The impact of the patient post-intensive care syndrome components upon caregiver burden

OBJECTIVE

To evaluate patient post-intensive care syndrome (PICS-P) and caregiver burden 3 months after discharge from the Intensive Care Unit (ICU) and determine the impact of different components of PICS-P upon caregiver burden.

DESIGN

A prospective observational study was conducted over 26 months (January 2013-February 2015).

SETTING

Medical-surgical ICU and follow-up consultation in Portugal.

PATIENTS OR PARTICIPANTS

Patients discharged after a minimum of 2 days in the ICU. Caregiver inclusion criteria: not paid, written and spoken Portuguese, and agreement to participate in the study.

MAIN VARIABLES OF INTEREST

In ICU: Patient gender, age, severity of illness (SAPS II) and length of ICU stay. At 3 months caregiver burden, physical (reduced mobility, weakness acquired in the ICU) and psychological components of PICS (anxiety, depression, post-traumatic stress disorder).

RESULTS

A total of 168 caregivers completed the survey (response rate of 69%). A low degree of overburden was reported by 34.5% of caregivers, while 15.5% showed moderate to high levels of overburden. Patient anxiety and depression 3 months after ICU discharge significantly influenced the presence of caregiver burden (p=0.030 vs p=0.008). When physical components of PICS-P were evaluated, no influence on caregiver burden was observed. Patient demographics, severity of illness and length of stay also failed to influence caregiver burden.

CONCLUSIONS

The presence of psychological components of PICS-P 3 months after ICU seems to have a negative impact upon caregiver burden. On the other hand, physical problems showed no important impact upon caregiver overburden.

A mixture containing the herbicides Mesotrione and Atrazine imposes toxicological risks on workers of Partamona helleri

A mixture of Mesotrione and Atrazine (Calaris®) has been reported as an improvement of the atrazine herbicides, which are agrochemicals used for weed control. However, its possible harmful effects on non-target organisms, including pollinators, needs to be better understood. In this work, the effects of the mix of herbicides on food consumption, behaviour (walking distance, and meandering), and the morphology of the midgut of the stingless bee Partamona helleri were studied. Foragers were orally exposed to different concentrations of the mix. The concentrations leading to 10% and 50% mortality (LC₁₀ and LC₅₀, respectively) were estimated and used in the analysis of behaviour and morphology. The ingestion of contaminated diets (50% aqueous sucrose solution + mix) led to a reduction in food consumption by the bees when compared to the control, bees fed a non-contaminated diet (sucrose solution). Ingestion of the LC₅₀ diet reduced locomotor activity, increased meandering, induced the degradation of the epithelium and peritrophic matrix, and also changed the number of cells positive for signalling-pathway proteins in the midgut. These results show the potential toxicological effects and environmental impacts of the mix of herbicides in beneficial insects, including a native bee.

The 1,3-dipolar cycloaddition reaction in the functionalization of carbon nanofibers

Carbon nanofibers were functionalized using a reaction scheme described in the literature for 1,3-dipolar cycloaddition of azomethine ylides generated in situ by the condensation of an alpha-amino acid and an aldehyde. The reagents used were Z-Gly-OH and paraformaldehyde. Their reaction with carbon nanofibers was studied as a solid mixture by controlled heating in the DSC. An oxazolidinone intermediate was formed as the major product. Z-Gly-OH and paraformaldehyde were also reacted with a model compound (anthracene) in DMF solution leading to the formation of a considerable amount of anthraquinone. These studies suggested that, under the conditions investigated, the 1,3-dipolar cycloaddition reaction was not favoured, and the main result of functionalization was the formation of quinone-type groups as a consequence of an oxidation process.

