The importance of metabolic evaluation in patients with nephrolithiasis

Urology and Surgical Nephrology Department, Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova, The 6th International Medical Congress for Students and Young Doctors, May 12-14, 2016Introduction: Nephrolithiasis has a significant social and financial burden. However, the impact of this disease can be diminished by the appropriate metabolic evaluation of recurrent stone formers, in order to identify the risk factors for recurrent stone events. The significance of biochemical screening in stone formers has been a debated topic. This study was conducted to investigate the rate of metabolic abnormalities in our recurrent kidney stone formers so that this information would help in assessing the value of biochemical screening in our practice. Purpose: To investigate the frequency of metabolic abnormalities in patients with nephrolithiasis. Material and methods: Over a fifteen-month period, recurrent kidney stone disease patients had one random blood specimen and one random 24-hour urine collection, analyzed for metabolic abnormalities. Serum was checked for calcium,uric acid, urea, phosphate and creatinine. The urine was measured for volume, pH, urea, creatinine, calcium, magnesium, oxalate, citrate, crystals and urine culture. Results: Out of a total of 110 patients, 85 (77,27%) had some urinary or blood abnormality. The highest number of abnormalities was in urine. Low volume 37 (43,52%), hypercalciuria34 (40,08%), hyperoxaluria20 (23,52%), hyperuraturia 21 (24,14%) and positive urine culture 18 (21,17%) were the main urinary abnormalities. Elevated serumcreatininein 9 (10,58%) patients was the commonest blood abnormality. Females had significantly higher frequencies of urinary infection (44,68% vs 12,5%, p<0,001), low urinary volume (46,81% vs 20,0%, p<0,01), hyperoxaluria(36,17% vs 10,0%, p<0,01) and hypocitraturia(36,17% vs 0%, p<0,001). Conclusion: A high frequency of urinary metabolic disorders in recurrent nephrolithiasis highlights the significance of metabolic evaluation in this category of patients. Most of the biochemical abnormalities, if treated, can considerably lower the recurrence rate of recurrent stone disease, one thus concludes that for rational, efficient and specific urolithiasis management, biochemical screening and particularly urinary screening should be practiced. Such diagnostic evaluation would help in providing precise treatment and efficient prophylaxis

A flood vulnerability index for coastal cities and its use in assessing climate change impacts

Worldwide, there is a need to enhance our understanding of vulnerability and to develop methodologies and tools to assess vulnerability. One of the most important goals of assessing coastal flood vulnerability, in particular, is to create a readily understandable link between the theoretical concepts of flood vulnerability and the day-to-day decision-making process and to encapsulate this link in an easily accessible tool. This article focuses on developing a Coastal City Flood Vulnerability Index (CCFVI) based on exposure, susceptibility and resilience to coastal flooding. It is applied to nine cities around the world, each with different kinds of exposure. With the aid of this index, it is demonstrated which cities are most vulnerable to coastal flooding with regard to the system's components, that is, hydro-geological, socio-economic and politico-administrative. The index gives a number from 0 to 1, indicating comparatively low or high coastal flood vulnerability, which shows which cities are most in need of further, more detailed investigation for decision-makers. Once its use to compare the vulnerability of a range of cities under current conditions has been demonstrated, it is used to study the impact of climate change on the vulnerability of these cities over a longer timescale. The results show that CCFVI provides a means of obtaining a broad overview of flood vulnerability and the effect of possible adaptation options. This, in turn, will allow for the direction of resources to more in-depth investigation of the most promising strategies

Destrucţiile pulmonare acute în practica pulmonologică

Autorul a analizat internările anuale şi mortalitatea prin destrucţii pulmonare acute în secţia de chirurgie toracică a SCR din ultimii 10 ani şi a stabilit că rata DPA din totalul internărilor anuale este de 16,3%, iar cota mortalităţii prin DPA din letalitatea generală este de 51,1%. Evaluarea unui lot de 100 de pacienţi cu destrucţii pulmonare acute a stabilit unele din cauzele frecvenţei acestei patologii în ţara noastră, accentul fi ind pus pe profi laxia DPA prin tratamentul corect al pneumoniilor acute la nivelul secţiilor de pneumologie

