Importanţa imunocorectorului BioR în tratamentul ulcerului duodenal la pacienţii vârstnici

Conferinţa naţională în medicina internă din Republica Moldova cu participare internaţională, 19-20 mai 2011, Chişinău, Republica MoldovaSummary. The combination of immunocorrector BioR with standard antiulcer scheme helped for earlier disappearing of pain and dyspeptic syndromes, shrinking of the terms of scarring of ulcerous defect, in increasing the level T-helpers and T-suppressors, and production of Ig M, G and В lymphocytes.Actualitatea temei. În ulcerul duodenal (UD) la pacienţii vârstnici se implică multe niveluri ale homeostazei, inclusiv sistemul imun, se stabileşte un proces cronic imun, manifestat prin implicarea verigilor celulare şi umorale ale sistemului imun, fapt ce necesită studierea ulterioară şi sistematizarea pentru crearea metodelor eficiente şi ştiinţific justificate de tratament. BioR este un imunocorector şi un stabilizator de membrane celulare, care are o acţiune antioxidantă, este un produs al Spirulinei platensis. Scopul lucrării: studiul comparativ al eficacităţii clinice a imunocorectorului BioR în tratamentul complex al ulcerului duodenal la pacienţii vârstnici. Material şi metode. Au fost investigaţi 50 de pacienţi vârstnici. Lotul I (25 pacienţi) – cu tratament standard antiulceros, la care s-a asociat BioR 0,5%- 1,0 (5,0 mg) ml i/m pe zi, timp de 10 zile. Lotul II (25 pacienţi) – cu tratament standard. Rezultate. La pacienţii lotului I media termenelor de suprimare a sindromului algic a constituit 10,4±0,3 zile (р<0,001); gradul mediu de gravitate (GMG) a sindromului dolor până şi după tratament a constituit 1,99 şi 0,91, cicatrizarea defectului ulceros peste 14 zile s-a constatat în 96% cazuri, peste 21 zile – 100% cazuri, s-a evidenţiat creşterea nivelului СD3, СD8, СD4, Ig M, G, B-limfocitelor. În lotul II media termenelor de suprimare a sindromului algic a fost de 15,5±0,6 zile (р<0,001); GMG până şi după tratament a constituit 1,97 şi 1,21; cicatrizarea defectului ulceros peste 14 zile s-a constatat în 88%, peste 21 de zile cicatrizarea completă nu a fost atestată la 1 (4%) pacient; modificări statistic veridice ale indicilor imunităţii celulare şi celei umorale nu au fost observate, cu toate că a existat o tendinţă de ameliorare a acestora. Concluzii. Administrarea imunocorectorului BioR în asociere cu terapia standard pacienţilor vârstnici cu UD contribuie la ameliorarea în termene mai reduse a sindromului dolor, la cicatrizarea mai rapidă a defectului ulceros, la diminuarea intensităţii reacţiilor imunopatologice celulare şi umorale, ceea ce argumentează asocierea remediului dat la tratamentul de bază al pacienţilor vârstnici cu UD

Particularităţile clinico-epidemiologice ale intoxicaţiei alimentare cu toxine din micelii genul Aspergillus a unui grup de eleve din gimnaziul s. Pănăşeşti, r. Străşeni

