Etiologicalagents of hospital-acquired infections in premature babies with gestationalage less than 32 weeks

Spital Clinic de Obstetrică-Ginecologie „Polizu” secţia neonatologie, Bucureşti, Institutul Naţional pentru Sănătatea Mamei şi Copilului „Alessandrescu-Rusescu”, Universitatea de Medicină şi Farmacie „Carol Davila”, Bucureşti, Facultatea de Medicină, Disciplina Obstetrică-Ginecologie, Facultatea de Moaşe şi Asistenţă medicală, Disciplina Pediatrie centrată pe nou-născutIntroducere. Morbiditatea prin infecţii nozocomiale, dificil de evaluat datorită tendinţelor de supraevaluare (colonizarea des interpretată ca infecţie) sau de subevaluare (infecţii nozocomiale nedeclarate) este o preocupare permanentă în neonatologie. Scop. Diminuarea morbidităţii şi mortalităţii neonatale. Obiective. Identificarea agenţilor etiologici ai infecţiilor nozocomiale survenite la prematuri cu vârsta de gestaţie <32 săptămâni. Material şi metodă. Studiu retrospectiv al prematurilor îngrijiţi în anul 2015 în Institutul Naţional pentru Sănătatea Mamei şi Copilului „Alessandrescu-Rusescu” - spitalul de Obstetrică Ginecologie – departamentul de neonatologie „Polizu”. Rezultate. Prematurii cu vârsta de gestaţie <32 săptămâni, reprezintă mai mult de 1/3 din totalul prematurilor îngrijiţi. Majoritatea infecţiilor nozocomiale au fost determinate de bacterii Gram negative (Enterobacter, Escherichia coli, Serratia) sau Gram pozitive (Staphylococcus aureus). Concluzii. Diminuarea morbidităţii şi a mortalităţii neonatale, a duratei de spitalizare şi implicit a costurilor deteminate de infecţiile nozocomiale, impun măsuri de prevenţie riguros aplicate, prima dintre acestea fiind igiena mâinilor.Introduction (Background). Nosocomial infections are a constant concern in neonatology, seeing the difficulty to evaluate the real incidence – either amplified (colonization falsely interpreted as infection) or underestimated (hospital-acquired infection remained unreported) Purpose. To diminish the neonatal morbidity and mortality Objectives. To identify the infectious agents in hospital-acquired infections of premature babies with GA under 32 weeks of gestation. Material and methods. The retrospective study realized in „The National Institute for the Health of the Mother and Child Alessandrescu-Rusescu, Polizu Hospital of Gynecology” regarding premature babies cared in the neonatology department during the year 2015. Results. Premature babies with GA under 32 weeks of gestation represent more than 1/3 of the number of premature babies born in our hospital. Most of the nosocomial infections have been caused by either Gram-negative (Enterobacter spp, E.Coli, Serratia) or Gram-positive (Staphylococcus aureus) bacteria. Conclusions. Lowering the neonatal morbidity and mortality, reducing the length of hospital stay and by that the costs associated with nosocomial infections do demand strict preventive measures, first of which should be hand hygiene

