rss_2.0Central European Journal of Clinical Research FeedSciendo RSS Feed for Central European Journal of Clinical Research European Journal of Clinical Research 's Cover of infections and antimicrobial resistance. A review<abstract><title style='display:none'>Abstract</title><p>The emergence of multi-drug resistant <italic>Acinetobacter spp</italic> involved in hospital-acquired infections, once considered an easily treatable pathogen, is troublesome and an immense burden for the modern medical systems worldwide. In the last 20 years the medical community recorded an increase in the incidence and severity of these infections as therapeutic means tend to be less and less effective on these strains. The ability of these bacteria to rapidly develop resistance to antimicrobial agents by continuously changing and adapting their mechanisms, their ability to survive for long periods of time in the hospital environment and the multitude of transmission possibilities raises serious issues regarding the management of these complex infections. The future lies in developing new and targeted methods for the early diagnosis of <italic>A. baumannii</italic>, as well as in the judicious use of antimicrobial drugs. This review details the evolution of the pathogenicity of this microorganism, together with the changes that appeared in resistance mechanisms and the advancements in molecular testing for the early detection of infection.</p></abstract>ARTICLE2019-05-04T00:00:00.000+00:00Nutrition challenges in polytrauma patients. New trends in energy expenditure measurements<abstract><title style='display:none'>Abstract</title><p>Patients hospitalized in Intensive Care Units (ICU) are in severe general condition and they need specialized care, rehabilitation and proper nutrition to improve their condition and recover as soon as possible. Therefore, it is very important that nutrition consists of all necessary elements that will cover their daily demand for nutrients. However, malnutrition among ICU patients is very common. According to statistics, up to 50% is malnourished. It enhances average length of stay, risk of infection, prolongs ventilator days, delays wound healing and translates into an increased hospital cost. It may end in multi-organ failure, what in consequence increases mortality. Polytrauma pa tients lost their energy because of intensified catabolism, due to neuroendocrine changes and inflammatory reactions, which may worsen already existing malnutrition.</p></abstract>ARTICLE2019-05-04T00:00:00.000+00:00The prevalence of Beta Hemolytic Streptococcus in a Children’s Tertiary Care Hospital in Timisoara<abstract><title style='display:none'>Abstract</title><p><bold>Background.</bold> Beta hemolytic streptococcus (BHS) represents a worldwide health problem because of the complications that can occur. Thus, it is important to identify the presence and type of BHS in time to start treatment if needed, avoiding the complications.</p><p><bold>Aim.</bold> Our aim was to identify the prevalence of Beta Hemolytic Streptococcus in a Children’s Tertiary Care Hospital in Timisoara.</p><p><bold>Methods.</bold> A cross-sectional study was conducted from April-June 2018 in Emergency Hospital for Children Timisoara. The study lot consists from 1100 children, ages between 0-18 years, which were not given, in the preceding two weeks, any antibiotics. We compared the study with two studies from different cities in Nepal, with the same subject as ours. Group A and Group C Streptococci were identified by beta hemolytic colonies, bacitracin sensitivity, catalase negativity test and latex agglutination test (Oxoid Streptococcal Grouping kit). ASO (Antistreptolysin O) test was also performed from serum samples, for patients with positive cultures. We also tested the antibiotic sensitivity to: Cefepime, Clindamycin, Erythromycin, Tetracycline.</p><p><bold>Results.</bold> The prevalence of BHS (Beta Hemolytic Streptococcus), especially GABHS (Group A Beta Hemolytic Streptococcus) was 4%, in children from a tertiary care hospital in Timisoara, Romania; which is comparable to the findings of similar studies. In the first study, the prevalence of GABHS was 7.2%, and in the second study was 9%. The patients with positive cultures were also tested for ASO, 28 patients (52%) had high levels, while 26 (48%) had normal levels. On all positive patients an antibiogram was made and we observed that most of the isolates were sensitive to the antibiotics used. A few isolates in Group A were resistant.</p><p><bold>Conclusions.</bold> Considering the limited data found on our subject, further epidemiological studies on streptococcal disease complex are needed.</p></abstract>ARTICLE2019-05-04T00:00:00.000+00:00New Drug Delivery Systems Concept in Anaesthesia and Intensive Care—Controlled Release of Active Compounds<abstract><title style='display:none'>Abstract</title><p>With time, medical and pharmaceutical research has advanced significantly. However, one of the major issues is how to administer the active substance. Among these, it counts over-or under-dosage of the active substance, low response to treatment, or increased clinical risk of the patient. An innovative method able to avoid these obstacles is represented by controlled release systems for active substances. The interest for these systems came with allowing encapsulation in the antibiotic release matrices, local anesthetics, protein or other substances. Moreover, a number of such vehicles are now available to release controlled substances used predominantly in the anesthesia and intensive care unit.</p></abstract>ARTICLE2019-05-04T00:00:00.000+00:00Volemic replacement during spinal cord injury patients. upper extremity deep vein thrombosis in a Caucasian woman<abstract><title style='display:none'>Abstract</title><p>Compared to deep vein thrombosis in the lower limbs, upper extremity deep vein thrombosis is uncommon and therefore much less explored or even neglected.</p><p>We present the case of a 40-year-old female working in the bakery industry, who was admitted for acute onset of upper limb oedema accompanied by pain and functional impairment, affirmative secondary to the sustained and intense effort of the dominant arm. The diagnosis was confirmed by Duplex Ultraso nography on the eighth day after the onset of symptoms. Since clinical examinations and laboratory work excluded any cause of secondary thrombosis, the diagnosis of primary thrombosis was established. The only possible cause of this episode was linked to the woman’s work. The trigger for the thrombotic event was represented most likely by strenuous physical activity with temporary obstruction of the thoracic outlet in the work field. Under anticoagulant treatment, the signs and symptoms gradually resolved. Unfortunately, at the one-year follow-up exam, the patient was diagnosed with post-thrombotic syndrome of the right, dominant arm.</p></abstract>ARTICLE2019-05-04T00:00:00.000+00:00Pharmacological therapies for acute respiratory distress syndrome<abstract><title style='display:none'>Abstract</title><p>Acute respiratory distress syndrome (ARDS) has no specific treatment, the only effective therapy currently being limited to minimizing potentially harmful ventilation and avoiding a positive fluid balance. These treatments could not be completely effective in severe disease and several measures must be undertaken simultaneously, including pharmacological therapies aimed at correcting the etiology or targeting the pathogenesis. In this review article we provide update on pharmacological therapies in ARDS, showing their effect on outcome in recent trials.</p></abstract>ARTICLE2019-05-04T00:00:00.000+00:00Hemofiltration Romanian Registry – Typologies of patients identified by cluster analysis<abstract><title style='display:none'>Abstract</title><p>Hemofiltration National Registry is one of the patient registries implemented lately in Romania, currently in use, in response to increased clinical and research needs. The registries of patients with extracorporeal support of vital functions were developed with the support of Romanian Society of Anesthesia and Intensive Care. The registry contains data on over 200 hemofiltration procedures that were per formed in the last 3 years in multiple Romanian hospitals. A sample of data containing records of 2018 was analyzed by K-means clustering, revealing patterns that are potentially useful for healthcare improvement. Among the 6 clusters identified, 3 contain patients with a high mortality rate (90-100%), 1 is defined by intermediate mortality (72%) and 2 by a lower mortality rate (62%). Further research is needed in order to refine the clustering criteria, by using a larger number of cases and potentially examining more outcomes.</p></abstract>ARTICLE2019-05-04T00:00:00.000+00:00Cystic fibrosis related diabetes<abstract><title style='display:none'>Abstract</title><p>Cystic fibrosis related diabetes (CFRD) is a redoubtable complication associated to cystic fibrosis, with an increasing frequency, directly proportional to children life expectancy. Although this complication has similar features with DM type 1 and some with type 2, the evolution and even the response to insulin therapy is different. It is also possible that other factors to influence the CFRD clinical expression and subsequently the disease evolution. Since its 1t diagnosis was associated with more frequent pulmonary exacerbations and with the deterioration of the respiratory status, therefore CFRD must be early and correctly diagnosed and managed. The aim of this paper is to present an overview of the recent updates and recommendations regarding this important CF complication.</p></abstract>ARTICLE2019-05-04T00:00:00.000+00:00Refeeding syndrome relevance for critically ill patients<abstract><title style='display:none'>Abstract</title><p>Refeeding Syndrome (RFS) is a potential life-threatening complication of the nutritional therapy in the replenishment phase after period of starvation. This not very known syndrome may be a life-threatening metabolic condition due to rapid, inadequate nutritional support in malnourished catabolic patients. The intake of food and therefore the switch from a catabolic to an anabolic metabolism is most considered etiological mechanism. The main biochemical feature of RFS is hypophosphatemia and low levels of potassium and magnesium. Lack of vitamins, especially vitamin B1 or thiamine is often present and involves severe clinical complications.