Routine assessment of cerebroplacental ratio at 35-37 weeks' gestation in the prediction of adverse perinatal outcome

Background: Third trimester studies in selected high-risk pregnancies have reported that low cerebroplacental ratio (CPR), due to high pulsatility index (PI) in the umbilical artery (UA), and or decreased PI in the fetal middle cerebral artery (MCA), is associated with increased risk of adverse perinatal outcomes. Objective: To investigate the predictive performance of screening for adverse perinatal outcome by the cerebroplacental ratio (CPR) measured routinely at 35+6 - 36+6 weeks’ gestation. Methods: This was a prospective observational study in 47,211 women with singleton pregnancies undergoing routine ultrasound examination at 35+6 - 36+6 weeks’ gestation, including measurement of UA-PI and MCA-PI. The measured UA-PI and MCA-PI and their ratio were converted to multiples of the median (MoM) after adjustment for gestational age. Multivariable logistic regression analysis was used to determine whether CPR improved the prediction of adverse perinatal outcome that was provided by maternal characteristics, medical history and obstetric factors. The following outcome measures were considered: first, adverse perinatal outcome consisting of stillbirth, neonatal death or hypoxic ischemic encephalopathy grades 2 and 3, second, presence of surrogate markers of perinatal hypoxia consisting of umbilical arterial or venous cord blood pH ≤7 and ≤7.1, respectively, 5-minute Apgar score 24 hours, third, cesarean section for presumed fetal distress in labor, and fourth, neonatal birthweight <3rd percentile for gestational age. Results: Low CPR was associated with increased risk of adverse perinatal outcome, presence of surrogate markers of perinatal hypoxia, cesarean section for presumed fetal distress in labor and birth of neonates with birthweight <3rd percentile. However, multivariable regression analysis demonstrated that the prediction of these adverse outcomes by maternal demographic characteristics and medical history was only marginally improved by the addition of CPR. The performance of low CPR in the prediction of each adverse outcome was poor, with detection rates of 13–26% and false positive rate of about 10%. In appropriate for gestational age (AGA) neonates with birthweight ≥10th percentile the predictive accuracy of CPR was low with positive and negative likelihood ratios (LRs) ranging from 1.21 to 1.82, and 0.92 to 0.98, respectively; although the accuracy was better in small for gestational age (SGA) neonates this was also low with positive LRs of 1.31 to 2.26 and negative LRs of 0.69 to 0.92. Similar values were obtained in fetuses classified as SGA and AGA according to the estimated fetal weight. In the prediction of adverse outcomes within two weeks, rather than at any stage, after assessment the detection rate was higher but this was achieved at higher false positive rate and therefore similar positive and negative LRs. Conclusion: In pregnancies undergoing routine antenatal assessment at 35+0 - 36+6 weeks’ gestation measurement of CPR provides poor prediction of adverse perinatal outcome in both SGA and AGA fetuses. Consequently, there is no justification in a shift of the focus of prenatal care from identification of pregnancies with low estimated fetal weight to that of pregnancies with low CPR

Histological and immunohistochemical evaluation of mandibular bone tissue regeneration

The purpose of the study was to perform an immunohistochemical and histological evaluation of samples taken from different bone regeneration procedures in atrophic human mandible. 30 patients (15 men and 15 women, age range of 35-60 years), non-smokers, with good general and oral health were recruited in this study and divided into three groups. The first group included patients who were treated with blood Concentration Growth Factors (bCGF), the second group included patients who were treated with a mixture of bCGF and autologous bone, while the third group of patients was treated with bCGF and tricalcium phosphate/hydroxyapatite (TCP-HA). Six months after the regenerative procedures, all patients undergone implant surgery, and a bone biopsy was carried out in the site of implant insertion. Each sample was histologically and immunohistochemically examined. Histological evaluation showed a complete bone formation for group II, partial ossification for group I, and moderate ossification for group III. Immunohistochemical analysis demonstrated a statistically significant difference between the three groups, and the best clinical result was obtained with a mixture of bCGF and autologous bone

Качественный анализ расхода и запасов медикаментов в госпитальных аптеках, важный фактор обеспечения качества лечения больных