Introducere. În perioada 1992–2012, în republică, anual se înregistrau de la 10 până la 35 izbucniri epidemice de boli diareice acute (BDA), majoritatea (50–90% în diferiţi ani) – cu calea alimentară de transmitere . În structura agenţilor etiologici predomină salmonelele (S. typfimurium, S. enteritidis), șigele (majoritatea Sh. Sonne biovarele 2e și 2g), agenţi condiţionat patogeni (ACP; majoritatea – St. aureus, Klebsiella, Citrobacter), în unele cazuri Y. enterocolitică. Din anul 2010 au apărut izbucniri provocate de infecţia rotavirală (IRV). Totuși, în această perioadă nu au fost înregistrat niciun caz de izbucniri provocate de micelii genul Aspergillus. Respectiv, cazul examinat mai jos poate fi apreciat ca ,,atipic” pentru republică, cu particularităţi clinico-epidemiologice și prezintă interes pentru specialiștii din sănătatea publică. Materiale și metode. Pentru efectuarea studiului, au fost folosite rapoartele statistice oficiale, rezultatele anchetării epidemiologice. Au fost utilizate metode tradiţionale de analiză epidemiologică. Rezultate. Începând cu ora 13, în ziua de 17.05.2012, în CSP Strășeni a fost primită informaţia din CS Pănășești despre înregistrarea a 6 cazuri de intoxicaţie alimentară printre elevii gimnaziului din localitate, cu următoarele simptome clinice: dureri în burtă, slăbiciune, cefalee, greţuri, vomă, febră 37-37,5°. Echipa din CSP Strășeni a început ancheta epidemiologică la faţa locului la ora 13:40 în aceeași zi. S-a stabilit că 35 de elevi din gimnaziul s. Pănășești au consumat, între orele 10 și 10:20, la 17.05.2012, bomboane în formă de pastile de culorile albă și cafenie, cu miros de ciocolată, procurate din bufetul gimnaziului, aprovizionat de ÎI Maria Chintea. Documente de provenienţă și termenul de păstrare a bomboanelor lipseau, iar directoarea întreprinderii n-a dorit categoric să dezvăluie această informaţie. Bomboanele au fost comercializate numai la data de 17.05.2012, într-o cantitate până la 500 grame. Din explicaţia consumatorilor de bomboane, ultimele aveau un gust suspect de detergenţi și aveau termenul expirat. Prima adresare a elevilor cu clinică de intoxicaţie alimentară a fost la punctul medical al școlii. Asistenta medicală a solicitat ajutor de la CS Pănășești. Asistenţa medicală primară a inclus spălături gastrice. A fost solicitată asistenţa de urgenţă pentru spitalizarea elevelor. În total, în ziua de 17-18.05.2012 au fost spitalizaţi 12 elevi (34,3%), din cei 35 care au consumat bomboane. Tabloul clinic în intoxicaţia cu micotoxine (aflatoxine) înregistrată la 12 copii se caracterizează prin: • perioadă prodromală scurtă – 1-2 ore (30 minute la 2 paciente, 1-1,5 ore la 5 paciente, 2 ore la 4, mai mult de 2 ore la o pacientă); • disconfort în epigastru la toate pacientele. Starea clinică a debutat cu greţuri, slăbiciune, dureri abdominale, cefalee la toate 12 eleve, febră – numai în ziua îmbolnăvirii – 37,4°-37,5° – la 5 paciente, 38° – la 2, vomă – la 5 paciente, scaun lichid de 1-2 ori la 4, vertiji la o pacientă, ea a indicat și dureri în extremităţi, care au dispărut odată cu perfuzia de lichid pentru dezintoxicare; • la 9 paciente s-au menţinut dureri moderate în epigastru pe parcursul a 3-4 zile, la o pacientă – în ziua a 5-a; • analizele paraclinice de laborator s-au manifestat prin schimbări în starea generală a sângelui – creșterea cu 5 unităţi a VSH la 2 bolnave, leucocitoză de 10,7 la o pacientă. În urină la 8 paciente erau prezente mucozităţi, epiteliu plat în cantităţi mari. În proba Niciporenko, la 2 bolnave numărul de leucocite a fost de 1200-3500. În coprogramă, la 2 paciente erau prezente mucozităţi, la 5 – amidon. Din cei 12 bolnavi, la internarea în staţionar la 8 s-a stabilit forma gravă a bolii, la 4 – forma medie.În rezultatul cercetărilor epidemiologice, cu stabilirea debutului acut al bolii la eleve după o perioadă minimă de incubaţie de o oră, în anamneză – consumul de bomboane procurate în aceeași perioadă de timp, cu predominarea simptomelor: dureri abdominale, slăbiciune, cefalee, greţuri, vomă, febră de la 37-37,8º, comisia a stabilit că printre elevii gimnaziului a avut loc o intoxicaţie în grup, posibil de origine mixtă, microbiană sau micotică. Reieșind din cele menţionate – debutul acut al bolii la toate 12 eleve, prezenţa în anamneză a consumului de bomboane procurate în bufetul gimnaziului, posibil afectate de micele gen Aspergillus, fapt confirmat prin analizele de laborator din masele vomitante, masele fecale și din lavajele de pe suprafeţele inventarului bufetului gimnaziului, tabloul clinic asemănător la toate 12 eleve, se poate concluziona că printre elevii gimnaziului s. Pănășești, la 17.05.2012 a avut loc o intoxicaţie alimentară de origine micotică Aspergillus, cu tablou clinic manifestat prin gastrită acută eritematoasă, nefrită interstiţială infecţioasă tranzitorie, colită infecţioasă