Selection of reference genes for quantitative real-time PCR normalization in European quail tissues

Coturniculture has been standing out as an industrial poultry activity in several countries around the world because of the several adaptive advantages of quails. Research that considers the analysis of gene expression can enhance this activity. This study aimed to analyze the stability of reference genes (RGs) in different tissues of quails (both males and females) for the recommendation of use in gene expression studies by the quantitative reverse transcription-polymerase chain reaction (RT-qPCR). The expression stability of ten RGs (ACTA1, ACTB, B2M, GAPDH, HMBS, SDHA, HPRT1, MRPS27, MRPS30, and RPL5) was analyzed in four tissues (breast muscle, abdominal fat, liver, and intestine), and assessed using the statistical tools geNorm, NormFinder, comparative ΔC_q method, and BestKeeper. The HPRT1 gene was the most stable in all quail tissues tested, followed by MRPS27 and MRPS30 in breast muscle, B2M and RPL5 in abdominal fat, HMBS and B2M in the liver, and RPL5 and HMBS in the intestine. These results may help studies using RT-qPCR assays to assess quail tissues from both sexes because they provide data on the most stable genes, which should be tested as candidate RGs for other experimental conditions.

Functionalization of carbon nanofibers by a Diels-Alder addition reaction

This paper reports functionalization of CNF via a Diels-Alder addition reaction and the characterization of the obtained materials. The functionalization was assessed by a calorimetric technique (DSC) and the morphology of CNF modified materials was characterized by scanning electron microscopy (SEM) and transmission electron microscopy (TEM). The functionalization was observed to be dependent on the preparative conditions. Detailed analysis of the CNF modified material surface using TEM, shows a deposited layer homogeneously distributed over the CNF structures with an average thickness of about 15 nm. Finally the chemical activity of the raw CNF and functionalized CNF was analyzed to determine the pH of the point of zero charge (pHpzc) values. The results obtained showed that the functionalized CNF materials presented enhanced acid activity comparatively with the modified carbonaceous materials reported in literature.

Gender analysis of 'man-in-the-barrel' syndrome: is 'person-in-the-barrel' a more adequate term?

BACKGROUND AND PURPOSE

Gender bias is a known issue in healthcare and academia. We analysed the gender of patients reported in the literature with 'man-in-the-barrel' syndrome or equivalent semiological terms.

METHODS

A search in the PubMed database was conducted using the terms 'man-in-the-barrel', 'person-in-the-barrel', 'woman-in-the-barrel', 'brachial diplegia', 'flail arm' and 'cruciate paralysis'. All articles published between 1969 and 2020 containing a detailed description compatible with the original description of man-in-the-barrel syndrome were included.

RESULTS

Ninety-five patients with a clinical picture compatible with man-in-the-barrel syndrome were included. Up to 33% of patients were female. Overall, the proportion of female patients with man-in-the-barrel syndrome was 25%.

DISCUSSION AND CONCLUSIONS

The term man-in-the-barrel may disenfranchise up to a third of women presenting with brachial diplegia with undesirable consequences. We propose a gender-neutral alternative such as 'person-in-the-barrel'.

Bioinsecticide spinosad poses multiple harmful effects on foragers of Apis mellifera

There are multifactorial causes for the recent decline in bee populations, which has resulted in compromised pollination and reduced biodiversity. Bees are considered one of the most important non-target insects affected by insecticides used in crop production. In the present study, we investigated the effects of acute oral exposure to spinosad on the survival, food consumption, flight behavior, respiration rate, activity of detoxification enzymes, total antioxidant capacity (TAC), brain morphology, and hemocyte count of Apis mellifera foragers. We tested six different concentrations of spinosad for the first two analyses, followed by LC₅₀ (7.7 mg L^-1) for other assays. Spinosad ingestion decreased survival and food consumption. Exposure to spinosad LC₅₀ reduced flight capacity, respiration rate, and superoxide dismutase activity. Furthermore, this concentration increased glutathione S-transferase activity and the TAC of the brain. Notably, exposure to LC₅₀ damaged mushroom bodies, reduced the total hemocyte count and granulocyte number, and increased the number of prohemocytes. These findings imply that the neurotoxin spinosad affects various crucial functions and tissues important for bee performance and that the toxic effects are complex and detrimental to individual homeostasis.

A conserved tooth resorption mechanism in modern and fossil snakes

Whether snakes evolved their elongated, limbless bodies or their specialized skulls and teeth first is a central question in squamate evolution. Identifying features shared between extant and fossil snakes is therefore key to unraveling the early evolution of this iconic reptile group. One promising candidate is their unusual mode of tooth replacement, whereby teeth are replaced without signs of external tooth resorption. We reveal through histological analysis that the lack of resorption pits in snakes is due to the unusual action of odontoclasts, which resorb dentine from within the pulp of the tooth. Internal tooth resorption is widespread in extant snakes, differs from replacement in other reptiles, and is even detectable via non-destructive μCT scanning, providing a method for identifying fossil snakes. We then detected internal tooth resorption in the fossil snake Yurlunggur, and one of the oldest snake fossils, Portugalophis, suggesting that it is one of the earliest innovations in Pan-Serpentes, likely preceding limb loss.

