Importanța indicatorilor de performanță în activitatea spitalicească

Background. Key performance indicators play an essential role in enhancement of management in medical institutions. The knowledge and proper use of indicators offers the possibility to increase the quality in providing medical services. Objective of the study. Identification and analysis of the most important indicators in order to evaluate, control and monitor the performance of hospital activity. Material and Methods. For study realization were used medical sources - international and local literature, statistics, scientific publications and individual researches. For data analysis was used the tool -STROBE Strengthening the Reporting of Observation Studies in Epidemiology, applied on studies: cohort, case-control and cross-sectional. Results. Were analyzed approx 20 studies and 50 articles with reference to the topic. After analyzing the data 22 performance indicators were selected and classified under four aspects: Internal Process - 10 ( Mortality rate; proportion of cancelled operations; Hospital infection rate; frequency of clinical errors; etc.) Finance -5 (Ratio of total revenue to total costs; the cost of drugs and materials; proportion personnel costs of total costs; etc.) Learning and Growth - 4 (Training expenditures per capita; Employee absenteeism rate; etc.) Patient - 3 (Level of facilities for families and visitors; Patients satisfaction percentage etc.). Conclusion. The model of studied indicators can be used for the performance assessment in hospitals and allows to recognize critical points cost efficiency of institution (SWOT analysis). This model can be adjusted according to hospital profile. Introducere. Indicatorii de performanță joacă un rol esențial în eficientizarea managementului spitalicesc. Cunoașterea și utilizarea eficace a indicatorilor oferă posibilitatea de a spori calitatea prestării serviciilor medicale. Scopul lucrării. Identificarea și analiza celor mai importanți indicatori care asigură evaluarea, controlul și monitorizarea performanței activității spitalicești. Material și Metode. Pentru realizarea studiului s-au utilizat surse de specialitate medicală - literatura internațională și autohtonă, date statistice, publicații științifice și cercetări individuale. Pentru analiza datelor s-a folosit instrumentul - STROBE Strengthening the Reporting of Observation Studies in Epidemiology utilizat în studii de tip: cohortă, caz-control și transversale. Rezultate. Au fost analizate circa 20 de studii și 50 de articole cu referire la temă. În urma analizei datelor, 22 de indicatori de performanță au fost selectați și clasificați sub patru aspecte: procesul intern – 10 (letalitatea spitalicească, proporția intervențiilor anulate, frecvența erorilor clinice etc.); finanțe – 5 (raportul venituri totale/costuri totale, costul medicamentelor și al materialelor, proporția remunerării personalului din costurile totale etc.); studiu și dezvoltare – 4 (costul instruirii personalului per capita, rata absenteismului angajaților etc.); pacientul – 3 (rata facilităților pentru familie și vizitatori, proporția satisfacției pacienților; etc.). Concluzii. Modelul indicatorilor studiat poate fi utilizat în evaluarea performanței instituțiilor medicale și în identificarea punctelor slabe și a cost eficienței instituției (analiza SWOT). Prin urmare modelul poate fi ajustat în funcție de profilul spitalului

National Ideology and the Making of a Nation: Simion Barnutiu and the Romanian Revolution of 1848-1849 in Transylvania

This dissertation is a case study: the emergence of liberal nationalism in the mid–nineteenth century Transylvania, one of the poorest parts of the Habsburg monarchy. Even in a still agrarian society it was yet possible for the Romanians to articulate a national program and to fight for self–determination. Simion Brnuiu was the mastermind of the revolutionary program of the Transylvanian Romanians in 1848, the visionary who gave the movement its sense and strategy. The course of his life unfolded along an interesting and often tragic path. Simion Brnuiu graduated from the Uniate Theological Seminary in Blaj. It is fair to say that Brnuiu was both a rebel and a reformist inside the Transylvanian Romanian Uniate Church. The study of law in Sibiu (1846–1848) paved the way to his “laic conversion” to the national cause. The Transylvanian Revolution offered him his lifetime opportunity to actively demonstrate his ideological and militant gift and talent. Brnuiu was the author of the programme of the Romanian Transylvanian Revolution and chairman of the Romanian National Committee, the Romanian revolutionary decisional council during the civil war. He wrote a number of revolutionary texts and programs: the March 24/25, 1848 proclamation, the famous Blaj speech of May 2/14, 1848 (at the open field congress), and other various manifests. His entire dense scholarly work makes out of Simion Brnuiu the first theoreticians of Romanian militant nationalism. After the defeat of the mid–century movement he went on with the study of jurisprudence in Vienna (1851–1852) and then Pavia, where he was awarded the bachelor degree in 1854. Since 1855 he had taught philosophy and natural right at this University of Iai, in Moldavia. The dissertation contains an intrinsic message: nations became over time what their ideologues programmed them to become. If today’s Romanian nation is the real product of imagined projections, this dissertation has sought to illuminate the force of ideas and spirit behind this process of imagining as well as the immense role and responsibility of the intellectual ideologues of the past

