Inner hospital evaluation and medical assistment of patients in politrauma

USMF “Nicolae Testemiţanu”, Centrul Naţional Ştiinţifico-Practic de Medicină de Urgenţă, Conferinţa a XI-a Naţională a ortopezilor-tramatologi din Republica Moldova “Politraumatisme – concepţii contemporane de diagnostic şi tratament”, 21 mai 2009, Chișinău, Republica MoldovaAutorul a selectat metodele optimale de apreciere a severităţii politraumatismelor în baza analizei comparative a utilizării Scalelor GCS; APACHE II ISS şi a eficacităţii utilizării acestor în clinică. Argumentează necesitatea folosirii conceptului contemporan “ Damage control surgery “ de tratament a pacienţilor politraumatizaţi, care va permite evaluare obiectivă şi eşalonarea măsurilor terapeutice urgente conform gravităţii leziunilor.The author selected optimal methods to appreciate rigour of politrauma based on comparative analyses of employment of Score GCS, APACHE II ISS and efficacy of employment this methods in clinic. Argumentate necessity of usage modern concept “ Damage control surgery “ of treatment politrauma patient, which premise obiective evaluation and immediate therapeutics measures according to severity of injury

Interaction between SARS-CoV-2 and human organism

Department of Infectious Diseases, Department of Infectious Diseases, Tropical and Medical Parasitology, Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, the Republic of MoldovaBackground: COVID-19 is a part of the betacoronaviridae group, sabercoviridae subgroup. At the moment we are confronting a pandemy, which has a completely new pathologic pattern for the whole world. Considering the highly contagious characteristics of the virus, which is the cause of death for many people, and also the fact that many people continue to be infected with this virus there is a stringing necesity of combating this pandemy. Because of that we need the knowledge that regards the physiopathologic mechanisms, particularities of the host-invader interactions, relevance of asymptomatic forms, explanations of the evolving divergencies, posibility of recurrent infections, clinical signs, comorbidities that harshen this pathology, pharmacologic agents that are effective to fight the infection and immune mechanisms of defense in the organism. A great importance is given for the identification of the intial criteria needed for a prognostic, to prevent the critical forms of pathology and to set the parameters for the severity indicators. Conclusions: The research in the field of SARS-CoV-2 requires the gathering of the databases that are related to the investigated persons, to establish the clinico-evolutive differences for the COVID-19 patients according to many factors that could influence the course of the disease. An important difference is the identification of early signs and prevention of the critical disease forms, by extending the laboratory investigations, establishing the parameters for severity indicators through determining the degree of the immune response

Managementul hemoragiilor severe la pacientul chirurgical, în chirurgia non-cardiacă: protocol clinic national (ediția III) PCN-250

Acest protocol a fost elaborat de grupul de lucru al Ministerului Sănătăţii al Republicii Moldova constituit din colaboratorii Catedrelor Anesteziologie și Reanimatologie, Chirurgie, Ortopedie şi Traumatologie a Universităţii de Stat de Medicină şi Farmacie „Nicolae Testemiţanu”, în colaborare cu AO Reprezentată din Republica Moldova a Asociaţiei Swiss Red Cross. Protocolul clinic național este elaborat în conformitate cu ghidurile internaţionale actuale privind managementul hemoragiilor la pacientul chirugical, în chirurgia noncardiacă: Management of severe perioperative bleeding: guidelines from the European Society of Anaesthesiology, First update 2016, şi poate servi drept bază pentru elaborarea protocoalelor instituţionale (în baza posibilităţilor reale ale fiecărei instituţii în anul current (1). La recomandarea Ministerului Sănătăţii pentru monitorizarea protocoalelor instituţionale pot fi folosite formulare suplimentare, care nu sunt incluse în protocolul clinic naţional

Managementul hemoragiilor severe la pacientul chirugical, în chirurgia noncardiacă: protocol clinic național PCN-250

