TAP block. What we learned from the cadavers ?

Catedra de anesteziologie și reanimatologie nr.1 „Valeriu Ghereg”, Catedra de chirurgie nr.1 „Nicolae Anestiadi”, USMF „Nicolae Testemiţanu”, Chişinău, Republica Moldova, Conferința stiințifică „Nicolae Anestiadi – nume etern al chirurgiei basarabene” consacrată centenarului de la nașterea profesorului Nicolae Anestiadi 26 august 2016Introducere. Blocul de plan transvers abdominal (TAP) este o tehnică de anestezie regională. În prezent puțin se cunoaște despre paternul de răspândire a anestezicului local în acest spațiu. Scop. A evalua particularitățile răspândirii colorantului în planul transvers abdominal. Material și metode. Protocolul studiului a fost aprobat de Comitetul de Etică a Cercetării. Studiul a fost efectuat pe 21 de cadavre proaspete, adulți. Cauza decesului fiind altă patologie decât cea abdominală. Cadavrele au fost repartizate în 3 grupuri (7 per grup), funcție de volumul de colorant administrat (10, 20 sau 40 mL). Au fost efectuate injecții bilaterale ecoghidate la fiecare cadavru în parte. La necropsie au fost evaluate răspândirea colorantului bilateral pe ambele părți a abdomenului. Au fost măsurate lungimile maxime de răspândire a colorantului în direcție cefalo-caudală și medio-laterală. Rezultate. Lungimea (cm) răspândirii cefalo-caudală: pentru (A) 40 mL – 12.9 (11.6-14.3); pentru (B) 20 mL – 11.9 (10.9-14.0); pentru (C)10 mL – 6.1 (5.5-7.2). (A vs. B: p=0.1; A vs. C: p<0.0001; B vs. C: p<0.0001). Lungimea (cm) răspândirii medio-laterale: pentru(D) 40 mL – 9.8 (8.1-11.0); pentru(E) 20 mL – 10.1 (8.9-11.4); pentru(F) 10 mL – 5.8 (5.1-6.4). (D vs. E: p=0.3; D vs. F: p<0.0001; E vs. F: p<0.0001). Concluzii. Nu au existat diferențe în lungimile maxime de răspândire a colorantului în spațiul TAP în direcție cefalo-caudală și medio-laterală, după administrarea unui volum de 20 și 40ml de colorant. La administrarea a 10 ml de colorant lungimea maximă de răspândire a fost semnificativ mai mică.Introduction. The transversus abdominis plane (TAP) block is a technique of regional anesthesia. In present days our knowledge about the spread of local anesthetics in this anatomical region are modest. Purpose. To assess the character of dye spread in TAP. Materials and Methods. Research Ethics Committee approved the study protocol. The study was conducted on 21 fresh, unembalmed adult cadavers. The cause of death was other than abdominal pathology. Cadavers were allocated into three groups (7 per group), based on the volume of dye injected (10, 20 or 40 mL). Bilateral USG guided injections were performed, in every single cadaver. After the dissection of the cadaver, the spread of the dye was assessed on both abdominal wall sides. The end points were the maximum length of dye spread in cephalo-caudal and medial-lateral direction. Results. Cephalo-caudal length (cm) of spread: for(A) 40 mL – 12.9 (11.6-14.3); for(B) 20 mL – 11.9 (10.9-14.0); for(C)10 mL– 6.1 (5.5-7.2). (A vs. B: p=0.1; A vs. C: p<0.0001; B vs. C: p<0.0001). Medio-lateral length (cm) of spread: for(D) 40 mL – 9.8 (8.1-11.0); for(E) 20 mL– 10.1 (8.9-11.4);for(F) 10 mL – 5.8 (5.1-6.4). (D vs. E: p=0.3; D vs. F: p<0.0001; E vs. F: p<0.0001). Conclusion. There were no differences in the length of dye spread in cephalo-caudal and medio-lateral direction in the transversus abdominal plane after injection of a volume of 40 mL and 20 mL, but there were significant differences after a 10 mL injection

Non-cystic fibrosis bronchiectasis and calcifications: are IGRAs of any use?

