Current Diagnostic Tests for Dry Eye Disease in Sjögren’s Syndrome

Sjogren’s syndrome (Sicca Syndrome) is mainly characterized by the presence of dry eye disease (DED). The diagnosis of DED in patients with Sjogren’s syndrome has been limited to tests such as the Schirmer test, tear breakup time (TBUT), and corneal stains; however, currently we can evaluate the functional unit in detail lacrimal, which is affected in patients with dry eye and Sjögren’s syndrome; thanks to technology that provides objective details for this difficult diagnostic. The newer evaluations that provide the greatest diagnostic value for Sjogren’s syndrome are: noninvasive keratograph tear rupture time (NIKBUT), tear meniscus height (TMH), Schirmer’s test, meibography, ocular surface disease index (OSDI), Vital stains of the ocular surface, Matrix Metalloproteinase 9 (MMP-9), Tear osmolarity (TearLab); all of these are important complements to the existing tests, which, although less objective, are not substitutable

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

Efecto del tiempo de exposición a la computadora sobre la función lagrimal en individuos con síndrome visual por computadora

"Se seleccionaron sujetos de 20-45 años derechohabientes de Hospital Universitario (n-108), ambos géneros, sin comorbilidades. Fueron excluidos sujetos con diagnóstico de enfermedad o cirugía ocular, usuarios de medicamentos tópicos y de lentes de contacto. A los sujetos seleccionados que cumplieron con los criterios de inclusión se les aplicó el cuestionario CVSS17 (por sus siglas en inglés, Computer Vision Scale Symptom 17) para ser agrupados en los diferentes niveles del SVC. Se detectó enfermedad de ojo seco (EOS) en dichos sujetos mediante el índice de enfermedad de superficie ocular (OSDI; por sus siglas en inglés, Ocular Surface Desease Índex). La función lagrimal se evaluó mediante tres criterios: 1) la secreción acuosa por medio de las pruebas Schirmer 1 (con anestésico tópico); 2) el tiempo de ruptura lagrimal mediante la prueba TRL , y 3) la integridad de la superficie ocular valorada por medio de tinciones corneales (Oxford, Nei-Clerk y Sicca OSS). El tiempo de exposición a la computadora se determinó mediante cuestionario específico dentro de la historia clínica.

Dry Eye Disease Association with Computer Exposure Time Among Subjects with Computer Vision Syndrome

Purpose: To assess the time of exposure to the computer and dry eye disease (DED) in subjects with computer vision syndrome (CVS).Methods: A cross-sectional study was conducted in office workers, computer users of both sexes, with an age range of 18– 45 years without comorbidities; we included 108 subjects divided into 3 groups according to the time of computer exposure in hours per day (H/D): 8 (n = 39). A specific questionnaire was applied to them on the exposure time and the type of visual display terminal (VDT) used, as well as the computer vision symptoms scale (CVSS17). DED was diagnosed with the Ocular Surface Disease Index (OSDI). Ocular surface damage and signs of DED were evaluated with the tear rupture time test (TBUT), the integrity of the ocular surface by ocular surface staining (OSS) and the production of the aqueous basal tear film using the Schirmer test.Results: Average computer exposure time, measured differently, was positively correlated with DED development. The computer exposure time measured in hours per year and TBUT showed a significant negative correlation (p < 0.001) (rho − 0.463). Years of computer exposure and staining of the ocular surface showed a significant positive correlation (p < 0 0.001; rho 0.404). The accumulated exposure time was negatively correlated with TBUT (p < 0.001; rho − 0.376) and positively with OSS (p < 0.001; rho 0.433). Schirmer test did not correlate with computer exposure time.Conclusion: The prolonged time of exposure to the computer in subjects with CVS was significantly correlated with the DED tests, in the different ways of measuring it; but not with the Schirmer test.Keywords: computer vision syndrome, dry eye disease

Dry eye disease association with computer exposure time among subjects with computer vision syndrome

