Management of bleeding in trauma victims by Portuguese nurses in prehospital setting

Introduction: External bleeding is the leading preventable cause of death from traumatic injuries. Implementation of guidelines for its control have been associated with a significant reduction in mortality. The objectives of this study were to provide a characterisation of trauma patients with external bleeding and to compare the outcomes from specific autonomous interventions applied by nurses in prehospital care.Methods: A non-randomised prospective study was conducted in the Immediate Life Support Ambulances in Portugal, from 1 March 2019 to 30 April 2020. Patients were divided into two groups according to whether external bleeding was controlled or not on their arrival at the emergency room.Results: A total of 189 patients were included in this study (73.0% men; mean age of 53.6 years). Among these patients, 140 (74.1%) had their external bleeding controlled by prehospital nurse’s intervention. The average time of assistance at the incident site was 31.5 min. Patients with uncontrolled bleeding had a higher average rescue time (30.8 ±15.2 vs 33.7 ±13.0). Cryotherapy was administered to 15.9% of all patients and 93.3% of these patients arrived at the emergency room with controlled bleeding (p=0.01).Discussion: Despite the substantial reduction in the number of patients who keep bleeding after prehospital care, it was observed that one fifth of patients have external bleeding on arrival at the emergency room. Cryotherapy has been shown to be effective in controlling external bleeding. Failure to use haemostatic agents may explain the ineffective control of more complex external bleeding.Contribution to Emergency Nursing Practice: The current literature on management of bleeding in trauma patients is scarce and contradictory, especially in terms of interventions provided by AUTHORSMAURO AL MOTA PhD, RN1,2,3,4,5MARGARIDA REIS SANTOS PhD, RN6,7EDUARDO JF SANTOS PhD, RN2,3ANDREA FIGUEIREDO MSN, RN5FILIPE MELO MSN, RN5,8,9SARA ALBUQUERQUE MSc, MD10MADALENA CUNHA PhD, RN2,31. Abel Salazar Institute of Biomedical Sciences, University of Porto, Porto, Portugal2. Health School of the Polytechnic Institute of Viseu, Portugal3. Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), Portugal4. Hospital Nossa Senhora da Assunção, Local Health Unit of Guarda, Seia, Portugal5. INEM – National Institute of Medical Emergency. Portugal6. Nursing School of Porto, Porto, Portugal7. CINTESIS – Center for Health Technology and Services Research, University of Porto, Porto, Portugal8. Hospital de Faro. University Hospital Center of Algarve. Faro, Portugal9. ABC – Algarve Biomedical Centre. Faro, Portugal10. Group of Health Centers – Greater Porto VII – Gaia, USF Nova Salus, Gaia, PortugalRESEARCH ARTICLESManagement of bleeding in trauma victims by Portuguese nurses in prehospital setting rehospital teams led by a registered nurse. In addition, interventions vary from country to country.This article increases awareness of autonomous interventions implemented by prehospital nurses to manage external bleeding.Key implications for emergency nursing practice identified in this study suggest greater fluid therapy appears harmful while cryotherapy achieved the best results (control of the bleeding on emergency room arrival). This may contribute to the review of institutional algorithms and training in this area.info:eu-repo/semantics/publishedVersio

Low Handgrip Strength Is Not Associated with Type 2 Diabetes Mellitus and Hyperglycemia: a Population-Based Study.

This is the final version. Available from The Korean Society of Clinical Nutrition via the DOI in this record. Type 2 diabetes mellitus (DM) is commonly linked to muscle weakness and metabolic abnormalities which increase healthcare costs. The study was undertaken to investigate if low handgrip strength, as a marker of muscle weakness, is associated with hyperglycemia and/or DM in Brazilian subjects. In a cross-sectional design, 415 individuals of both sexes (46.7% male) were interviewed by a questionnaire and the DM diagnostic was self-reported. Anthropometric measurements, such as weight, height, body mass index (BMI), arm circumference, mid-arm and calf circumference and handgrip strength, were obtained by trained nutritionists. Blood glucose concentrations were determined by portable monitor analysis. Student's t-test was applied to compare DM cases with non-diabetic individuals, and logistic regression analysis was performed to verify the odds for becoming diabetic or having altered glycemia and p < 0.05 was considered as significant. From 415 subjects, 9.2% (n = 35) were classified as DM. DM patients had significantly higher age, BMI, casual glycemia and lower handgrip strength and normalized (to body weight) handgrip strength (NHS) when compared with non-diabetic patients. Individuals with low NHS have 2.7 odds ratio to DM without adjustment for covariate (crude model, p = 0.006) and have 2.7 times higher the likelihood of DM than individuals with high NHS after adjusting for age (model 1, p = 0.006); however, this association disappeared after further adjusting for sex. In conclusion, low handgrip strength normalized or not to body weight, was not associated with hyperglycemia and DM diagnosis.Cape

