Les soins infirmiers les plus efficaces pour prévenir les infections chez des patients porteurs d'un cathéter veineux cental en milieu de soins aigus: une revue de littérature étoffée

Les voies veineuses centrales (VVC), sont souvent utilisées dans les soins aigus. L’infection reliée à ce dispositif est la complication la plus fréquente et il est primordial que les infirmières prodiguent des soins de qualité pour les éviter. En se basant sur des données probantes, les infirmières pourraient diminuer le risque d’infection et ainsi augmenter la satisfaction des patients tout en diminuant les coûts

Patent Foramen Ovale in Cerebral Infarction

Recent studies support the hypothesis of a close aetiological and pathogenic association between the presence of patent foramen ovale (PFO) and cryptogenic stroke. The therapeutic options currently used in the treatment of these patients range from standard antiaggregation and standard-dose anticoagulation to the percutaneous occlusion of the PFO. The use or recommendation of treatment is based both on clinical risk factors associated with PFO, such as age, detection of states of hypercoagulability and previous history of stroke, and on the risks associated to right-to-left shunt (RLSh) and PFO, such as the size of PFO, magnitude of RLSh and the presence of atrial septal aneurysm (ASA). However, there is currently no consensus regarding the most suitable treatment and it is surprising to observe the widespread use of certain therapeutic approaches which are not supported by clinical evidence

Prevalence of the Frank's sign by aetiopathogenic stroke subtype: A prospective analysis

Enfermedades cerebrovasculares; Pabellón auricularCerebrovascular disorders; Ear auricleMalalties cerebrovasculars; Pavelló auricularBackground and purpose: The Frank's sign is a diagonal earlobe crease running from the tragus to the edge of the auricle at an angle of 45°. Many studies have associated this sign with coronary artery disease and some with cerebrovascular disease. The objective of this study was to analyse the prevalence of the Frank's sign in patients suffering from acute stroke with a particular focus on its prevalence in each of the five aetiopathogenic stroke subtypes. Special interest is given to embolic stroke of undetermined source (ESUS), correlating the sign with clinical and radiological markers that support an underlying causal profile in this subgroup. Methods: Cross-sectional descriptive study including 124 patients admitted consecutively to a stroke unit after suffering an acute stroke. The Frank's sign was evaluated by the same blinded member of the research team from photographs taken of the patients. The stroke subtype was classified following SSS-TOAST criteria and the aetiological study was performed following the ESO guidelines. Results: The Frank's sign was present in 75 patients and was more prevalent in patients with an ischaemic stroke in comparison with haemorrhagic stroke (63.9 vs. 37.5, p<0.05). A similar prevalence was found in the different ischaemic stroke subtypes. The Frank's sign was significantly associated with age, particularly in patients older than 70 who had vascular risk factors. Atherosclerotic plaques found in carotid ultrasonography were significantly more frequent in patients with the Frank's sign (63.6%, p<0.05). Analysing the ESUS, we also found an association with age and a higher prevalence of the Frank's sign in patients with vascular risk factors and a tendency to a high prevalence of atherosclerosis markers. Conclusion: The Frank's sign is prevalent in all aetiopathogenic ischaemic stroke subtypes, including ESUS, where it could be helpful in suspecting the underlying cardioembolic or atherothrombotic origin and guiding the investigation of atherosclerosis in patients with ESUS and the Frank's sign.JS: 3 -Spanish Ministry of Economy and Competitiveness for grants RETICS-INVICTUSPLUS (RD0016/0019/0003) funded by Instituto de Salud Carlos III and cofunded by the European Regional Development Fund [ERDF]. -Instituto de Salud Carlos III with a Grant for Health Research (PI16/01540) -Government of Catalonia-Agència de Gestio´ d’Ajuts Universitaris i de Recerca (2017 SGR 1730). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript

Water in oil emulsions from hydrophobized metal membranes and characterization of dynamic interfacial tension in membrane emulsification