</p></abstract>ARTICLE2019-05-04T00:00:00.000+00:00Procedural Sedation and Analgesia in Adults - new trends in patients safety<abstract><title style='display:none'>Abstract</title><p>Sedation and analgesia may be needed for many interventional or diagnostic procedures, whose number has grown exponentially lately. The American Society of Anesthesiologists introduced the term “procedural sedation and analgesia” (PSA) and clarified the terminology, moderate sedation and Monitored Anesthesia Care. This review tries to present a nondissociative sedation classification, follow ing ASA guidelines as well as pre-procedural assessment and preparation, in order to choose the appropriate type and level of sedation, patient monitoring and agents, which are most commonly used for sedation and/or analgesia, along with their possible side effects. The paper also lists the possible complications associated with PSA and a few specific particularities of procedural sedation.</p></abstract>ARTICLE2019-05-04T00:00:00.000+00:00The Clinical Value of Red Blood Cell Distribution Width as a Prognosis Factor and Severity Marker in Sepsis and Septic Shock<abstract><title style='display:none'>Abstract</title><p>Red blood cell distribution width (RDW) is a hematological parameter usually measured with every complete blood count. Its place in daily practice is mainly in the differential diagnosis of anemia, but nowadays, researchers are focused on different approaches for the erythrocyte’s changes in function and morphology.</p><p>Sepsis and its most advanced form, septic shock, induces profound disturbances into organ system’s function and morphology. The red blood cells physiology and structure are directly and indirectly altered by these im balances produced in sepsis. RDW was studied in many diseases, like acute heart failure, acute stroke, inflammatory bowel diseases, chronic lung diseases and cancer, but also in sepsis. Its changes are seen to be mainly associated with prognosis. Higher values of RDW are correlated with mortality and severity of illnes in septic and all-cause critically ill patients. RDW was studied also as an independent variable in different predictive scores and some studies suggest it should be introduced in the scores use on a daily basis in critical care settings and emergency departments.</p><p>In this review we will focus on how RDW was associated with mortality and severity of illness in the recent literature, as an independent prognosis factor and as a component part in different predictive and severity scores.</p></abstract>ARTICLE2019-05-04T00:00:00.000+00:00Association of Coronary Wall Shear Stress With Atheromatous Plaque Vulnerability: A Systematic Review<abstract><title style='display:none'>Abstract</title><p> Acute coronary syndromes are usually triggered by the erosion or rupture of a vulnerable coronary plaque. A vulnerable plaque (VP) is an atheromatous plaque which, after suffering different transformations, is prone to rupture causing an acute coronary event. Such a VP carries inside several biomarkers considered as “signatures of vulnerability”, which, if identified, can prompt timely initiation of therapeutic measures in order to prevent the development of an acute myocardial infarction. The most freqeuntly used techniques for identification of vulnerability markers are computed tomographic angiography (CTA), intravascular ultrasound and optical coherence tomography. Endothelial shear stress (ESS) represents a new promising biomarker associated with plaque vulnerability. Determination of ESS is nowadays possible using noninvasive imaging techniques, based on complex computational post-processing of multiple datasets extracted from CTA images and advanced computational fluid dynamics technologies. The aim of this systematic review was to evaluate the role of the coronary ESS, determined using advanced computational techniques for image post-processing, as a feature associated with CTA-derived biomarkers of atheromatous plaque vulnerability, underlining the conceptual differences between high ESS and low ESS as promotors of vulnerability.</p></abstract>ARTICLE2018-10-03T00:00:00.000+00:00Recurrent Wheezing Fibrillation a Benign Condition? Quality of Life Approach<abstract><title style='display:none'>Abstract</title><p> Introduction: Atrial fibrillation (AF) is the most frequent cardiac rhythm disorder, considered until recently benign. Due to its major complications (cardio-embolic episodes) patients need to be anticoagulated. Aim: To assess the quality of life (QOL) in patients with new oral anticoagulants (NOAC) versus those using classical anticoagulants (VKA). Methods: A total of 483 patients admitted consecutively in our clinic were evaluated during hospitalization and after discharge. Follow-up visits were conducted: at baseline, 6, 12, 18 and 24 months; the quality of life (QoL) was measured by a specific questionnaire (EQ-5D-3L), and the results were assessed. Patients were divided in two groups considering their anticoagulant use: NOAC or VKA. Baseline characteristics, clinical outcomes as well as QoL indices were compared between the two groups The current research has been conducted in accordance with the ethical prin ciples set out in the Helsinki Declaration and Good Clinical Practice Recommendations and was approved by our hospital Ethics Committee. Results: The mean