CHARACTERISTICS OF PATIENTS WITH TB/ HIV COINFECTION

Universitatea de Stat de Medicină şi Farmacie „Nicolae Testemiţanu”, Chişinău, Republica MoldovaIntroducere. Potrivit datelor OMS persoanele care trăiesc cu HIV dezvoltă tuberculoza de 19 (15-22) ori mai des decât cei neinfectați. La nivel global în anul 2019 au decedat 208.000 TB/HIV din 1,4 mln decese de TB, iar în anul 2020 au decedat 214.000 și au contribuit la creșterea mortalității până la 1,5 mln. Scopul lucrării. Caracteristica bolnavilor cu coinfecția TB/HIV aflați la tratament în staționarul municipal de tuberculoză. Material și Metode. Studiul retrospectiv, selectiv, descriptiv. Datele anamnestice, clinice și paraclinice au fost prelevate din fișele medicale a 74 bolnavi aflați în staționar în perioada anilor 2018-2020. Rezultate. Repartizarea după sex: bărbați au fost 49, femei – 25. A predominat vârsta între 35-44 ani (46%) urmată de 25-34 ani (20,3 %) și 45-54 ani (19 %). După tipul de caz au fost: cazuri noi – 47 (63,5%), recidive – 12 (16,3%), pierduți din supraveghere – 10(13,5%), eșec terapeutic- 5(6,7%). Forma infiltrativă de tuberculoză s-a înregistrat la 49 (66,2%), diseminată- la 21 (28,3%) și fibro-cavitară – la 4 (5,5%) bolnavi. Confirmarea microbiologică a fost stabilită la 40 (54,1%), iar rezultat negativ – la 34 (45,9%). Micobacteriile de tuberculoză au fost sensibile către preparatele antituberculoase la 29 (72,5%) și rezistente – la 11 (27,5%) cazuri. Concluzii. La bolnavii cu coinfecția TB/HIV tratați în staționar predomină vârsta tânără, cazurile noi, formele extinse de tuberculoză, o jumătate din ei erau baciliferi, iar rezistența micobacteriilor de tuberculoză s-a constat la 1/3 din bolnavi.Background. According to WHO data, people living with HIV develop tuberculosis 19 (15-22) times more often than those who are not infected. Globally, in 2019, 208,000 TB/ HIV died out of 1.4 million TB deaths, and in 2020, 214,000 died and contributed to the increase in mortality to 1.5 million. Objective of the study. Characteristics of patients with TB/HIV coinfection undergoing treatment in the municipal tuberculosis hospital. Material and Methods. Retrospective, selective, and selective study. Anamnestic, clinical and paraclinical data were taken from the medical records of 74 patients in hospital during the years 2018-2020. Results. Distribution by sex: men were 49, women – 25. The predominant age was 35-44 years (46%) followed by 25-34 years (20.3%) and 45-54 years (19%). By type of case were: new cases – 47 (63.5%), relapses – 12 (16.3%), lost supervision – 10 (13.5%), therapeutic failure – 5 (6.7%). The infiltrative form of tuberculosis was registered in 49 (66.2%), disseminated – in 21 (28.3%) and fibrous-cavernous – in 4 (5.5%) patients. The microbiological confirmation was set at 40 (54.1%) and the negative result at 34 (45.9%). Tuberculosis mycobacteria were sensitive to antituberculosis drugs in 29 (72.5%) and resistant – in 11 (27.5%) cases. Conclusion. In patients with TB/HIV coinfection treated in inpatient care, young age predominates, new cases, widespread forms of tuberculosis, half of them were bacilli, and the resistance of mycobacteria to tuberculosis was found in 1/3 of patients

