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  • Author: Ovidiu Horea Bedreag x
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Metabolism Disaster in Polytrauma Patients
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Oxidative Stress and Antioxidant Therapy in Critically Ill Polytrauma Patients with Severe Head Injury

Abstract

Traumatic Brain Injury (TBI) is one of the leading causes of death among critically ill patients from the Intensive Care Units (ICU). After primary traumatic injuries, secondary complications occur, which are responsible for the progressive degradation of the clinical status in this type of patients. These include severe inflammation, biochemical and physiological imbalances and disruption of the cellular functionality. The redox cellular potential is determined by the oxidant/antioxidant ratio. Redox potential is disturbed in case of TBI leading to oxidative stress (OS). A series of agression factors that accumulate after primary traumatic injuries lead to secondary lesions represented by brain ischemia and hypoxia, inflammatory and metabolic factors, coagulopathy, microvascular damage, neurotransmitter accumulation, blood-brain barrier disruption, excitotoxic damage, blood-spinal cord barrier damage, and mitochondrial dysfunctions. A cascade of pathophysiological events lead to accelerated production of free radicals (FR) that further sustain the OS. To minimize the OS and restore normal oxidant/antioxidant ratio, a series of antioxidant substances is recommended to be administrated (vitamin C, vitamin E, resveratrol, N-acetylcysteine). In this paper we present the biochemical and pathophysiological mechanism of action of FR in patients with TBI and the antioxidant therapy available.

Open access
Surgical Pleth Index™ (SPI)-Guided Analgesia during Damage Control Surgery in Trauma Patients
Open access
Entropy-Guided Depth of Anesthesia in Critically Ill Polytrauma Patients
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Influence of Hypothermia on the Clinical and Molecular Status of a Freshwater Drowning Victim with Severe Trauma. A Case Report

Abstract

Drowning in freshwater kills many people around the world. Complications are multiple and sometimes impossible to treat. Fluid and electrolyte resuscitation is difficult because of all the physiological, biophysical and biochemical changes that decrease the rate of survival. Extreme lung injury and cardiovascular disorders are responsible for tissue hypoxia, increased production of inflammation markers, biosynthesis of reactive oxygen species and finally, multiple organ damage. Hypothermia, frequently associated with drowning, provides multiple benefits to this type of patients. Various studies have developed the idea that hypothermia protects the brain from biochemical mediators, thereby preventing neuronal cell destruction. In this case report we present the biological parameters and evolution of a patient drowned in freshwater, and also the benefits of hypothermia to the clinical picture.

Open access
Hemofiltration Romanian Registry – Typologies of patients identified by cluster analysis

Abstract

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.

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Evolution of Acinetobacter baumannii infections and antimicrobial resistance. A review

Abstract

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.

Open access
Detection of Myocardial Injury Using miRNAs Expression as Genetic Biomarkers in Acute Cardiac Care

Abstract

Cardiovascular disease is a leading cause of death globally. At present, there are many ways to diagnose this pathophysiology. The greatest disadvantages related to current biomarkers are their low specificity, low selectivity and low accuracy. A new method, extensively studied recently, is the expression of miRNAs, used as genetic biomarkers for the early diagnosis of cardiovascular diseases. This paper presents an update of miRNAs species expression that can serve as early diagnostic biomarkers and for the continuous monitoring of patients with cardiovascular disease.

Open access
A novel evaluation of microvascular damage in critically ill polytrauma patients by using circulating microRNAs

Abstract

The management of the critically ill polytrauma patient is complex due to the multiple complications and biochemical and physiopathological imbalances. This happened due to the direct traumatic injury, or due to the post-traumatic events. One of the most complex physiopathology associated to the multiple traumas is represented by microvascular damage, subsequently responsible for a series of complications induced through the imbalance of the redox status, severe molecular damage, reduction of the oxygen delivery to the cell and tissues, cell and mitochondrial dead, augmentation of the inflammatory response and finally the installation of multiple organ dysfunction syndrome in this type of patients. A gold goal in the intensive care units is represented by the evaluation and intense monitoring of the molecular and physiopathological dysfunctions of the critically ill patients. Recently, it was intensely researched the use of microRNAs as biomarkers for the specific physiopathological dysfunctions. In this paper we wish to present a series of microRNAs that can serve as biomarkers for the evaluation of microvascular damage, as well as for the evaluation of other specific physiopathology for the critically ill polytrauma patient.

Open access
The Effects of Homocysteine Level in the Critically Ill Patient. A Review

Abstract

Increased levels of homocysteine (HCYS) represent a risk factor for a series of physiopathological conditions: mental retardation, cardiovascular and neurodegenerative diseases, Parkinson's and Alzheimer's disease, depression, osteoporosis, endothelial dysfunction and inhibition of cell proliferation. This paper aims to present the pathophysiological implications of HCYS and the correlation of hyperhomocysteinemia (H-HCYS) with critical condition in the intensive care unit (ICU). Hypovitaminosis B and folate deficiency is directly involved in the inhibition of HCYS metabolism and the accumulation of HCYS in the plasma and tissues. Critically ill patients are more prone to H-HCYS due to hypermetabolism and accelerated synthesis produced by reactive oxygen species (ROS). In conclusion it can be affirmed that the determination and monitoring of HCYS plasma levels may be of interest in optimizing the therapy for critically ill patients. Moreover, by controlling HCYS levels, and implicitly the essential cofactors that intervene in the specific biochemical pathways, such as vitamin B6, vitamin B12 and folic acid can provide a diversified and personalized treatment for each patient.

Open access