Catedră Anesteziologie şi Reanimatologie nr.1 „Valeriu Ghereg”, USMF „Nicolae Testemiţanu”, Catedră Urgenţă medicală, USMF „Nicolae Testemiţanu”, Catedră Chirurgie nr.1 „Nicolae Anestiadi”, USMF „Nicolae Testemiţanu”, Catedra Anesteziologie şi Reanimatologie nr.2, USMF „Nicolae Testemiţanu”, Catedra Ortopedie şi traumatologie, USMF „Nicolae Testemiţanu”Acest protocol a fost elaborat de grupul de lucru al Ministerului Sănătăţii al Republicii Moldova constituit din colaboratorii Catedrelor Anesteziologie și Reanimatologie, Chirurgie, Urgenţe medicale, Ortopedie şi Traumatologie a Universităţii de Stat de Medicină şi Farmacie „Nicolae Testemiţanu”, în colaborare cu AO Reprezentată din Republica Moldova a Asociaţiei Swiss Red Cross. Protocolul clinic național este elaborat în conformitate cu ghidurile internaţionale actuale privind managementul hemoragiilor la pacientul chirugical, în chirurgia non-cardiacă (National Institute for Health and Clinical Excellence, 2010; Institute for Clinical Systems ImprovementHealth Care Guideline, 2011, Management of severe perioperative bleeding. Guidelines from the European Society of Anaesthesiology, 2013) şi poate servi drept bază pentru elaborarea protocoalelor instituţionale (în baza posibilităţilor reale ale fiecărei instituţii în anul curent. La recomandarea Ministerului Sănătăţii pentru monitorizarea protocoalelor instituţionale pot fi folosite formulare suplimentare, care nu sunt incluse în protocolul clinic naţional

Multicentre, randomised, single-blind, parallel group trial to compare the effectiveness of a Holter for Parkinson's symptoms against other clinical monitoring methods: study protocol

Introduction In recent years, multiple studies have aimed to develop and validate portable technological devices capable of monitoring the motor complications of Parkinson's disease patients (Parkinson's Holter). The effectiveness of these monitoring devices for improving clinical control is not known. Methods and analysis This is a single-blind, cluster-randomised controlled clinical trial. Neurologists from Spanish health centres will be randomly assigned to one of three study arms (1:1:1): (a) therapeutic adjustment using information from a Parkinson?s Holter that will be worn by their patients for 7 days, (b) therapeutic adjustment using information from a diary of motor fluctuations that will be completed by their patients for 7 days and (c) therapeutic adjustment using clinical information collected during consultation. It is expected that 162 consecutive patients will be included over a period of 6 months. The primary outcome is the efficiency of the Parkinson?s Holter compared with traditional clinical practice in terms of Off time reduction with respect to the baseline (recorded through a diary of motor fluctuations, which will be completed by all patients). As secondary outcomes, changes in variables related to other motor complications (dyskinesia and freezing of gait), quality of life, autonomy in activities of daily living, adherence to the monitoring system and number of doctor?patient contacts will be analysed. The noninferiority of the Parkinson's Holter against the diary of motor fluctuations in terms of Off time reduction will be studied as the exploratory objective. Ethics and dissemination approval for this study has been obtained from the Hospital Universitari de Bellvitge Ethics Committee. The results of this study will inform the practical utility of the objective information provided by a Parkinson's Holter and, therefore, the convenience of adopting this technology in clinical practice and in future clinical trials. We expect public dissemination of the results in 2022.Funding This work is supported by AbbVie S.L.U, the Instituto de Salud Carlos III [DTS17/00195] and the European Fund for Regional Development, 'A way to make Europe'

Prognostic model to predict postoperative acute kidney injury in patients undergoing major gastrointestinal surgery based on a national prospective observational cohort study.