Division of Pneumology and Allergology, Department of Internal Medicine, State University of Medicine and Pharmacy „Nicolae Testemiţanu”, Phthisiopneumology Institute "Chiril Draganiuc", Chisinau, Republic of Moldova, Congresul consacrat aniversării a 75-a de la fondarea Universității de Stat de Medicină și Farmacie „Nicolae Testemițanu” din Republica Moldova, Ziua internațională a științei pentru pace și dezvoltareIntroduction: Tuberculosis (TB) is known as a leading cause of non-CF bronchiectasis in high burden TB settings. However, the finding of pulmonary sequelae suggestive for past-TB is not always associated with a positive history for tuberculosis episode. QFT-TB GOLD could reflect the past history of pulmonary TB. Aim: To evaluate the prevalence of IGRAs positive test among patients with non-CF bronchiectasis patients, calcifications and no history of TB treatment. Material and methods: 34 enrolled patients (mean age 56.6 years, 53% females) with non-CF bronchiectasis and calcifications were tested with QFT-TB Gold (results were reported as positive, negative, indeterminate). High-resolution computed tomography images (HRCT) were analyzed to appreciate the type and extent of bronchiectasis and the presence of calcifications in chest and abdominal organs. Results: Severe bronchiectasis was identified in 20 patients with a BSI score ≥9 points, 68% (23 cases) demonstrating cystic bronchiectasis at least in one lobe. The modified Reiff score was 7.9±4.1 (1-14), and the more detailed Bhalla score was 12.8±4 (5-19). The most frequent localization of the calcifications was in the lung parenchyma 27 cases (76%) and bronchial wall 25 cases (74%), followed by calcification of lymph nodes 50% and pleural calcifications 32%. Eight patients (24%) had positive QFT-TB Gold test result at study enrollment. After a one year follow up, only one of the QFT positive patients developed active smear positive pulmonary TB (by the 6th month). Conclusions: Presence of calcification on HRCT in patients with non-CF bronchiectasis has a poor correlation with positive latent tuberculosis infection status

Infection control, genetic assessment of drug resistance and drug susceptibility testing in the current management of multidrug/extensively-resistant tuberculosis (M/XDR-TB) in Europe: A tuberculosis network European Trialsgroup (TBNET) study

Aim Europe has the highest documented caseload and greatest increase in multidrug and extensively drug-resistant tuberculosis (M/XDR-TB) of all World Health Organization (WHO) regions. This survey examines how recommendations for M/XDR-TB management are being implemented. Methods TBNET is a pan-European clinical research collaboration for tuberculosis. An email survey of TBNET members collected data in relation to infection control, access to molecular tests and basic microbiology with drug sensitivity testing. Results 68/105 responses gave valid information and were from countries within the WHO European Region. Inpatient beds matched demand, but single rooms with negative pressure were only available in low incidence countries; ultraviolet decontamination was used in 5 sites, all with &gt;10 patients with M/XDR-TB per year. Molecular tests for mutations associated with rifampicin resistance were widely available (88%), even in lower income and especially in high incidence countries. Molecular tests for other first line and second line drugs were less accessible (76 and 52% respectively). A third of physicians considered that drug susceptibility results were delayed by &gt; 2 months. Conclusion Infection control for inpatients with M/XDR-TB remains a problem in high incidence countries. Rifampicin resistance is readily detected, but tests to plan regimens tailored to the drug susceptibilities of the strain of Mycobacterium tuberculosis are significantly delayed, allowing for further drug resistance to develop

Rifapentine access in Europe: growing concerns over key tuberculosis treatment component

[No abstract available]Support statement: C. Lange is supported by the German Center of Infection Research (DZIF). All other authors have no funding to declare for this study. Funding information for this article has been deposited with the Crossref Funder Registry

The impact of the WHO surgical safety checklist on systematic communication in the operating room