The evolution of tuberculosis among the students

Introduction. Tuberculosis (TB) remains a major medical and socio-economic problem of public health, growing alarmingly. There are about 10 million new cases of tuberculosis and more than 1.5 million deaths worldwide each year. It is one of the top 10 causes of death in the world. In recent decades there has been a constant "rejuvenation" of TB. Contact with TB-infected patients is known as a major factor of Mycobacterium tuberculosis infection. Aim of study. The features of the evolution of pulmonary TB, diagnosed in student-patients. Methods and materials. A descriptive, retrospective study was conducted for the period 2018-2020. The subjects of the study consisted of 36 cases of pulmonary TB diagnosed in students from different educational institutions in Chisinau. The data was collected using the information system of tuberculosis monitoring and assessment (SIME TB) and the patient's medical history, archive’s database. Were estimated the clinical symptoms, results of bacterioscopic examination of liquid and solid culture. The highsensitive detection method as molecular-genetic test GeneXpert MTB / RIF), thoracic radiology examination and treatment strategy were assessed. Results. The males predominated about three times according to follow-up.The vast majority of the patients lived in rural areas - 29 (89%) and only 7 (11%)- in Chisinau. Was observed that students from rural areas had a more difficult adaptation period, living in dorms or in dissatisfied conditions, which exposed them to higher risk for tuberculosis. The active and passive patient’s screening was applied in approximately 1:1. According to research, the broncho-pulmonary syndrome was most common, especially cough - 90%, followed by intoxication and temperature’s rising in 69% of cases. Among the comorbid conditions were the mentioned digestive tract pathology -15 (41.6%), previous allergy to various foods and drugs - 12 (33.3%), urinary tract infections - 10 (27.7%), Central Nervous System (CNS) impairment - 7 (19.4%), history of trauma - 5 (13.8%) cases. The infiltrative pulmonary tuberculosis was the most common clinical form of TB, found in 32 (88.8%) of patients. Nodular pulmonary tuberculosis and pleurisy of tuberculous origin were detected in 2 (5.5%) cases. From the total number of patients included in the study, the microbiological etiology of TB was established only in 27 (75%) cases, when in 9 patients (25%) it was not confirmed. According to outcomes, complete recovery from TB was in 25 students (69.4%), enclosed treatment-in 9 (25.0%) patients and in 2 (5.6%) cases the therapeutic failure was found. Conclusion. The medical-biological and social factors increase the risk of TB in students due to adaptation period, unfavorable nutrition and living conditions. Early diagnosis and correct treatment of TB lead to benign evolution and favorable outcomes

Assessment of demographic and diagnostic features of TB in patients with HIV infection in the Republic of Moldova

