Antimicrobial management of the diabetic foot infections

USMF ”N. Testemiţanu” Catedra Chirurgie FECMF, Al XI-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” din Republica Moldova și cea de-a XXXIII-a Reuniune a Chirurgilor din Moldova „Iacomi-Răzeșu” 27-30 septembrie 2011Introducere. Infecția piciorului la un pacient cu diabet zaharat este cauza amputației la 25%-50% dintre ei, fiind mai înaltă în infecțiile profunde. Evoluția severă a procesului inflamator este consecința influenței tipului microorganismului etiologic, dereglării metabolismului, a neuropatiei şi a afectului macro- şi microvascular din diabet. Obiective. Evaluarea antibioterapiei curente a piciorului diabetic infectat în baza analizei a 38 cazuri consecutive de pacienți, tratați în secțiile de chirurgie generală şi reanimare septică a SCR Chişinău în perioada octombrie 2010 – mai 2011. Material şi metode. La internarea pacientului s-au prelevat analize microbiologice din plaga infectată. Până la primirea rezultatelor, antibioterapia a fost empirică. Ghidarea antibioterapiei s-a efectuat conform rezultatelor însămânțărilor ulterioare, prelevate săptămânal. Rezultate. Analiza datelor investigațiilor microbiologice primare demonstrează prezența monoculturilor în 16/38 (42%) cazuri şi a asocierilor microbiene la 22/38 (58%) pacienți. Dintre monoculturi, în 12 cazuri a fost depistat stafilococul auriu, dintre care în 5 (42%) cazuri microorganismul era sensibil la oxacilină, iar în 7 (58%) cazuri-rezistent la oxacilină. La 2 pacienți a fost depistat Enterococcus faecalis, rezistent la cefalosporine şi rifampicină, sensibil la ampicilină, amoxicilină,ofloxacină, doxiciclină, levomicetină,ciprofloxacină, moxifloxacină, vancomicină, imipenem, meropenem. Floră polimicrobiană a fost prezentată prin asocieri gram(+) şi gram (-) la 15 (68%) dintre ei, la 6 (27%) asocieri de microorganisme gram negative şi la 1(5%) pacient s-a depistat asociere de grampozitive. Concluzii: 1. Micloflora în piciorul diabetic este variată, constând preponderent din asocieri microbiene la pacienții tratați în alte spitale, fiind monomicrobiană la pacienții cu picior diabetic, internați prima oară. 2. Antibioterapia este foarte importantă în tratamentul piciorului diabetic infectat, dat nu poate substitui managementul chirurgical. 3. Datele studiului demonstrează necesitatea utilizării antibioticelor de ultimă generație în tratamentul infecției piciorului diabetic. .Background. Infection of the foot in patients with diabetes causes amputation in 25-50%, this rate being even higher in deep infections. Severe evolution of the inflammatory process is influenced by the type of microorganism, grade of metabolic impairment, diabetic neuropathy, diabetic micro-, and macro-vascular lesions. Objectives. Evaluation of the current antimicrobial therapy used in diabetic foot infections by analysis of 38 consecutive patients, treated in the departments of general surgery and septic intensive care unit of the Clinical Republican Hospital, Kishinau, in the period from October 2010 to May 2011. Material and method. At admission swabs from the wound, areas were collected in all patients. Initial antibiotic therapy was empiric prior to the pathogen identification. Afterward, the treatment was selected in accordance with the culture test performed weekly. Results. Analysis of the primary culture tests shows monomicrobial infection in 42% (16/38) of cases and microbial association in 58 % (22/38) cases. Monomicrobial infection was produced in 12 cases by Staph. aureus, which was sensible to oxacillin in 5 (42%) cases and resistant in 7 (58%) cases. Enterococcus faecalis resistant to cephalosporines and rifampicin was detected in 2 patients. This agent was sensible to ampicillin, amoxicillin, ofloxacin, doxycycline, levomycetin, ciprofloxacin, moxifloxacin, vancomycin, imipenem, meropenem. Polymicrobial infections were represented by gram-negative and gram-positive associations in 15 (68%) cases, only gram-negative bacteria in 6 (27%) patients, and pure gram-positive associations in one case (5%). Conclusions. 1. Diabetic foot infections are produced by variable pathogens. Patients referred from other hospitals present polymicrobial infection in contrast to patients at first admission who demonstrate monomicrobial culture. 2. Antibiotic therapy is very important in the complex treatment of diabetic foot infection, but it cannot substitute surgical treatment. 3. Data of this study demonstrate the necessity of the use of the last generation antibiotics in patients with diabetic foot infections

