KAKO MLADI LJUDI PROVODE VRIJEME ONLINE?

Nowadays, children and young adults have embraced new information technologies in large numbers. These younger age groups use Internet for many of their daily activities and they do it more than any other age group. Information and communication technologies (ICT) affect people’s everyday lives in so many ways. Mobile phones, tablets, netbooks, laptops and computers are just some of the devices used frequently, often daily, by a large proportion of the population and particularly by young people. So, in this article we will address the issue of young adult\u27s (ages 18 - 25) dependence on gadgets, how do they spend their time online and what their preferences are. The objectives of this paper are: to examine the time spend by the young adults with their tech-devices, to analyze the purpose of following certain sites, to examine what tech-devices they are preferring. The research was conducted to evaluate and to compare the time spend by the young adults with their tech- devices between two countries, Romania and Croatia, in the period from 10 May to 15 May by online survey questionnaire on 136 students from Romania and Croatia.Mlađa populacija ljudi (djeca i adolescenti) danas su prigrlili nove informacijske tehnologije u velikom broju. Navedena populacija koristi Internet za svoje mnogobrojne dnevne aktivnosti te to rade više od svih drugih dobnih skupina. Informacijske i komunikacijske tehnologije utječu na živote ljudi na mnogo različitih načina. Mobiteli, tableti, netbook, prijenosna računala i sl. samo su neki od uređaja koje veliki dio populacije svakodnevno koristi, a pogotovo mladi ljudi. Stoga se ovaj rad bavi problematikom vezanom za mlade ljude (u dobnoj skupini od 18 do 25 godina) i njihovom povezanošću sa informacijskim i komunikacijskim tehnologijama, odnosno kako provode svoje vrijeme online te koje su im preferencije posebice u pogledu informacijskih uređaja koje koriste. Ciljevi rada su: istražiti koliko vremena provode na svojih uređajima, razloge zbog kojih prate određene stranice te koje tehnološke uređaje preferiraju. U tu svrhu provedeno je istraživanje kako bi se usporedile dvije skupine mladih ljudi, jednu skupinu čine mladi ljudi iz Rumunjske dok drugu skupinu čine mladi ljudi iz Hrvatske. Istraživanje je provedeno u period od 10. do 15. svibnja putem online anketnog upitnika na uzorku od 136 studenata

The principles of sterilization of allogenic bone grafts

Coordonator d.h.m., profesor Nacu Viorel Laboratorul Inginerie Tisulară şi Culturi Celulare, Catedra Anatomie Topografică şi Chirurgie Operatorie USMF „Nicolae Testemiţanu”The existence of many methods of sterilization indicates the absence of an ideal method for processing bone grafts, so the search for new methods or upgrade existing ones remains actual. This article analyzes the known methods of sterilization of allogeneic bone grafts. The effectiveness of any sterilization methods depend on the microorganisms contamination. The 209 purpose of this reasearch is to study the literature and to determine the actuality of chemical and physical methods of sterilization of bone grafts. It is difficult to determine a perfect sterilization method because each method has advantages and disadvantages. To use of any material for conservation and sterilization must meet the following criteria: to sterilize tissue; to keep its morphological structure, to reduce its antigenicity, to maintain the maximum regenerative capacity, do not have toxic action or cause inflammatory reactions after transplantation. Multitudinea metodelor de sterilizare indică inexistenţa unei metode ideale pentru procesarea grefelor osoase, astfel căutarea unor metode noi sau modernizarea celor existente rămâne actuală. În acest articol sunt analizate metodele de sterilizare a grefelor osoase alogene cu oxid de etilen, formaldehidă şi iradiere gamma. Scopul acestui studiului este studierea bibliografiei şi elucidarea actualităţii în metodele de sterilizare chimică şi fizică a grefelor osoase. Eficacitatea oricărei metode de sterilizare depinde şi de tipul de microorganism prezent. Este greu de evaluat o metodă de sterilizare perfectă, deoarece fiecare metodă are unele avantaje şi dezavantaje. Utilizarea oricăror materiale de conservare şi sterilizare trebuie să îndeplinească următoarele criterii: să sterilizeze ţesutul; să păstreze structura morfologică a lui; să reducă antigenitatea acestuia; să menţină la maximum capacităţile regeneratoare ale ţesutului pentru utilizarea clinică; să nu aibă acţiune toxică sau să provoace reacţii inflamatorii în organism