Universitatea de Stat de Medicină şi Farmacie „Nicolae Testemiţanu”, Chişinău, Republica MoldovaIntroducere. Persoanele infectate cu HIV (PIH) dezvoltă tuberculoza de 19 (15-22) ori mai des decât cei neinfectați. La nivel global în anul 2021 au decedat 1,6 mln. bolnavi de tuberculoză, inclusiv 187.000 persoane care trăiesc cu HIV. În Republica Moldova cazurile noi de tuberculoză la PIH constituie aproximativ 10 %. Scopul lucrării. Studierea depistării tuberculozei pulmonare (cazuri noi) la persoanele care trăiesc cu HIV. Material și metode. A fost realizat un studiu retrospectiv, selectiv care a inclus 160 bolnavi de tuberculoză pulmonară, cazuri noi la persoanele care trăiesc cu HIV (PIH) pe parcursul anului 2021 în Republica Moldova. Rezultate. Pe malul drept al Nistrului au fost depistați 112 (70 %), iar pe malul stâng – 48(30 %) bolnavi. S-a constatat predominarea pacienților de sex masculin 121 (75,6%), iar sexul feminin - 39(24,4%). Majoritatea pacienților depistați s-au încadrat în grupa de vârstă între 25-54 (95,6%) ani. HIV infecția a fost depistată concomitent cu tuberculoza pe parcursul screening-ului TB la 101 (63,1%), pe când la ceilalți bolnavi au dezvoltat tuberculoza pe fondalul HIV infecției. Metoda de depistare a tuberculozei a fost activă la 86(53,8%) și pasivă la 74(46,2%). Peste o jumătate din bolnavii depistați au fost baciliferi: microscopia și Xpert MTB/ RIF pozitiv - la 55(34,4%), Xpert MTB/RIF pozitiv, microscopia negativă - la 32 (20,0%) și microscopia pozitivă, Xpert MTB/RIF negativ – la 5 (3,1%). Concluzii. Rata bolnavilor TB/HIV cazuri noi, pe malul stâng al Nistrului a constituit 1/3 din lotul studiat. În perioada sreening-ului bolnavilor de tuberculoză, HIV infecția a fost constatată concomitent la peste ½ din cei examinați. Metoda molecular-genetică Xpert MTB/RIF a fost prioritară în depistarea bolnavilor baciliferi.Background. People living with HIV (PLHIV) are 19 (1522) times more likely to develop tuberculosis than non-infected individuals. Globally, in 2021, 1.6 million tuberculosis-related deaths were reported, including 187,000 deaths among people living with HIV. In the Republic of Moldova, new tuberculosis cases among PLHIV account for approximately 10% of all cases. Objective of the study. To investigate the detection of new pulmonary tuberculosis cases in people living with HIV. Material and methods. A retrospective, selective study was conducted, including 160 newly diagnosed pulmonary tuberculosis patients among PLHIV in the Republic of Moldova during the year 2021. Results. On the right bank of the Nistru River, 112 cases (70%) were detected, while on the left bank, 48 cases (30%) were identified. A predominance of male patients was observed, with 121 (75.6%) males and 39 (24.4%) females. The majority of detected patients belonged to the age group between 25-54 years (95.6%). HIV infection was detected simultaneously with tuberculosis during TB screening in 101 patients (63.1%), while in the remaining patients, tuberculosis developed on the background of HIV infection. The method of tuberculosis detection was active in 86 cases (53.8%) and passive in 74 cases (46.2%). Over half of the detected patients were smear-positive: positive by microscopy and Xpert MTB/RIF in 55 cases (34.4%), positive by Xpert MTB/ RIF with negative microscopy in 32 cases (20.0%), and positive by microscopy with negative Xpert MTB/RIF in 5 cases (3.1%). Conclusion. The rate of new TB/HIV cases on the left bank of the Nistru River constituted one-third of the studied population. During TB screening, HIV infection was concurrently identified in over half of the examined individuals. The molecular-genetic method Xpert MTB/RIF was prioritized for the detection of smear-positive patients