"Purpose: To assess the time of exposure to the computer and dry eye disease (DED) in subjects with computer vision syndrome (CVS). Methods: A cross-sectional study was conducted in office workers, computer users of both sexes, with an age range of 18-45 years without comorbidities; we included 108 subjects divided into 3 groups according to the time of computer exposure in hours per day (H/D): 8 (n = 39). A specific questionnaire was applied to them on the exposure time and the type of visual display terminal (VDT) used, as well as the computer vision symptoms scale (CVSS17). DED was diagnosed with the Ocular Surface Disease Index (OSDI). Ocular surface damage and signs of DED were evaluated with the tear rupture time test (TBUT), the integrity of the ocular surface by ocular surface staining (OSS) and the production of the aqueous basal tear film using the Schirmer test"

Contemporary use of cefazolin for MSSA infective endocarditis: analysis of a national prospective cohort

Objectives: This study aimed to assess the real use of cefazolin for methicillin-susceptible Staphylococcus aureus (MSSA) infective endocarditis (IE) in the Spanish National Endocarditis Database (GAMES) and to compare it with antistaphylococcal penicillin (ASP). Methods: Prospective cohort study with retrospective analysis of a cohort of MSSA IE treated with cloxacillin and/or cefazolin. Outcomes assessed were relapse; intra-hospital, overall, and endocarditis-related mortality; and adverse events. Risk of renal toxicity with each treatment was evaluated separately. Results: We included 631 IE episodes caused by MSSA treated with cloxacillin and/or cefazolin. Antibiotic treatment was cloxacillin, cefazolin, or both in 537 (85%), 57 (9%), and 37 (6%) episodes, respectively. Patients treated with cefazolin had significantly higher rates of comorbidities (median Charlson Index 7, P <0.01) and previous renal failure (57.9%, P <0.01). Patients treated with cloxacillin presented higher rates of septic shock (25%, P = 0.033) and new-onset or worsening renal failure (47.3%, P = 0.024) with significantly higher rates of in-hospital mortality (38.5%, P = 0.017). One-year IE-related mortality and rate of relapses were similar between treatment groups. None of the treatments were identified as risk or protective factors. Conclusion: Our results suggest that cefazolin is a valuable option for the treatment of MSSA IE, without differences in 1-year mortality or relapses compared with cloxacillin, and might be considered equally effective

Evolution over Time of Ventilatory Management and Outcome of Patients with Neurologic Disease∗

OBJECTIVES: To describe the changes in ventilator management over time in patients with neurologic disease at ICU admission and to estimate factors associated with 28-day hospital mortality. DESIGN: Secondary analysis of three prospective, observational, multicenter studies. SETTING: Cohort studies conducted in 2004, 2010, and 2016. PATIENTS: Adult patients who received mechanical ventilation for more than 12 hours. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Among the 20,929 patients enrolled, we included 4,152 (20%) mechanically ventilated patients due to different neurologic diseases. Hemorrhagic stroke and brain trauma were the most common pathologies associated with the need for mechanical ventilation. Although volume-cycled ventilation remained the preferred ventilation mode, there was a significant (p &lt; 0.001) increment in the use of pressure support ventilation. The proportion of patients receiving a protective lung ventilation strategy was increased over time: 47% in 2004, 63% in 2010, and 65% in 2016 (p &lt; 0.001), as well as the duration of protective ventilation strategies: 406 days per 1,000 mechanical ventilation days in 2004, 523 days per 1,000 mechanical ventilation days in 2010, and 585 days per 1,000 mechanical ventilation days in 2016 (p &lt; 0.001). There were no differences in the length of stay in the ICU, mortality in the ICU, and mortality in hospital from 2004 to 2016. Independent risk factors for 28-day mortality were age greater than 75 years, Simplified Acute Physiology Score II greater than 50, the occurrence of organ dysfunction within first 48 hours after brain injury, and specific neurologic diseases such as hemorrhagic stroke, ischemic stroke, and brain trauma. CONCLUSIONS: More lung-protective ventilatory strategies have been implemented over years in neurologic patients with no effect on pulmonary complications or on survival. We found several prognostic factors on mortality such as advanced age, the severity of the disease, organ dysfunctions, and the etiology of neurologic disease

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