Instabilitatea hemodinamică la donatorul în moarte cerebrală

Spitalul Clinic Județean de Urgență Oradea, România, The 5th International Congress of the Society of Anesthesiology and Reanimatology of the Republic of Moldova, 16th Edition of the International Course of Guidelines and Protocols in Anesthesia, Intensive Care and Emergency Medicine, 28th Meeting of the European Society for Computing and Technology in Anesthesia and Intensive Care September 27-29, 2018, Chisinau, the Republic of MoldovaIntroducere: Depresia miocardică intrinsecă la donatorul în moarte cerebrală duce la instabilitate hemodinamică, valori TAM scăzute, aritmii cardiace grave. Resuscitarea pacienţilor în moarte cerebrală trebuie iniţiată prompt, la fel şi tratamentul agresiv. Măsurile de îmbunătăţire a perfuziei tisulare sunt efective atunci când sunt aplicate devreme. Se instituie obligatoriu cateter venos central (subclavie sau jugulară internă), cateter arterial. Resuscitarea va urmări menţinerea presiunii arteriale, a frecvenţei cardiace, a debitului urinar, perfuzia la nivelul tegumentelor. Se vor monitoriza continuu pH-ul, lactacidemia, ionograma, saturaţia în O2 şi CO2 a sângelui arterial astfel încât să nu se degradeze perfuzia tisulară. Studii ecocardiografice sugerează că 40-50% dintre pacienţii în moarte cerebrală dezvoltă depresie miocardică, definită prin scăderea fracţiei de ejecţie. Scopul acestui studiu constituie demonstrarea eficacităţii metodei de monitorizare invazivă, hemodinamică la pacientul în moarte cerebrală. Material şi metode: Acest studiu clinic este de tip mixt, observaţional şi experimental, prospectiv, longitudinal şi randomizat, efectuat în cadrul Clinicii ATI I din Spitalul Clinic Judeţean de Urgenţă Oradea în perioada 2013-2017, pe un lot de 302 potențiali donatori în moarte cerebrală, dintre care 89 au fost donatori reali (29,47%). Donatorii incluşi în studiu au fost împărţiţi randomizat în două loturi: lotul C (de control) – donatori supuşi tratamentului fără monitorizare invazivă; lotul S (de studiu) – pacienţi trataţi conform ghidurilor standard, exceptând tratamentul vasopresor şi inotrop, care s-a realizat urmărind modificările dinamice ale parametrilor hemodinamici. Rezultate: În urma distribuţiei aleatorii am încadrat 150 donatori în lotul C şi 152 donatori în lotul S. Nu s-au înregistrat diferenţe semnificative între loturi, din punct de vedere statistic, în ceea ce priveşte caracteristicile demografice, clinice şi paraclinice în momentul introducerii în studiu. S-au comparat scorurile de gravitate APACHE II, SAPS II la diferite intervale după includerea donatorilor în studiu. Diferenţe semnificative se remarcă la 72 de ore după includerea donatorilor în cele două loturi, dar evoluţia mai favorabilă a lotului de studiu S se poate observa deja de la 48 de ore. Oprirea cardiacă din cauza instabilității hemodinamice în lotul S s-a înregistrat la 56 pacienți (36,84%), comparativ cu lotul C unde pierderea de donatori a fost mai mare - 84 (56%), cu o medie pe cele două loturi studiate de 46,35%. Concluzii: Având în vedere lipsa unui ghid exact pentru suportul hemodinamic la donatorii cadavru, studiul nostru şi-a propus utilizarea unei metode invazive pentru a monitoriza şi pentru a optimiza combinaţia aminelor vasopresoare şi inotrop pozitive, după reumplerea volemică adecvată. Donatorii care au beneficiat de monitorizarea invazivă a parametrilor hemodinamici au calitatea perfuziei pentru organele care urmează a fi prelevate, îmbunătățită semnificativ. Metoda ghidată de monitorizare invazivă şi-a dovedit eficacitatea în conducerea tratamentului hemodinamic la donatorul cadavru cu posibilitatea de a fi recoltate mai multe organe și salvarea de vieți umane

The Effects of Oregano Oil on Fungal Infections Associated with Metabolic Syndrome

