available systems, the dynamic and multicompartmental TNO gastrointestinal model (TIM-1) is currently the most complete simulator of the human upper gastrointestinal tract. The TIM-1 was used for a comparative study of C. parvum infection under adult and young children digestive conditions. The TIM-1 was programmed to reproduce both physicochemical digestive conditions upon simulated ingestion of a glass of mineral water, which was experimentally contaminated with C. parvum oocysts. The parasite excystation kinetics throughout the course of the in vitro digestion was determined by flow cytometry analysis. Parasite invasion ability was assessed after reinoculation of sporozoites collected from the TIM-1 onto HCT-8 cells. A luciferase reporter gene assay was also used to follow sporozoite activity throughout the digestive process. Our data show that the parasite excystation rate is almost maximal in the duodenal compartment, one hour after the beginning of digestion in the TIM-1. However, a higher number of parasites reaches the distal ileal compartment while protected in their oocyst shell upon simulation of child compared to adult digestive conditions. This suggests that a lower amount of sporozoites is released in the small intestine in children, nevertheless, the luciferase activity expressed by these free stages in the ileal compartment is significantly higher in children compared to adults. Invasion assay performed on HCT-8 cells suggests that only sporozoites collected in the ileum after three hours of digestion are able to invade host cells.Our study is the first one exploring the impact of different digestive conditions on Cryptosporidium using a sophisticated gastrointestinal model. A global transcriptome analysis by RNA-Seq is also being performed on samples collected during in vitro digestion to identify parasite genes that are differentially expressed under child and adult digestive conditions

Desenvolvimento de massa alimentícia fresca funcional com a adição de isolado protéico de soja e polidextrose utilizando páprica como corante

A tendência do consumidor atual é utilizar alimentos de fácil preparo que, adicionalmente à qualidade nutritiva, tragam benefícios à saúde. Neste trabalho, uma massa alimentícia fresca funcional foi desenvolvida pela incorporação de Isolado Protéico de Soja (IPS) e polidextrose, utilizando páprica como corante. O consumo de IPS pode contribuir para a diminuição dos níveis de colesterol, enquanto a polidextrose, funcionando como fibra, pode promover a redução de risco de câncer de cólon. A otimização da formulação foi realizada utilizando-se um delineamento fatorial completo 23, considerando como variáveis independentes os teores de: i) IPS; ii) polidextrose; e iii) páprica. Os efeitos destas variáveis na qualidade da massa alimentícia foram avaliados em função das características físico-químicas (cor e teste de cozimento), textura instrumental e propriedades sensoriais. Na avaliação dos parâmetros físicos, observou-se que a cor instrumental da massa crua foi influenciada apenas pelo teor de páprica; já o tempo de cozimento (2,5 minutos), o aumento de massa (1,40 a 1,64%) e a perda de sólidos (3,80 a 5,56%) não foram influenciados pelos ingredientes utilizados; e a elasticidade (parâmetro da textura instrumental) foi reduzida com o aumento do teor de polidextrose. Na avaliação sensorial da massa crua, o aumento na porcentagem de IPS e a redução na porcentagem de polidextrose afetaram positivamente a aceitação global e a intenção de compra; e os aumentos nas porcentagens de IPS e de páprica aumentaram a aceitação da cor. Na avaliação sensorial da massa cozida, observou-se que o IPS teve influência positiva sobre a textura, enquanto que a polidextrose e a páprica afetaram negativamente este parâmetro. Entretanto, na avaliação da intenção de compra da massa cozida, não houve influência dos ingredientes adicionados. Os percentuais ideais de adição de polidextrose, isolado protéico de soja e páprica foram de 3,5, 8,0 e 1,5%, respectivamente

Impact of physicochemical parameters of the digestive tract on Cryptosporidium parvum infection

