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.
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.
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.
Liviu-Laurențiu Pop, Mihaela Dediu, Iulian Velea, Mirela Mogoi and Ioana M. Ciuca
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.
Sonia Elena Popovici, Ovidiu Horea Bedreag and Dorel Sandesc
The emergence of multi-drug resistant Acinetobacter spp 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 A. baumannii, 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.
Corina V. Vernic, Paul T. Tamas, Ruxandra Buriman, Ovidiu Horea Bedreag and Dorel Sandesc
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.
Anca Dinu, Mihai Sandesc, Sonia Elena Popovici, Razvan Gabriel Dragoi, Amaricai Elena and Tiberiu Bratu
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.
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.
Robert Ivaşcu, Ligia Torsin, Darius Morlova, Alina Stanca, Mihai Neguţu, Silvius Negoiţă and Mădălina Duţu
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.
Ana Antoaneta Bobia, Oana Alexandra Blaj, Denis Oancea, Bagiu Iulia-Cristina, Bagiu Radu-Vasile, Horhat Delia-Ioana, Laurentiu Pirtea, Silvia Matinca, Amel Isaq and Ioana Ciuca
Background. 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.
Aim. Our aim was to identify the prevalence of Beta Hemolytic Streptococcus in a Children’s Tertiary Care Hospital in Timisoara.
Methods. 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.
Results. 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.
Conclusions. Considering the limited data found on our subject, further epidemiological studies on streptococcal disease complex are needed.
Mihaela Ioana Maris, Mihaela Flavia Avram and Danina Mirela Muntean
Compared to deep vein thrombosis in the lower limbs, upper extremity deep vein thrombosis is uncommon and therefore much less explored or even neglected.
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.
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, 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.