Impact of copper sulfate on survival, behavior, midgut morphology, and antioxidant activity of Partamona helleri (Apidae: Meliponini)

Copper sulfate (CuSO₄) is widely used in agriculture as a pesticide and foliar fertilizer. However, the possible environmental risks associated with CuSO₄ use, particularly related to pollinating insects, have been poorly studied. In this study, we evaluated both lethal and sublethal effects of CuSO₄ on the stingless bee Partamona helleri. Foragers were orally exposed to five concentrations of CuSO₄ (5000, 1666.7, 554.2, 183.4, 58.4 μg mL^-1), and the concentration killing 50% (LC₅₀) was estimated. This concentration (142.95 μg mL^-1) was subsequently used in behavioral, midgut morphology, and antioxidant activity analyses. Bee mortality increased with the ingestion of increasing concentrations of CuSO₄. Ingestion at the estimated LC₅₀ resulted in altered walking behavior and damage to the midgut epithelium and peritrophic matrix of bees. Furthermore, the LC₅₀ increased the catalase or superoxide dismutase activities and levels of the lipid peroxidation biomarker malondialdehyde. Furthermore, the in situ detection of caspase-3 and LC3, proteins related to apoptosis and autophagy, respectively, revealed that these processes are intensified in the midgut of treated bees. These data show that the ingestion of CuSO₄ can have considerable sublethal effects on the walking behavior and midgut of stingless bees, and therefore could pose potential risks to pollinators including native bees. Graphical abstract.

Heat stress-mediated effects on the morphophysiological, biochemical, and ultrastructural parameters of germinating Melanoxylon brauna Schott. seeds

The present study showed that the heat stress (40 °C) caused changes in morphophysiological, biochemical, and ultrastructural parameters to the seeds Melanoxylon brauna, ultimately leading to loss of germination capacity. Temperature is an abiotic factor that influences seed germination. In the present study, we investigated morphophysiological, biochemical, and ultrastructural changes during the germination of Melanoxylon brauna seeds under heat stress. Seed germination was evaluated at constant temperatures of 25 and 40 °C. The samples consisted of seeds soaked in distilled and ionized water for 48 and 96 h at both temperatures. For the evaluation of internal morphology, the seeds were radiographed. Ultrastructural parameters were assessed using transmission electron microscopy (TEM). The production of reactive oxygen species (ROS), content of malondialdehyde (MDA) and glucose, carbonylated proteins, and activity of the enzymes (superoxide dismutase-SOD, ascorbate peroxidase-APX, catalase-CAT, peroxidase-POX, glucose-6-phosphate dehydrogenase-G6PDH, lipase, α- and β-amylase, and protease) were measured by spectrophotometric analysis. An 82% reduction in the germination of M. brauna seeds was observed at 25 °C, and 0% at 40 °C. TEM showed that seeds submitted to heat stress (40 °C) had poorly developed mitochondria and significantly reduced respiration rates. The content of ROS and protein carbonylation in seeds subjected to 40 °C increased compared to that at 25 °C. The activity of antioxidant enzymes, namely SOD, APX, CAT, and POX, was significantly reduced in seeds subjected to heat stress. Glucose content, G6PDH, and lipase activity also decreased when the seeds were exposed to heat stress. Conversely, α- and β-amylase enzymes and the protease increased due to the increase in temperature. Our data showed that the increase in temperature caused an accumulation of ROS, increasing the oxidative damage to the seeds, which led to mitochondrial dysfunction, ultimately leading to loss of germination.