Peptides Derived from Vascular Endothelial Growth Factor B Show Potent Binding to Neuropilin-1

Vascular endothelial growth factors (VEGFs) regulate significant pathways in angiogenesis, myocardial and neuronal protection, metabolism, and cancer progression. The VEGF-B isoform is involved in cell survival, anti-apoptotic and antioxidant mechanisms, through binding to VEGF receptor 1 and neuropilin-1 (NRP-1). We employed surface plasmon resonance technology and X-ray crystallography to analyse the molecular basis of the interaction between VEGF-B and the b1 domain of NRP-1, and developed VEGF-B - C-terminus derived peptides to be used as chemical tools for studying VEGF-B - NRP-1 related pathways. Peptide lipidation was used as a means to stabilise the peptides. VEGF-B - derived peptides containing a C-terminal arginine show potent binding to NRP1-b1. Peptide lipidation increased binding residence time and improved plasma stability. A crystal structure of a peptide with NRP-1 demonstrated that VEGF-B peptides bind at the canonical C-terminal Arginine binding site. VEGF-B C-terminus imparts higher affinity for NRP-1 than the corresponding VEGF-A_{165} region. This tight binding may impact on the activity and selectivity of the full-length protein. The VEGF-B_{167} derived peptides were more effective than VEGF-A_{165} peptides in blocking functional phosphorylation events. Blockers of VEGF-B function have potential applications in diabetes and non-alcoholic fatty liver disease

Quantum Aspects of Massive Gravity II: Non-Pauli-Fierz Theory

We investigate the non-Pauli-Fierz(nPF) theory, a linearized massive gravity with a generic graviton mass term, which has been ignored due to a ghost in its spectrum and the resultant loss of unitarity. We first show that it is possible to use the Lee-Wick mechanism, a unitarization through the decay of a ghost, in order to handle the sixth mode ghost of nPF, and then check for the quantum consistency. Once proven to be consistent, nPF could become a viable candidate for a large distance modification of gravity, because it naturally solves the intrinsic problems that most dark energy/modified gravity models suffer from: It smoothly converges to general relativity at short distances, and the small graviton mass necessary to modify gravity at large scales can be stable under the radiative corrections from the minimal gravity-to-matter coupling.Comment: 1+16pp, accepted for JHE

Low frequency of CD4(+) CD25(+) Treg in SLE patients: a heritable trait associated with CTLA4 and TGF gene variants

Background: CD4(+)CD25(+) regulatory T cells play an essential role in maintaining immune homeostasis and preventing autoimmunity. Therefore, defects in Treg development, maintenance or function have been associated with several human autoimmune diseases including Systemic Lupus Erythematosus (SLE), a systemic autoimmune disease characterized by loss of tolerance to nuclear components and significantly more frequent in females

Immunization with genetically attenuated P52-deficient Plasmodium berghei sporozoites induces a long-lasting effector memory CD8+ T cell response in the liver

Item does not contain fulltextABSTRACT: BACKGROUND: The induction of sterile immunity and long lasting protection against malaria has been effectively achieved by immunization with sporozoites attenuated by gamma-irradiation or through deletion of genes. For mice immunized with radiation attenuated sporozoites (RAS) it has been shown that intrahepatic effector memory CD8+ T cells are critical for protection. Recent studies have shown that immunization with genetically attenuated parasites (GAP) in mice is also conferred by liver effector memory CD8+ T cells. FINDINGS: In this study we analysed effector memory cell responses after immunization of GAP that lack the P52 protein. We demonstrate that immunization with p52-GAP sporozoites also results in a strong increase of effector memory CD8+ T cells, even 6 months after immunization, whereas no specific CD4+ effector T cells response could be detected. In addition, we show that the increase of effector memory CD8+ T cells is specific for the liver and not for the spleen or lymph nodes. CONCLUSIONS: These results indicate that immunization of mice with P. berghei p52-GAP results in immune responses that are comparable to those induced by RAS or GAP lacking expression of UIS3 or UIS4, with an important role implicated for intrahepatic effector memory CD8+ T cells. The knowledge of the mediators of protective immunity after immunization with different GAP is important for the further development of vaccines consisting of genetically attenuated sporozoites

Short-Term Creatine Supplementation May Alleviate the Malnutrition-Inflammation Score and Lean Body Mass Loss in Hemodialysis Patients: A Pilot Randomized Placebo-Controlled Trial

