Infections and Multidrug-Resistant Pathogens in ICU Patients

This chapter aims to highlight the main types of infections in the ICU, in order to improve diagnostic and therapeutic management. Risk factors for patients hospitalised in the ICU will be raised: the increasing use of invasive devices and procedures, aggressive antimicrobial therapies, surgical interventions, immunosuppressive treatments or co-morbidities responsible for immune deficiencies. Starting from the rising mortality risk among patients with hospital-acquired infections (HAI), in the case of failure to control the pathogen in the first 24–48 h, we will tackle about the prevention, reduction and control of the emergence of resistant pathogens. The rational administration of antibiotics will also be addressed, with the aim of reducing adverse reactions, including secondary infections, decreasing the mortality rate, length of hospital stay and costs of health care

Current Noninvasive MR-Based Imaging Methods in Assessing NAFLD Patients

The chapter will focus on the different aspects of nonalcoholic fatty liver disease (NAFLD). An update in noninvasive MR-based imaging will be offered in detail, pointing mainly to fat, iron, and fibrosis deposition and the accuracy of quantitative methods in disease grading and severity assessment. NAFLD is the most common cause of chronic liver disease (CLD) in Western countries. MRI is used to evaluate the disease, to assess the severity, and to quantify the amount of fat deposition, being also the method of choice to evaluate and quantify iron overload. Diagnosis and staging of liver fibrosis is one of the most challenging aspects of noninvasive imaging. “Virtual biopsy” refers to the possibility of imaging techniques to depict, map, and measure fibrosis minimizing the need for invasive liver biopsies in CLD. MRI allows an accurate determination of steatosis, iron overload, and fibrosis, even if they coexist

Research on main morphological and physiological characters of the species Brassica oleracea var. Acephala in Iaşi

The research was based on morphological and physiological characterization of a range of eight hybrids of ornamental cabbage, as forms of cabbage leaves (Brassica oleracea var. Acephala DC). The research was conducted in 2011 in the experimental field of the Department of Vegetable, within USAMV to farm "Vasile Adamache". The aim of the research was to promote forms of ornamental cabbage studied to enrich knowledge of these varieties and their exploitation in landscape architecture. The results obtained showed the influence of hybrids and B factor (month) on plant height, influence of hybrids and B factor (month) to the number of leaves and vegetative mass dynamics of the species studied. Analysis of hybrids and B factor (month) on plant height and number of leaves showed a progressive increase in the values recorded by them. Number of leaves ranged from 10.48 to 26.33 Crane Pink hybrid to Red Peacock hybrid. Regarding the vegetative mass is noted that the Glamour Red hybrid achieves highest vegetative mass of 800.6 g and hybrid lowest mass Crane Pink vegetative, respectively 591.6

Evaluation of morphological and phenological aspects of the species Cucurbita pepo L. in Iaşi

The research was based on morphological and physiological characterization of a range of eight hybrids of ornamental cabbage, as forms of cabbage leaves (Brassica oleracea var. Acephala DC). The research was conducted in 2011 in the experimental field of the Department of Vegetable, within USAMV to farm "Vasile Adamache". The aim of the research was to promote forms of ornamental cabbage studied to enrich knowledge of these varieties and their exploitation in landscape architecture. The results obtained showed the influence of hybrids and B factor (month) on plant height, influence of hybrids and B factor (month) to the number of leaves and vegetative mass dynamics of the species studied. Phenological observations reveal characteristics of each hybrid in the study, on the number of days for each phenophase. Plants showed a morphology that falls in botanical description of the species, allowing their proper development

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Growth, quality index, and mineral composition of five ornamental cabbage cultivars grown under different nitrogen fertilization rates

The fertilizer nitrogen (N) inputs to some potted plants such as ornamental cabbage (Brassica oleraceaL. var. acephalaD.C.) are frequently higher than the actual demand. Optimization of N fertilization rate and selecting N-efficient cultivars are important approaches to increase the nitrogen use efficiency (NUE) and to reduce environmental pollution from nitrate leaching. The aim of this study was to assess the effect of increasing levels of nitrate (0.5, 2.5, 5, 10 or 20 mM of NO3-) in the nutrient solution on plant growth, quality, SPAD index, chlorophyll fluorescence, leaf pigments, mineral composition, and NUE in five ornamental cabbage cultivars(‘Coral Prince’, ‘Coral Queen’, ‘Glamour Red’, ‘Northern Lights Red’, and ‘White Peacock’), grown in closed subirrigation system. ‘Glamour Red’ and ‘Northern Lights Red’ needed 3.3, and 2.9 mM of NO3-in the supplied nutrient solution, respectively to produce 50% of predicted maximum shoot dry weight, whereas the vigorous cultivars ‘Coral Prince’, ‘Coral Queen’, and ‘White Peacock’ needed 5.5, 4.7, and 4.3 mM of NO3-, respectively. Total leaf area, shoot dry weight, SPAD index, N, Ca, and Mg concentrations increased linearly and quadratically in response to an increase of the nitrate concentration in the nutrient solution. Irrespective of cultivars, fertilizing above10 mM NO3-produced high-quality plants (quality index of 5) and resulted in sufficiently high tissue concentrations of N, P, K, Ca, Mg and Fe