The study represents a qualitative analysis of drugs consumption and stocks in National Center of Emergency Medicine during 2009-2010 years. The results show a high relatively of line consumption drugs according to classification ATC (Anatomical, Therapeutical, and Chemical). Evaluation of drug stocks has shown some positive and negative deviations from normative stock that were possible to be estimated clearly only from consumption and stocks data analysis according to Pharmacotherapeutic drug groups for a month and year periods, and are argument in determining annual medicine needs and planning the financial allocations, which directly depends on the quality of medical services in medical, paramedical sections, and other subdivisions of public medical institutions.Данная работа заключается в качественном анализе расхода и запасов медикаментов в Национальном Научно-Практическом Центре Ургентной Медицины в период 2009-2010 годов. Результаты показывают практическое совпадение расхода медикаментов по основным группам анатомической, терапевтической и химической классификационной системы ВОЗ (АТХ классификация). Анализ запасов медикаментов за соответствующий период указывает на некоторые положительные и отрицательные отклонения от расхода за месяц или год, которые удалось выявить более наглядно только при изучении данных запасов по фармакотерапевтическим группам. Полученные результаты вместе с данными о расходе медицинского имущества послужат основанием для качественного расчета годовых потребностей, для планирования финансирования закупок медикаментов и организации текущего снабжения, что в конечном итоге напрямую повлияет на качество оказываемых медицинских услуг в лечебных отделениях и других подразделениях лечебно-санитарных учреждений

Rapid communication: Physical and linkage mapping of the porcine calcitonin (CALC) gene

Genus and Species. Sus scrofa. Locus. Porcine calcitonin (CALC) gene. Source and Description of Primers. Primers, CCA1F and CCA1R, were designed from canine calcitonin sequence (GenBank Accession no. AJ271090) to amplify genomic porcine DNA. Using sequence obtained from the amplified PCR product, additional pig-specific primers (CIPBF, CIPBR, CIPCF, CIPCR) were designed

Quantum Phase Transition of Spin-2 Cold Bosons in an Optical Lattice

The Bose-Hubbard Hamiltonian of spin-2 cold bosons with repulsive interaction in an optical lattice is proposed. After neglecting the hopping term, the site-independent Hamiltonian and its energy eigenvalues and eigenstates are obtained. We consider the hopping term as a perturbation to do the calculations in second order and draw the phase diagrams for different cases. The phase diagrams show that there is a phase transition from Mott insulator with integer number bosons to superfluid when the ratio $c_0/t$ ($c_0$ is the spin-independent on-site interaction and $t$ the hopping matrix element between adjacent lattice sites) is decreased to a critical value and that there is different phase boundary between superfluid and Mott insulator phase for different Zeeman level component in some ground states. We find that the position of phase boundary for different Zeeman level component is related to its average population in the Mott ground state.Comment: 16 pages, 6 figure