International audienceThis study aims to compare the evolution of mycosis associated with metabolic syndrome under allopathic treatment compared to phytotherapy using oregano essential oil. The study was conducted over a period of 6 months, on a total of 72 patients diagnosed with fungal infections associated with metabolic syndrome. The patients were divided into 3 groups, depending on the administered treatment: group 1: 24 patients who received allopathic treatment; group 2: 24 patients who received oregano oil treatment; group 3: control, which did not undergo any antifungal treatment. All three groups were subjected to specific diet therapy for mycosis. The patients were initially evaluated at 10 days after the begining of the treatment (to track mycotic disease evolution in the acute phase), at 60 days (to evaluate the recurrence of mycoses) and at 180 days to track recurrent disease. Most infections were acute (77.78%), the chronic ones representing only 5.56% of cases. There were also 12 cases with recurrent infections (16.67%), out of which 6 cases (8.33%) had previously shown resistance to Nystatin. In the 72 cases there was a sensitivity of 100.00% for oregano oil and Ketaconazolum, insignificantly higher than for Myconazolum (97.22%, p=0.157), but significantly higher than for Clotrimazolum and Nystatinum (94.44%, p=0.0437), Variconazole and Fluconazole (88.89%, p=0.0038) and Itraconazole (86.11%, p=0.0011). The results of this study showed an increased efficiency of oregano oil on the symptomatic and paraclinical improvement of mycotic infections in the study, both on short term and on long term, which was completed with high tolerability

Financial Burden of Stroke Reflected in a Pilot Center for the Implementation of Thrombolysis

Stroke represents a serious illness and is extremely relevant from the public health point of view, implying important social and economic burdens. Introducing new procedures or therapies that reduce the costs both in the acute phase of the disease and in the long term becomes a priority for health systems worldwide. The present study quantifies and compares the direct costs for ischemic stroke in patients with thrombolysis treatment versus conservative treatment over a 24-month period from the initial diagnosis, in one of the 7 national pilot centres for the implementation of thrombolytic treatment. The significant reduction (p < 0.001) of the hospitalization period, especially of the days in the intensive care unit (ICU) for stroke, resulted in a significant reduction (p < 0.001) of the total average costs in the patients with thrombolysis, both at the first hospitalization and for the subsequent hospitalizations, during the period followed in the study. It was also found that the percentage of patients who were re-hospitalized within the first 24-months after stroke was significantly lower (p < 0.001) among thrombolyzed patients. The present study demonstrates that the quick intervention in cases of stroke is an efficient policy regarding costs, of Romanian Public Health System, Romania being the country with the highest rates of new strokes and deaths due to stroke in Europe

Clostridium difficile Infection Epidemiology over a Period of 8 Years—A Single Centre Study

International audienceClostridium dicile infection (CDI) is the most common infectious disease related to antibiotic-associated diarrhoea and is a current leading cause of morbidity/mortality, with substantial consequences for healthcare services and overall public health. Thus, we performed a retrospective epidemiological study of CDI for a long period (8 years), in an infectious hospital located in north-western Romania, which serves an entire county of the country (617,827 inhabitants). From 2011 to 2018, 877 patients were diagnosedwith CDI; the mean incidence of this disease was 2.76 cases/10,000 patient-days, with an increasing trend in the annual incidence until 2016, at which point there was adecrease. The most commonly aicted were patients in the 75–84 age group, observed in winter and spring. The results show that the antibiotics were administered in 679 (77.42%) subjects, within the last 3 months before CDI, statistically significant more than proton-pump inhibitors (PPIs)—128 (14.60%) and antidepressant medications—60 (6.84%), which were administered during the same period (p < 0.001). No medication was reported in 10 (6.84%) cases of CDI, in the last 3 months of the study. The fatality rate attained 4.1%, tripling in 2018 vs. 2011. CDI became a significant public health conundrum that can, nevertheless, be combatted through a judicious use of antibiotic

What antibiotics for what pathogens? The sensitivity spectrum of isolated strains in an intensive care unit

International audienceAntibiotic sensitivity spectrum of isolated strains differs according to hospital departments, the hospitals themselves, and countries. Discrepancies also exist in terms of antibiotic use and dosage. The aim of the present study is to compare the antibacterial agents, the types of infections, the number and type of pathogens, and the sensitivity to antibiotics used in the Intensive Care Unit (ICU) of the Emergency Clinical County Hospital of Oradea, Romania. Over a one-year period, data were gathered from the pharmacy computer system and medical records of inpatients. WHO Anatomical Therapeutic Chemical (ATC)/defined daily doses (DDD) methodology was used to assess drug administration data, and antibiotic use was expressed as DDD/1000 PD (patient days). The antibiotic susceptibility of isolated strains was expressed through the cumulative antibiogram. The overall consumption of antimicrobial agents was 1247.47 DDD/1000 PD. The most common drugs used were cephalosporins andfluoroquinolones (52.97% of the total). Ceftriaxone was the most commonly used, followed by levofloxacin