Ghidurile pentru practica epidemiologică în spital - o necesitate în strategia de supraveghere a infecţiilor nosocomiale

Universitatea de Medicina şi Farmacie Gr. T. Popa, Iaşi, România, Disciplina de Asistenţa Primară a Stării de Sănătate şi Epidemiologie, Unitatea de Epidemiologie, Clinică Iaşi, Disciplina de Boli InfecţioaseIntroducere. Evoluţia infecţiilor nosocomiale (IN) are un caracter dinamic, fiind dependentă de numeroși factori. Monitorizarea terapiei cu antibiotice în cadrul acţiunilor de supraveghere a infecţiilor nosocomiale cu includerea rezultatelor în Ghidul pentru practică epidemiologică de spital are ca scop ameliorarea semnificativă a evoluţiei acestei patologii iatrogene. Scopul studiului a urmărit limitarea infecţiilor nosocomiale prin standardizarea recomandărilor de antibioterapie. Obiectivele studiului au constat în supravegherea sistematică a incidenţei IN apărute în perioada 2002-2011, concomitent cu înregistrarea evoluţiei rezistenţei la antibiotice a tulpinilor microbiene izolate de la pacienţii spitalizaţi în sectiile de Chirurgie toracică, Terapie intensivă și Pneumologie ale Spitalului Clinic de Pneumoftiziologie Iași. Material și metode. Studiul longitudinal, care a inclus pacienţii spitalizaţi, a urmărit identificarea incidenţei IN, conform definiţiei de caz, și a cauzelor de producere a acestora prin înregistrarea factorilor de risc cu ocazia anchetei epidemiologice. Din datele laboratorului de microbiologie privind tulpinile cu semnificaţie clinică izolate din produselele patologice (spută, lichid pleural, aspirat bronșic, secreţie din plaga postoperatorie etc.) a fost analizată sensiblitatea acestora la antibiotice. Rezultate. În perioada studiată au fost identificate cazurile de IN în serviciile de Terapie intensivă și Chirurgie toracică. Numărul total al acestora a fost 180, cu variaţii de la 48 în anul 2002 la 6 în 2011 și o incidenţă specifică de 1,52 IN pleurale/ 100 de pacienţi internaţi. După forma clinică au predominat IN de plagă operatorie profundă (pleurale) și, respectiv, superficială. Etiologia IN a fost dominată de tulpinile multiplurezistente de Pseudomonas aeruginosa și Staphylococcus aureus, iar cele respiratorii, fără caracteristici de nosocomialitate, Streptococcus pneumoniae și Haemophilus influenzae. Strategia generală în IN este de antibioterapie de dezescaladare și utilizarea asocierii unui antibiotic de ultimă generaţie (precum linezolid/vancomicină) cu un aminoglicozid de ultimă generaţie sau o fluorochinolonă în infecţiile cu stafilococ, iar în cele cu Pseudomonas – a carbapenemelor, urmate de asocierea de peniciline cu inhibitori de betalactamaze, cu sau fără aminoglicozid. Concluzii. Beneficiile colaborării dintre clinician, infecţionist, epidemiolog și microbiolog sunt cuantificate prin scăderea riscului și incidenţei IN, iar informaţiile privind profilul de sensibilitate a tulpinilor microbiene izolate oferă posibilitatea antibioterapiei adecvate. Elaborarea unui ghid naţional, cu recomandări generale, la care fiecare spital, să asocieze rezultatele analizei anuale a particularităţilor profilului de rezistenţă a tulpinilor circulante în unitatea medicală proprie, reprezintă o necesitate în contextul actual în care patologia infecţioasă indusă de riscul infecţiilor nosocomiale generează suferinţă și invaliditate pentru pacienţi, dar și pierderi economice importante pentru sistemul de sănătate

Immunoassay Techniques Highlighting Biomarkers in Immunogenetic Diseases

Diagnosis of autoimmune diseases is crucial for the clinician and the patient alike. The immunoassay techniques most commonly used for this purpose are immunohistochemistry, ELISA, and Western blotting. For the detection of more specific biomarkers or the discovery of new ones for diagnostic purposes and as therapeutic targets, microarray techniques are increasingly used, for example, protein microarray, Luminex, and in recent years, surface plasmon resonance imaging. All of these technologies have undergone changes over time, making them easier to use. Similar technologies have been invented but responding to specific requirements for both diagnostic and research purposes. The goals are to study more analytes in the same sample, in a shorter time, and with increased accuracy. The reproducibility and reliability of the results are also a target pursued by manufacturers. In this chapter, we present these technologies and their utility in the diagnosis of immunogenetic diseases

Role of Nutraceuticals in Modulation of Gut-Brain Axis in Elderly Persons

A rather new and somewhat unusual concept connects brain functions to gut microbiota. It is called “gut-brain axis” (or “microbiota-gut-brain axis”) and states that probiotics consumption and a healthy gut microbiota positively influence brain functions related to behavior and cognition. Synergistic with a low chronic grade peripheral inflammation, this faulty barrier exposes the aged brain to negative extra-cerebral signals. Given the quasi-constant failure of pharmacological treatments in neurodegenerative diseases, increased interest is directed toward allopathic medicine, including dietary supplements. Interplay between gut microbiota and central nervous system by immune, neural and metabolic pathways is being explored as a possible modulator of cognitive impairment and behavior disorders. In elderly persons, this axis has been reported to be altered, contributing to systemic inflammation and was also indicated as a possible marker for early frailty in younger population. Currently, there are several clinical trials addressing the relationship between gut microbiota and central nervous system psychiatric disorders and at least one directly investigating whether there is a correlation between composition of gut microbiome, permeability of intestinal barrier and systemic inflammation in patients with dementia. This chapter discusses evidence-based data on positive modulation of gut-brain axis to alleviate behavior and cognition alterations in the elderly