Modern treatment of Dry Eye Syndrome (DES)

Clinica oftalmologie Instituţia Medico-Sanitară Publică Spitalul Clinic Republican, Chişinău R. MoldovaThe study is based on 78 patients with DES of various ethiology and moderate severity. All the patients were distributed into 3 groups: I group - 26 patients treated with Oxial (lubricant Eye drops, Santen, Finlanda); II group included 30 patients treated by insertion of SMART PLUG into inferior lacrimal canaliculus; III group included 22 patients treated by laser-coagulation of the inferior lacrimal punctum. All the methods are effective, modern, inofensive, non- or mini-invasive. Management of DES should take into account the ethiology and severity of the disease, personal and professional particularities. Articolul este bazat pe un studiu ce a cuprins 78 pacienţi cu SOU de diversă etiologie şi gravitate medie. După metoda de tratament pacienţii au fost distribuiţi în 3 loturi: - lotul I – 26 bolnavi trataţi cu preparatul Oxial (Santen, Finlanda)în instilaţii; - lotul II a cuprins 30 pacienţi, ce au beneficiat de blocajul canaliculului lacrimal inferior cu obturatorul SMART PLUG; - lotul III – 22 pacienţi trataţi prin laser-coagularea punctului lacrimal inferior. Toate metode de tratament sunt eficace, moderne, non- sau mini-invazive, inofensive. Conduita de tratament al SOU este în funcţie de etiologia, gravitatea procesului, particulatăţi personale şi profesionale a pacienţilor

Star-shaped Magnetic-plasmonic Au@Fe3O4 nano-heterostructures for photothermal therapy

Here, we synthesize a Au@Fe3O4 core@shell system with a highly uniform unprecedented star-like shell morphology with combined plasmonic and magnetic properties. An advanced electron microscopy characterization allows assessing the multifaceted nature of the Au core and its role in the growth of the peculiar epitaxial star-like shell with excellent crystallinity and homogeneity. Magnetometry and magneto-optical spectroscopy revealed a pure magnetite shell, with a superior saturation magnetization compared to similar Au@Fe3O4 heterostructures reported in the literature, which is ascribed to the star-like morphology, as well as to the large thickness of the shell. Of note, Au@Fe3O4 nanostar-loaded cancer cells displayed magneto-mechanical stress under a low frequency external alternating magnetic field (few tens of Hz). On the other hand, such a uniform, homogeneous, and thick magnetite shell enables the shift of the plasmonic resonance of the Au core to 640 nm, which is the largest red shift achievable in Au@Fe3O4 homogeneous core@shell systems, prompting application in photothermal therapy and optical imaging in the first biologically transparent window. Preliminary experiments performing irradiation of a stable water suspension of the nanostar and Au@Fe3O4-loaded cancer cell culture suspension at 658 nm confirmed their optical response and their suitability for photothermal therapy. The outstanding features of the prepared system can be thus potentially exploited as a multifunctional platform for magnetic-plasmonic applications

A multi-component flood risk assessment in the Maresme coast (NW Mediterranean)

Coastal regions are the areas most threatened by natural hazards, with floods being the most frequent and significant threat in terms of their induced impacts, and therefore, any management scheme requires their evaluation. In coastal areas, flooding is a hazard associated with various processes acting at different scales: coastal storms, flash floods, and sea level rise (SLR). In order to address the problem as a whole, this study presents a methodology to undertake a preliminary integrated risk assessment that determines the magnitude of the different flood processes (flash flood, marine storm, SLR) and their associated consequences, taking into account their temporal and spatial scales. The risk is quantified using specific indicators to assess the magnitude of the hazard (for each component) and the consequences in a common scale. This allows for a robust comparison of the spatial risk distribution along the coast in order to identify both the areas at greatest risk and the risk components that have the greatest impact. This methodology is applied on the Maresme coast (NW Mediterranean, Spain), which can be considered representative of developed areas of the Spanish Mediterranean coast. The results obtained characterise this coastline as an area of relatively low overall risk, although some hot spots have been identified with high-risk values, with flash flooding being the principal risk process