CONTRIBUTION OF IMAGING EXAMINATIONS IN DIAGNOSIS OF INTRACRANIAL COMPLICATIONS IN CHILDREN OTOMASTOIDITIS

Introduction. Otitis media (OM) is one of the most common infections in child pathology, most often with selflimited evolution (1,2). In 2-6% of cases (2) developed, intracranial complications with unfavorable, fatal outcome in 8-26.3% of them (2,3). Presence of neurological signs in the evolution of suppurative otitis require early imaging examinations (2-8). Material and methods. We presents the case of a 10 year old girl with suppurative otitis complicated, transferred to the Clinical Emergency Hospital for Children „M.S. Curie“, Bucharest to ENT department after 2 weeks of disease progression. The child presents at hospital: fever, purulent otorrhea, neurological signs represented by headache, seizures, stiff neck. Contrast-enhanced computed tomographic (CT) were performed in emergency. Result. CT scanning, extended to the neck show the presence of a lytic process in the temporal bone, solution of continuity between mastoid antrum and meninges with epidural abscess form over sigmoid sinus,trombophlebitis and thrombus of sigmoid sinus, which is propagate to the lateral sinus and the jugular vein ;signs of meningitis, cerebellar cerebritis, brain temporal abscess and subdural empyema. Conclusions. Complications in middle ear infections are rare, but the appearance of neurological signs in clinical examination must be completed by CT of head with contrast, which can specify local architecture, presence of local or distant complications, help in the application to a fast and appropriate therapy

Tehnologii medicale avansate – HIFU – tratamentul cancerului prostatic prin ablaţie termică

HIFU Center, Clinica Endoplus, Cluj Napoca, Romania, Universitatea de Medicină şi Farmacie ”Iuliu Haţieganu” Cluj Napoca, Romania, Al V-lea Congres de Urologie, Dializă şi Transplant Renal din Republica Moldova cu participare internaţională (1-13 iunie 2011)Cancerul de prostată reprezintă una din cauzele majore de morbiditate şi mortalitate la bărbaţi. Alternativele terapeutice ale acestei patologii variază de la supraveghere activă, chirurgie clasică, radioterapie, la modalităţi inovatoare, miniminvazive, cum este cazul terapiei focale cu ultrasunete (HIFU, High-intensity focused ultrasound) sau chirurgia robotică. HIFU este o procedură medicală de înaltă precizie care utilizează ultrasunetele [1]. Prin focusarea ultrasunetelor şi concentrarea lor într-un punct prestabilit se obţine o temperatură de 65–100°C. Valurile acustice sunt propagate spre ţesutul ţintă, iar undele sunt absorbite cu derularea conversiei termice. Rezultatul este ablaţia ţesutului vizat prin necroză de coagulare, fără efect cumulativ în organul ţintă [2]. Terapia unei anumite zone se efectuează prin mobilizarea sondei sau a braţului robotic de susţinere, cu respectarea unui protocol specific fiecărui organ sau patologie prestabilite de către echipa operatorie. În prezent, singura metodă de cuantificare a distrugerilor tisulare postterapie HIFU este rezonanţa magnetică, cu rezerva dezavantajului că nu se poate aplica (momentan) în timp real [3]

Spatio-temporal insights into microbiology of the freshwater-to-hypersaline, oxic-hypoxic-euxinic waters of Ursu Lake

Ursu Lake is located in the Middle Miocene salt deposit of Central Romania. It is stratified, and the water column has three distinct water masses: an upper freshwater-to-moderately saline stratum (0–3 m), an intermediate stratum exhibiting a steep halocline (3–3.5 m), and a lower hypersaline stratum (4 m and below) that is euxinic (i.e. anoxic and sulphidic). Recent studies have characterized the lake's microbial taxonomy and given rise to intriguing ecological questions. Here, we explore whether the communities are dynamic or stable in relation to taxonomic composition, geochemistry, biophysics, and ecophysiological functions during the annual cycle. We found: (i) seasonally fluctuating, light-dependent communities in the upper layer (≥0.987–0.990 water-activity), a stable but phylogenetically diverse population of heterotrophs in the hypersaline stratum (water activities down to 0.762) and a persistent plate of green sulphur bacteria that connects these two (0.958–0.956 water activity) at 3–3.5 to 4 m; (ii) communities that might be involved in carbon- and sulphur-cycling between and within the lake's three main water masses; (iii) uncultured lineages including Acetothermia (OP1), Cloacimonetes (WWE1), Marinimicrobia (SAR406), Omnitrophicaeota (OP3), Parcubacteria (OD1) and other Candidate Phyla Radiation bacteria, and SR1 in the hypersaline stratum (likely involved in the anaerobic steps of carbon- and sulphur-cycling); and (iv) that species richness and habitat stability are associated with high redox-potentials. Ursu Lake has a unique and complex ecology, at the same time exhibiting dynamic fluctuations and stability, and can be used as a modern analogue for ancient euxinic water bodies and comparator system for other stratified hypersaline systems

Effect of alirocumab on mortality after acute coronary syndromes. An analysis of the ODYSSEY OUTCOMES randomized clinical trial