Hypertrophic cardiomyopathy with involving of the right ventricle

Introduction. Hypertrophic cardiomyopathy (HCM) is defined by the presence of increased left ventricular (LV) wall thickness that isn't solely explained by abnormal loading conditions. Most previous studies include the LV for definition of HCM, neglecting the right ventricle (RV), but recently the RV involvement in HCM was reported. Cardiac magnetic resonance (CMR) is useful in characterizing the phenotypes of RV and LV in HCM. RV involvement is associated with increased risk of arrhythmias, dyspnea, pulmonary thromboembolism, heart failure and sudden death. Case presentation. The 32y.o. man was admitted at Institute of Cardiology in December, 2021 with complaints: intermittent chest pain on physical endeavor, low tolerance to exertion. Family history revealed the father`s death in middle age of unknown cause. In childhood was suspected of rheumatic fever followed by tonsillectomy at the age 18y.o. without improvement of symptoms due to which wasn’t admitted to compulsory military service. In March 2020 suffered an episode of fainting. ECG performed at that time showed sinus rhythm with repolarization abnormalities, manifested by T-wave inversion in precordial leads. Patient was referred to the emergency department with suspicion of acute coronary syndrome. Subsequently diagnosis was not confirmed either clinically or laboratory. Physical examination at admission revealed regular rhythm without extracardiac sounds, HR-75b/min, BP-110/75mmHg,SpO2- 98%. On ECG deep negative T wave in V1-V4. NT-proBNP-253ng/ml, ESR-14mm/h. EcoCG: normalsized heart chambers, normal systolic function (EF 62%), IVS medio-apical thickness-20mm, apical segment of RV-17mm, obstructed outflow tract of RV. Holter ECG: pronounce respiratory arrhythmia, negative T wave in V1-V5. CMR: Accentuated LV trabeculae type `non-compact spectrum`. Fibrotic intramural lesion in hypertrophic LV, late gadolinium enhancement. Hypertrophic RV myocardium. Two septal interventricular defects. Non-obstructive HCM, asymmetric form. Regardless of the patient’s complaints and instrumental findings the diagnosis of Non-obstructive hypertrophic cardiomyopathy was confirmed. The treatment with b-blockers was initiated. Discussion. This case represents clinical interest because of detection of RV myocardial hypertrophy, less described in the literature. It's certain that the patient suffers from a genetically determined cardiomyopathy, however a more accurate diagnosis requires a comprehensive genetic evaluation, including storage disease which have similar features. Unfortunately, HCM is delayed diagnosis as in the patient's case. Thus making a differential diagnosis for chest pain and syncope in the young population is an important heart assessment by CMR. This patient is supervised by a cardiologist and will continue treatment with b-blockers. The thromboembolic risk assessment and the decision of anticoagulants are required. Conclusion. The case emphasized that assessment of young patients with chest pain and fainting is multidimensional and can hide life-threatening conditions

PRÁTICAS DE LAZER DE/PARA ESTUDANTES TRABALHADORES: NARRATIVAS DE JOVENS CONTEMPORÂNEOS

This research delves into the narratives of nocturnal high school students attending a public school in Garibaldi-RS, exploring their engagement in leisure activities. Drawing upon the frameworks of Cultural Studies in Education and Leisure Studies, coupled with ethnographic methodologies, the study endeavours to critically examine the perception of school as a leisure realm in the lives of adolescents. Furthermore, it investigates the role of cell phones as a source of amusement and its correlation with potential leisure pursuits. Through this analysis, a more comprehensive understanding of the daily experiences of young individuals is fostered, while also offering insights valuable for informing prospective public policies pertaining to this domain.Este estudio tiene como objetivo analizar las narrativas de los alumnos del Bachillerato nocturno de una escuela pública, en Garibaldi-RS, acerca de sus prácticas de ocio. La investigación adopta como referencia teórica los Estudios Culturales en Educación y los Estudios acerca del ocio, además de emplear metodologías etnográficas. A partir de estos fundamentos, se propone problematizar la comprensión de la escuela como un espacio de ocio en la vida de los jóvenes, así como el uso del móvil como una manera de entretenimiento y su asociación con las posibilidades de prácticas de ocio. Este análisis contribuye para una mejor comprensión de la vida cotidiana de los jóvenes, además de proporcionar posibilidades de conocimiento para el posible desarrollo de políticas públicas relacionadas con el tema.Este estudo tem como objetivo analisar as narrativas dos alunos do Ensino Médio noturno de uma escola pública, em Garibaldi-RS, sobre suas práticas de lazer. A pesquisa adota como referência teórica os Estudos Culturais em Educação e os Estudos sobre Lazer, além de empregar metodologias de cunho etnográfico. A partir desses fundamentos, busca-se problematizar a compreensão da escola como espaço de lazer na vida dos jovens, assim como o uso do telefone celular como forma de entretenimento e sua associação com as possibilidades de práticas de lazer. Essa análise contribui para uma melhor compreensão do cotidiano dos jovens, além de fornecer possibilidades de conhecimento para possível desenvolvimento de políticas públicas relacionadas ao tema

