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Background The SARS-CoV-2 pandemic is still ongoing and a major challenge for health care services worldwide. In the first WSES COVID-19 emergency surgery survey, a strong negative impact on emergency surgery (ES) had been described already early in the pandemic situation. However, the knowledge is limited about current effects of the pandemic on patient flow through emergency rooms, daily routine and decision making in ES as well as their changes over time during the last two pandemic years. This second WSES COVID-19 emergency surgery survey investigates the impact of the SARS-CoV-2 pandemic on ES during the course of the pandemic. Methods A web survey had been distributed to medical specialists in ES during a four-week period from January 2022, investigating the impact of the pandemic on patients and septic diseases both requiring ES, structural problems due to the pandemic and time-to-intervention in ES routine. Results 367 collaborators from 59 countries responded to the survey. The majority indicated that the pandemic still significantly impacts on treatment and outcome of surgical emergency patients (83.1% and 78.5%, respectively). As reasons, the collaborators reported decreased case load in ES (44.7%), but patients presenting with more prolonged and severe diseases, especially concerning perforated appendicitis (62.1%) and diverticulitis (57.5%). Otherwise, approximately 50% of the participants still observe a delay in time-to-intervention in ES compared with the situation before the pandemic. Relevant causes leading to enlarged time-to-intervention in ES during the pandemic are persistent problems with in-hospital logistics, lacks in medical staff as well as operating room and intensive care capacities during the pandemic. This leads not only to the need for triage or transferring of ES patients to other hospitals, reported by 64.0% and 48.8% of the collaborators, respectively, but also to paradigm shifts in treatment modalities to non-operative approaches reported by 67.3% of the participants, especially in uncomplicated appendicitis, cholecystitis and multiple-recurrent diverticulitis. Conclusions The SARS-CoV-2 pandemic still significantly impacts on care and outcome of patients in ES. Well-known problems with in-hospital logistics are not sufficiently resolved by now; however, medical staff shortages and reduced capacities have been dramatically aggravated over last two pandemic years.

Background: Aromatase inhibitor therapy is currently the preferred choice in postmenopausal women with estrogen receptor positive breast cancer. This article reviews the ocular side effects of treatment with aromatase inhibitors (AIs) in patients with breast cancer. Materials and Methods: A comprehensive search was performed on PubMed, Web of Science and Google scholar. Results: After duplication removal, 14 clinical studies and 5 case reports, published between 2008 and 2021, were identified. Most frequently, AI treatment resulted in minor to moderate dry eye symptoms. “De novo” onset of Sjogren syndrome during AI therapy was also reported. Retinal and optic nerve side effects varied from mild, subclinical anatomic and functional impairment to severe decreased vision, secondary to hemi-central retinal artery occlusion, bilateral optic neuritis or uveitis with bilateral macular edema. Conclusion: Visual disturbances encountered during AI treatment may be underestimated. Ophthalmic screening is important for early detection and appropriate treatment.

This review discusses the evidence on diabetic retinopathy (DR) in patients with diabetic foot ulceration (DFU). A systematic literature review was performed on PubMed, Medline, Springer Nature, and Scopus, following the PRISMA guidelines, using the following terms, individually or in combination: “diabetic foot ulcer” OR “diabetic foot syndrome” OR “DFU” and “diabetic retinopathy.” The initial search yielded 648 articles published between 1975 and 2020. After applying exclusion and inclusion criteria, a total of 9 articles were analyzed, assessing the correlations between DR and DFU. In all cases, DR and especially proliferative diabetic retinopathy were significantly higher in the presence of DFU, though the frequency of DR showed large variability (22.5% to 95.6%). There was a significant correlation between advanced stages of DFU and increased frequency of DR and proliferative diabetic retinopathy. On the other hand, there is a risk of accelerated progression of DR in nonhealing DFUs, possibly related to chronic inflammation and associated infection. Hence, patients with DFUs should be monitored by an ophthalmologist, and those with DR should be promptly referred to a specialized diabetic foot clinic.