age of our studied group (374 eligible patients) was 64.7 ± 8.2 years (p=0.220); 116 patients (31.01%) used NOAC. Patients with NOAC obtained better results in all domains: physical (57.0±8.9 vs. 51.1±12.5 vs. 42.0±6.2; p&lt;0.001), social (62.6±19.8 vs. 52.5±20.0 vs. 45.7±16.0; p=0.019) and environmental (62.9±12.7 vs. 52.7±7.6 vs. 60.7±3.6; p =0.018). Compared to VKAs, NOACs were more commonly prescribed in patients with a history of stroke or with a higher thromboembolic risk (p&lt;0.001). EQ-5D-3L total score: 75.6 ± 20.9; visual analogue scale: 63.1 ± 20.6. Conclusion(s): Satisfaction and QoL with oral anticoagulants were high, although they were both better with NOACs. A worse QoL was associated with comorbidities, polypragmasy, and previous treatment with VKA. Patients strongly expressed their desire to improve their QoL.</p></abstract>ARTICLE2018-10-03T00:00:00.000+00:00Erector Spinae Block. A Narrative Review<abstract><title style='display:none'>Abstract</title><p> The erector spinae plane block is a novel ultrasound-guided technique that has recently been described for the management of acute and chronic thoracic pain. Currently an increasingly number of indications for the ESP block have been published. Nevertheless, the anatomy, mechanism of action, doses and volume of local anesthetic needed are still unclear. The aim of this narrative review is study this new block with base on the updated medical literature.</p></abstract>ARTICLE2018-10-03T00:00:00.000+00:00Sepsis in Critically Ill Patients – From Molecular to Clinical View Characteristics Among Cystic Fibrosis Patients in Western Romania<abstract><title style='display:none'>Abstract</title><p> Background: Pulmonary infectious inflammation is a major cause of decline in lung function in patients with cystic fibrosis (CF) marked by exacerbations, consequently, slowing evolution of lung disease is a primary aim in CF management. The objective of the study was to analyze the microbiological spectrum from epidemiological point of view in our patients. Methods: An observational, cross-sectional transversal study including fifty-seven patients evaluated the prevalence of CF-related microbes in the study group and their pulmonary status. Results: The most frequent microorganism found in our group, regardless age, was Staphyloccocus aureus, closely followed by Pseudomonas aeruginosa. Bacillus tuberculosis was a rare germ, despite the important frequency in our country. The microbes frequency was different with age groups, thus 3.5% of 1-3 years old children had the methicillin sen sitive Staphylococcus aureus (MSSA) strain, while for the 6-12 years group, Pseudomonas aeruginosa was found in an equal percentage of 14% with MSSA. Pseudomonas prevalence was found in 14.0% of adults and the combined infections were diagnosed in about a fifth of our patients. Conclusions: We concluded that the percentage of respiratory infections with redoubtable microbes is relatively moderate. The presence of underweight among CF patients with severe mutations are risk factor for a worse outcome and measures should be instituted.</p></abstract>ARTICLE2018-10-03T00:00:00.000+00:00Read Science Differently, Look at Science Differently, and Publish Your Science Differently D in Critically Ill Patients - From Molecular Damage Interactions to Clinical Outcomes Benefits. When, Why, How?<abstract><title style='display:none'>Abstract</title><p> Vitamin D - „the sunshine vitamin” is essential for the good functioning of the human body. The most important forms of the vitamin D are the vitamin D2 and the vitamin D3, both biologically inactived. Vitamin D can come from: diet or nutritiv suplimentts and skin. The activation of vitamin D is effect in two steps to the physiologically active 1,25-dihydroxyvitamin D [1,25(OH)2D]. The biological actions of Vitamin D involve regulation of gene expression at the transcriptional level and are mediated through binding to a Vitamin D Receptor (VDR). Vitamin D has multiple roles: hormonale/ nonhormonale, skeletale/nonscheletale, genomice/nongenomice. Interesting is inversely corelation between Vitamin D and total body fat (BMI) and correlation between Vitamin D and cognitive impairment, especially Alzheimer Disease or delirium during hospitalisation. The curent recomandations regarding the supplying with Vitamin D are different for regions of the globe, also differ depending on the baseline serum Vitamin D and on the desired effect. So, potential nonskeletal effects occur at levels &gt;30ng/ml, above 50-75ng/ml, serum level who should become the target of the supplementation. The loading dose should be considered perioperatively for rapid effects. In conclusion, Vitamin D is more than just a vitamin. It is a substance with multiple roles in body’s economy, and in recent years there has been an interest in the relation be tween vitamin D deficiency and obesity or cognitive impairment. The majority of the data supports association, not causation, of low vitamin D levels. In other words, much of data does not clearly support the idea that vitamin D supplementation in a patient with low vitamin D levels reduces the risk of these diseases. But, the supplimentation is very easy and no harm might be done.</p></abstract>ARTICLE2018-10-03T00:00:00.000+00:00en-us-1