International audienceCryptosporidium parvum is responsible for a zoonotic disease affecting both human health and livestock. The parasite infects its host through the oral route and develops in ileal epithelial cells, leading to acute and sometimes lethal diarrhoea. The severity of cryptosporidiosis is closely related to the immune status of its host, young ruminants, infants, and immunocompromised individuals being more susceptible. Other non-immune-related factors, such as digestive physicochemical properties, can also vary widely with age but their contribution to infection establishment in young individuals has never been investigated. In vitro digestion models have been designed and validated to study the fate of orally ingested substances while closely mimicking the physiological processes occurring during digestion. Among the available systems, the dynamic and multicompartmental TNO gastrointestinal model (TIM-1) is currently the most complete simulator of the human upper gastrointestinal tract. The TIM-1 was used for a comparative study of C. parvum infection under adult and young children (from 6 months to 2 years) digestive conditions. The TIM-1 was programmed to reproduce both physicochemical digestive conditions upon simulated ingestion of a glass of mineral water, which was experimentally contaminated with C. parvum oocysts. The parasite excystation kinetics throughout the course of the in vitro digestion was determined by flow cytometry analysis. Parasite invasion ability was assessed after reinoculation of sporozoites collected from the TIM-1 onto HCT-8 cells. A luciferase reporter gene assay was also used to follow sporozoite activity throughout the digestive process. Our data show that the parasite excystation rate is almost maximal in the duodenal compartment, one hour after the beginning of digestion in the TIM-1. However, a higher number of parasites reaches the distal ileal compartment while protected in their oocyst shell upon simulation of child compared to adult digestive conditions. This suggests that a lower amount of sporozoites is released in the small intestine in children, nevertheless, the luciferase activity expressed by these free stages in the ileal compartment is significantly higher in children compared to adults. Invasion assay performed on HCT-8 cells suggests that only sporozoites collected in the ileum after three hours of digestion are able to invade host cells.Our study is the first one exploring the impact of different digestive conditions on Cryptosporidium using a sophisticated gastrointestinal model. A global transcriptome analysis by RNA-Seq is also being performed on samples collected during in vitro digestion to identify parasite genes that are differentially expressed under child and adult digestive conditions

Impact of physicochemical parameters of child or adult digestive tract on Cryptosporidium parvum infection

National audienceCryptosporidium parvum is responsible for a zoonotic disease affecting both human health and livestock. The parasite infects its host through the oral route and develops in ileal epithelial cells, leading to acute and sometimes lethal diarrhoea. The severity of cryptosporidiosis is closely related to the immune status of its host, young ruminants, infants, and immunocompromised individuals being more susceptible. Other non-immune-related factors, such as digestive physicochemical properties, can also vary widely with age but their contribution to infection establishment in young individuals has never been investigated. In vitro digestion models have been designed and validated to study the fate of orally ingested substances while closely mimicking the physiological processes occurring during digestion. Among the available systems, the dynamic and multicompartmental TNO gastrointestinal model (TIM-1) is currently the most complete simulator of the human upper gastrointestinal tract. The TIM-1 was used for a comparative study of C. parvum infection under adult and young children digestive conditions. The TIM-1 was programmed to reproduce both physicochemical digestive conditions upon simulated ingestion of a glass of mineral water, which was experimentally contaminated with C. parvum oocysts. The parasite excystation kinetics throughout the course of the in vitro digestion was determined by flow cytometry analysis. Parasite invasion ability was assessed after reinoculation of sporozoites collected from the TIM-1 onto HCT-8 cells. A luciferase reporter gene assay was also used to follow sporozoite activity throughout the digestive process. Our data show that the parasite excystation rate is almost maximal in the duodenal compartment, one hour after the beginning of digestion in the TIM-1. However, a higher number of parasites reaches the distal ileal compartment while protected in their oocyst shell upon simulation of child compared to adult digestive conditions. This suggests that a lower amount of sporozoites is released in the small intestine in children, nevertheless, the luciferase activity expressed by these free stages in the ileal compartment is significantly higher in children compared to adults. Invasion assay performed on HCT-8 cells suggests that only sporozoites collected in the ileum after three hours of digestion are able to invade host cells.Our study is the first one exploring the impact of different digestive conditions on Cryptosporidium using a sophisticated gastrointestinal model. A global transcriptome analysis by RNA-Seq is also being performed on samples collected during in vitro digestion to identify parasite genes that are differentially expressed under child and adult digestive conditions