Background: Acute illness, existing co-morbidities and surgical stress response can all contribute to postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery. The aim of this study was prospectively to develop a pragmatic prognostic model to stratify patients according to risk of developing AKI after major gastrointestinal surgery. Methods: This prospective multicentre cohort study included consecutive adults undergoing elective or emergency gastrointestinal resection, liver resection or stoma reversal in 2-week blocks over a continuous 3-month period. The primary outcome was the rate of AKI within 7 days of surgery. Bootstrap stability was used to select clinically plausible risk factors into the model. Internal model validation was carried out by bootstrap validation. Results: A total of 4544 patients were included across 173 centres in the UK and Ireland. The overall rate of AKI was 14·2 per cent (646 of 4544) and the 30-day mortality rate was 1·8 per cent (84 of 4544). Stage 1 AKI was significantly associated with 30-day mortality (unadjusted odds ratio 7·61, 95 per cent c.i. 4·49 to 12·90; P < 0·001), with increasing odds of death with each AKI stage. Six variables were selected for inclusion in the prognostic model: age, sex, ASA grade, preoperative estimated glomerular filtration rate, planned open surgery and preoperative use of either an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker. Internal validation demonstrated good model discrimination (c-statistic 0·65). Discussion: Following major gastrointestinal surgery, AKI occurred in one in seven patients. This preoperative prognostic model identified patients at high risk of postoperative AKI. Validation in an independent data set is required to ensure generalizability

Study on the Function of Translation Initiation Factor IF1

Initiation is the first step in protein biosynthesis representing a fundamental event in cell life which determines fidelity, efficiency and regulation of gene expression. In addition to the ribosome and mRNA, three protein factors IF1, IF2 and IF3 are involved in the initiation of translation in prokaryotes. Several minor functions have been attributed to the smallest of these factors, IF1. However, the main function of IF1 remains to be elucidated. In order to investigate the role of this protein in the initiation process we have mutated the corresponding gene infA. Using a high-copy plasmid and site-directed mutagenesis, the six arginine residues of IF1 were separately altered to leucine or aspartate. Another set of plasmid-encoded IF1 mutants with a cold-sensitive phenotype was collected using localized random mutagenesis. This strategy was followed by deletion of the chromosomal infA gene. All variants with a mutated infA gene on a plasmid and a deletion of the chromosomal infA copy were viable, except for an R65D alteration. Several of the mutated infA genes were successfully recombined into the chromosome thereby replacing the wild-type allele. Some of these mutants displayed reduced growth rates and a partial cold-sensitive phenotype. The influence of the leucine group of mutants in IF1 on the expression of two reporter genes with different initiation and/or +2 codons has been investigated. Our results do not indicate any involvement of IF1 in recognition of the +2 codon immediately following the start codon, thus representing the A-site. In addition, this group of mutants has no changed efficiency of decoding at the near-cognate initiation codons UUG and GUG. However, one cold-sensitive IF1 mutant shows a general overexpression of both reporter genes, in particular at low temperatures. Overall, the results do not support the hypothesis that IF1 could possess codon discriminatory functions while blocking the A-site of the ribosome. In this study we also identify that IF1 has RNA chaperone activity both in vitro and in vivo. The chaperone assays are based on splicing of the group I intron in the thymidylate synthase gene (td) from phage T4. Some of the IF1 mutant variants are more active as RNA chaperones than the wild-type. Both wild-type IF1 and mutant variants bind with high affinity to RNA in a band-shift assay. It is suggested that the RNA chaperone activity of IF1 contributes to RNA rearrangements during the early phase of translation initiation

IPSAG Cognitive Radio Routing Protocol: Models and Performance

The paper is about performance evaluation of IP Spectrum Aware Geographic routing protocol (IPSAG). IPSAG is an opportunistic cognitive routing protocol which determines a source-destination route in a hop by hop manner, based on both global and local information. Simulation results are reported for a particular case of IPSAG, where the cognitive radio (CR) nodes are uniformly distributed inside the cognitive radio network (CRN), and a two-dimensional random walk model is used to model the mobility of CR nodes. The results show that the IPSAG protocol is performing well in the case of a highly mobile CRN and that the source-destination path is successfully found in the majority of the cases, especially when the network is highly populated