Hemopneumotoracele spontan

Pneumohemotoracele spontan este o cauză importantă a hipovolemiei inexplicabile la pacienţii tineri şi poate fi pericol vital. Tactica de management la pacienţii stabilizaţi hemodinamic după drenajul pleural şi fără pierderi sanguine ulterioare este controversată. Sunt prezentate 2 cazuri clinice proprii, unde sunt aplicate metode diferite de tratament. Actualmente, micşorarea duratei tratamentului staţionar, a complicaţiilor postoperatorii, a costului tratamentului, favorizează videotoracoscopia chirurgicală vs toracotomie în managementul pacienţilor cu pneumohemotorace spontan

Evaluation of nutrition harmlessness in Rîşcani district

Department of Hygiene Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of MoldovaIntroduction. The people’s health mainly depends on living conditions, including the quality and safety of food. Thus, producers and food service providers, directly or indirectly involved in the food chain, must provide safe products according with consumers expectations, European regulations and National legislation. In order to maintain the quality and safety of food chain, there are necessary regulations for determination of food quality and monitoring procedures to ensure that the whole process is carried out in good condition. Aim of the study. To evaluate the sanitary-hygienic indicators harmlessness of food products in Rîşcani district during 2011-2015. Materials and methods. We conducted a retrospective study of laboratory tests of food samples at the Public Health Center in Rîşcani district during the last 5 years,2011-2015, using laboratory and instrumental methods approved by the Public Health Center laboratories. Food samples were taken in Rîşcani district. In order to assess their safety, the data analyzed were: the sanitarymicrobiological indicators, the pesticide content, and the sanitary-hygienic indicators. Foodsamples, also, were researched according to the following sanitary - microbiological indicators: the number of aerobic mesophilic germs and optionally anaerobic bacteria(NGMAFA), B.coliforme, E. coli, B. cereus, S. aureus, pathogenic Enterobacteria, P. aeruginosa, B. acidolactic, Enterococi, and others. Results. We have examined 4174 samples tested for 15023 indicators. In 2015, out of 2,188 indicators, only 20 were inappropriate (0,91%), the most harmless year. In 2011 was established the highest proportion of inadequate samples, 1.31% (45 out of 3430 indicators). The most frequent bacteria determined in food samples were NGMAFA, established in 54 samples out of 146 (36.98%). The highest number of NGMAFA bacteria were determined in 2012, and the most favorable year was 2011. More frequent deviations in NGMAFA indicators were established in the following food products: milk and dairy products, meat and meat products, poultry and poultry products, eggs and others. The second most frequent bacteria determined was B. Coliform with 52 samples infected out of 146(35.61%), and the third place was S. Aureus with 36 samples infected out of 146( 24.65%). Conclusions. During 2011-2015 there was a decrease in food samples deviations according with sanitary-hygienic indicators in Rîşcani district

Sepsisul în inflamaţiile şi distrucţiile pulmonare acute

Autorul analizează particularităţile infecţiei generalizate cu punct de origine pleuropulmonar conform criteriilor de Consens internaţional 1991, 2001. În baza analizei tuturor cazurilor de pneumonie cu evoluţie severă, a destrucţiilor pulmonare acute şi a complicaţiilor lor, tratate în secţia toracală a SCR în anii 1995-2005, autorul a stabilit prezenţa tuturor fazelor sepsisului, inclusiv disfuncţia de organe şi şocul septic

Rupture of the left main bronchus (case report)

