POSTOPERATIVE DELIRIUM - A NEW CHALLENGE?

Universitatea de Stat de Medicină şi Farmacie „Nicolae Testemiţanu”, Chişinău, Republica MoldovaIntroducere. Delirul postoperator (DPO) este o ,,disfuncție acută a creierului”, o tulburare severă a cogniției și a stării de conștiență, dezvoltată la 20-50% din pacienții supuși intervențiilor chirurgicale. DPO se dezvoltă în primele ore sau 5 zile după operație. DPO poartă un caracter fluctuant tip hiperactiv, hipoactiv sau mixt. DPO nediagnosticat este însoțit de un prognostic rezervat, creșterea perioadei de spitalizare, a morbidității și mortalității. Scopul lucrării. Evaluarea gradului de identificare DPO la pacienții post chirurgicali în UTI. Material și metode. Studiu retrospectiv. Au fost analizate fișele medicale a pacienților după intervenție chirurgicală pe anul 2022 din UTI a SCR „Timofei Moșneaga”. Rezultate. Din 1445 de fișe medicale diagnosticul de DPO a fost identificat la 37 de pacienți (2,56%). Vârsta medie a fost de 60±14 ani; >65 ani -36,84% și 65 years – 36.84% and <65 years – 63.16%. Females - 24 (42.86%) and 32 males (57.14%). Among them in the first 24 hours 30 (81.08%) patients developed OPD. The remaining 7 (18.91%) cases developed during the following days. OPD occurred in patients undergoing surgery: cardiac surgery (valvuloplasty) - 9 (24.32%); colorectal surgery - 8 (21.62%), vascular surgery in 7 (18.91%), gastric resection 6 (16.21%), urological surgery (prostate adenoma) with trans-urethral approach (TURP) 5 (13.51%), ophthalmological surgery - 2 (5.40%). All identified cases of OPD were hyperactive type. Among patients with OPD 5 (13.51%) had pre-existing stroke; 21 (56.76%) - atrial fibrillation; 22 (59.46%) - chronic alcohol users. In 12 (34.43%) patients were identified intra-operatively low O 2 consumption (VO 2 <150 dl/l), and in 17 (45.95%) - TAM < 65 mmHg of duration (15-20 min) with need of vasoactive substances. Conclusion. POD is underdiagnosed in the ICU and hypoactive type delirium is overlooked. As timely assessment of POD may decrease diagnostic and therapeutic costs, further studies are needed to assess the causes of POD

Acute respiratory distress syndrome particularities in oncological patients with AH1N1 influenza. Case series report

Grigore T. Popa University of Medicine and Pharmacy, Iași, România, Regional Institute of Oncology, Iași, 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 MoldovaIntroduction: In oncological patients influenza may result in severe forms associated with high mortality (11-33% in solid cancers, 23% in bone marrow transplant), one of them being acute respiratory distress syndrome (ARDS). Objective: Evaluation of diagnostic, management and outcome particularities in ARDS AH1N1 influenza oncological patients. Material and methods: The study enrolled all ARDS AH1N1 influenza patients, diagnosed and managed in ICU IRO Iași in January-February 2018 during a hospital-acquired influenza outbreak. Analyzed parameters were patient related (cancer type and treatment), influenza related (virus type and identification tests), ARDS related (severity, management, outcome). Results: Out of 40 symptomatic or influenza contact asymptomatic patients, 21 tested positive for AH1N1 influenza virus, 9 out of them having ARDS managed in ICU. 5 pts presented severe ARDS in the context of post-therapeutic severe immune compromise: 4 pts post-chemotherapy medullary aplasia for hemato-oncological disease and 1 pt post-radio/chemo/surgical therapy for gynecological cancer. All received ventilatory support: 3 pts invasive ventilatory support in prone position (worst PaO2/FiO2 29-46 mmHg, nonsurvivors), 2 pts non-invasive ventilatory support (worst PaO2/FiO2 54-94 mmHg, survivors). After 25th Jan 2018 (first case) epidemiological alert and management were instituted, resulting in outbreak control on 23rd Feb 2018 (last case). Conclusions: In immuno-compromised oncological patients AH1N1 influenza may rapidly generate a hospital-acquired outbreak and severe ARDS forms associated with high mortality. Early diagnostic and management are the most effective strategies in reducing associated mortality and controlling influenza outbreak

The role of sodium glucose cotransporter or glucagon-like peptide-1 receptor agonists in treating heart failure with preserved ejection fraction in patients with type 2 diabetes mellitus