Caracteristica bolnavilor cu coinfecția TB/HIV

Background. According to WHO data, people living with HIV develop tuberculosis 19 (15-22) times more often than those who are not infected. Globally, in 2019, 208,000 TB/ HIV died out of 1.4 million TB deaths, and in 2020, 214,000 died and contributed to the increase in mortality to 1.5 million. Objective of the study. Characteristics of patients with TB/HIV coinfection undergoing treatment in the municipal tuberculosis hospital. Material and Methods. Retrospective, selective, and selective study. Anamnestic, clinical and paraclinical data were taken from the medical records of 74 patients in hospital during the years 2018-2020. Results. Distribution by sex: men were 49, women – 25. The predominant age was 35-44 years (46%) followed by 25-34 years (20.3%) and 45-54 years (19%). By type of case were: new cases – 47 (63.5%), relapses – 12 (16.3%), lost supervision – 10 (13.5%), therapeutic failure – 5 (6.7%). The infiltrative form of tuberculosis was registered in 49 (66.2%), disseminated – in 21 (28.3%) and fibrous-cavernous – in 4 (5.5%) patients. The microbiological confirmation was set at 40 (54.1%) and the negative result at 34 (45.9%). Tuberculosis mycobacteria were sensitive to antituberculosis drugs in 29 (72.5%) and resistant – in 11 (27.5%) cases. Conclusion. In patients with TB/HIV coinfection treated in inpatient care, young age predominates, new cases, widespread forms of tuberculosis, half of them were bacilli, and the resistance of mycobacteria to tuberculosis was found in 1/3 of patients.Introducere. Potrivit datelor OMS persoanele care trăiesc cu HIV dezvoltă tuberculoza de 19 (15-22) ori mai des decât cei neinfectați. La nivel global în anul 2019 au decedat 208.000 TB/HIV din 1,4 mln decese de TB, iar în anul 2020 - au decedat 214.000 și au contribuit la creșterea mortalității până la 1,5 mln. Scopul lucrării. Caracteristica bolnavilor cu coinfecția TB/HIV aflați la tratament în staționarul municipal de tuberculoză. Material și Metode. Studiul retrospectiv, selectiv, descriptiv. Datele anamnestice, clinice și paraclinice au fost prelevate din fișele medicale a 74 bolnavi aflați în staționar în perioada anilor 2018-2020. Rezultate. Repartizarea după sex: bărbați au fost 49, femei – 25. A predominat vârsta între 35-44 ani (46%) urmată de 25-34 ani (20,3 %) și 45-54 ani (19 %). După tipul de caz au fost: cazuri noi – 47 (63,5%), recidive – 12 (16,3%), pierduți din supraveghere – 10(13,5%), eșec terapeutic- 5(6,7%). Forma infiltrativă de tuberculoză s-a înregistrat la 49 (66,2%), diseminată- la 21 (28,3%) și fibro-cavitară – la 4 (5,5%) bolnavi. Confirmarea microbiologică a fost stabilită la 40 (54,1%), iar rezultat negativ – la 34 (45,9%). Micobacteriile de tuberculoză au fost sensibile către preparatele antituberculoase la 29 (72,5%) și rezistente – la 11 (27,5%) cazuri. Concluzii. La bolnavii cu coinfecția TB/HIV tratați în staționar predomină vârsta tânără, cazurile noi, formele extinse de tuberculoză, o jumătate din ei erau baciliferi, iar rezistența micobacteriilor de tuberculoză s-a constat la 1/3 din bolnavi

F015 Role des fibroblastes cardiaques dans la tolérance des cardiomyocytes à l’ischémie reperfusion

