Качество предоставления анестезиологической помощи: предварительное исследование

Catedra Anesteziologie şi Reanimatologie nr. 1, USMF “Nicolae Testemiţanu”This prospective and descriptive study was carried out on 50 women who underwent minimally invasive gynaecological interventions under general, regional or combined anaesthesia. The purpose was to evaluate the quality of anaesthetic assistance in terms of the information provided the patients, the doctor-patient relationships, and the patients’comfort, general needs and anxieties prior to intervention. The study verified the hypothesis that the difference in quality is related to the level of education of the patients. The quality of information about anaesthesia and eventual complications were considered “unsatisfactory by 43% (95CI 36-51%, p<0,0001) of respondents. Significant differences in the quality of information (p=0,033) were identified, as well as in the quality of the anaesthesiologist-patient relationship (p=0,019) in persons with only a primary education as contrasted with those patients with secondary or higher education. Anaesthetic techniques seemed not to affect the patients’ views (significance at limit, p=0,051). The attention paid to comfort and needs was considered „unsatisfactory” by 46% (95CI 28-63%, p<0,0001) patients. Each woman had at least one preoperative inexplicable fear; 80% of fears were focused on anaesthesia and not specifically on intervention.Исследование было проведено проспективным, дескриптивным методом, на основе данных, полученных после проведения миниинвазивных гинекологических операций у 50 пациенток под общей, невраксиальной или комбинированной анестезией. Цель исследования – определить качество предоставления анестезиологической помощи, оценив аспекты информирования, отношения врач-пациент, степени комфорта с учетом предоперационных опасений, а также выявить возможное влияние на перечисленные параметры уровня образования пациенток. Качество информации об анестезии и возможных осложнениях было оценено как неудовлетворительное» 43% (95CI 36-51%, p<0,0001) опрошенных. Былa выявленa существенная разница в качестве предоставленной информации (p=0,033) и в аспектах отношений анестезиолог – пациент (p=0,019) у лиц с начальным, средним и высшим образованием. Вид проведенной анестезии не повлиял на оценку качества анестезиологической помощи, хотя выявленная разница находится на рубеже статистической достоверности (p=0,0051). Внимание, уделенное комфорту и потребностям, оценено как «неудовлетворительное» 46% (95CI 28-63%, p<0,0001) пациенток. Каждая пациентка испытала, по меньшей мере, одно нeразъясненное опасение; 80% из опасений были связаны с анестезией, а не с самой операцией