Rosacea is a chronic inflammatory skin disease with a complex pathogenesis that mainly affects the central part of the face, with a global incidence of 5.46%. The present study was performed on a group of 68 patients with rosacea 1 and 2 subtypes, patients between 34-63 years old. The treatments were performed using a Cutera Xeo laser, using 2 types of probes: NdYag 1064nm for telangiectasias and LimeLight 520-1100nm for diffuse facial erythema, papules, and pustules, having an 10x30mm window. For patients with diffuse facial erythema, etc., the optimal number of sessions was between 3 and 6 with or without anesthetic cream, using energies between 14-19J / cm. The average recovery time was 5 days. Registered effects included bruises, pustules, burning sensation, transient stinging, and hypopigmentation. For patients with telangiectasia, the optimal number of sessions was two, performed at an average interval of once per month/ monthly.

Peritonitis remains, despite the diagnostic and therapeutic developments, a serious condition, the main cause of septic shock with lethal potential in abdominal surgery Identifying and characterizing the dynamics of early biomarkers of the inflammatory response in abdominal sepsis is important to better follow-up evolution and postoperative infectious complications. The paper aims to study the dynamics of serum concentration of biomarkers LBP, IL6 and bilirubin in patients with acute peritonitis of appendicular cause, in the pre and postoperative stage and the correlation with the clinical evolution of inflammatory syndrome. A prospective 6-month study was performed, including patients for appendicular peritonitis. LBP, IL6, bilirubin, leukocytes were sampled preoperatively, then postoperatively at 72 h, and repeated at 72 h until values returned to normal. Clinical evolution and leukocytes were correlated with biochemical parameters. The mean preoperative values for the studied biochemical parameters were for Il6 of 14.81 +/- 4,047 pg / mL, for LBP of 33,826 +/- 5.5.02 microgram / mL and for bilirubin of 1.77 +/- 0.55mg / mL. The postoperative values decreased in all cases, but remained above normal limits in cases with septic complications. LBP, Il 6 and bilirubin are biomarkers useful in the pre- and postoperative evaluation of sepsis in appendicular peritonitis, correlating more accurately with the evolution of the inflammatory response than leukocytosis. Bilirubin is useful in monitoring intraperitoneal infection, but is not influenced by the existence of extraperitoneal infection. The dynamics of LBP is the most accurate description of bacterial infectious factor exposure.

Introduction. With more than 1,000,000 infections around the world, SARS-Cov 2 is responsible for the most severe healthcare crisis in the last 100 years. Aim. The paper analyzes the impact of COVID 19 pandemic upon the current ophthalmological clinical activity. Materials and Method. A comparative analyses was carried regarding the clinical activity in March 2019 and March 2020: the number of one day hospitalizations, of continuous hospitalizations, the percentage of emergencies, the number of surgeries, bed turn over, mean hospital stay. The protocols for the health care personnel protection and decontamination were analyzed. Results. During March 2019, 381 patients were treated in the day hospitalization and 297 patients in the continuous hospitalization regime, with an average length of hospitalization of 3.2 days, and a bed turnover of 6.05. Of these, 76.43% underwent ophthalmic surgery and 14.1% represented ophthalmological emergencies. The comparative analysis shows that in March 2020, the number of one day hospitalizations decreased by 87.4%, and that of the hospitalizations continued with 89.2%. Of the patients admitted, 46.8% were in emergency. Clinical ophthalmological practice has been deeply changed in the context of the COVID 19 pandemic in order to prevent contamination both for patients and medical personnel. Conclusions. The ocular manifestations associated to SARS-Cov 2 infection are self-limited, but the possibility of infection due to the presence of the virus at the level of the tear secretion is an aspect that we must consider in the ophthalmological clinical practice.