Hydrophobization of metal surfaces is reported based on silanization reactions. The aim was its application to metal porous membranes for the production of water in oil emulsions using a process known as membrane emulsification. A vertical oscillating membrane system was used to carry out drop formation experiments. It is shown that drop size can be tuned between 35 and 85. μm by changing just the surfactant concentration in the continuous phase. In addition, a method to determine the percentage of active pores during the membrane emulsification process is demonstrated. This method links knowledge acquired in the surfactant adsorption dynamics and drop expansion rate. Using this approach, pore velocity can be determined, which will help in determining the boundary between dripping and jetting from a pore. This study reinforces the importance of dynamic interfacial tension which must be considered in process design, and modelling purposes, particularly in two liquid phase systems using membranes such as membrane emulsification

IP-10/CXCL10 induction in human pancreatic cancer stroma influences lymphocytes recruitment and correlates with poor survival

Pancreatic ductal adenocarcinoma (PDAC) is characterized by an abundant desmoplastic reaction driven by pancreatic stellate cells (PSCs) that contributes to tumor progression. Here we sought to characterize the interactions between pancreatic cancer cells (PCCs) and PSCs that affect the inflammatory and immune response in pancreatic tumors. Conditioned media from mono- and cocultures of PSCs and PCCs were assayed for expression of cytokines and growth factors. IP-10/CXCL10 was the most highly induced chemokine in coculture of PSCs and PCCs. Its expression was induced in the PSCs by PCCs. IP-10 was elevated in human PDAC specimens, and positively correlated with high stroma content. Furthermore, gene expression of IP-10 and its receptor CXCR3 were significantly associated with the intratumoral presence of regulatory T cells (Tregs). In an independent cohort of 48 patients with resectable pancreatic ductal adenocarcinoma, high IP-10 expression levels correlated with decreased median overall survival. Finally, IP-10 stimulated the ex vivo recruitment of CXCR3+ effector T cells as well as CXCR3+ Tregs derived from patients with PDAC. Our findings suggest that, in pancreatic cancer, CXCR3+ Tregs can be recruited by IP-10 expressed by PSCs in the tumor stroma, leading to immunosuppressive and tumor-promoting effects

Clinical and laboratory parameters as predictors of long-term outcome according to the etiology of underlying chronic liver disease in patients who underwent liver transplantation for hepatocellular carcinoma treatment

OBJECTIVES: This study aimed to analyze clinical and laboratory parameters and their association with longterm outcomes in patients who underwent liver transplantation for hepatocellular carcinoma treatment, according to the etiology of the underlying chronic liver disease, in order to identify predictors of response to this therapeutic modality. METHODS: Demographic, clinical, and laboratory data from a cohort of 134 patients who underwent orthotopic liver transplantation for hepatocellular carcinoma treatment at a referral center in Brazil were retrospectively selected and compared according to the etiologic group of the underlying chronic liver disease. Events, defined as tumor recurrence or death from any cause, and event-free survival were also analyzed, and multivariate analysis was performed. RESULTS: The etiologies comprised hepatitis C and B virus infection, alcohol abuse, and cryptogenic disorder. Although liver transplantation was performed outside the Milan criteria in 33.3% of the subjects, according to pathologic examination of the explanted liver, the Model for End-Stage Liver Disease score was low (o22) in most patients (70.6%) and recurrence was identified in only 10 (7.9%) patients. Events occurred in 37 patients (28.5%), and the median event-free survival was 75 months (range, 24-116 months). No difference among etiologic groups was found in the parameters analyzed, which were not independently associated with outcome. CONCLUSION: Clinical and laboratory characteristics according to etiologic groups were not different, which might have led to comparable long-term outcomes among these patient groups and failure to identify predictors that could aid in better selection of subjects for liver transplantation in the management of this cancer

Continuous EEG monitoring by a new simplified wireless headset in intensive care unit

