Organizing the endoscopy suite: implementing preventive measures for nosocomial infections in digestive endoscopy

Institutul de Gastroenterologie și Hepatologie, Spitalul Clinic Județean de Urgențe ”Sf.Spiridon”, Universitatea de Medicină și Farmacie ”Grigore T. Popa”, Iași, România, 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 Moldovan ultima decadă problematica infecțiilor nosocomiale legate de endoscopia digestivă domină atât sfera publicațiilor profesionalmedicale cât și pe cea relaționată mass-mediei. Infecțiile legate de endoscopia digestivă în genere și de duodenoscoape sau echoendoscoape în particular par a fi cauzate de bacterii multidrog-rezistente vehiculate în cadrul unui biofilm atașat suprafețelor polimerice ale endoscoapelor cu deosebire în spațiile greu de reprocesat. În acest sens, organizarea laboratorului de endoscopie digestivă și implementarea unor principii de reprocesare eficientă și reproductibilă a endoscoapelor reprezintă finalități care se impun drept obligatorii în vederea asigurării securității microbiologice și a controlului infecțiilor nosocomiale. Prezentarea își propune o analiză critică a ultimelor recomandări internaționale referitoare la metodele de reprocesare a endoscoapelor digestive urmărind totodată o trecere în revistă a modelelor prin care aceste recomandări pot fi implementate în cadrul normelor de organizare a laboratorului de endoscopie digestivă. * * * During the last decade, the nosocomial infections as complications of GI endoscopy have become one of the main topics for numerous both scientific and mass-media articles and reports. Infections seen as complications of GI endoscopy and especially related to duodenoscopes and echoendoscopes seem to be caused by multidrug resistant bacteria spread from biofilm contaminating the polymeric surfaces of the GI flexible scopes in hard-to-reach areas during reprocessing. Therefore, it is our belief that organizing the endoscopy suite and implementing efficient and reproducible principles for scope reprocessing should be among the main concerns for GI endoscopists and surgeons in order to achieve microbiological safety of the procedures and infection control. The presentation aims a critical analysis of the latest guidelines and recommendations for scope reprocessing and a review of how such protocols may be implemented in the day-to-day management of the endoscopy suite

MUNCHAUSEN SYNDROME BY PROXY IN PEDIATRIC DENTISTRY: MYTH OR REALITY?

Background and aims: Munchausen syndrome by proxy is a condition traditionally comprising physical and mental abuse and medical neglect as a form of psychogenic maltreatment of the child, secondary to fabrication of a pediatric illness by the parent or guardian. The aim of our paper is to assess whether such condition occurs in current pediatric dental practice and to evidence certain situations in which the pediatric dentist should suspect this form of child abuse. Problem statement: Munchausen syndrome by proxy in pediatric dentistry may lead to serious chronic disabilities of the abused or neglected child, being one of the causes of treatment failure. Discussion: Prompt detection of such condition should be regarded as one of the duties of the practitioner who should be trained to report the suspected cases to the governmental child protective agencies. This should be regarded as a form of child abuse and neglect, and the responsible caregiver could be held liable when such wrongful actions cause harm or endanger child’s welfare. Conclusion: Munchausen syndrome by proxy should be regarded as a reality in current pediatric dental practice and dental teams should be trained to properly recognize, assess and manage such complex situations

Severe Intentional Corrosive (Nitric Acid) Acute Poisoning: A Case Report and Literature Review

Despite being one of the most debilitating conditions encountered in the field of toxicology, there is a lack of neutralization measures for the toxins involved in acute corrosive poisoning, and this promotes progressive contact injury of deep tissues after poisoning has occurred. Multiple controversies still surround management strategies during the acute phase of poisoning and the long-term follow-up of the patient. Here, we report a severe case of intentional poisoning with nitric acid complicated by extensive injury of the upper digestive tract, multiple stricture formation, and complete dysphagia. Serial endoscopic dilation and insertion of a jejunostomy feeding tube were necessary, and underlying psychiatric illness negatively affected the outcome of the patient. We conclude that an interdisciplinary approach is necessary to properly reduce the extent of lesions and sequelae induced by corrosion. Early endoscopic mapping of injuries is of major importance to better predict the evolution and possible complications of poisoning. Interventional and reconstructive surgical procedures may significantly improve the life expectancy and quality of life of patients following intoxication with corrosive substances