Degenerative neurological diseases (senile dementia, Alzheimer`s disease, glaucoma), post-stroke sequelae are increasing as prevalence nowadays, in context of aging in general population, and there are strong evidences that astrocytes may play a significant role in neuroprotection. The study evaluates the effects of low intensity low frequency electromagnetic field (EMF) �in vitro� stimulation (195 mA, 7-8 Hz) on the glial cells, in different conditions, in order to identify the neuroprotective potential. Three cell lines were used for the study: the Clonetics (Lonza) line of normal human astrocytes, U87 glioblastoma tumor cells (ATCC) and L929 murine fibroblasts. The cell cultures were exposed to EMF stimulation for 2 hours/day, for 5 and 10 day, in absence and in the presence of oxidative stress stimuli. Cell viability, apoptotic potential, changes in cell phenotype, stimulation of cell proliferation for normal and malignant transformed cell lines, resilience to oxidative stress were investigated. The viability of the cells was investigated by MTS assay, and the Griess test was used to detect nitrite production as a marker of oxidation and inflammation. Inverted microscopy examination revealed that following exposure to the tested EMF, no morphological changes of the cells were recorded. In none of the cell lines tested, no cytotoxic or cytopathic effects were observed in the cultures exposed under low density conditions. In case of exposure of cell cultures for 10 days to the action of EMF, a viability of 98.2% of glial cells and 97% of exposed fibroblasts is observed, compared to unexposed cells. The viability of the cells exposed to both EMF and oxidative and inflammatory stimuli is increased by 0.96% in the case of H2O2 stimulation and in 3.76% in the case of LPS stimulation, suggesting a possible neuroprotective effect of EMF exposure. Low intensity low frequency EMF �in vitro� stimulation increased viability of the glial cells exposed to oxidative and inflammatory stimuli. No cytotoxic or cytopathic effects were observed in the exposed cultures under conditions of low density. Further tests are needed in order to elucidate the mechanisms of action of EMF on astrocytes, especially on astrocyte-neuron co-cultures to highlight the interactions between these cell types. Confirmation of the neuroprotective effect of low intensity and low frequency EMF opens the way for the development of an innovative, non-invasive therapy.

Diabetic retinopathy (DR) is a microvascular disorder occurring due to the long-term effects of diabetes, leading to vision-threatening damage to the retina. The human body has an elaborate system for managing and regulating the number of key trace metals circulating in the blood and stored cells. Inadequate zinc (Zn) and concurrent excess of copper (Cu) levels are associated with an increased level of oxidative stress, which may aggravate the microvascular lesions in diabetes mellitus. Several studies have revealed a significantly lower serum Zn concentration and increased Cu levels in DR when compared with diabetic patients without retinopathy and normal controls. These abnormalities are correlated with the duration of diabetes and higher levels of HbA1C. Multiple pathological mechanisms are proposed to explain these changes including hyperzincuria associated with polyuria, glycosuria, and proteinuria in diabetic patients, as well as impaired absorption of Zn at the gastrointestinal level. Increased levels of free Cu ions may be attributed to glycation and the release of Cu ions from the Cu-binding sites of proteins. Zn supplements and selective Cu chelators may be useful to alleviate oxidative stress and prevent DR progression.

The 2019 novel coronavirus, known as severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) or coronavirus disease 2019 (COVID-19), is causing a global pandemic. The virus primarily affects the upper and lower respiratory tracts and raises the risk of a variety of non-pulmonary consequences, the most severe and possibly fatal of which are cardiovascular problems. Data show that almost one-third of the patients with a moderate or severe form of COVID-19 had preexisting cardiovascular comorbidities such as diabetes mellitus, obesity, hypertension, heart failure, or coronary artery disease. SARS-CoV2 causes hyper inflammation, hypoxia, apoptosis, and a renin–angiotensin system imbalance in a variety of cell types, primarily endothelial cells. Profound endothelial dysfunction associated with COVID-19 can be the cause of impaired organ perfusion that may generate acute myocardial injury, renal failure, and a procoagulant state resulting in thromboembolic events. We discuss the most recent results on the involvement of endothelial dysfunction in the pathogenesis of COVID-19 in patients with cardiometabolic diseases in this review. We also provide insights on treatments that may reduce the severity of this viral infection.

Diabetic retinopathy and diabetic foot ulcer are the most frequent, but also the most disabling complications of diabetes mellitus, with a sinister impact on patients’ quality of life. Microvascular changes related to the deleterious effect of chronic hyperglycemia play an important role in the pathophysiology of both clinical entities by multiple molecular pathways. Vision-threating diabetic retinopathy may be treated by laser photocoagulation, anti-vascular endothelial growth factor (VEGF) agents and vitreoretinal surgery. Diabetic foot lesions are best treated by revascularization if needed, off-loading, infection control and therapeutic adjuncts (e.g. special dressings). Treatment should ideally be offered by a multidisciplinary expert team. Prevention and early detection, along with adequate control of glucose, lipids and arterial hypertension are of paramount importance to avoid and mitigate these fearful complications.

Bariatric surgery is an emerging therapeutic approach for obese type 2 diabetes mellitus (T2DM) patients, with proven benefits for achieving target glucose control and even remission of diabetes. However, the effect of bariatric surgery upon diabetic retinopathy is still a subject of debate as some studies show a positive effect while others raise concerns about potential early worsening effects. We performed a systematic review, on PubMed, Science Direct, and Web of Science databases regarding the onset and progression of diabetic retinopathy in obese T2DM patients who underwent weight-loss surgical procedures. A total of 6375 T2DM patients were analyzed. Most cases remained stable after bariatric surgery (89.6%). New onset of diabetic retinopathy (DR) was documented in 290 out of 5972 patients (4.8%). In cases with DR at baseline, progression was documented in 50 out of 403 (12.4%) and regression in 90 (22.3%). Preoperative careful preparation of hemoglobin A1c (HbA1c), blood pressure, and lipidemia should be provided to minimize the expectation of DR worsening. Ophthalmologic follow-up should be continued regularly in the postoperative period even in the case of diabetic remission. Further randomized trials are needed to better understand the organ-specific risk factors for progression and provide personalized counseling for T2DM patients planned for bariatric surgery.

Neurotoxic warfare chemical agents (CWA/NA) induce major toxicological effects to the affected personnel. Their increased toxicity justifies the necessity of developing analytical methods for diagnosis and specific medical counter measures. CWA/NA are extremely toxic agents which are subject to international regulations (The Geneva Protocol regarding the prohibition of chemical weapons). Taking into account the ban on human experimenting due to high toxicity, simulators of neurotoxic chemical agents are being used in laboratories. These are analogue chemical compounds which possess the same relevant physical, chemical and pharmacodynamical properties of the corresponding agents, but with lower intrinsical toxicity. The synthesis and toxicological characterization of these simulators of neurotoxic chemical agents allow the laboratory research of these extremely toxic compounds and the unfolding of risk-free antidote studies. This paper proposes the synthesis and toxicological testing of chemical compounds which simulate sarin (4-nitrophenyl isopropyl methylphosphonate - NIMP) and VX (4-nitrophenyl ethyl methylphosphonate - NEMP).

The present study aimed to compare the clinical, paraclinical, intraoperative findings, and postoperative complications in acute cholecystitis in diabetic patients vs. non-diabetic patients. A 2-year retrospective study was performed on the patients who underwent emergency cholecystectomy for acute cholecystitis between 2017 and 2019 at the 4th Department of Surgery, Emergency University Hospital Bucharest. The diabetic subgroup numbered 46 eligible patients and the non-diabetic one 287 patients. Demographics, the severity of the clinical forms, biological variables (including white cell count, urea, creatinine, coagulation and liver function tests) comorbidity status, surgical approach, postoperative complications, and hospital stay were analyzed. Statistical analyses were performed to assess comparative results between the aforementioned data (SPSS V 13.0). The CCI and ASA risk classes were increased in the diabetic group, with 34.78% of patients having 3 or more associated comorbidities. No statistically significant associations were demonstrated between diabetes and the severity of the cholecystitis and risk for conversion. Postoperatively both minor complications such as surgical site infections and major cardiovascular events were more common in the diabetic subgroup (P=0.0254), well associated with the preoperative status and baseline cardiovascular comorbidities. Laparoscopic cholecystectomy is a safe procedure for diabetic patients, which can provide the best outcomes, by decreasing the risks of surgical wounds. Attentive perioperative care and good glycemic control must be provided to minimize the risk of complications.