Background: In critically ill patients continuous EEG (cEEG) is recommended in several conditions. Recently, a new wireless EEG headset (CerebAir®,Nihon-Kohden) is available. It has 8 electrodes, and its positioning seems to be easier than conventional systems. Aim of this study was to evaluate the feasibility of this device for cEEG monitoring, if positioned by ICU physician. Methods: Neurological patients were divided in two groups according with the admission to Neuro-ICU (Study-group:20 patients) or General-ICU (Control-group:20 patients). In Study group, cEEG was recorded by CerebAir® assembled by an ICU physician, while in Control group a simplified 8-electrodes-EEG recording positioned by an EEG technician was performed. Results: Time for electrodes applying was shorter in Study-group than in Control-group: 6.2 ± 1.1' vs 10.4 ± 2.3'; p&nbsp;&lt; 0.0001. Thirty five interventions were necessary to correct artifacts in Study-group and 11 in Control-group. EEG abnormalities with or without epileptic meaning were respectively 7(35%) and 7(35%) in Study-group, and 5(25%) and 9(45%) in Control-group;p&nbsp;&gt; 0.05. In Study-group, cEEG was interrupted for risk of skin lesions in 4 cases after 52 ± 4 h. cEEG was obtained without EEG technician in all cases in Study-group; quality of EEG was similar. Conclusions: Although several limitations should be considered, this simplified EEG system could be feasible even if EEG technician was not present. It was faster to position if compared with standard techniques, and can be used for continuous EEG monitoring. It could be very useful as part of diagnostic process in an emergency setting

Investigação de Erros Inatos do Metabolismos na Associação de Pais e Amigos dos Excepcionais de Itabira – Minas Gerais

The present study aims to present the results of urinary screening performed in the Association of Parents and Friends of Exceptional (APAE) of Itabira in an attempt to identify some Metabolism Inborn Errors. Urine samples were collected from students enrolled in APAE / Itabira without a closed diagnosis in medical records. Eight qualitative urine tests were performed to screen for Metabolism Inborn Errors. Those responsible for the students were informed about the research objectives and only the samples of patients who had signed a Free and Informed Consent Form were collected. Samples of 38 students were analyzed, being 29 male and 9 female. In urine screening, 5 positive results were found for Benedict, 4 doubtful and 1 positive for cetyltrimethylammonium bromide (CTMA), 8 doubtful and 4 positive for Ferric Chloride, 2 doubtful for Dinitrophenylhydrazine, and 3 doubtful for Nitrosonaftol. In order to have a reliable definitive diagnosis, it is necessary to correlate the symptomatology presented by the student and the results obtained, sending the analyzed sample to laboratories that perform specific tests to confirm or cancel the diagnostic hypothesis. The frequency of altered samples demonstrates that urinary screening is a method of easy achievement, low cost and high reliability.El presente estudio tiene como objetivo presentar los resultados del tamizaje urinario realizado en la Asociación de Padres y Amigos de los Excepcionales (APAE) de Itabira en el intento de identificar algunos Errores Innatos del Metabolismo. Se recogieron muestras de orina de alumnos matriculados en la APAE / Itabira sin diagnóstico cerrado en prontuario. Se realizaron 8 pruebas cualitativas en la orina para la clasificación de Errores Innatos del Metabolismo. Los responsables de los alumnos fueron informados sobre los objetivos de la investigación y solamente fueron recolectadas las muestras de pacientes que presentaron Término de Consentimiento Libre y Esclarecido firmado. Se analizaron muestras de 38 alumnos, siendo 29 sexo masculino y 9 sexo femenino. En el tamizaje urinario se encontraron: 5 resultados positivos para Benedict, 4 dudosos y 1 positivo para Bromuro de ceftalmetona (CTMA), 8 dudosos y 4 positivos para Cloruro Férrico, 2 dudosos para Dinitrofenilhidrazina, y 3 dudosos para Nitrosonaftol. Para que se tenga un diagnóstico definitivo confiable, es necesario hacer la correlación entre la sintomatología presentada por el alumno y los resultados obtenidos, haciendo el encaminamiento de la muestra analizada para laboratorios que realizan pruebas específicas para la confirmación o la anulación de la hipótesis diagnóstica. La frecuencia de muestras alteradas demuestra que la selección de orina es un método de fácil realización, bajo costo y alta confiabilidad.O presente estudo tem como objetivo apresentar os resultados da triagem urinária realizada na Associação de Pais e Amigos dos Excepcionais (APAE) de Itabira na tentativa de identificar alguns Erros Inatos do Metabolismo. Foram coletadas amostras de urina de alunos matriculados na APAE/Itabira sem diagnóstico fechado em prontuário. Foram realizados 8 testes qualitativos na urina para triagem de Erros Inatos do Metabolismo. Os responsáveis pelos alunos foram informados sobre os objetivos da pesquisa e somente foram coletadas as amostras de pacientes que apresentaram Termo de Consentimento Livre e Esclarecido assinado. Foram analisadas amostras de 38 alunos, sendo 29 sexo masculino e 9 sexo feminino. Na triagem urinária foram encontrados: 5 resultados positivos para Benedict, 4 duvidosos e 1 positivo para Brometo de de cetiltrimetilamônio (CTMA), 8 duvidosos e 4 positivos para Cloreto Férrico, 2 duvidosos para Dinitrofenilhidrazina, e 3 duvidosos para Nitrosonaftol. Para que se tenha um diagnóstico definitivo confiável, é necessário fazer a correlação entre a sintomatologia apresentada pelo aluno e os resultados obtidos, fazendo o encaminhamento da amostra analisada para laboratórios que realizam testes específicos para a confirmação ou a anulação da hipótese diagnóstica. A frequência de amostras alteradas demonstra que a triagem urinária é um método de fácil realização, baixo custo e alta confiabilidade

