Partial vertebrectomy with vertebral shortening for thoraco-lumbar fracture-dislocation: Case report and technical note

Thoraco-lumbar fracture-dislocations represent one of the most instable lesions and are frequently associated with neurological deficit. We present a patient with a T11 – T12 fracture-dislocation with complete neurological deficit – ASIA - A, who underwent partial vertebrectomy, shortening of the spine and posterior instrumentation 21 days after a motor vehicle accident

Manganese(III) Porphyrin-based Potentiometric Sensors for Diclofenac Assay in Pharmaceutical Preparations

Two manganese(III) porphyrins: manganese(III) tetraphenylporphyrin chloride and manganese(III)-tetrakis(3-hydroxyphenyl)porphyrin chloride were tested as ionophores for the construction of new diclofenac–selective electrodes. The electroactive material was incorporated either in PVC or a sol–gel matrix. The effect of different plasticizers and additives (anionic and cationic) on the potentiometric response was studied. The best results were obtained for the PVC membrane plasticized with dioctylphtalate and having sodium tetraphenylborate as a lipophilic anionic additive incorporated. The sensor response was linear in the concentration range 3 × 10−6 – 1 × 10−2 M with a slope of −59.7 mV/dec diclofenac, a detection limit of 1.5 × 10−6 M and very good selectivity coefficients. It was used for the determination of diclofenac in pharmaceutical preparations, by direct potentiometry. The results were compared with those obtained by the HPLC reference method and a good agreement was found between the two methods

ASPECTE PRIVIND CODIFICAREA CLINICĂ

Clinical coding is the process by which some clinical information about the patient are transformed into codes, to enable grouping of medical activities in a limited number of categories, that are easy to process, store and analyzed. The essential element in making a correct clinical coding is the allocation of each diagnosis or procedure in the group category to which it belongs, underpinning the general concept for the quality in clinical coding.Modernization of health care involves the continuous guidance towards quality standards of both medical act itself and adjacent activities. Clinical coding is one of the key components of the coordination process for all stakeholders and has a major impact on health service monitoring, but also on morbidity assessment and estimates regarding the need for health services.Good clinical coding is one of the essential elements for quality care therefore providing resources for this and implementing a clinical coding system will have a positive impact on the process in Romanian health system. Key words: clinical coding, quality in clinical coding, DRG, health care financing. Codificarea clinică este procesul prin care o parte din informațiile clinice legate de pacient sunt transformate în coduri, pentru a face posibilă gruparea activităților medicale într-un număr limitat de categorii, mai ușor de prelucrat, informația medicală astfel stocată putând fi analizată mai ușor. Elementul esențial în realizarea unei codificări clinice corecte îl constituie respectarea regulilor de alocare a fiecărui diagnostic sau procedură în grupa de categorii de care aceasta aparţine, toate acestea stând la baza conceptului general de respectare a calității codificării clinice. Modernizarea sistemelor de sănătate implică o orientare continuă a acestora către standarde de calitate, atât a actului medical în sine cât şi a activităților adiacente acestuia. Codificarea clinică reprezintă una dintre componentele cheie ale procesului coordonării tuturor părților  implicate şi are un impact major în monitorizarea activității furnizorilor serviciilor de sănătate, dar şi asupra evaluării morbidității şi a estimărilor legate de nevoia de servicii de sănătate. O bună codificare clinică este unul dintre elementele esenţiale pentru îngrijirile de calitate de aceea, acordarea resurselor pentru realizarea acesteia și implementarea unui sistem de verificare a codificării clinice vor avea un impact pozitiv asupra proceselor din sistemul de sănătate românesc.­Cuvinte cheie: codificare clinica, calitatea codificarii, DRG, finantarea sistemului de sanatate

Peculiarities of the Edaphic Cyanobacterium Nostoc linckia Culture Response and Heavy Metal Accumulation from Copper-Containing Multimetal Systems

Soil and water pollution is a major problem that has a negative impact on ecosystems and human health in particular. In the bioremediation processes, the application of photosynthetic microorganisms, including cyanobacteria, is a direction of action addressed with increasing frequency in the context of further development and improvement of environmentally friendly techniques needed for detoxification of soils and waters polluted with low concentrations of toxic elements, since they pose a challenge for traditional treatment methods. In the present study, the removal of copper and other metal ions from multielement systems by three generations of Nostoc linckia is discussed. Changes in the biochemical composition of the nostoc biomass, which accumulates metal ions, were monitored. Neutron activation analysis was applied to assess Cu, Fe, Ni, and Zn accumulation by biomass, as well as to determine the biochemical composition of biomass after specific biochemical methods were used. The capacity of the accumulation of copper and other metal ions from multi-elemental systems by cyanobacteria Nostoc linckia was high and increased over two cycles of biomass growth in the systems Cu-Fe-Ni and Cu-Fe-Zn and over three cycles in Cu-Fe and Cu-Fe-Ni-Zn systems. It constituted 1720–10,600 µg metal/g depending on the system and cycle of cultivation. The accumulation of Fe, Ni, and Zn also increased over the generations of nostoc. The process of metal accumulation was demonstrated by a significant change in the biomass biochemical composition. Cyanobacteria Nostoc linckia possess a pronounced capacity of copper and other metal ion accumulation from multimetal systems and showed an increased resistance in environments polluted with heavy metals