Universitatea de Stat de Medicină și Farmacie ”Nicolae Testemițanu”, Chișinău, Republica Moldova, Al XIII-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” și al III-lea Congres al Societății de Endoscopie, Chirurgie miniminvazivă și Ultrasonografie ”V.M.Guțu” din Republica MoldovaIntroducere: Siguranța pacientului chirurgical a devenit o problemă de sănătate publică. Intervenția chirurgicală este un proces complex, realizat independent de membrii echipei. Comunicarea dintre membrii echipei poate fi uneori deficitară. Checklistul de siguranță chirurgicală conform OMS (Checklist) presupune a fi un instrument cu multiple funcții, una din ele fiind asiguarea unui sistem robust de comunicare în interiorul echipei în sala de operație. Material și metode: Studiu prospectiv, observațional tip pre- post-implementare. Lot I n=2,145 intervenții chirurgicale pre-implementare Checklist observate consecutiv în toate sălile de operați ale Institutului Medicină Urgentă. Lot II n=2212 intervenții observate post – implementare. Au fost urmăriți parametrii de comunicare în sala de operație: comunicarea de către anesteziolog a riscului de căi aeriene; chirurgul întreabă asistenta medicală dacă este totul pregătit pentru operație; chirurgul comunică durata estimată și hemoragia; chirurgul și anestezistul comunică riscurile specifice. Rezultate obținute: Gradul de risc al căilor aeriene a fost comunicat de către anesteziolog în 33 cazuri (1.6%) Lot I și 1839 (83,1%) lot II. Pîna la implementare checklist nu exista evaluare standardizată documentată a acestui parametru în preoperator. Confirmarea chirurgului cu asistenta medicală de operație despre pregătirea pentru operație realizat 323cazuri lot I și 2146 (97%) lot II. Chirurgul a anunțat verbal echipa anestezico-chirurgicală despre hemoragia și durata intervenției preconizate în 88 cazuri (4,1%) lot I și 2100 (94,9%) lot II. Chirurgul și anesteziologul au discutat riscurile medicale ale pacientului sau particularitățile cazului curent în 146 (6,9%) lotI și 2092 (94,6%) în lotII. Concluzii: Checklistul contribuie semnificativ îmbunătățirea parametrilor de comunicarea sistematică în sala de operație.Introduction: The safety of the surgical patient has become a public health issue. Surgery is a complex process, carried out independently by team members and communication between them may sometimes be defficient. The WHO surgical safety Checklist is a multifunctional tool, one of which is to provide a robust communication system inside the operating room team. Methods: Prospective, observational pre-post-implementation study. Lot I n = 2145 patients observed consecutively in all operating theaters of the Emergency Medicine Institute pre-implementation of the Checklist. Lot II n = 2212 patients observed post implementation of Checklist. The communication parameters in the operating theater were monitored: anesthesiologist communication of the airway risk; the surgeon asks the nurses if all is ready for surgery; the surgeon communicates the estimated duration and haemorrhage; surgeon and anesthetist communicate specific risks. Results: The risk of airways was communicated by the anesthetist in 33 cases (1.6%) Lot I and 1839 (83.1%) Lot II. Prior to implementation of the checklist, there was no documented standardized assessment of this parameter preoperatively. Surgeon conrfirms with scrub nurse the preparation for surgery in 323 cases Lot I and 2146 (97%) Lot II. The surgeon verbally informed the team about the estimated haemorrhage and duration of the intervention in 88 cases (4.1%) in Lot I and 2100 (94.9%) Lot II. Conclusions: The checklist significantly improves the parameters of systematic communication in the operating room

IDENTIFICATION OF RISK FACTORS FOR POSTOPERATIVE ACUTE SEVERE PAIN IN ABDOMINAL SURGERY.

Culegere de Rezumate Stiinţifice a Congresului SRATI 2012: AL 38-LEA CONGRES AL SOCIETĂŢII ROMÂNE DE ANESTEZIE ŞI TERAPIE INTENSIVĂ; AL 6-LEA CONGRES ROMÂNO - FRANCEZ DE ANESTEZIE ŞI TERAPIE INTENSIVĂ; AL 4-LEA SIMPOZION ROMÂNO - ISRAELIAN DE ACTUALITĂŢI ÎN ANESTEZIE ŞI TERAPIE INTENSIVĂ; AL 11-LEA CONGRES AL ASISTENŢILOR DE ANESTEZIE ŞI TERAPIE INTENSIVĂ; AL 10-LEA CONGRES AL SOCIETĂŢII ROMÂNE DE SEPSISIntroducere: În pofida măsurilor luate, prevalenţa durerii postoperatorii acute intense, DPOI (≥5/10 pe SVN) rămâne înaltă (24- 46% – în Europa de Vest şi 64% – în Republica Moldova). Strategiile preventive pentru DPOI trebuie să ia în consideraţie şi factorii de risc. Scopul lucrării: Identificarea factorilor de risc pentru DPOI după intervenţii pe abdomen (herniorafie, apendectomie, colecistectomie) prin screening-ul unor condiţii pre- şi intraoperatorii suspecte. Introduction: Despite recent acivements, the prevalence of postoperative acute severe pain, PASP (≥5/10, VNS) is high (24-46% – in West European countries and 64% – in Republic of Moldova). Prevention strategies for PASP should take into account the risk factors. Goal of the Study: Identification of risk factors for PASP after abdominal surgery (hernioplasty, appendectomy, cholecystectomy) via screening of some intra- and postoperative suspected conditions