Produção e composição do leite em vacas com desordens no pós-parto

This study aimed to determine the impact of different post-partum disorders on milk yield and composition. One hundred and fifteen Holstein cows from a commercial dairy farm located in the state of Rio Grande do Sul in southern Brazil were monitored up to 62 days post-partum. During this period, body condition score evaluation and animal clinical examination were conducted. Percentages of fat, protein, and lactose, as well as somatic cells score, were determined in milk samples. The AST activity and concentrations of NEFA, calcium, and BHBA, were analyzed in blood samples. The occurrence of clinical disorders was identified in 30 (26%) cows. Subclinical disorders were identified in 64 (56%) cows. Only 21 (18%) cows did not suffer any kind of disorder within the studied period. In this study, no significant differences were found in milk production, protein, and somatic cell count in clinical, subclinical, and healthy cows. Milk fat and the fat: protein quotient (F:P) were higher in cows with clinical disorders and the 6 to 21 days in milk, and lactose were lower in cows with clinical disorders and the 22 to 42 days in milk (P<0.05).O objetivo deste estudo foi determinar o impacto de diferentes distúrbios após o parto na produção de leite e em sua composição. Cento e quinze vacas Holandesas de uma fazenda de gado leiteiro, localizada em estado da região Sul do Brasil, foram monitoradas até 62 dias após o parto. Durante esse período, foram realizadas avaliações do escore de condição corporal e exame clínico nos animais. As porcentagens de gordura, proteína e lactose, bem como o escore de células somáticas, foram determinadas nas amostras de leite. A atividade do AST e as concentrações de NEFA, cálcio e BHBA foram analisadas em amostras de sangue. A ocorrência de distúrbios clínicos foi identificada em 30 (26%) vacas, os distúrbios subclínicos foram identificados em 64 (56%) vacas. Apenas 21 (18%) vacas não sofreram nenhum tipo de distúrbio ao longo do período estudado. Neste estudo, não foram encontradas diferenças significativas na produção do leite, proteína e na contagem de células somáticas em vacas com doenças clínicas, subclínicas e saudáveis. No leite, a gordura e o quociente gordura e proteína (G:P) foram maiores em vacas com doença clínica no período de seis a 21 dias de lactação, e a lactose foi menor em vacas com doença clínica no período de 22 a 42 dias de lactação (P<0,05)