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.
Tiberiu Bratu, Anca Dinu, Mihai Sandesc, Sonia Elena Popovici, Razvan Gabriel Dragoi, Amaricai Elena and Dorel Sandesc
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.
Mădălina Duţu, Robert Ivascu, Darius Morlova, Alina Stanca, Dan Corneci and Silvius Negoita
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, following 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.
Annabella Benedek, Diana Opincariu, Imre Benedek, Ionuț Ferenț, Roxana Hodaș, Emese Marton and Theodora Benedek
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.
Țica Ovidiu, Otilia Anca Țica, Adrian Hatos, Larisa Roșan and Mircea Ioachim Popescu
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<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<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.
María Bermúdez López, Álvaro Gasalla Cadórniga, José Manuel López González, Enrique Domínguez Suárez, Carlos López Carballo and Francisco Pardo Sobrino
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.
Ioana Mihaiela Ciuca, Liviu Laurentiu Pop, Alexandru Florin Rogobete, Monica Marc, Liviu Athos Tamas and Florin George Horhat
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.