Medical Device-Related Pressure Injury in an Intensive Care Unit: A Cross-Sectional Study.

BACKGROUND: Medical devices can cause pressure injuries. PURPOSE: This study was conducted to determine the prevalence of and factors associated with medical device-related pressure injury (MDRPI) in an intensive care unit (ICU). METHODS: A cross-sectional study was performed among adult patients (at least 18 years of age) admitted to an ICU in a referral hospital in Brazil between December 2019 and February 2020. The skin of patients who consented to participate was assessed for the presence of an MDRPI, and the use of all medical devices was noted. Other independent variables (sociodemographic variables, medical history, pressure injury risk factors, medications, and length of hospitalization) were abstracted from the medical records. Bivariate data analysis included Pearson's chi-square test or Fisher's exact test; odds ratio and a confidence interval of 95% also were established. Correlation among independent variables and MDRPI was determined using the ρ Spearman correlation test, and a hierarchical binary logistic regression analysis was performed using statistically significant variables from the bivariate analysis. P < .05 was considered statistically significant. RESULTS: The 125 study participants ranged in age from 15 to 97 years (mean, 63.02 ± 19.2), 76 (60.8%) were men, and 76 (60.8%) were White. Of the 125 participants, 43 (34%) experienced MDRPI; the total number of MDRPIs was 58 (3 patients had 3 injuries, and 7 patients had 2 injuries). Of those 58 MDRPIs, 46 were stage 1, and 12 were stage 2. Polypharmacy (> 4 medications) was a significant risk factor for MDRPI. Use of a nasal catheter, cord for orotracheal tube fixation, oximeter, intra-abdominal pressure equipment, and indwelling urinary catheter was significantly associated with the presence of MDRPI. Renal and respiratory diseases and the presence of infection were positively related to the presence of MDRPI. CONCLUSION: Medical device-related pressure injury was prevalent in this patient population. Most of these injuries were stage 1, which suggests that frequent monitoring and device repositioning (when possible) may help prevent more serious injuries. Additional research involving other hospitals in Brazil is needed to increase the understanding of the prevalence and risk factors of MDRPIs in patients in the ICU.

Moving the needle towards the democratization of echocardiography: a case report.

BACKGROUND: Echocardiography has been traditionally performed in echo labs and the potential benefits of its use by primary care physicians (PCPs) are still unexplored. We present a case where POCUS (point-of-care ultrasound) was used as a complement of physical examination by a family doctor, allowing a prompt clinical decision in a heart failure (HF) patient. CASE SUMMARY: An 85-year-old woman, living independently, asks her family doctor for a home consultation due to increasing dyspnoea. On examination, severe dyspnoea and bilateral ankle oedema was noted and a point-of-care echocardiogram was performed by the primary care physician, who observed: severely compromised left ventricular systolic function, moderate mitral and tricuspid regurgitation, and severe dilation of the inferior vena cava. As a result, the diagnosis of HF with decreased ejection fraction was formed supporting the therapeutic decision. DISCUSSION: This case represents an elderly patient with dyspnoea, without previous HF diagnosis. The primary care physician, used portable ultrasound as a complement of physical examination, which confirmed a HF diagnosis, allowing a prompt decision-making on therapy. POCUS, can be a powerful tool to expedite treatment in different settings, including the home consultations by PCPs.

Trimethylation of histone 3 at lysine 4 in cryopreserved bovine embryos produced in vivo with sexed semen.

The production rates of viable embryos using sexed semen through the conventional methodologies of multiple ovulation and embryo transfer are generally not satisfactory. However, the cryopreservation of these embryos is considered efficient. Knowledge of epigenetics can provide new tools or allow for adapting new protocols that could enhance the efficiency of reproductive biotechnologies. The aim of this study was to characterize the pattern of trimethylation of histone 3 at lysine 4 (H3K4me3) in bovine embryos produced in vivo with sexed semen that were submitted to cryopreservation. Bos taurus × Bos indicus cows (n = 5) were superovulated and inseminated with sexed (two sessions) or conventional (two sessions) semen. A portion of the embryos collected on Day 7 was immediately stored in paraformaldehyde (3%) and another portion was stored in paraformaldehyde after cryopreservation/thawing. All embryos from the four groups (fresh, conventional semen; fresh, sexed semen; cryopreserved, conventional semen; and cryopreserved, sexed semen; 15 embryos per group) were evaluated by immunofluorescence under confocal microscopy to identify and quantify the H3K4me3 status. In total, 190 embryos were recovered, 100 of which were produced with conventional semen and 90 with sexed semen. The use of conventional semen after superovulation yielded 72% (72 of 100) viable embryos, which were mostly (81%; 59 of 72) in advanced stages of development (blastocysts and expanded blastocysts). Embryos produced with sexed semen had a lower viability rate (36.7%; 33 of 90), and most of them were collected at earlier stages of development (morulae and early blastocysts; P < 0.05). The H3K4me3 signal was similar among groups; however, there was a difference between morulae and blastocysts. A high intensity of H3K4me3 was observed in bovine embryos produced in vivo, and this pattern did not vary using sexed semen and the slow cryopreservation process. The lower viability of bovine embryos produced with sexed semen could be not explained by differences in H3K4me. Cryopreservation did not alter the pattern of H3K4me3; in this sense, we suggest that it is a process that exerts minimal damage to the embryos.

Chemical composition and extraction yield of the extract of Origanum vulgare obtained from sub- and supercritical CO2.

In this work sub- and supercritical CO(2) were used to obtain extracts from two origanum samples, one commercial, and another cultivated under agronomic control. The experiments were performed in the temperature range of 293-313 K and from 100 to 200 bar in pressure, employing around 26 g of origanum samples. Results show that the commercial sample provides a higher yield of extract if compared to the other sample. It is also achieved that a raise in temperature at constant pressure leads to an increase in the extraction yield despite solvent density changes. Chemical analyses were carried out in a GC-MSD, allowing the identification of around 24 compounds by use of the library of spectra of the equipment and injection of some standard compounds for both commercial and cultivated origanum samples. It was also found that the distribution of chemical components as a function of extraction time differs appreciably between the origanum species. The chromatographic analysis permitted the identification of thymol and cis-sabinene hydrate as the most prominent compounds present in commercial oregano sample and carvacrol and cis-sabinene hydrate in the cultivated Origanum vulgare.

The effects of temperature and pressure on the characteristics of the extracts from high-pressure CO(2) extraction of Majorana hortensis Moench.

The aim of this work is to assess the influence of temperature and pressure (solvent density) on the characteristics of the essential oil obtained from high-pressure carbon dioxide extraction of marjoram (commercial marjoram samples available in the free market and Majorana hortensis Moench, cultivated in South Brazil under rigorous agronomic conditions). The extracts were analyzed in terms of the liquid yield (extract/raw material, wt/wt) and distribution of volatile chemical components. The experiments were performed in a laboratory-scale unit using the dynamic method in the temperature range of 293.15-313.15 K, from 100 to 200 bar in pressure. Chemical analyses were carried out in a GC/MSD. Results show that an increase in temperature leads to a rise in the extract liquid yield despite large changes in solvent density. Chromatographic analyses permitted the identification of cis-sabinene hydrate, terpineol-4, alpha-terpineol, and cis-sabinene hydrate acetate as the main volatile compounds present in both commercial and cultivated samples.