Pharmaco-economic aspects of perioperative pain management

Université de médecine et pharmacie Nicolae Testemitanu, Chişinǎu, Moldova Centre national scientifique et pratique de médecine d'urgence, Chişinǎu, MoldovaRésumé Nous présentons une réflexion pharmacoéconomique dans le domaine de la prise en charge de la douleur. Une optimisation réelle des dépenses peut être obtenue par la prise en considération des facteurs qui augmentent et qui diminuent les coûts d’un processus, par l’organisation du processus lui-même, par une optimisation des circuits d’information et de décision. Le coût d’un analgésique est non significatif par rapport au coût du processus intégré de prise en charge de la douleur. Abstract We present a reflection on pharmaco-economy of perioperative pain management. A real optimisation of expenses could be obtained if taking into consideration factors that augment and diminish costs of the process, due to the organisation of the process itself, due to optimisation of the information and decision's circuits. The cost of an analgesic is not significant when compared with the cost of entire process of pain management

Recent advances in the treatment of tuberculosis.

BACKGROUND: Tuberculosis is a global health challenge and one of the leading causes of death worldwide. In the last decade, the tuberculosis treatment landscape has dramatically changed. After long years of stagnation, new compounds entered the market (bedaquiline, delamanid and pretomanid) and phase III clinical trials have shown promising results towards shortening duration of treatment for both drug-susceptible (Study 31/A5349, TRUNCATE-TB, SHINE) and drug-resistant tuberculosis (STREAM, NiX-TB, ZeNix, TB-PRACTECAL). Dose optimization of rifamycins and repurposed drugs have also brought hopes of further development of safe and effective regimens. Consequently, international and World Health Organization clinical guidelines have been updated multiple times in the last years to keep pace with these advances. OBJECTIVES: This narrative review aims to summarize the state-of-the-art on treatment of drug-susceptible and drug-resistant tuberculosis, as well as recent trials results and an overview of ongoing clinical trials. SOURCES: A non-systematic literature review was conducted in PubMed and MEDLINE, focusing on the treatment of tuberculosis. Ongoing clinical trials were listed according to the authors' knowledge, and completed consulting clinicaltrials.gov and other publicly available websites (www.resisttb.org/clinical-trials-progress-report, www.newtbdrugs.org/pipeline/trials). CONTENT: This review summarizes the recent, major changes in the landscape for drug-susceptible and drug-resistant treatment, with a specific focus on their potential impact on patient outcomes and programmatic TB management. Moreover, insights in host-directed therapies, and advances in pharmacokinetic and pharmacogenomics are discussed. A thorough outline of ongoing therapeutic clinical trials is presented, highlighting different approaches and goals in current TB clinical research. IMPLICATIONS: Future research should be directed to individualize regimens and protect these recent breakthroughs by preventing and identifying the selection of drug resistance and providing widespread, affordable, patient-centered access to new treatment options for all people affected by tuberculosis

Clinical implications of molecular drug resistance testing for Mycobacterium tuberculosis: a 2023 TBnet/RESIST-TB consensus statement.

Drug-resistant tuberculosis is a substantial health-care concern worldwide. Despite culture-based methods being considered the gold standard for drug susceptibility testing, molecular methods provide rapid information about the Mycobacterium tuberculosis mutations associated with resistance to anti-tuberculosis drugs. This consensus document was developed on the basis of a comprehensive literature search, by the TBnet and RESIST-TB networks, about reporting standards for the clinical use of molecular drug susceptibility testing. Review and the search for evidence included hand-searching journals and searching electronic databases. The panel identified studies that linked mutations in genomic regions of M tuberculosis with treatment outcome data. Implementation of molecular testing for the prediction of drug resistance in M tuberculosis is key. Detection of mutations in clinical isolates has implications for the clinical management of patients with multidrug-resistant or rifampicin-resistant tuberculosis, especially in situations when phenotypic drug susceptibility testing is not available. A multidisciplinary team including clinicians, microbiologists, and laboratory scientists reached a consensus on key questions relevant to molecular prediction of drug susceptibility or resistance to M tuberculosis, and their implications for clinical practice. This consensus document should help clinicians in the management of patients with tuberculosis, providing guidance for the design of treatment regimens and optimising outcomes