Hepatocytes isolation from adult rats for liver recellularization

Tissue Engineering and Cells Cultures Laboratory, Nicolae Testemitsanu State University of Medicine and Pharmacy, Chisinau, the Republic of MoldovaBackground: Currently hepatocytes obtaining is prerequisite to create the necessary conditions for medical research, because it is an important tool in developing of new strategies in tissue engineering domain, which represents obtaining functional organs in laboratory conditions. Material and methods: The study was made on adult Wistar rats liver with body weight 274.66± 2.52 g (n=3) which were used for hepatocytes extraction by perfusion through the upper cave vein with combination of type II collagenase and type I dispase and Hank’s 0.9 mM MgCl2, 0.5 mM EDTA and 25 mM HEPES (HiMedia, India). Results: The cells were counted with trypan blue 0.25% in hemocytometer and cultured in William’s E medium (HiMedia, India) with 2 mM L-glutamine, 5% fetal bovine serum (Lonza, Belgium), antibiotic antimycotic solution (HiMedia, India), 100 nM dexamethasone and 100 nM insulin, with 2.5 x 105 cells per well in 12-well plates. After isolation were obtained 324, 48 ± 1, 25 x 106 hepatocytes, with a viability of 94.7 ± 0.9 % which indicates a high yield of cells viability. Conclusions: The hepatocyte isolation method by liver perfusion with the combination of collagenase-dispase is feasible for obtaining a large amount of functional hepatocytes intended for the recellularization in vitro of decellularized liver scaffolds. The yield and viability of hepatic cells could be increased by enzymatic digestion of liver tissue using combination of collagenase/dispase solution due to the less cytotoxic effect

The right to life. Legal status of the human embryo

Introduction. This paper aims to review the controversial issues in the field of human rights: the status of the human embryo. Since the moment the creation of human embryos in laboratory condition became available, ethical questions continued to arise and emphasize it’s irascible status. During pregnancy the embryo is part of another human being’s body lacking a legal status distinct from that of his mother’s. Defining the right to life and its prime beneficiaries is an important step in gaining a unitary position on a special status of the human embryo. This special legal status derives from the embryo’s recognized potential to become a human being. Aim of the study. Evaluation of the legal, medical, ethical and philosophical approaches of defining life and the right to life. Materials and methods. This study is a review of the literature, based on the synthesis of articles published in the period 1977-2021, 31 scientific sources were researched. This article includes publications identified through Google Search Engines, PubMed Databases, etc. The information has been systematized, highlighting the most important aspects of the detection and use of stem cells derived from menstrual blood (MenSC). Results. The new reproductive technologies allows interference in the whole process of human creation, from conception to the establishment of characters such as the choice of sex which, in a world ruled by good faith would only bring benefits, but in reality can be used as a discriminatory tool. Despite the undeniable importance of this right, none of the international documents that value the right to life have come to define it. Moreover, there is no unanimous definition of the term "person" or "human being", the direct beneficiaries of the right to life. Conclusions. Human embryos, through their potential to become human beings, are a powerful symbol of human life, but it is not possible to grant it an equivalent status to individuals, or any direct collision with the interests of already born human beings would deprive it of any legal protection. Key words: the right to life, reproductive rights, embryo

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Laparoscopy in management of appendicitis in high-, middle-, and low-income countries: a multicenter, prospective, cohort study.

BACKGROUND: Appendicitis is the most common abdominal surgical emergency worldwide. Differences between high- and low-income settings in the availability of laparoscopic appendectomy, alternative management choices, and outcomes are poorly described. The aim was to identify variation in surgical management and outcomes of appendicitis within low-, middle-, and high-Human Development Index (HDI) countries worldwide. METHODS: This is a multicenter, international prospective cohort study. Consecutive sampling of patients undergoing emergency appendectomy over 6 months was conducted. Follow-up lasted 30 days. RESULTS: 4546 patients from 52 countries underwent appendectomy (2499 high-, 1540 middle-, and 507 low-HDI groups). Surgical site infection (SSI) rates were higher in low-HDI (OR 2.57, 95% CI 1.33-4.99, p = 0.005) but not middle-HDI countries (OR 1.38, 95% CI 0.76-2.52, p = 0.291), compared with high-HDI countries after adjustment. A laparoscopic approach was common in high-HDI countries (1693/2499, 67.7%), but infrequent in low-HDI (41/507, 8.1%) and middle-HDI (132/1540, 8.6%) groups. After accounting for case-mix, laparoscopy was still associated with fewer overall complications (OR 0.55, 95% CI 0.42-0.71, p < 0.001) and SSIs (OR 0.22, 95% CI 0.14-0.33, p < 0.001). In propensity-score matched groups within low-/middle-HDI countries, laparoscopy was still associated with fewer overall complications (OR 0.23 95% CI 0.11-0.44) and SSI (OR 0.21 95% CI 0.09-0.45). CONCLUSION: A laparoscopic approach is associated with better outcomes and availability appears to differ by country HDI. Despite the profound clinical, operational, and financial barriers to its widespread introduction, laparoscopy could significantly improve outcomes for patients in low-resource environments. TRIAL REGISTRATION: NCT02179112

Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.

BACKGROUND: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. METHODS: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. RESULTS: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. CONCLUSIONS: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care. STUDY REGISTRATION: ISRCTN5181700

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

Global economic burden of unmet surgical need for appendicitis

Background: There is a substantial gap in provision of adequate surgical care in many low-and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods: Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results: Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion: For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially