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Introducere. Începând cu anul 2016, România se confruntă cu o epidemie importantă de rujeolă apărută pe fondul unui procent tot mai scăzut de vaccinare. Evoluţia epidemiei a fost marcată şi de o creştere alarmantă a numărului de complicaţii şi decese. Materiale şi metode. Am evaluat retrospectiv 632 pacienţi diagnosticaţi cu rujeolă, internaţi în Spitalul Clinic de Boli Infecţioase şi Tropicale „Dr. Victor Babeş“, în perioada ianuarie 2016 – decembrie 2017. Datele epidemiologice, caracteristicile clinice şi rezultatele probelor biologice au fost obţinute din fişele medicale ale pacienţilor. Rezultate. Din cei 632 de pacienţi, 341 (53,9%) au fost de sex masculin. Grupa de vârstă cea mai afectată a fost 1-4 ani (39,2%), urmată de cea a sugarilor cu un procent de 19,6%. O treime din cazuri (31,3%) au avut contactul infectant în cadrul familiei. În ceea ce priveşte statusul vaccinal, aproape jumătate din pacienţi (47,1%) nu au fost vaccinaţi, iar 44,3% nu cunoşteau istoricul de vaccinare (probabil nevaccinaţi sau incomplet vaccinaţi). Complicaţiile virale au fost prezente la majoritatea pacienţilor (84,1%) sub forma unei pneumonii interstiţiale. Pneumonia bacteriană a fost prezentă la 15% dintre pacienţi, iar dintre aceştia 45,2% au asociat şi insuficienţă respiratorie. Şase pacienţi au necesitat transfer în secţia de terapie intensivă pediatrie pentru suport respirator, înregistrându-se 2 decese. Laringita a fost prezentă în 8,2% cazuri, otita în 12% cazuri, în timp ce 61,7% dintre pacienţi au avut afectare gastrointestinală. Paraclinic, a fost evidenţiată citoliza hepatică la 101 (15,9%) pacienţi şi diselectrolitemia a fost prezentă la 94 (14,8%) din cazuri. Concluzii. Studiul prezent arată creşterea alarmantă a incidenţei bolii şi a complicaţiilor sale în ultimii 3 ani, mai ales la vârstele mici. Considerăm imperios necesară aplicarea programului de vaccinare pentru a asigura o acoperire vaccinală optimă, utilă atât în stoparea epidemiei actuale, cât şi în prevenirea unor viitoare epidemii.

Romania is located in an area with high seismicity, the role of emergency hospitals being a major one in providing medical aid in the case of earthquakes with mass casualties. The article aims to characterize the particular issues related to specific pathology in case of a seismic disaster, whose proactive awareness and anticipation are important for a good management of the medical-surgical activity. An extensive review of literature was conducted, including scientific studies, recommendations, and practice guides on emergency response planning, published between 2000 and 2018. Emergency hospitals must provide for a surge of 20% in total beds number, allocating the necessary human and material resources. The medical assistance in case of disaster with mass victims presents clinico-surgical particularities related to the dynamics of aflux in the ER, triage, casuistic, gravity and specific risks, with a direct impact on the medical-surgical care protocols. Conclusions. Pre-disaster preparation is the key to an effective management in crisis. Simulation, repeat, and periodic renewal of planning are required. Besides, for an orderly and efficient medical activity, regular education and training of health personnel is of major importance.

Infectious meningitis is a serious medical problem that can be fatal if treatment is delayed. Objectives. There are presented clinical and laboratory aspects of patients with suspected meningitis, presented and hospitalized during 2014-2017 at Hospital for Infectious and Tropical Diseases Dr V. Babes Bucharest. Clinical and paraclinical variables that show statistically significant differences depending on the etiology of meningitis have been identified. Methods. Patients who showed signs and symptoms according to the case definition would be included in the study. Clinical and laboratory values were recorded in a database which was then processed to identify statistically significant differences between the group of patients with suspicion only but subsequently not ill against the group of confirmed, and also among different subgroups within the confirmed. Results. Of the 97 cases of infectious meningitis included within 3 years, 53 cases (55%) were viral, 31 (32%) bacterial, one case of fungal meningitis and 12 cases of tuberculous meningitis.

Meningitele infecţioase sunt afecţiuni severe cu evoluţie rapid nefavorabilă în cazul întârzierii aplicării tratamentului corect. Obiective. Prezentarea aspectelor clinice şi paraclinice (laborator) ale pacienţilor suspectaţi de meningită, internaţi în perioada 2014-2017 la Spitalul Clinic de Boli Infecţioase şi Tropicale „Dr. V. Babeş“. Metode. Au fos incluşi în studiu pacienţii care prezentau semne şi simptome de meningită acută conform definiţiei de caz. Valorile clinice şi paraclinice au fost înregistrate într-o bază de date care ulterior a fost prelucrată statistic pentru identificarea diferenţelor semnificative statistic între grupul infirmat şi grupul celor confirmaţi de meningită şi între diferitele subgrupuri din cadrul celor confirmaţi de meningită. Rezultate. Dintre cele 96 de cazuri de meningite infecţioase confirmate, 53 (54%) de cazuri au fost virale, 31 (32%) bacteriene, 12 cazuri de meningită tuberculoasă, 1 caz de meningită fungică. Au fost identificate diferenţe semnificative statistic între variabilele clinice şi paraclinice şi etiologia meningitei.

Diabetic retinopathy is a well-known complication of diabetes, a major cause of vision loss worldwide. Purpose. The present study investigates the correlation between hypertension and evolution of diabetic retinopathy in patients with type II diabetes. Materials and methods. We conducted a prospective study between June and December 2016, on 24 patients hospitalized in Ophthalmology Clinic, Emergency University Hospital Bucharest, with AO: diabetic retinopathy and arterial hypertension under medical treatment. Patients were evaluated at baseline, 2 months, 4 months and 6 months through comprehensive eye examination and measuring the value of blood pressure (BP). Comparative data were analyzed in patients with compensated hypertension (BP = 150 mmHg). Results. Of the 24 patients, 15 had values offset BP (group A) and 9 associated hypertension subcompensated (group B). In group A proportion of patients (at baseline) with diabetic retinopathy absent or nonproliferative was higher than patients in group B (47% vs. 22%, p = 0.052995019518117). Patients in group B had a higher tendency to record an evolution of diabetic retinopathy (in group B, 55.55% of patients had a progression, and in group A, only 26.66%). Conclusions. Incomplete therapeutic control of hypertension may affect the retinal microvasculature impacting the progression of diabetic retinopathy. Maintaining a strict control of systolic BP of permanent value bellow 140 mmHg should be part of the patient management guide of the diabetic patient in order to prevent ophthalmic complications with major risk of vision loss.

Objective. Analyzing the dynamycs of global antibiotic resistance of some bacterial species isolated from patients admitted to the „Dr. V. Babes” Hospital for Infectious and Tropical Diseases, between the years 2000 to 2015. Material and methods. Antibiotic resistance profiles of bacteria isolated from inpatients, were identified by the standard diffusion method and MIC values by VITEK2C and E-test methods. (CLSI and EUCAST standards). Screening of carbapenemases – producing isolates were performed by phenotipic methods, and the confirmation by RealTimePCR: “MasterPure™ Complete DNA and RNA Purification Kit” (Epicentre), „Primer Design™ Kit” (blaOXA48; blaKPC, blaNDM, blaVIM)/ LightScanner 32 Instrument/LS32 (Idaho Technology), and GeneXpert. Internal quality control: Staphylococcus aureus ATCC29213, Streptococcus pneumoniae ATCC49619, E. coli ATCC25922, Pseudomonas aeruginosa ATCC27853. Results. The incidence of St. aureus meticilino-rezistent (MRSA) highlights an increase from 12.2% (2002) to 40.4% (2015). In the past 3 years SVB microbiology lab found a sharp increase in the incidence of erytromycin resistant strains of Streptococcus pyogenes. In 2015 we registered 20.3% of macrolide resistant strains. Global resistance to penicillin G for Str. pneumoniae (non-meningeal infections) was 45.3%- 54.5% until 2009, and 2.7% in 2013. Enterococcus faecium strains showed 0% resistance to vancomycin between 2000 and 2012. A significant growth was recorded in 2015 of 11%. Isolation rate of Klebsiella pneumoniae ESBL producing strains has increasewd progressively from 17.6 in 2000 to 57% in 2015. Carbapenems – resistant K. pneumoniae isolated strains were 18,8% in 2015. Carbapenemases types identified by phenotypic and genetic methods where: 35/ Oxa48, 8 KPC and 21/MBL (NDM-1). Resistance to carbapenems recorded an upward trend: 23.9% in 2004 to 37.9% in 2015, and for Acinetobacter baumannii 69%. Conclusions. Antibiotic resistance of bacteria is a major challenge for public healts. Therapeutic solutions are extremely limited.

During 1985-2014 in our Clinic nearly 4,925 gastrostomes were performed, for a large variety of pathologies: benign and malign esophageal stenosis, esophageal fistulas, posttraumatic ruptures, iatrogenic pathology, strokes. Among those, some were definitives and the others were temporary. We used Gavriliu technique with peritoneal collar in 96% of the cases. During those 30 years we managed to establish an immediate and long-term care protocol of the feeding gastrostomes. This protocol contains specific measures for the monitoring of the vital parameters, biological and metabolical ones, but also the close analysis of the gastric stasis, the imposing of the digestive repose during the first 48-72 hours, the continue follow-up of the quality and the rhythm of alimentation and the mechanical protection of the Pezzer tube. The efficiency of this type of nursing consists in the introduction of food after 48-72 hours, with the second stage of efficiency of the gastrostomy in the same time with the long-term care of the associated oncological and metabolical complications. Due to the importance of the moment of the surgical indication, the technique and nursing that has been used, the survival of the patient with definitive gastrostomy has significantly improved. The elimination of the temporary ones didn’t involve in most of the cases surgical closing.

The study aims that, starting from preoperative clinical and laboratory variables, to identify the most effective predictive multidimensional models for anatomopathological result in acute appendicitis. A prospective study was performed on 147 patients operated for acute appendicitis. The set of potential predictors considered for the selection is as follows: IL6, LBP, Alvarado score, total bilirubin, neutrophils count and WBC, all determined preoperatively. For data analysis we used a variant of a classic sequential analysis discrimination based on linear functions of Discrimination method of Fisher (SPSS). The most effective statistical models with an accuracy of classification of 100% were obtained from the variables: IL6 preop, LBP preop and WBC on admission Model 1) and IL6 preop, LBP preop and score Alvarado (Model 2). These observations lead us to believe that developing a procedure for preoperative diagnosis of appendicitis type is achievable. Defining, validating and assessing the reliability of such a procedure however require further research on a larger volume samples and are representative of both the pathology of appendicitis and population with acute appendicitis.