Роль Сумамеда в лечении инфекционных обострений хронической обструктивной болезни легких

Catedra Medicină internă nr. 6, USMF „Nicolae Testemiţanu”The comparative clinical efficiency of different antibacterial remedies was studied in 85 patients with bacterial exacerbations of chronic obstructive lung disease (COLD). It was established that in patients with stage I COLD who were administered Sumamed, the respiratory symptoms reduced in intensity by 4.5 times and by 2.9 times in patients with stage II of COLD, while the therapy with Augmentin reduced the symptomatic by 2.2 times only in patient with COLD stage I, which is 2 times worse than the treatment with Sumamed. Administration of Sumamed resulted in a faster normalization of inflammatory markers in comparison with the control group. The administered therapy resulted in a lasting positive effect in 86.6% of cases 6 to 12 months, while the basic therapy – only in 47.5% cases.У 85 больных хронической обструктивной болезнью легких (ХОБЛ) изучена сравнительная клиническая эффективность Сумамеда и Аугментина в лечении I типа обострений заболевания. Установлено, что у больных ХОБЛ I стадии, принимавших Сумамед, интенсивность респираторных симптомов снизилась в 4,5 раза, при II стадии – в 2,9 раза. Включение Аугментина способствовало снижению респираторных симптомов при I стадии в 2,2 раза, а при II стадии существенной достоверной динамики не отмечено. Применение Сумамеда в комплексной терапии больных ХОБЛ I и II стадии способствовало нормализации биохимических маркеров воспаления в более короткие сроки, чем в группе контроля. После курсового лечения Сумамедом положительный эффект был стабилен в 86,6% случаев на протяжении 6-12 месяцев, в то время как после Аугментина – только в 47,5% случаев

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Background: Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. // Methods: We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung's disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. // Findings: We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung's disease) from 264 hospitals (89 in high-income countries, 166 in middle-income countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in low-income countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. // Interpretation: Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between low-income, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Control Efficiency Improvement of an Electro-hydraulic Winch

The paper presents a study regarding electro-hydraulic control systems for drive winches, a structural part of LARS (Launch and Recovery Systems). In the Introduction section of the paper, the authors present the domains of the research vessel. Furthermore, there is presented the importance of launch and recovery systems (LARS) and drive winches on the deck of a research vessel. The launch and recovery systems (LARS) using drive winches are installed on the stern of the research vessel. Further in the paper, the authors present the results of studying three simplified systems that use electric, hydraulic and electro-hydraulic driving solutions. Furthermore, there are presented comparative advantages of using this three types of drive winches. At the end of the paper, the authors perform an analysis of the electro-hydraulic systems for the drive winch, using a modelling and simulation software. Each schematic is presented along with its components. Moreover, the authors mention that all the schematics presented in this paper are modelled using FluidSim software from FESTO. In this case, only three mathematic relations are used in the paper: the Cauchy momentum (convective form), the incompressible Euler relations and the pressure losses in the hydraulic and electro-hydraulic drive winch

Intraoperative transfusion practices in Europe

BACKGROUND: Transfusion of allogeneic blood influences outcome after surgery. Despite widespread availability of transfusion guidelines, transfusion practices might vary among physicians, departments, hospitals and countries. Our aim was to determine the amount of packed red blood cells (pRBC) and blood products transfused intraoperatively, and to describe factors determining transfusion throughout Europe. METHODS: We did a prospective observational cohort study enrolling 5803 patients in 126 European centres that received at least one pRBC unit intraoperatively, during a continuous three month period in 2013. RESULTS: The overall intraoperative transfusion rate was 1.8%; 59% of transfusions were at least partially initiated as a result of a physiological transfusion trigger- mostly because of hypotension (55.4%) and/or tachycardia (30.7%). Haemoglobin (Hb)- based transfusion trigger alone initiated only 8.5% of transfusions. The Hb concentration [mean (sd)] just before transfusion was 8.1 (1.7) g dl(-1) and increased to 9.8 (1.8) g dl(-1) after transfusion. The mean number of intraoperatively transfused pRBC units was 2.5 (2.7) units (median 2). CONCLUSION: Although European Society of Anaesthesiology transfusion guidelines are moderately implemented in Europe with respect to Hb threshold for transfusion (7-9 g dl(-1)), there is still an urgent need for further educational efforts that focus on the number of pRBC units to be transfused at this threshold. CLINICAL TRIAL REGISTRATION: NCT 01604083