Background: Previous trials of PCSK9 (proprotein convertase subtilisin-kexin type 9) inhibitors demonstrated reductions in major adverse cardiovascular events, but not death. We assessed the effects of alirocumab on death after index acute coronary syndrome. Methods: ODYSSEY OUTCOMES (Evaluation of Cardiovascular Outcomes After an Acute Coronary Syndrome During Treatment With Alirocumab) was a double-blind, randomized comparison of alirocumab or placebo in 18 924 patients who had an ACS 1 to 12 months previously and elevated atherogenic lipoproteins despite intensive statin therapy. Alirocumab dose was blindly titrated to target achieved low-density lipoprotein cholesterol (LDL-C) between 25 and 50 mg/dL. We examined the effects of treatment on all-cause death and its components, cardiovascular and noncardiovascular death, with log-rank testing. Joint semiparametric models tested associations between nonfatal cardiovascular events and cardiovascular or noncardiovascular death. Results: Median follow-up was 2.8 years. Death occurred in 334 (3.5%) and 392 (4.1%) patients, respectively, in the alirocumab and placebo groups (hazard ratio [HR], 0.85; 95% CI, 0.73 to 0.98; P=0.03, nominal P value). This resulted from nonsignificantly fewer cardiovascular (240 [2.5%] vs 271 [2.9%]; HR, 0.88; 95% CI, 0.74 to 1.05; P=0.15) and noncardiovascular (94 [1.0%] vs 121 [1.3%]; HR, 0.77; 95% CI, 0.59 to 1.01; P=0.06) deaths with alirocumab. In a prespecified analysis of 8242 patients eligible for ≥3 years follow-up, alirocumab reduced death (HR, 0.78; 95% CI, 0.65 to 0.94; P=0.01). Patients with nonfatal cardiovascular events were at increased risk for cardiovascular and noncardiovascular deaths (P<0.0001 for the associations). Alirocumab reduced total nonfatal cardiovascular events (P<0.001) and thereby may have attenuated the number of cardiovascular and noncardiovascular deaths. A post hoc analysis found that, compared to patients with lower LDL-C, patients with baseline LDL-C ≥100 mg/dL (2.59 mmol/L) had a greater absolute risk of death and a larger mortality benefit from alirocumab (HR, 0.71; 95% CI, 0.56 to 0.90; Pinteraction=0.007). In the alirocumab group, all-cause death declined wit h achieved LDL-C at 4 months of treatment, to a level of approximately 30 mg/dL (adjusted P=0.017 for linear trend). Conclusions: Alirocumab added to intensive statin therapy has the potential to reduce death after acute coronary syndrome, particularly if treatment is maintained for ≥3 years, if baseline LDL-C is ≥100 mg/dL, or if achieved LDL-C is low. Clinical Trial Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT01663402

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

APORTUL IMAGISTICII ÎN DIAGNOSTICUL COMPLICAŢIILOR INTRACRANIENE SECUNDARE OTOMASTOIDITEI LA COPIL

Introducere. Otita medie (OM) acută este una dintre cele mai comune infecţii diagnosticate în patologia copilului, cu evoluţie autolimitată cel mai frecvent (1,2). Ea poate duce în 2-6% dintre cazuri (2) spre complicaţii supurative intracraniene cu evoluţie nefavorabilă, fatală în 8-26,3% din ele (2,3). Apariţia semnelor neurologice în evoluţia unei otite supurative necesită investigaţii imagistice de urgenţă (2-8). Material şi metodă. Se prezintă cazul unei fetiţe de 10 ani diagnosticată cu otită supurată complicată, transferată la Spitalul Clinic de Urgenţă pentru Copii „M.S. Curie“ Bucureşti în secţia ORL după o evoluţie a bolii de 2 săptămâni. Copilul se prezintă la internare cu: febră, otoree purulentă, semne neurologice reprezentate de cefalee, convulsii, redoare de ceafă. Se efectuează în urgenţă un examen computer tomografi c (CT) cu substanţă de contrast intravenoasă (iv). Rezultat. Examenul CT, extins şi la nivel cervical evidenţiază prezenţa unui proces litic la nivelul stâncii temporale şi soluţie de continuitate între antrul mastoidian şi meninge, şi evidenţierea unui abces epidural perisigmoidian, tromboza de sinus sigmoid extinsă la nivelul jugularei şi sinusului lateral, semne de meningită, cerebrită cerebeloasă, abces cerebral şi empiem subdural. Concluzii. Complicaţiile în infecţiile urechii medii sunt rare, însă apariţia semnelor neurologice la examenul fi zic impune un examen imagistic care poate preciza arhitectura locală, prezenţa complicaţiilor locale sau la distanţa pentru instituirea unui tratament adecvat şi rapid

Opportunity and Utility in Applying Scenarios Method in the Critical Infrastructures Protection Field

Critical infrastructures protection research field is booming today because of the practical aspects and sometimes by taking in consideration its imminence character which should be addressed to it. The complexity of this domain originates from critical infrastructures architectures, dominated by the local or regional interdependencies and by the necessity feature of ensuring proper functionality, all in a framework of analysis characterized by unprecedented diversification of physical and / or virtual threats. In this context, this article analyzes (theoretical and based on a practical study) the possibility of using scenarios as a high form of contextual representation method