Outcome of cardiopulmonary resuscitation in a Portuguese university hospital

Portugal has many weak links in the so-called 'chain of survival' both in the pre-hospital and in-hospital setting. Apart from evaluating the performance of a newly implemented in-hospital cardiac arrest system, we assessed the correlation between different clinical variables and outcome after cardiopulmonary resuscitation (CPR). All resuscitation attempts during 1995 were registered using the form recommended by the European Resuscitation Council. One hundred and twenty-five patients either collapsing out-of-hospital (42; 33.6%) or having in-hospital cardiac arrest (83; 66.4%) were included in the study. The number of patients who experienced recovery of spontaneous circulation was 10 (23.8%) in the out-of-hospital group and 35 (42.2%) in the in-hospital one. Of all out-of-hospital patients, 11.9% were discharged from hospital compared with 22.8% of the in-hospital group. Asystole was the initial rhythm in a significant number of arrests. The average call-response interval of the in-hospital cardiac arrest team was under 3 min. The results from this series concur with other reported series. Although good standards of care were achieved, we are aware that this was only an isolated step in the implementation of the 'chain of survival' in our country. The authors conclude that there is an urgent need for a nationwide programme that improves the standards of care for these patients.

Analysis of performance, bone characteristics, and expression of genes involved in the balance of ionic concentrations in broilers subjected to dietary electrolyte balance levels

1. Sodium bicarbonate (NaHCO₃), potassium carbonate (K₂CO₃), and ammonium chloride (NH₄Cl) are commonly used to correct dietary electrolyte balance (DEB) in birds. However, there are many gaps in the knowledge of their effects when used simultaneously. This study investigated the effect of DEB levels on performance, femur bone characteristics and the expression of genes related to the balance of ionic concentrations in broilers at 21 days of age.2. Male Cobb broiler chickens (n = 245), aged 1-21 d, were divided into groups based on a completely randomised design with five DEB levels (110 mEq/kg, 175 mEq/kg, 240 mEq/kg, 305 mEq/kg, and 370 mEq/kg).3. The performance characteristics measured included body weight (BW), body weight gain (BWG), feed intake (FI), feed conversion (FCR) and body weight birds slaughtered (BWS).4. The bone variables assessed in the femur were weight (WE), relative bone weight (RBWE), length (L), width (WI), maximum load supported (MLS), bone-breaking resistance (BR), and Seedor index (SI). In addition, the expression of CHP1, SLC9A1, and SLC24A3 in the livers, intestines and kidneys of birds was evaluated.5. The DEB level of 370 mEq/kg, at Na⁺ content of 0.48%, resulted in the highest averages for L, MLS, and BR of the femur. This DEB level increased the expression of SLC9A1 in the liver and SLC24A3 in the intestine. A 240 mEq/kg DEB level decreased the expression of CHP1 in the liver, while supplementation with 110 mEq/kg increased the expression of SLC24A3 in the kidney.6. In conclusion, 370 mEq/kg DEB improved FCR and increased the mean bone characteristics of the femur (L, MLS, and BR) and the expression of SLC9A1 and SLC24A3 in the liver and intestine, respectively. These findings should be considered in future assessments of the effects of DEB levels on broilers.

Improving medical emergency system: Results of a multi-professional questionnaire

OBJECTIVE

This study aimed to identify ways to improve the Medical Emergency System (MES) in its different components and infer Medical Emergency Team (MET) activation failure causes.

METHODS

A questionnaire regarding opinions and attitudes towards the MES was conducted, targeting all professionals at the hospital, which has an implemented MES with Basic Life Support (BLS) since 1998.

RESULTS

Thirty two percent (n=585) of hospital professionals answered, from these 37.8% were neither doctors nor nurses. In mean six years passed since the BLS certification, yet 102 professionals (17.4%) had not done it. A relevant percentage admitted to not being familiarized with the different components of the MES (activation criteria 16.4%, telephone number 4.1%, content of the resuscitation trolleys 42.4% and defibrillator-monitor 47.4%), percentages lessened among those had taken the BLS course. The majority highly valued MET, however 83 (23%) could not confirm that debriefingand 17 (4.4%) that allocation of tasks happened after and during activation, respectively. When activating MET 52 (18.1%) admitted fear of criticism and 38 (13.3%) agreed that they needed validation by another professional, factors not influenced by BLS course completion. Excessive workload as a barrier to recognize ill patients was pointed by 127 (45.7%) of the respondents.