Reduction of Anastomotic Time Through the Use of Cyanoacrylate in Microvascular Procedures

Background: Ever since the description of the first microvascular anastomosis, numerous alternative methods have been described to the classical approach. Tissue adhesive has shown promising result in previous studies and can be a fast and efficient alternative which still requires more studies to allow its clinical implementation. Methods: A randomized comparative experimental study was conducted on rats’ femoral arteries and an end-to-end anastomosis was performed in order to compare 2 anastomosis techniques. In one group, a simple interrupted suture was utilized, whereas in the second group a combination between fewer sutures and tissue adhesive was used. The anastomotic time, total operative time, blood flow velocity before, immediately after and 48 hours after the procedure, as well as an independent grading of the anastomosis immediately after the procedure were performed. Magnetic resonance imaging (MRI) was performed in order to assess the degree of stenosis. After euthanasia, histology and scanning electron microscopy (SEM) were performed on the vessels in order to assess possible complications. Results: A total of 24 anastomoses were performed, of which 12 with a classic technique and 12 with an adhesive technique. All the anastomoses were patent with a significant reduction of anastomotic and total operative time. The grading of the anastomoses showed better results in the classic suture group. The blood flow velocities were not statistically significant between the 2 groups. On MRI there was one stenotic anastomosis, whereas histology and SEM showed more complications on the adhesive group. Conclusion: Anastomotic times were significantly lower with a non-significant trend toward more thrombotic complications in the adhesive group. Further improvement of the glue properties and refinement of the technique will likely make it a viable alternative to interrupted suturing in the future

The Evaluation of the Four-Chamber Cardiac Dissection Method of the Fetal Heart as an Alternative to Conventional Inflow–Outflow Dissection in Small Gestational-Age Fetuses

The examination of very small fetal hearts requires special equipment and a specialist that are not available in many general pathology laboratories. Compared to conventional examination, the four-chamber cardiac dissection (4CCD) method can be performed by any pathologist using instruments generally available in pathology services. The aim of this study is to evaluate the efficiency of the 4CCD method in the examination of small fetal hearts using post-mortem magnetic resonance imaging (pm-MRI) at 7T as the standard. Twelve fetuses with gestational ages between 13 and 19 weeks have been included in this study. All fetuses underwent pm-MRI examination prior to pathologic examination. The 4CCD method was used for the cardiac examination in all cases following the same guidelines for cardiac sectioning. The 4CCD was able to identify all cardiac anatomic structures as compared to pm-MRI at 7T, demonstrating a sensibility of 95.8% (95% CI, 94.5–95.8) and specificity of 100% (95% CI, 32.3–100). The overall accuracy in identifying cardiac anatomic structures was 95.8% (95% CI, 93.4–95.8). Additionally, the 4CCD method was able to detect cardiac anomalies with an overall diagnostic accuracy of 91% (95% CI, 85.8–94.2), sensibility of 67.6% (95% CI, 54.5–75.3), and specificity of 97% (95% CI, 93.7–99) as compared to pm-MRI at 7T. The four-chamber view dissection method can be considered as an alternative to the conventional inflow–outflow dissection method in selected cases

Human Rights in Patient Care: A Practitioner Guide - Romania

Health systems can too often be places of punishment, coercion, and violations of basic rights—rather than places of treatment and care. In many cases, existing laws and tools that provide remedies are not adequately used to protect rights.This Practitioner Guide series presents practical how-to manuals for lawyers interested in taking cases around human rights in patient care. The manuals examine patient and provider rights and responsibilities, as well as procedures for protection through both the formal court system and alternative mechanisms in 10 countries.Each Practitioner Guide is country-specific, supplementing coverage of the international and regional framework with national standards and procedures in the following:ArmeniaGeorgiaKazakhstanKyrgyzstanMacedoniaMoldova (forthcoming)RomaniaRussia (forthcoming)SerbiaUkraineThis series is the first to systematically examine the application of constitutional, civil, and criminal laws; categorize them by right; and provide examples and practical tips. As such, the guides are useful for medical professionals, public health mangers, Ministries of Health and Justice personnel, patient advocacy groups, and patients themselves.Advancing Human Rights in Patient Care: The Law in Seven Transitional Countries is a compendium that supplements the practitioner guides. It provides the first comparative overview of legal norms, practice cannons, and procedures for addressing rights in health care in Armenia, Georgia, Kazakhstan, Kyrgyzstan, Macedonia, Russia, and Ukraine.A Legal Fellow in Human Rights in each country is undertaking the updating of each guide and building the field of human rights in patient care through trainings and the development of materials, networks, and jurisprudence. Fellows are recent law graduates based at a local organization with expertise and an interest in expanding work in law, human rights, and patient care. To learn more about the fellowships, please visit health-rights.org