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Summary Introduction Although prevalent and associated with worsened outcomes, vitamin D severe deficiency is not systematically searched among intensive care unit (ICU) admissions and waiting time for measurement results range from hours to few days. Hence, we developed and internally validated a simple nomogram for predicting severe vitamin D deficiency at ICU admission. Patients and methods Data of 3338 ICU admissions from an observational prospective cohort registered between January 2017 and December 2019 were analyzed. Demographic data as well as severity scores and season of admission were obtained. After splitting the population into training and test sets, a least absolute shrinkage (LASSO) regression model was used to select factors and construct the nomogram. Calibration and discrimination were used to assess the nomogram performance. Clinical use was evaluated by a decision curve analysis. Results Age, gender, Sequential Organ Failure Assessment (SOFA), Simplified Acute Physiology Score III (SAPS3) and season of admission were identified by the LASSO regression analysis as significant predictors of vitamin D severe deficiency at ICU admission. The nomogram model showed good discrimination with a 1000 bootstrap analysis and good calibration with a C-index of 0.64. The decision curve analysis showed that at a threshold probability between 30% and 50%, using the nomogram adds more benefit that considering that all patients are severely deficient or non-severely deficient. Conclusions This easy-to-use dynamic nomogram can help physicians to select patients that could benefit the most from vitamin D supplementation at ICU admission. External validation is needed to verify the generalizability of this nomogram.

The alarming situation of the increasing problem of the antibiotics resistance in the whole world requires an immediate need of the exploration of better alternatives for combating resistance. The main aim of the present work was the isolation and the screening of large range of lactic acid bacteria with important potential of antibacterial activity against multidrug resistance pathogenic strains and the characterization of the molecules responsible for anti-bacterial activity. The primary screening indicated the isolation of total of 200 lactic acid bacteria (LAB) from harvested milk (camel and goat) and tradi-tional fermented dairy products (Jben and kamaria) of south Algeria and in-vestigated for their antibacterial activity against clinical pathogens bacteria. Furthermore, Nineteen representative isolates (19) were selected and char-acterized with regard to their functional properties. The obtained results indicated that produced bacteriocin by both bacterial strains L. raffinolactis LAB9 and Leuconostoc mesenteroides subsp. cremoris LAB13 has manifested an excellent antagonistic activity against P.aeruginosa (PA) and Staphylococcus aureus (MRSA), which was Methicillin resistant Staphylococcus aureus (MRSA). A Further investigation indicated that the produced bacteriocin by LAB9 and LAB 13 were heat stable, where their inactivation was observed when treated with pepsin and trypsin. Additionally, the purification of the produced bacteriocin by L.raffinolactis LAB9 and Leuconostoc mesenteroides subsp. cremoris LAB13 has been achieved by the using of the partial ammonium sulfate precipitation. The technological properties and the stability of bacteriocins of LAB may lead for bioprospection of antibacterial components in the current struggle against increasing pandrug resistance and slowing down the expansion of multi drug resistance.

Sepsis-associated brain dysfunction is a frequent disorder in septic patients and has a multifactorial pathophysiology. Cholinergic pathways and brainstem dysfunction may result in pupillary alterations. The aim of this study was to evaluate whether early assessment of the Neurological Pupil Index (NPiRetrospective cohort study of adult critically ill septic patients admitted to the intensive care unit of a University Hospital; patients with acute or known brain damage were excluded. Patients' severity was assessed by the daily Sequential Organ Failure Assessment Score and the SOFAinfmax/inf(i.e., highest SOFA Score during the first five days) was computed. The worst NPi (i.e., lowest value from one eye) was collected daily and then computed over the first five days of assessment. Mortality was assessed at hospital discharge.A total of 75 patients were included over the study period (median age 67 [53-75] years and median SOFA Score at admission 10 [8-12]); 64 (85%) presented septic shock; 48 (64%) died at hospital discharge. The worst NPi during the first five days of sepsis was significantly lower in non-survivors compared to survivors (4.4 [3.6-4.6] vs. 4.5 [4.2-4.7]; P=0.042). The worst NPi was also significantly lower in high severity group (i.e., SOFAinfmax/inf≥12) when compared to others (4.4 [3.2- 4.5] vs. 4.5 [4.0-4.7] P=0.01). However, in the multivariate analyses, the NPi value was not independently associated with in-hospital mortality or high SOFAinfmax/inf.In this study, no independent prognostic role of NPi was observed in septic patients. Further larger prospective studies are needed to better evaluate the role of automated pupillometry in this setting.