Evolution issues in pediatric dilated cardiomypathy in children

Department of Pediatrics, State University of Medicine and Pharmacy “Nicolae Testemitanu”, Republic of Moldova, Mother and Children Institute, Republic of MoldovaAim. Cardiomyopathy presents a heterogeneous group of myocardial disorders. Dilated cardiomyopathy (DCM) is the most common pediatric primary cardiomyopathy. The annual incidence of DMC in children is, according to different authors, from 0.57 to 2.6 / 100,000 pediatric population. The authors mention a higher incidence for children aged up to 1 year and is prevalent at boys. Evaluation of children with DCM includes clinical and instrumental parameters, especially the left ventricular (LV) function. The aim of the study was to evaluate echocardiographic evaluation of children with DCM. Material and methods. The study included a total of 75 children with primary cardiomyopathy (45 boys and 30 girls), aged 1 month - 18 years (mean age - 4.81 ± 2.42 years) consecutively admitted in cardiology department of Mother and Child Institute (Chisinau, Moldova). The diagnosis was confirmed through clinical methods and explorative complex tests: anamnestic (relationship-onset symptomatic viral infection, family history), general clinical examination, chest radiography, electrocardiography (ECG), EcoCG at rest, laboratory tests to determine the specific enzyme activity in myocardial cells. Average duration of patient follow-up was 12 months. The entire group of patients was then divided according to clinical diagnosis: group I - 40 patients with the diagnosis of myocarditis (17 girls, 23 boys), and group II - 35 DCM children (9 girls, 26 boys). There were not significant differences by gender and average age between groups. Results and discussion. Initial clinical general manifestations more pronounced in the group were fatigability (90.6%) and dyspnea (46.6%). Analysis of demographic, clinical and laboratory parameters revealed apparent prevalence of boys, the presence of cardiomegaly, and frequent association of general signs of cardiac insufficiency (ICC grade II-III NYHA / Ross). We determined to improve clinical status in terms of functional class NYHA / Ross. Patients with myocarditis (group I) had a better prognosis, which showed improvement of LV myocardial function in over 90% of the analyzed cases. At the same time, children with DCM showed different signs of ICC degree, of which 3 (11.4%) died in 4-6 months after primary presentation, and 2 children were included in the waiting list for heart transplantation ICC due to progression of degree of ventricular dysfunction (Table 1). Table 1. Assessing of EcoCG parameters in children with myocarditis and DCM Parameters Iniţial 3 month 12 month DTDVS, mm (M±m) Group I Group II 38,51±2,1 39,32±1,2 36,4±2,3* 37,62±1,4 36,14±1,7* 36,33±1,6* DTSVS, mm (M±m) Group I Group II 25,91±1,5 26,85±1,3 25,21±2,1 25,23±2,3 23,36±2,1* 23,91±1,7** SIV, mm (M±m) Group I Group II 5,81±0,4 6,46±0,3 5,35±0,2◊ 6,34±0,4 5,21±0,3*◊ 6,24±0,4 FE, % (M±m) Group I Group II 35,32±3,1◊ 27,18±8,1 42,4±1,13*◊ 32,21±4,2* 48,63±1,34** 41,24±1,82** FS, % (M±m) Group I Group II 20,32±2,3 18,21±4,3 23,5±3,1* 23,2±3,1* 24,3±1,17** 26,7±3,24** Index Tei (IT) (M±m) Group I Group II 0,44±0,2 0,50±0,2 0,38±0,18*◊ 0,46±0,1 0,33±1,15**◊ 0,42±0,02** Note: a) DTDVS-enddiastolic diameter of the LV; DTSVS-endsystolic diameter of the LV, SIV- interventricular septum, b) compared to baseline - * p <0.05, ** p <0, 01, ◊ - p <0.05 - the difference between parameter changes in groups I and II evaluation stages. Conclusions: 1. The etiology of primary cardiomyopathy in children is heterogeneous, the data of our study confi rmed contact with fl u-like infectious in 50.6% of cases. 2. Acute myocarditis can associate a transient LV dysfunction, which recovered in the fi rst 3 months of treatment in most cases (90.6%). 3. EcoCG measurements: FE, FS, and Tei index (TI) are easy to calculate, and are useful in assessing LV performance in children both in establishing the initial diagnosis and the clinical evaluation of patients with myocarditis and DCM, independent of the clinical signs of ICC

Лёгочная гипоплазия у детей

Department of Pediatry, NicolaeTestemitanu State Medical and Pharmaceutical University, Research Institute for Maternal and Child Health Care, Chisinau, Republic of MoldovaPulmonary hypoplasia is a congenital malformation of the bronchial tree and lung parenchyma. Caused by the frailty of the embryogenesis mechanisms, it manifests through incomplete development of lung tissue. The severity of the injury depends on when the malformations appear at the prenatal age and the presence of additional anatomical abnormalities. One third of patients with Pulmonary Hypoplasia have additional abnormalities in other organs and systems (examples: heart defects, renal and urinary malformations, locomotor system malformations, etc.) We present a clinical case of diagnosed Hypoplasia in the right lung of a newborn who also has agenesis of the left kidney and paresis of the right facial nerve as well. We discuss the etiologic factors responsible for development of these congenital malformations. Following specialized literature, we do not exclude the impact of the renal and urinary malformations, nervous system disorders, and the impact of the multifactorial teratogens in development of HP in children.Лёгочная гипоплазия является врожденным порокoм развития бронхиального дерева и лёгочной паренхимы, обусловленной хрупкостью эмбриогенеза, которая проявляется неполноценным развитием лёгочной ткани. Тяжесть аномалий зависит от момента её возникновения в пренатальном периоде и наличие дополнительных анатомических аномалий. У 1/3 пациентов с лёгочной гипоплазией диагностируются сопутствующие аномалии других органов и систем (пороки сердца, пороки мочевыделительной системы, опорно-двигателъной системы и др.). Мы представляем клинический случай с гипоплазией правого лёгкого, диагностированного у новорождённого, у которого наблюдается и гипоплазия правой лёгочной артерии, агенезия левой почки, парез правого лицевого нерва. Обсуждается значимость этиологического фактора развития этих врождённых пороков. По данным литературы не исключается ролъ врождённых пороков мочевыделительной системы или патологий нервной системы и тератогенного полифакториалъного воздействия развития гипоплазии лёгкого у детей