Oxidative stress in premature infants with respiratory distress syndrome

Institutul Naţional pentru Sănătatea Mamei şi Copilului “Alessandrescu-Russescu”, Maternitatea Polizu Bucureşti, România, Universitatea de Medicină şi Farmacie “Victor Babeş” Timişoara, România, Universitatea de Medicină şi Farmacie “Carol Davila” Bucureşti, RomâniaIntroducere. Dezechilibrul dintre prooxidanţi şi sistemul antioxidant al organismului determină stresul oxidativ. Prematurii au risc crescut pentru stres oxidativ. Sistemele antioxidante intra şi extracelulare protejează împotriva radicalilor liberi în exces. Material şi metodă. Lotul de studiu: 46 de prematuri cu vârstă de gestaţie sub 32 de săptămâni şi detresă respiratorie, născuţi în anul 2016, în Maternitatea „Bega” Timişoara. S-au recoltat două probe de sânge: la naştere şi la 72 de ore. S–a determinat d-ROMs (capacitatea oxidativă a plasmei) şi BAP (potenţialul antioxidant). O creştere a d-ROMs şi/sau o reducere a BAP sunt indicatori ai stresului oxidativ. Rezultate. Valoarea de la care începe stresul oxidativ (d-ROMs) s-a stabilit la 320. În majoritatea cazurilor, la naştere, d-ROMs este sub nivelul de risc; valoare maximă de 545,8 (risc crescut). Valoarea de referinţă pentru BAP este 1900. În 4,34% dintre cazuri, la naştere, s–au înregistrat valori sub limită. La un singur caz d-ROMs se menţine crescut şi BAP rămâne sub nivelul ideal. La 72 de ore d-ROMs creşte în majoritatea cazurilor, dar nu atinge valoarea de risc şi se asociază cu creşterea BAP. Există corelaţie între evoluţia markerilor de stres oxidativ şi perioada de ventilaţie mecanică invazivă de peste 7 zile. Concluzii. Markerii indică faptul că stresul oxidativ apare în perioada perinatală şi poate persista la nou-născut. 21,73% dintre prematuri au avut, în evoluţie, nivele crescute ale dROMs şi scăzute ale BAP. Se corelează cu evoluţia clinică critică şi forma severă de detresă respiratorie.Introduction. The imbalance between the pro-oxidant and antioxidant systems of the organism determines oxidative stress. Premature newborns are at high risk for stress. Intra and extracellular antioxidant systems protect against excessive free oxygen radicals. Material and method. Study lot: 46 premature infants, gestational age < 32 weeks with respiratory distress syndrome, born in 2016, at „Bega” Hospital from Timişoara. We took two blood samples, at birth and at 72 hours. We determined d-ROMs (plasma oxidative capacity) and BAP (antioxidant potential). An increase in d-ROMs and/or a decrease of the BAP are markers of oxidative stress. Results. We set at 320 the d/ROMs value when oxidative stress occurs. The majority of the cases, at birth, were below the risk; maximum value 545.8 (high risk). The ideal BAP is 1900 (favorable antioxidant potential). At birth, 4.34% of the cases had lower values. In only one case the d-ROMs remain high and BAP is under the ideal value. At 72 hours d-ROMs increase in the majority of the cases, but remains below the risk value and correlates with an increase of the BAP. There is a correlation between the evolution of oxidative stress markers and the need for invasive mechanical ventilation for more than 7 days. Conclusions. The markers indicate that oxidative stress occurs in the perinatal period and continues in the newborn. 21.73% of premature infants had high values of d-ROMs and low BAP. This correlates with an unfavorable clinical evolution and severe respiratory distress syndrome

Auxological correlation between the maternal obesity, excessive weight gain during pregnancy, macrosomia, feeding practices and infant obesity

UMF “Iuliu Haţieganu” Cluj, UMF “Gr. T. Popa” Iaşi, UMF “Carol Davila” Bucureşti, Fac. Medicină Oradea, UMF Târgu Mureș, SJU SibiuThe infant and adult obesity is becoming a real public health concern in Romania too. The mother's obesity and excessive weight gain during pregnancy are proven risk factors for the obesity of the child in the future. The protective role of breastfeeding against obesity is already demonstrated. The most important issue is whether the choice of a milk formula with the right protein composition could also protect or not the newborn from becoming future obese infants and children.Obezitatea copilului şi adultului are rate îngrijorătoare şi în Romania. Obezitatea mamei şi creşterea excesivă în greutate a gravidei constituie factori de risc pentru macrosomie şi pentru obezitatea ulterioară a copilului. Rolul protector al laptelui de mamă în prevenţia obezităţii infantile este deja demonstrat. Se pune întrebarea dacă alegerea unei formule de lapte cu conţinut adecvat de proteine protejează sau nu nou-născuţii care au deja greutate mare la naştere, pentru dezvoltarea obezităţii în perioada de sugar si copil mic