CONCLUSION

Despite educational and auditing efforts, the MES is not fully integrated into hospital culture. BLS certification for all professionals and non-technical skills of MET were identified has major areas for MES improvement. Unfamiliarity with activation criteria, fear of criticism and excessive workload were identified as failure of activation causes.

Behavioral and physiological effects of difenoconazole on stingless bees: A multi-species analysis

Stingless bees, vital to ecosystems and plant production, face increasing threats from pesticide use, with poorly understood potential impacts of fungicides on these pollinators. The goal of this work was to evaluate the effect of contact or oral exposure to difenoconazole, a broad-spectrum fungicide, on foragers of three species of stingless bees: Frieseomelitta varia, Melipona mondury, and Trigona spinipes. The study employed a field-realistic dose of difenoconazole (0.075 mg a.i./mL, referred to as 1×) and its dilutions (10× or 100×) to assess survival and food consumption. The recommended field dose was used to evaluate behaviors, as well as total hemocyte count (THC), and midgut morphology. Contact or oral exposure increased THC in F. varia, while oral exposure decreased food consumed, distance walked, and social interactions, and caused injuries to the midgut. In M. mondury, contact exposure decreased survival and THC while increasing interactions, whereas oral exposure increased walking distance and interactions. For T. spinipes, contact exposure increased walking distance and interactions. Exposures caused adverse effects with variations in the level or type of damage depending on the species and route of exposure. This emphasizes the significance of understanding the potential impacts of fungicides on various pollinators, particularly on stingless bees.

Morphological characterization of antennal sensilla in Toxorhynchites theobaldi, Toxorhynchites violaceus, and Lutzia bigoti adults: a comparative study using scanning electron microscopy

Some mosquitoes, including species of the genus Toxorhynchites, are known for actively preying on other mosquito larvae, making these predators valuable allies in the fight against vector-borne diseases. A comprehensive understanding of the anatomy and physiology of these potential biological control agents is helpful for the development of effective strategies for controlling vector populations. This includes the antennae, a crucial component in the search for hosts, mating, and selection of oviposition sites. This study utilized scanning electron microscopy to characterize the sensilla on the antennae of adult mosquitoes from two species that are exclusively phytophagous, including Toxorhynchites theobaldi and Toxorhynchites violaceus, as well as Lutzia bigoti, which females are allegedly hematophagous. The types of sensilla in each species were compared, and five basic types of antennal sensilla were identified: trichoid, chaetic, coeloconic, basiconic, and ampullacea. The analysis also found that they were morphologically similar across the three species, regardless of feeding habits or sex. The identification and characterization of basic types of antennal sensilla in T. theobaldi, T. violaceus, and L. bigoti suggest that these structures, which play a crucial role in the behavior and ecology, have common functions across different mosquito species, despite differences in feeding habits or sex.

Effect of vaccination against Mycoplasma hyopneumoniae on divergent pig genetic groups

The bacterium Mycoplasma hyopneumoniae (Mhp) causes a chronic infectious respiratory disease in pigs, leading to important economic losses. This study aimed to compare the immune response of the local Piau breed and a commercial line to Mhp vaccination. For this, two phases were carried out. In the first, gene expression of toll-like receptors (TLR2, TLR4, TLR6, and TLR10) and cytokines (IL2, IL6, IL8, IL10, IL12, IL13, TNFα, and TGFβ) was assessed in porcine blood mononuclear cells (PBMC) from the two genetic groups before and after vaccination. In the second experiment, nitric oxide production, specific antibodies, and gene expression of toll-like receptors and cytokines were evaluated in bronchoalveolar lavage fluid (BALF) cells of vaccinated and unvaccinated pigs. After vaccination against Mhp, TLR2, TLR4, TLR6, TLR10, IL6, TNFα, and TGFβ expression levels were elevated in PBMC from commercial animals, and TLR6, TLR10, and TGFβ expression levels were elevated in PBMC from the Piau group. Vaccination also increased the production of Mhp-specific IgG antibodies in BALF cells in the Piau breed. Comparison of the two genetic groups revealed differences in TNFα and IL10 expression in BALF cells. These results show that Piau pigs have different immune responses to vaccination compared with commercial animals. It is worth noting that these genetic differences between both genetic groups may be related to phenotypic differences in Mhp resistance or susceptibility.