This is the author accepted manuscript. The final version is available from Wiley via the DOI in this recordBackground Creatine supplementation has been proposed to alleviate muscle loss in various populations, but has not been investigated in hemodialysis (HD) patients. Thus, our objective was to evaluate whether creatine supplementation could attenuate the loss of lean body mass (LBM) and malnutrition‐inflammation score (MIS) in HD patients. Methods A randomized, placebo‐controlled, double blind, parallel‐design study included HD patients, of both sexes, aged 18–59 years. The patients were allocated to a Placebo Group (PG; n = 15; received maltodextrin, 1st week: 40 g/day and 2nd–4th weeks: 10 g/day) and a Creatine Group (CG; n = 15; received creatine plus maltodextrin, 1st week: 20 g/day of creatine plus 20 g/day of maltodextrin and 2nd–4th weeks: 5 g/day of creatine plus 5 g/day of maltodextrin). Pre and post the intervention, patients were evaluated for food intake, MIS, body composition and biochemical parameters. Results CG group attenuated the MIS (Pre: 5.57 ± 0.72 vs. Post: 3.85 ± 0.47 score, P = 0.003) compared with PG (Pre: 5.71 ± 0.97 vs. Post: 5.36 ± 0.95 score, P = 0.317) (supplement × time P = 0.017, effect size: 0.964). The change of LBM was greater in CG than in PG (CG: Δ0.95 vs PG: Δ0.13 kg). At post‐intervention, 28.6% of PG patients presented LBM loss and 71.4% remain stable. In contrast, 14.4% of CG patients had LBM loss, 42.8% remain stable and 42.8% gained. Food intake and quality of life did not change. CG increased the BMI and gait speed in post‐compared to pre‐moment, but no difference among the groups. Conclusion In HD patients, four weeks of creatine supplementation may alleviate the MIS as well as attenuate the LBM loss compared to placeboCapes, Brazi

Preliminary checklist of the Italian gypsophilous flora

The richness and uniqueness of the flora growing on gypsum substrates in Italy is known since the XIX century (Macchiati, 1888). Furthermore, the concept of plant gypsophily can be defined as the exclusiveness (or virtually exclusiveness) for living in gypsum outcropping rocks. Thus only those plant species, which show preference – or even exclusivity - for gypsum substrates, would be classified as gipsophilous (Mota et al., 2011). The main aim of this research has been the elaboration of a checklist of the Italian gypsophilous flora. The study was made possible through international collaboration between the "Mediterranea" University of Reggio Calabria (Italy) and the University of Almería (Spain). During the first step, an extensive literature review has been carried out in order to collect all available information about gypsophilous flora and to compile a preliminary list. Afterwards 18 regional botanists experts on Italian gypsum flora have been asked to rank the preference of these species for gypsum soils. Following the methodology proposed by Mota et al. (2009), the gypsophilous character of more than 100 plant species has been thus ranked on a scale ranging from 1 to 5 (with 5 representing for a total dependence on gypsum substrates). According to the obtained values, all the plant species, ranking between absolute or preferent gypsophytes, will figure in the final checklist of the gypsophytes of the whole Italian territory

Influence of muscle fitness test performance on metabolic risk factors among adolescent girls

<p>Abstract</p> <p>Background</p> <p>The purpose of this study was to examine the association between muscular fitness (MF), assessed by 2 components of Fitnessgram test battery, the Curl-Up and Push-Ups tests and the metabolic risk score among adolescent girls.</p> <p>Methods</p> <p>A total of 229 girls (aged 12-15 years old) comprised the sample of this study. Anthropometric data (height, body mass, waist circumference) were collected. Body mass index (BMI) was also calculated. Muscular strength was assessed taking into account the tests that comprised the FITNESSGRAM test battery, i.e. the curl-up and the push-up. Participants were then categorized in one of 3 categories according the number of tests in which they accomplished the scores that allow them to be classified in health or above health zone. The blood pressure [BP], fasting total cholesterol [TC], low density lipoprotein-cholesterol [LDL-C], high density lipoprotein-cholesterol [HDL-C], triglycerides [TG], glucose, and a metabolic risk score (MRS) were also examined. Physical Activity Index (PAI) was obtained by questionnaire.</p> <p>Results</p> <p>Higher compliance with health-zone criteria (good in the 2 tests), adjusted for age and maturation, were positive and significantly (p ≤ 0.05) associated with height (r = 0.19) and PAI (r = 0.21), while a significant but negative association was found for BMI (r = -0.12); WC (r = -0.19); TC (r = -0.16); TG (r = -0.16); LDL (r = -0.16) and MRS (r = -0.16). Logistic regression showed that who were assigned to MF fittest group were less likely (OR = 0.27; p = 0.003) to be classified overweight/obese and less likely (OR = 0.26; p = 0.03) to be classified as having MRS. This last association was also found for those whom only performed 1 test under the health zone (OR = 0.23; p = 0.02).</p> <p>Conclusions</p> <p>Our data showed that low strength test performance was associated with increased risk for obesity and metabolic risk in adolescent girls even after adjustment for age and maturation.</p