Mutations in the Neuronal Vesicular SNARE VAMP2 Affect Synaptic Membrane Fusion and Impair Human Neurodevelopment

VAMP2 encodes the vesicular SNARE protein VAMP2 (also called synaptobrevin-2). Together with its partners syntaxin-1A and synaptosomal-associated protein 25 (SNAP25), VAMP2 mediates fusion of synaptic vesicles to release neurotransmitters. VAMP2 is essential for vesicular exocytosis and activity-dependent neurotransmitter release. Here, we report five heterozygous de novo mutations in VAMP2 in unrelated individuals presenting with a neurodevelopmental disorder characterized by axial hypotonia (which had been present since birth), intellectual disability, and autistic features. In total, we identified two single-amino-acid deletions and three non-synonymous variants affecting conserved residues within the C terminus of the VAMP2 SNARE motif. Affected individuals carrying de novo non-synonymous variants involving the C-terminal region presented a more severe phenotype with additional neurological features, including central visual impairment, hyperkinetic movement disorder, and epilepsy or electroencephalography abnormalities. Reconstituted fusion involving a lipid-mixing assay indicated impairment in vesicle fusion as one of the possible associated disease mechanisms. The genetic synaptopathy caused by VAMP2 de novo mutations highlights the key roles of this gene in human brain development and function

Computer Science within the Academic Curriculum Used in Maritime Training

In our study we underline the need that academic curriculum used in maritime training must be in resonance with the achievements in the Computer Science and Information Technology fields. Starting from the fact that the primary role of maritime transport is to ensure the economic link between production and consumption, we connect it with the development in computer related domains. In our days, computers ar utilized in nearly each facet of our lives. The computer industry is one among the quickest growing segments of our economy. Computer professionals in maritime field might find themselves in a variety of situations. To maintain a competitive edge, the maritime industry should continue to make creative scientific and engineering advances in order to provide the most effective possible technological assets and information systems. This can be achieved by the connection to the computer science curriculum which can be adapted to the needs of the maritime domain

Surface Features Changes and Corrosion Stability of Titanium Surfaces by Suitable Treatments

Keywords: titanium, TiO 2 film, surface treatments, corrosion stability Titanium is the ninth of the most common elements in the Earth's crust, with a crustal abundance of 0.5% (or 0.8% as titanium dioxide) The exposed surface of the titanium is however attacked by corrosion in the first part of the exposure at environment, but the growth of a naturally protective oxide layer (less than 10 nm thick) can prevent its degradation. When titanium is in a fully passive state, the corrosion rates in aqueous media are typically below 40 μm/year, a value much lowered as compared to the value of 130 μm/ year that is generally accepted by designers as standard for general corrosion The oxide layer occurred in direct contact with the Ti surface consists of TiO; the intermediate layer is composed of Ti 2 O 3 and the outer layer is TiO 2 To improve the stability and other functional properties of the oxide protective layer, and to change the surface morphology for various applications, the oxide layer is grown by different techniques leading to different morphologies and surface characteristics. For Depending on the preparation method, experimental conditions, and target applications, TiO 2 has a large variety of presentation forms: nanoparticles, nanorods, nanowires, nanotubes, under columnar or compact films and can be obtained in amorphous form or in three crystalline phases: anatase, rutile, and brookite. For each type of application there are some important properties for TiO 2 that are essential. As the most promising photocatalyst, TiO 2 materials have already an important role in solving many serious environmental and pollution challenges In medical applications, TiO 2 is used firstly as coating for Ti and Ti alloys to assure the protection against corrosion and secondly, a tissue-friendly nanostructure is designed in order to facilitate the integration of material in body In this work, three different techniques will be presented that deal with the formation of a thin layer of TiO 2 , which beside the protective aspects will be followed by properties that are valuable in the context of today's self-renewing energy or that responding to modern biomedical needs. These techniques (Chemical Vapour Deposition, anodic oxidation and laser treatment) have some advantages in the growth stages, and produce films with different properties which recommend them for specific applications

Information as Object of Computer Science in Maritime Transport

In our paper we make a connection between the notion of information and the economic, strategic, and security value that it have in the maritime domain. In the last decades increasing the degree of computerization of industrial processes and increasing the use of information in solving human problems has made information considered as an economic resource. The sea is a resource for the transport of goods and people to its real capacity. The transport policy aims at transferring the quantities of goods in efficient forms, which can be accomplished by using informatics means such as: optimized databases, algorithms aimed at smart routes, data encoding for a good communication between actors. The use of Information Technology infrastructures and the Internet, in addition to economic, social and political benefits, may also lead to tensions. The issue of cyber security can be addressed by promoting international maritime cyber security interests in international alliances