Background. Heart failure with preserved ejection fraction is not a single disease but a clinical syndrome secondary to important comorbidities, is increasing in prevalence, and is associated with high functional impairment. This study aimed to compare the results of treating patients with heart failure with preserved ejection fraction and type 2 diabetes mellitus with sodium-glucose cotransporter inhibitors (SGLT-2 inhibitors) or Glucagon-like peptide-1 receptor agonists (GLP-1 RAs). Methods. Observational trial in one medical center with assessments at baseline and 6 months. Participants were patients with type 2 diabetes mellitus and heart failure with preserved ejection fraction. The primary endpoint was to measure the impact of treatment on weight loss, diastolic dysfunction, Kansas City Cardiomyopathy Questionnaire. We performed anthropometric measurements, blood samples and transthoracic echocardiography for systolic and diastolic dysfunction. Results. After 6 months of intervention, both groups had a significant increase in results of Kansas City Cardiomyopathy Questionnaire, and the mean change in the group treated with GLP-1 Ras was 15.88 ± 7.7 points (95% confidence interval[CI], 19.7-12.7, p<0.01) while in the group treated with sodium-glucose cotransporter inhibitors was 13.57 ± 7.96 points (95% confidence interval[CI], 16.22-10.91, p<0.01) so the quality of life was better. The weight loss was more important in the group with GLP-1 Ras with 5.8 ± 1.8 kg (95% confidence interval [CI], 4.7-7.0, p<0.01) while in the other group was 1.37 ± 1.4 kg (95% confidence interval [CI], 0.54-2.21, p<0.01). Diastolic dysfunction was improved in monitoring E/E' lateral and was 3.28 ±1.27 less (95% confidence interval [CI], 2.75-3.80, p<0.01) in the GLP-1 Ras group and 2.93 ± 2.15 less (95% confidence interval [CI], 2.21-3.64, p<0.01) in the SGLT-2 inhibitors group. Conclusions. The present study establishes an improvement in symptoms, diastolic dysfunction, and weight loss in patients with type 2 diabetes mellitus and heart failure with preserved ejection fraction and treatment with GLP-1 Ras or SGLT-2 inhibitors

Towards understanding post-COVID-19 condition: A systematic meta-analysis of transcriptomic alterations with sex-specific insights

Background Post COVID-19 Condition (PCC), characterized by lingering symptoms post-acute COVID-19, poses clinical challenges, highlighting the need to understand its underlying molecular mechanisms. This meta-analysis aims to shed light on the transcriptomic landscapes and sex-specific molecular dynamics intrinsic to PCC. Methods A systematic review identified three studies suitable for comprehensive meta-analysis, encompassing 135 samples (57 PCC subjects and 78 recovered subjects). We performed meta-analysis on differential gene expression, a gene set enrichment analysis of Reactome pathways, and weighted gene co-expression network analysis (WGCNA). We performed a drug and disease enrichment analysis and also assessed sex-specific differences in expression patterns. Key findings A clear difference was observed in the transcriptomic profiles of PCC subjects, with 530 differentially expressed genes (DEGs) identified. Enrichment analysis revealed that the altered pathways were predominantly implicated in cell cycle processes, immune dysregulation and histone modifications. Antioxidant compounds such as hesperitin were predominantly linked to the hub genes of the DEGs. Sex-specific analyses highlighted disparities in DEGs and altered pathways in male and female PCC patients, revealing a difference in the expression of ribosomal proteins. PCC in men was mostly linked to neuro-cardiovascular disorders, while women exhibited more diverse disorders, with a high index of respiratory conditions. Conclusion Our study reveals the intricate molecular processes underlying PCC, highlighting that the differences in molecular dynamics between males and females could be key to understanding and effectively managing the varied symptomatology of this condition.This study has been funded by funds from Agència de Gestió d’Ajuts Universitaris de Recerca (AGAUR 2017 SGR 00030–2021 Teresa Auguet), the Investigador actiu Program from the URV (2021-10-837-AUGUET to Teresa Auguet) and own financing.Peer reviewe

Metabolic effects of low glycaemic index diets

The persistence of an epidemic of obesity and type 2 diabetes suggests that new nutritional strategies are needed if the epidemic is to be overcome. A promising nutritional approach suggested by this thematic review is metabolic effect of low glycaemic-index diet

Identification of pollution sources in closed mining sites with an Impact on the quality of surface water in the Brad area

Pollution caused by closed mining activities is particularly difficult to treat because it dates back a very long time. Water contamination results from large-scale disturbance of the land on which the underground exploitation of the useful mineral substance took place. Discharges from underground mines can be treated as diffuse point sources; water quality is due to reactions that occur in an area that can cover tens of square kilometres. The main sources are groundwater, which increases after the pumping is stopped, and tailings stored in dumps and tailings ponds. When the mine closes, the pumps are stopped and the groundwater level rises until it reaches the surface or discharges into the aquifers above. Although discharges from wells and galleries are often the most visible sources, surface activities such as mineral processing, tailings and waste disposal are also a significant source of pollution. The river is located on the Barza gold-silver ore mining operation took place. The runoff waters present in this perimeter can transport contaminated sediments, where the tailings dumps are washed away by precipitation. The paper aims to identify the sources of surface water pollution in the Barza closed mining site that influences the quality of surface water