Development of functional fresh food adding soy protein isolate and polidextrose using paprika as coloring agent

The trend of the current consumer is to use foods that are easy to prepare and that besides having nutritional quality provide health benefits. In this work, fresh food with functional characteristics was developed incorporating Soy Protein Isolate (SPI) and polidextrose using paprika as the coloring agent. The consumption of IPS could contribute to decrease cholesterol levels while polidextrose, acting as a fiber, could promote the reduction of risk of colon cancer. The optimization of the formulation was carried out using a 23 complete factorial design considering independent variables the following contents: i) SPI; ii) polidextrose; and iii) paprika. The effects of these variables on the quality of the food were evaluated through physical-chemical characteristics (color and cooking test), instrumental texture, and sensory analysis. Regarding the physical parameters, instrumental color of the raw pasta was affected only by the addition of paprika. The parameters cooking time (2.5 minutes), increase in mass (1.40 to 1.64%), and loss of solids (3.80 to 5.56%) were not influenced by the ingredients used. Elasticity (instrumental texture parameter) was reduced with the increase of polidextrose. Regarding sensory analysis of the raw food, an increase in the addition of SPI and a reduction in the addition of polidextrose positively affected global acceptance and purchase intention. An increases in SPI and paprika increased color acceptance. Regarding sensory analysis of the cooked food, SPI had a positive effect on texture while polidextrose and paprika negatively affected this parameter. Nevertheless, the ingredients used did not influence purchase intention of the cooked food. The ideal percentages of polidextrose, soy protein isolate, and paprika were 3.5, 8.0, and 1.5%, respectively.A tendência do consumidor atual é utilizar alimentos de fácil preparo que, adicionalmente à qualidade nutritiva, tragam benefícios à saúde. Neste trabalho, uma massa alimentícia fresca funcional foi desenvolvida pela incorporação de Isolado Protéico de Soja (IPS) e polidextrose, utilizando páprica como corante. O consumo de IPS pode contribuir para a diminuição dos níveis de colesterol, enquanto a polidextrose, funcionando como fibra, pode promover a redução de risco de câncer de cólon. A otimização da formulação foi realizada utilizando-se um delineamento fatorial completo 23, considerando como variáveis independentes os teores de: i) IPS; ii) polidextrose; e iii) páprica. Os efeitos destas variáveis na qualidade da massa alimentícia foram avaliados em função das características físico-químicas (cor e teste de cozimento), textura instrumental e propriedades sensoriais. Na avaliação dos parâmetros físicos, observou-se que a cor instrumental da massa crua foi influenciada apenas pelo teor de páprica; já o tempo de cozimento (2,5 minutos), o aumento de massa (1,40 a 1,64%) e a perda de sólidos (3,80 a 5,56%) não foram influenciados pelos ingredientes utilizados; e a elasticidade (parâmetro da textura instrumental) foi reduzida com o aumento do teor de polidextrose. Na avaliação sensorial da massa crua, o aumento na porcentagem de IPS e a redução na porcentagem de polidextrose afetaram positivamente a aceitação global e a intenção de compra; e os aumentos nas porcentagens de IPS e de páprica aumentaram a aceitação da cor. Na avaliação sensorial da massa cozida, observou-se que o IPS teve influência positiva sobre a textura, enquanto que a polidextrose e a páprica afetaram negativamente este parâmetro. Entretanto, na avaliação da intenção de compra da massa cozida, não houve influência dos ingredientes adicionados. Os percentuais ideais de adição de polidextrose, isolado protéico de soja e páprica foram de 3,5, 8,0 e 1,5%, respectivamente.76777