SALIVARY PARAMETERS ALTERED IN SMOKERS AND POSSIBLE CORRELATIONS WITH THE CARIOGENIC ACTIVITY

Objectives. Our research team aimed to evaluate the effects smoking has on several salivary parameters and to assess if there are any correlations between smoking and the cariogenic activity. Material and method. The present research included a total of 35 participants. Saliva was collected from every participant to the study. Salivary chloride, calcium and potassium levels, as well as salivary flux and pH were determined for all subjects. Results. Our results showed significantly lower salivary flux and pH levels in smokers compared to nonsmokers (p < 0.01). Chloride, calcium and potassium we found to have higher concentrations in smokers compared to the control group. However, a statistical significance could be found only for calcium (p = 0.02). Moreover, we were able to find in the smokers group a positive correlation in smokers between salivary chloride levels and cariogenic activity as well as a negative correlation could be found in smokers between salivary calcium levels and the cariogenic activity Conclusions. The results of the present study show that smoking alters salivary parameters and that these modifications can favour the development of dental caries

Cerebral oxygenation during the period of transition to extrauterine life after natural versus cesarean birth

Objective. We aim to evaluate the implications of cesarean delivery compared to natural birth by analyzing newborns’ systemic and cerebral oxygenation levels during the first 10 minutes of life. Design. This paper presents a 4-year prospective cohort study. Setting. Polizu Maternity, "Alessandrescu-Rusescu" National Institute for Mother and Child's Protection, Bucharest, Romania. Patients. Randomly selected pregnant women and their fetuses. Interventions. During the 10 min following umbilical cord clamping, regional cerebral oxygen saturation (rcSO2) was measured using the INVOS 5100 device and peripheral oxygen saturation (SpO2) was determined using the Masimo SET pulse oximeter in neonates from cesarean and natural deliveries. Main outcome measures. The cerebral fractional tissue oxygen extraction (cFTOE) in the first 10 minutes of life was calculated based on these values. Results. Newborns delivered vaginally showed higher rcSO2 levels at 1 minute of life than those born via C-section (40.5 ± 16.5% vs 33.7 ± 14.8%, AUC = 0.625; IC 95%: 0.506 - 0.743; p = 0.043). Neonatal cFTOE at 1 minute of life was significantly higher in caesarean-delivered newborns versus naturally born neonates (0.40 ± 0.25 vs 0.50 ± 0.19, p = 0.03; AUC = 0.638; IC 95%: 0.517-0.758; p = 0.023). Conclusions. Prelabor cesarean delivery seemingly plays a significant role in the process of fetal and neonatal cerebral oxygenation immediately postnatally, which is highlighted by lower rcSO2 and higher cFTOE values. Cerebral oxygen saturation monitoring in the delivery room allows the optimization of oxygen therapy in order to prevent the consequences of hypoxia or hyperoxia

Indirect Analysis of a Homogeneous Ternary Mixture

When there is a saturated homogeneous ternary mixture, composed by two immiscible liquids and an amphiphilic one, it is possible to prepare a second one starting from the first. The compositions of the two mixtures are uniquely determined if their solubility curve is known. In this work, one describes a new procedure to determine these compositions. The procedure is applied to a ternary system known in literature: water + <i>n</i>-propanol + <i>n</i>-butanol at 294.15 K and atmospheric pressure. Comparing the results obtained by the new procedure to those determined by measuring the refractive index one concludes that the two analysis methods have similar accuracies