Fournier's gangrene: summary of 8 years of clinical experience

Catedra Chirugie nr.1 „N.Anestiadi”, USMF „Nicolae Testemiţanu”, Spitalul „Sf.Arhanghel Mihail”, Chişinau, Republica Moldova, Al XII-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” din Republica Moldova cu participare internațională 23-25 septembrie 2015Introducere: Gangrena Fournier este o fasciită necrozantă care implică zona genitală şi perineul, progresează spre coapse şi peretele abdominal prin trabeculele fasciale. Material şi metode: Experienţa noastră include opt pacienţi cu gangrena Fournier, trataţi pe parcursul anilor 2006-2014. Repartizarea după sex a fost: 5 femei şi 3 bărbaţi. În etiologia bolii putem evidenţia calea ano-rectală (2 cazuri), infecţia urogenitală (3 cazuri) şi infecţia pielii (3 cazuri). Diagnosticul a fost stabilit în baza tabloulului clinic şi examenului ultrasonor. Toţi pacienţii au beneficiat de debridare chirurgicală radicală imediată, necrozectomii seriate, antibioticoterapia combinată şi terapie intensivă. Numărul de operaţii seriate a variat de la 4 până la 13. Rezultate: În urma tratamentului efectuat am obţinut stoparea procesului de necroză la 7 pacienţi. Doi pacienţi au evoluat spre septicemie cu hemocultură pozitivă. La un pacient sa dezvoltat şocul toxico-infecţios. Analiza bacteriologică din plagă a determinat: Staphylococcus aureus (2 cazuri), Enterococcus faecium (un caz), Escherichia coli (2 cazuri), floră mixtă (3 cazuri). Mortalitatea a fost de 37,5%. Concluzii: Stabilirea precoce a diagnosticului şi debridarea primară imediată urmată de necrozectomii etapizate stau la baza evoluţiei favorabile a procesului necrotico-septic. Antibioticoterapia efectuată prin asocierea a 3 antibiotice cu diferit spectru de acţiune împiedică răspândirea procesului putrid şi generalizarea infecţiei. Mortalitatea înaltă în gangrena Fournier este dic tată de insuccesele terapiei intensive în stările septice avansate cu comorbidităţi severe, în pofida metodelor contemporane de tratament chirurgical.Introduction: Fournier's gangrene is a necrotizing fasciitis which involves the genitals regions and perineum, spreading to thighs and abdominal wall through fascial trabeculae. Material and methods: Our experience includes eight patients with Fournier's gangrene treated during 2006-2014. Distribution by gender: 5 women and 3 men. In the etiology of the disease we can highlight ano-rectal way (2 cases), urogenital infection (3 cases) and skin infection (3 cases). The diagnosis was based on clinical features and ultrasound exam. All patients underwent immediate radical surgical debridement, serial necrosectomy, combined antibiotic therapy and intensive care. Number of serial operations ranged from 4 to 13. Results: After the provided treatment we were able to stop the process of necrosis in 7 patients. Two patients progressed to sepsis with positive blood test. Toxico-infectious shock was present in one patient. Bacteriological analysis showed: Staphylococcus aureus (2 cases), Enterococcus faecium (one case), Escherichia coli (2 cases), and mixed flora (3 cases). Mortality was 37.5%. Conclusions: Early diagnosis establishment and immediate primary debridement followed by serial necrosectomy is the base of the favourable evolution of the necrotic septic process. Antibacterial therapy carried out by the association with 3 different action spectrum antibiotics prevent the spread of the putrid process and generalized of infection. High mortality in Fournier's gangrene is a consequence of failures in intensive care in advanced sepsis with severe comorbidities, in spite of the contemporary methods of the surgical treatment

Задачи фармацевтической службы в чрезвычайных ситуациях

With the sharp rise of accidents and great catastrophes caused by man, local military conflicts in recent centuries, and unprecedented acts of terrorism, the economies of many countries are faced with choosing liquidation as a solution to the related medical consequences in order to provide medical assistance to their victims—in particular the prediction of sanitary losses and stockpiling drugs necessities for these purposes. The economy and health system in The Republic of Moldova is currently facing such a situation. The analysis results defined the role and place of drugs and other medicine supply systems along with the need to establish appropriate pharmaceutical resources depending on the projected number of sanitary losses as a consequence of emergency situations. Based on the estimated volume of sanitary losses and the nomenclature and consumption quantity of drugs for medical assistance, a number of victims were identified with common needs or drugs for these purposes. An emphasis was placed on the ability of the country’s pharmaceutical market for the creation of an adequate supply of medicines for emergency-situation needs and simultaneously save funds under the state budget deficit.Одновременно с резким ростом, в последние столетия, количество техногенных аварий и катастроф особо крупных размеров, локальных военных конфликтов во многих странах мира, террористических актов, невиданных по своей жестокости, экономика стран столкнулась с решением проблем по ликвидации последствий чрезвычайных ситуаций. В частности, в оказании медицинской помощи пострадавшим, что предполагает прогнозирование санитарных потерь и создание запасов медицинского имущества для этих целей. С подобными ситуациями сталкивается экономика и система здравоохранения Республики Молдова. В результате проведенных анализов были определены: роль и место снабжения медикаментами и другим медицинским имуществом, необходимость создания соответствующих запасов, в зависимости от прогнозируемого количества санитарных потерь, как следствие чрезвычайных ситуаций. Исходя из объема прогнозируемых санитарных потерь, номенклатуры и количества медикаментов для оказания медицинской помощи определенного количества пострадавших, были определены общие потребности для этих целей. Был сделан акцент на возможности внутреннего фармацевтического рынка в создании необходимых запасов медикаментов для чрезвычайных ситуаций, что одновременно может сэкономить значительное количество денежных средств из государственного бюджета страны