ObjectifLes fibroblastes cardiaques sont la population cellulaire majoritaire du tissu cardiaque. Leurs possibles implications au cours de la séquence ischémie-reperfusion n’a jamais été étudiée. Le présent travail a donc pour but de déterminer si les fibroblastes sont impliqués dans une modulation de la cardioprotection.Matériel et MéthodesNous avons utilisé dans cette étude un modèle de cardiomyocytes de rats nouveau-nés soumis à une séquence d’ischémie-reperfusion simulées. Les cellules ont été isolées à partir de ventricules de rats nouveau nés. Les myocytes cardiaques ont été purifiés par attachements différentiels puis cultivés en présence d’un milieu de culture supplémenté en cytosine arabinoside (Ara C, 10μm). Les cardiomyocytes et les fibroblastes ont été cultivés séparément puis placés en contact direct (cultures mixtes) ou indirect (insert). Ces co-cultures ont subi une ischémie de 3H en absence de nutriments et d’O2 suivie d’une reperfusion de 20H en présence de nutriments et d’O2. Des tests de viabilité (test MTT) et de mortalité cellulaire (dosage de l’activité LDH et Troponine I) ont été effectués à la fin de la reperfusion.RésultatsNous avons montré qu’il était possible de simuler des séquences d’ischémie reperfusion et d’induire une souffrance cellulaire détectable pour une durée d’ischémie de 3H et de reperfusion de 20H. Dans les cultures mixtes (cardiomyocytes + fibroblastes), les tests MTT et LDH ont montré une amélioration de la viabilité cellulaire globale en comparaison avec la viabilité spécifique de chaque type cellulaire seul. Pour les cultures placées en insert, les tests MTT et Troponine I ont montré une amélioration de la viabilité des cardiomyocytes en présence des fibroblastes (p<0.001).ConclusionsNos résultats indiquent que les fibroblastes cardiaques semblent être impliqués dans une modulation de la cardioprotection lors de l’ischémie reperfusion. Cette modulation passe au moins en partie par des mécanismes de type paracrine et elle est dépendante de la quantité de fibroblastes en co-culture avec les cardiomyocytes

West синдром - эпилепсия раннего детства: лечение путем ускорения созревания нервной системы. Клинический случай

Universitatea de Stat de Medicină și Farmacie „Nicolae Testemiţanu”, Departamentul PediatrieEpilepsy is a dangerous pathology, which if not treated in time, epileptic seizures become more aggressive and can result in a tragic end - the patient becomes disabled or dies. The principal cause of epilepsy in children is intrauterine immaturity of the brain. The trigger factors of seizures decompensate the weak (fragile), immature place in the brain, causing a „short circuit bioelectric” with destruction of hundreds and thousands of neurons and nerve fibers, forming an epileptic crater. The early prophylaxis of epilepsy and other various pathologies of the nervous system should be started in the intrauterine period by accelerating the maturation of the brain by administering to the pregnant mothers unsaturated fatty acids, essential phospholipids, essential amino acids. The classic treatment, recommended by the International League for Combating Epilepsy, is based exclusively on antiepileptic drugs. The metabolic treatment of epilepsy helps to eliminate the epileptic outbreak, to decrease the duration of treatment and the dose of the antiepileptic drugs, to reduce the toxicity of antiepileptic drugs, to improve the lost acquisitions by the child (motor, cognitive functions, speech). The metabolic treatment of epilepsy in children should be put on the same scale as antiepileptic drugs and the ketogenic diet (low in carbohydrates).Эпилепсия чрезвычайно опасная патология, которая, если вовремя не лечить, эпилептические припадки становятся более агрессивными и могут закончиться трагически - пациент становится инвалидом или умирает. Основная причина эпилепсии у детей - внутриутробная незрелость головного мозга. Триггер факторы эпилепсии декомпенсируют слабый, незрелый участок мозга, вызывая «биоэлектрическое короткое замыкание» с разрушением сотен и тысяч нейронов и нервных волокон, образуя эпилептический кратер. Раннюю профилактику эпилепсии и других различных патологий нервной системы следует начинать во внутриутробном периоде с ускорения созревания мозга путем назначения беременным женщинам ненасыщенных жирных кислот, фосфолипидов, незаменимых аминокислот. Классическое лечение, рекомендованное Международной Лигой Борьбы с Эпилепсией, основано исключительно на противоэпилептических препаратах. Метаболическое лечение эпилепсии направлено на более быстрое устранение эпилептического очага, уменьшение продолжительности лечения и дозы противоэпилептического препарата, снижение токсичности противоэпилептических препаратов, более быстрое улучшение утраченных ребенком приобретений (двигательных, когнитивных функций, речи). Метаболическое лечение эпилепсии у детей следует поставить на одну ступень с противоэпилептическими препаратами и кетогенной диетой (с низким содержанием углеводов)