Suspicion of lead poisoning is confirmed by its concentration in blood and protoporphyrin red blood cells. At low concentrations, lead influences the synthesis of the heme in the sense of lowering it. Acute and chronic lead intoxication is extremely polymorphic in regards to its clinical manifestations, with digestive, hematological, cardiovascular, renal hepatic and neurological features. The aim of the study was to evaluate the presence of lead in human whole blood and urine harvested before and during chelation treatment in the case of lead poisoning. An atomic absorption spectroscopic method for the analysis of lead was developed using graphite furnace atomic absorption spectrophotometer (GF-AAS), Varian Spectra AA-880 with a hollow cathode lead lamp and a deuterium lamp for background correction, coupled to a GTA-100 atomizer and a programmable sample dispenser. Standard calibration solutions were used for the range 10-100 µg/l. The linearity range was 10.0 to 100.0 µg/l with the correlation coefficient of 0.999. We established that the method can be applied for the determination of lead in whole blood and urine, and the results obtained are useful for monitoring chelation therapy in cases of acute lead poisoning, a neglected cause of abdominal colic pain in an emergency situation.

The present study investigated the effects of the COVID-19 pandemic on the clinical presentation and therapeutic management of acute surgical abdomen. A retrospective study of emergency hospitalizations with a diagnosis of acute surgical abdomen between April and July 2020 vs. a similar period in 2019 was performed. The observation sheets and the operating protocols were analyzed. Between April and July 2020, 50 cases of acute surgical abdomen were hospitalized and treated, compared to 43 cases in the same period last year. The main types of pathology in both groups included: Occlusions (60%, respectively 44.2% in 2019) and peritonitis (32%, respectively 41.8% in 2019). There was an increased rate of patients with colorectal cancers neglected therapeutically or uninvestigated, who presented during the pandemic period with emergencies for complications such as occlusion or tumor perforation (32 vs. 6.97%, P=0.0039). One case, with gastric perforation, was COVID-positive, with no pulmonary symptoms at admission. The number of postoperative infectious complications was lower during the pandemic (2 vs. 13.95%, P=0.0461). As the COVID-19 pandemic appears to be still far from ending, we should learn to adapt our surgical protocols to the new evidence. Oncological patients are a vulnerable group, who were neglected in the first months of the pandemic. SARS-Cov-2 infection may be a cause of abdominal pain and should be taken into account in different diagnoses of acute abdomen in surgical wards. Correct wearing of adequate personal protective equipment (PPE) and respecting strict rules of asepsis and antisepsis are required for preventing in-hospital transmission of infection.

Background and Objectives: This study investigates the impact of age upon the safety and outcomes of laparoscopic cholecystectomy performed for acute cholecystitis, by a multivariate approach. Materials and Methods: A 2-year retrospective study was performed on 333 patients admitted for acute cholecystitis who underwent emergency cholecystectomy. The patients included in the study group were divided into four age subgroups: A ≤49 years, B: 50–64 years, C: 65–79 years, D ≥80 years. Results: Surgery after 72 h from onset (p = 0.007), severe forms, and higher American Society of Anesthesiologists Physical Status Classification and Charlson comorbidity index scores (p &lt, 0.001) are well correlated with older age. Both cardiovascular and surgical related complications were significantly higher in patients over 50 years (p = 0.045), which also proved to be a turning point for increasing the rate of conversion and open surgery. However, the comparative incidence did not differ significantly between patients aged from 50–64 years, 65–79 years and over 80 years (6.03%, 9.09% and 5.8%, respectively). Laparoscopic cholecystectomy (LC) was the most frequently used surgical approach in the treatment of acute cholecystitis in all age groups, with better outcomes than open cholecystectomy in terms of decreased overall and postoperative hospital stay, reduced surgery related complications, and the incidence of acute cardiovascular events in the early postoperative period (p &lt, 0.001). Conclusions: The degree of systemic inflammation was the main factor that influenced the adverse outcome of LC in the elderly. Among comorbidities, diabetes was associated with increased surgical and systemic postoperative morbidity, while stroke and chronic renal insufficiency were correlated with a high risk of cardiovascular complications. With adequate perioperative care, the elderly has much to gain from the benefits of a minimally invasive approach, which allows a decreased rate of postoperative complications and a reduced hospital stay.

Glaucoma, one of the significant causes of blindness worldwide, is a chronic optic neuropathy, characterized by progressive loss of retinal ganglion cells and specific perimetric defects. This study aimed to assess the association between the risk of glaucoma progression and different systemic vascular abnormalities. A 4-year prospective study was carried out on 204 patients diagnosed with open-angle glaucoma. Associated systemic vascular pathology was documented in 102 cases. Progression was encountered in 57 (55.9%) patients with vascular comorbidities and only in 10 (9.8%) patients with no associated vascular diseases (OR 13.81, P

Diabetic foot ulcer (DFU) is a well-known complication of diabetes and a significant burden on the national health systems. The neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio are inexpensive and easily accessible biomarkers that have proved to be useful in several inflammatory, infectious and cardiovascular diseases. We carried out a comprehensive review examining the association of NLR and PLR with the onset and progression of DFU. PLR and NLR were significantly increased in patients with DFU, compared with a control group of T2DM patients without DFU, and correlate well with DFU severity, evaluated by Wagner and IWGDF grading scales. In patients with diabetic foot infections (DFI), elevated NLR and PLR were correlated with osteomyelitis, increased risk of amputation, and septic complications. The significance of the elevated value of these biomarkers in DFU is related to chronic hyperglycemia and low-grade systemic inflammation, atherosclerotic and vascular complications, and also the associated septic factor. Serial, dynamic follow-up can provide useful information in planning and monitoring DFU treatment, as well as in risk stratification of these vulnerable patients. Further randomized studies are needed to set the cut-off values with clinical significance.

(1) Background: The paper aims to review the available evidence regarding the health risk of the aerosolization induced by laparoscopy induced and impact of the COVID-19 pandemic upon minimally invasive surgery. (2) Materials and methods: A systematic review of the literature was performed on PubMed, Medline and Scopus until 10 July. (3) Results: Chemicals, carcinogens and biologically active materials, such as bacteria and viruses, have been isolated in surgical smoke. However, the only evidence of viral transmission through surgical smoke to medical staff is post-laser ablation of HPV-positive genital warts. The reports of SARS-CoV-2 infected patients who underwent laparoscopic surgery revealed the presence of the virus, when tested, in digestive wall and stools in 50% of cases but not in bile or peritoneal fluid. All surgeries did not result in contamination of the personnel, when protective measures were applied, including personal protective equipment (PPE) and filtration of the pneumoperitoneum. There are no comparative studies between classical and laparoscopic surgery. (4) Conclusions: Previously published data showed there is a possible infectious and toxic risk related to surgical smoke but not particularly proven for SARS-CoV-2. Implementing standardized filtration systems for smoke evacuation during laparoscopy, although increases costs, is necessary to increase the safety and it will probably remain a routine also in the future.

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.

Nowadays, surgical innovations incorporate new technological conquests and must be validated by evidence-based medicine. The use of augmented reality-assisted indocyanine green (ICG) fluorescence has generated a myriad of intraoperative applications such as demonstration of key anatomical landmarks, sentinel lymph nodes, and real-time assessment of local blood flow. This paper presents a systematic review of the clinical evidence regarding the applications of ICG near-infrared (NIR) fluorescence in colorectal surgery. After we removed duplicate publications and screened for eligibility, a total of 36 articles were evaluated: 23 on perfusion assessment, 10 on lymph node mapping, and 3 on intraoperative identification of ureters. Lack of homogenous studies, low statistical power, and confounding evidence were found to be common amongst publications supporting the use of ICG in colorectal surgery, raising concerns over this seductive technique′s cost efficiency and redundancy. The compiled data showed that ICG NIR fluorescence may be a game-changer in particular situations, as proven for low colorectal anastomosis or lateral pelvic lymph node dissection, but it remains controversial for routine use and sentinel lymph node assessment. Further randomized studies are needed to confirm these conclusions. Future research directions include tumor-targeted fluorescence imaging and digital software for quantitative evaluation of fluorescence.

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.