Catedra chirurgie FECMF, USMF „Nicolae Testemiţanu", Chişinău, Republica Moldova, Al XII-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” din Republica Moldova cu participare internațională 23-25 septembrie 2015Caz clinic: În timpul unor lucrări, pieptul unui bărbat de 25 ani a fost prins între un perete şi tractor. În spitalul raional au fost drenate ambele cavităţi pleurale, s-a eliminat aer şi 200 ml lichid sero-hemoragic. Peste 5 zile pacientul a fost transportat în secţia toracală a SCR. La internare acuză dureri în hemitoracele stîng, tuse cu eliminări de spută muco-purulentă, dispnee la efort fizic minim, febră – 37,3°C, stabil respirator şi hemodinamic. Din drenul stîng se elimină 150 ml lichid hemoragic în 24 ore. La bronhoscopie – bronhia primitivă stîngă (BPS) este obturată la nivelul bifurcaţiei lobare, după aspiraţie s-a stabilit ruptura completă a acesteia. Peste 9 zile după traumă s-a efectuat operaţia: intubaţia în bronhia principală dreaptă, toracotomia posterolaterală stînga, prin spaţiul intercostal 6. Plămânul este colabat la 1/3 volum, atelectazat, în pleură – 300 ml lichid galben, fibrină în cantităţi mari. S-a stabilit ruptura complectă a BPS cu 3 cm mai sus de diviziunea lobară. S-a efectuat anastomoza termino-terminală cu fire separate Vicryl®. După completarea anastomozei, tubul de intubaţie a fost extras în trahee, iar ventilarea pulmonară a stabilit etanşietatea anastomozei. Primele 4 zile s-a efectuat bronhoscopie zilnic, ulterior – la 2-3 zile cu înlăturarea granulaţiilor. S-a dezvoltat o infecţie superficială a plăgii postoperatorii, tratată prin drenaj aspirativ. După 3 săptămâni postoperator dinamica clinică a devenit progresiv pozitivă, cu restabilirea completă a ventilaţiei plămânilor.Clinical case: The chest of a 25 years old man was compressed between a wall and a machine. At the rural hospital, both pleural cavities were drained with elimination of 200 mL of serous hemorrhagic fluid. After 5 days he was transferred to thoracic surgery department of Republican Clinical Hospital. At admission patient had complaints to the pain in left hemithorax, productive cough with purulent sputum, and shortness of breath at minimal effort. The body temperature was 37.3°C, he was stabil cardiorespiratory. The volume of hemorrhagic fluid from left pleural cavity was 150 mL in 24 hours. During bronchoscopy we detected complete rupture of the left main bronchus. On 9th posttrauma day he was operated: after intubation of right main bronchus, via a left posterolateral thoracotomy through the 6th intercostals space revealed pulmonary collapse by 1/3 of volume, complete atelectasis of left lung, and 300mL of yellow fluid with fibrin in pleural cavity. Complete rupture of the left main bronchus, 3 cm above the lobar division, was repaired by end-to-end anastomosis with interrupted Vicryl® sutures. After completion of the anastomosis, the intubation tube was withdrawn to the trachea, and ventilation of the left lung confirmed anastomosis integrity. During the first 4 postoperative days, bronchoscopy was performed daily, then, at 2-3 days interval. There was a minor, superficial surgical site infection, treated by aspirative drainage and lavage of the wound. After 3 weeks, ventilation of both lungs become normal and the patient was discharged

„Round pneumonia”. Case report and review

Catedra Chirurgie FPM, USMF „N.Testemiţanu”Este prezentat un caz clinic în care manifestările clinico-radiologice pulmonare corespund entităţii nozologice „pneumonie rotundă”, cu localizare în lobul superior stâng. Analiza datelor literaturii de specialitate evidenţiază faptul că acest tip de pneumonie poate fi provocat de diverse microorganisme şi viruşi, evoluţia clinică poate fi severă, antibioterapia fiind metoda efectivă. În lipsa dinamicii clinico-radiologice sub tratament antibacterian, se recomandă diagnosticul diferenţial cu carcinomul pulmonar, inclusiv prin metode invazive.A case of „round pneumonia”, located in left upper lobe is reported. Bibliographic review of similar reports demonstrates that „coin” pulmonary lesions have different bacterial and viral etiologies and identical pathogenesis. Absence of clinico-radiologic improvement/ resolution on antibiotics imposes invasive differential diagnosis with bronchopulmonary carcinoma