Severe hypertension of pregnant women - cause of iatrogenic preterm birth

Universitatea de Medicină şi Farmacie “ Carol Davila“, Bucureşti, România, Clinica Neonatologie, I.O.M.C. “Prof. Dr. Alfred Rusescu “, Bucureşti, RomâniaThe goal of study is to verify the hypothesis that increased blood pressure values cause premature delivery. Material and Method: Retrospective Study in which newborn babies of mothers with arterial hypertension were analyzed at I.M.C.C“ Prof. Dr. Alfred Rusescu”, Department of Obstetrics and Gynecology from September 1, 2013 to March 1, 2014. Blood Pressure values of pregnant women were analyzed as well as gestational age of the newborns, anthropometric measurements, adaptation to extrauterine life, morbidity and mortality. Results: During the period from September 1, 2013 – March 1, 2014 at the I.M.C.C.”Prof. Dr. Alfred Rusescu, Department of Obstetrics and Gynecology, 1008 births were recorded. Hypertension was present in 4,5% of the cases. Chronic (preexisting) hypertension - 10,41%, gestational hypertension - 75%, Preeclampsia - 12,5% and preeclampsia superimposed upon chronic hypertension -2%. Out of the newborns of mothers with arterial hypertension 29,1%had a GA<37 weeks, and 60% of these came from mothers with arterial hypertension (AHT) values for systolic AHT>160mmHg and diastolic AHT>110mmHg. Perinatal asphyxia was present in 64,28% of the premature babies, 28,57% required invasive resuscitation techniques. Complications stemming from severe AHT in the mother include cardiorespiratory, digestive, metabolic and cerebral. Two intrauterine deaths were recorded in mothers with gestational hypertension, where values reached 200/140mmHg and 180/100mmHg. Conclusion: Severe Hypertension (systolic AHT>160mmHg, diastolic AHT>110 mmHG) and Preeclampsia superimposed on Chronic Hypertension represents the highest risk for “iatrogenic” preterm delivery

TOXICOMANIA ÎN SARCINĂ – FACTOR DE RISC PENTRU INFECŢIE PERINATALĂ

Introducere. Infecţiile neonatale sunt cauze majore de morbiditate şi mortalitate neonatală. Toxicomania prin injectarea de droguri ilicite este un important factor de risc pentru infecţii perinatale. Obiectivul studiului a fost evaluarea incidenţei infectiilor cu debut precoce la nou-născuţi proveniţi din sarcini cu risc de infecţie perinatală: sarcini neinvestigate, marcate de toxicomanie şi sarcini investigate clinico-paraclinic. Material şi metodă. Studiu retrospectiv care a cuprins nou-născuţi în Institutul pentru Ocrotirea Mamei şi Copilului, Spitalul Clinic de Obstetrică-Ginecologie „POLIZU”, grupaţi în 2 loturi: un lot de 25 nou-născuţi în perioada 2005-2012 proveniţi din sarcini neinvestigate survenite la femei consumatoare de droguri ilicite şi un lot de 50 nou-născuţi proveniţi din sarcini corect investigate anamnestico-clinic cu factori de risc pentru infecţie perinatală. Datele au fost analizate statistic (teste specifi ce de corelaţie: Student T, Fisher exact, Chi-square). Rezultate. Incidenţa nou-născuţilor din sarcini marcate de toxicomanie a fost de 0,09% din totalul de 28.489 naşteri, cu o maximă de 0,2% înregistrată în anul 2011. Diferenţe semnifi cativ statistic s-au înregistrat între cele două loturi de nou-născuţi cu factori de risc infecţios prezent în privinţa: vârstei mamelor – mai mică la toxicomane (p_value = 0,0002) a procentului de infecţii congenitale (p_value = 0,00003) OR = 0,03; 95%CI precum şi a duratei medii (zile) de spitalizare (p_value = 0,0180) mai mari la nou-născuţi ai mamelor cu toxicomanie, dar şi în privinţa modului de naştere prin cezariană (p_value = 0,0010) a colonizării bacteriene a tractului uro-genital matern (p_value = 0,0016) mai frecvente la nou-născuţi proveniţi din sarcini investigate. 22% din femeile însărcinate investigate, au prezentat Streptococ grup B, cel mai frecvent tip fi ind serotipul Ib. Ponderea, în cadrul morbidităţii neonatale, a infecţiilor perinatale a fost pentru nou-născuţi din mame toxicomane de 33%, iar pentru nou-născuţi proveniţi din sarcini investigate de 27%. Incidenţa infecţiei perinatale a fost de 52% la nou-născuţi din mame toxicomane (risc de infecţie de 1/1,9 cazuri) şi de 18% la nou-născuţi din sarcini supravegheate (ceea ce reprezintă un risc de 1/5,5 cazuri). Concluzii. Toxicomania în cursul sarcinii constituie, prin boli infecţioase dobândite pe cale sexuală sau sanguină asociate cu defi cienţe de igienă pe fond de nutriţie precară şi de imunitate scăzută, un important factor de risc pentru infecţie perinatală. Asistenţa sanitară în cursul sarcinii, prin diagnostic şi tratament precoce al infecţiei materne, poate diminua incidenţa şi consecinţele medico-sociale ale infecţiei neonatale

Use of QSAR Global Models and Molecular Docking for Developing New Inhibitors of c-src Tyrosine Kinase

A prototype of a family of at least nine members, cellular Src tyrosine kinase is a therapeutically interesting target because its inhibition might be of interest not only in a number of malignancies, but also in a diverse array of conditions, from neurodegenerative pathologies to certain viral infections. Computational methods in drug discovery are considerably cheaper than conventional methods and offer opportunities of screening very large numbers of compounds in conditions that would be simply impossible within the wet lab experimental settings. We explored the use of global quantitative structure-activity relationship (QSAR) models and molecular ligand docking in the discovery of new c-src tyrosine kinase inhibitors. Using a dataset of 1038 compounds from ChEMBL database, we developed over 350 QSAR classification models. A total of 49 models with reasonably good performance were selected and the models were assembled by stacking with a simple majority vote and used for the virtual screening of over 100,000 compounds. A total of 744 compounds were predicted by at least 50% of the QSAR models as active, 147 compounds were within the applicability domain and predicted by at least 75% of the models to be active. The latter 147 compounds were submitted to molecular ligand docking using AutoDock Vina and LeDock, and 89 were predicted to be active based on the energy of binding

DRUG ADDICTION DURING PREGNANCY – RISK FACTOR FOR PERINATAL INFECTIONS

Introduction. Neonatal infections are a major causes of neonatal morbidity and mortality. Pregnancy complicated by illicit drug abuse is a risk for perinatal infection. Objective. To assess the incidence of early-onset neonatal sepsis (the fi rst 7 days of life) in newborns from high-risk pregnancies for perinatal infections: the ones affected by drug abuse, without medical assistance versus clinical and fully investigated pregnancies. Material and methods. Retrospective study on newborns from “IOMC – Emergency Clinical Hospital of Obstetrics and Gynaecology Gh Polizu”, Bucharest, sorted in two separate groups: one of 25 newborns, from 2005 to 2012, coming from uninvestigated pregnancies in women with illicit drug dependencies and another of 50 newborns from properly managed pregnancies from the clinical and anamnestic point of view, but with known risk factors for perinatal infections. The data has been statistically analysed (correlation tests: Student T, Fisher exact, chi-square) Results. The incidence of newborns from pregnancies affected by drug abuse was 0,09% in all 28489 newborns, the highest percentage of 0,2% being recorded in 2011. Statistically signifi cant differences between the two groups of newborns with risk factors for perinatal infections (emerged from uninvestigated pregnancies with drug abuse and respectively from investigated pregnancies) were: the age of the mothers – lower in drug addicted mothers (p_value 0,0002), the percentage of congenital infections (p_value 0,00003; OR 0,03; 95%CI) and respectively the mean length of hospital stay-days (p_value0,0180) higher in dug addicted mothers. On the other hand: the delivery by cesarean section (p_value 0,0010), urogenital colonisation (p_value 0,0016) were more frequent in newborns from investigated pregnancies. A percent of 22 of all investigated women were positive for Group B Streptococcus and the most frequent type was I b type. The share of perinatal infections among neonatal morbidity was 33% for the newborns from drug addicted mothers and 27% for the newborns from investigated mothers. The incidence of neonatal infections was 52% for the newborns from drug addicted mothers (a risk of 1 in 1,9 cases) and 18% for the newborns from investigated mothers (a risk of 1 in 5,5 cases) Conclusions. Drug addiction during pregnancy represents a high risk factor for perinatal infections due to sexual and blood transmitted diseases associated with lack of hygiene, precarious nutrition and low immunological status and leads to high medical and social costs. The correct medical management of pregnancies, through early diagnosis and treatment of neonatal infections may lower the incidence and the consequences of perinatal infections