Anoxic brain injuries represent the main determinant of poor outcome after cardiac arrest (CA). Large animal models have been described to investigate new treatments during CA and post-resuscitation phase, but a detailed model that includes extensive neuromonitoring is lacking.Before an electrically-induced 10-minute CA and resuscitation, 46 adult pigs underwent neurosurgery for placement of a multifunctional probe (intracranial pressure or ICP, tissue oxygen tension or PbtO42 animals underwent the CA procedure and 41 achieved the return of spontaneous circulation (ROSC). In 4 cases (8.6%) an adverse event took place during preparation, but only in two cases (4.3%) this was related to the neurosurgery. In 6 animals (13.3%) the minor complications that occurred resolved after probe repositioning.Herein we provide a detailed comprehensive neuromonitoring approach in a large animal model of CA that might help future research.

An ethnobotanical survey was undertaken to collect information from traditional healers on the use of plants (Atriplex halimus L., Searsia tripartita (Ucria) Moffett, Limoniastrum guyonianum Durieu ex Boiss., Haplophyllum tuberculatum Juss., Tamarix gallica L. and Nitraria retusa (Forssk.) Asch.) in folkloric medicine of Ouargla (Algeria), using a predesigned questionnaire. The studied plants were screened for the presence of secondary metabolites. The traditional healers in the study area used the investigated species for the treatment of various diseases. The average of the informant consensus factor (FIC) value for all ailment categories was 0.93, with the highest number of species being used for digestive problems (449) followed by dermatological symptoms (154) and nervous disorders (144). These pathologies were mainly treated by leaves in the form of decoction, representing the dominant formulation. The oral administration which regrouped the major form of usage, which was in form of drink, was most exercised. The phytochemical analysis showed the presence of polyphenolic compounds and saponins in almost all tested plants. For the other metabolites classes, results varied between plants. The multi-uses of species demonstrated the importance of these plants and the diversity of the ancestral knowledge. Key words: Ethnobotanical study, spontaneous plants, traditional pharmacopeia, phytochemical analysis, Ouargla.

Introduction Observational studies have demonstrated an association between vitamin D deficiency and increased risk of morbidity and mortality in critically ill patients. Cohort studies and pilot trials have suggested promising beneficial effects of vitamin D replacement in the critical ill, at least in patients with severe vitamin D deficiency. As vitamin D is a simple, low-cost and safe intervention, it has potential to improve survival in critically ill patients. Methods and analysis In this randomised, placebo-controlled, double-blind, multicentre, international trial, 2400 adult patients with severe vitamin D deficiency (25-hydroxyvitamin D≤12 ng/mL) will be randomised in a 1:1 ratio by www.randomizer.at to receive a loading dose of 540 000 IU cholecalciferol within 72 hours after intensive care unit (ICU) admission, followed by 4000 IU daily for 90 days or placebo. Hypercalcaemia may occur as a side effect, but is monitored by regular checks of the calcium level. The primary outcome is all-cause mortality at 28 days after randomisation. Secondary outcomes are: ICU, hospital, 90-day and 1-year mortality; hospital and ICU length of stay, change in organ dysfunction on day 5 as measured by Sequential Organ Function Assessment (SOFA) score, number of organ failures; hospital and ICU readmission until day 90; discharge destination, self-reported infections requiring antibiotics until day 90 and health-related quality of life. Recruitment status is ongoing. Ethics and dissemination National ethical approval was obtained by the Ethics Committee of the University of Graz for Austria, Erasme University Brussels (Belgium) and University Hospital Frankfurt (Germany), and will further be gained according to individual national processes. On completion, results will be published in a peer-reviewed scientific journal. The study findings will be presented at national and international meetings with abstracts online. Trial registration NCT03188796, EudraCT-No: 2016-002460-13., SCOPUS: ar.j, info:eu-repo/semantics/published