Gastrointestinal infections are among the most common infectious diseases found all over the world, varying depending on the etiological agent. Symptoms usually include diarrhea, vomiting, and abdominal pain. Water and electrolyte imbalance is the main consequence of gastrointestinal infections. Most of them are cured or self-limited in few days, but at the same time, for a specific population such as immunocompromised, elderly patients or new-borns, these infections are potentially severe. In this context, it is very important to identify the etiological agents of acute diarrhea for the appropriate treatment and infection control measures. While routine laboratory diagnosis of parasitic diarrhea still depends largely on microscopic examination of fecal samples, immunological and molecular methods are becoming increasingly commercially available and, in well-resourced settings, will ultimately displace traditional methods. The present paper presents some of the most common and well-known pathologies of this type, being a brief presentation of the variety of gastrointestinal diseases, each with characteristic clinical manifestations and diagnosis.
Background and aim. The presence of acute kidney injury (AKI) in subjects diagnosed with acute coronary syndromes (ACS) represents a major predictor of a negative outcome.The purpose of this study is to reveal the incidence of AKI in ACS subjects and to illustrate the prognosis of these subjects, using special models for mortality prediction, based on the creatinine values and the presence of acute heart failure (AHF). Methods. Using multiple linear regression, several models were designed to predict the mortality including: comorbidities of the subjects, initial and highest value of the serum creatinine (sCr) during hospitalization, presence of theAHF and Killip class compared with sCr values, the last model illustrating the influence of all the previous variables. Results. AKI had a significant incidence in the chronic kidney disease (CKD) group (53.11%). The mortality rate and the hospital readmission were higher in the CKD subjects (41.14%) versus the patients with normal kidney function (21.23%, p<0.01). The association of AKI and AHF, known as cardio-renal syndrome, was related to a negative outcome in the CKD group. The models for prediction of mortality emphasize that the age, dyslipidaemia, worst sCr, Killip class and AHF presence can be used to assess the mortality risk of patients with AKI and ACS. Previous pathological conditions such as diabetes, peripheral artery disease, coronary artery disease (CAD) and obesity, failed to achieve statistically significance for prediction of death. Conclusions. AKI represents a serious pathological condition with a high prevalence in subjects with CKD; the association with AHF increases the risk of hospital readmission and fatal outcome.
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In the past, finding out the chemical resistance of the barrier materials designated for the production of individual protective equipment ofthe protection forces (policemen, firefighters, soldiers) was based on the need to respond to protection against weapons of mass destruction. Simple chemical methods based on indicating the colorimetric reactions were used. It was necessary to switch to more universal methods due to a change in the security of the environment and the need to focus on toxic industrial materials. The universality is due to using sensitive QCM sensors equipped with a special detection layer and some special carbon electrodes. The paper deals with new methods that are used to determine the chemical resistance of the barrier materials against the permeation of toxic substances, primarily in field conditions. However, they can also be used in stationary chemical laboratory conditions.
The tracheoesophageal fistula which occurred during oro-tracheal intubation of a patient in intensive care unit is a true challenge both in diagnostic and in therapeutic approach. The best treatment is prevention, by identifying risk factors but especially is important which the mechanism in the occurrence of tracheoesophageal fistula was. The occurrence of this complication in the evolution of hospitalized patients in ICU is accompanied by significant increase in mortality, contributing to negative prognostic. We have started a large multicentric study in April 2016 regarding all patients who required intubation longer than 7 days. The study will finish at the end of 2020. We are looking for a definite conclusion, in this moment we do not have enough data for a conclusion.[1, 2] INTRODUCTION fistula tracheoesophageal The is an abnormal communication between the esophagus and trachea. It can be congenital or acquired. Most of them are congenital with a frequency of 1 to 3500/ 6000 births. In this case usually are associated, or appear within, with other birth defects (trisomy 13, 18 or 21, tetralogy of Fallot, other digestive problems or muscle skeletal VACTERL Syndrome (Vertebral anomalies, Anal atresia, Cardiac defects, Tracheoesophageal fistula and/or Esophageal atresia, Renal & Radial anomalies and Limb defects.). Then, there are the malignant ones which appear in the posterior infiltrating tracheal wall or the anterior wall of the esophagus. The last ones are those acquired, non- malignant [1, 3, 4]. maneuver, in the operating room but especially in ICU. The first fistula appeared after a prolonged period of intubation and was initially described in 1956 by d’Avignon [2, 4]. in involved factors are Several these serious complications during a prolonged period of intubation. The most important and most discussed about in recent years is represented by the cuff pressure of orotracheal tube. If the cuff is overinflated, it leads to compression on the rear wall membranous trachea, which in time leads to ischemia and necrosis, basically forming an abnormal communication between the trachea and esophagus. Other possible complication of a hyper-inflated cuff is tracheal stenosis or bleeding erosion of a significant blood vessel. Often, both The situations simultaneously. occur can They occur particularly after a prolonged period of intubation with or without mechanical ventilation. intubation Fistula can result from incidents of 1 Carol Davila Central University Emergency Military Hospital, Bucharest 2 Carol Davila University of Medicine and Pharmacy, Bucharest 3 University Emergency Hospital, Bucharest 35
This study analyzes the satisfaction of the patients with radical prostatectomy according to the signs and symptoms included in the EORTC QLQ – C30 and EORTC QLQ – PR25 questionnaires, including their relation with the health state that influences the pre and postoperative life quality. Fifty patients with prostate cancer in a localized stage were studied and analyzed in a prospective manner and for a period of 12 months, before and 6 months after the radical prostatectomy. In choosing the patients, the common denominator was the use of the same postoperative plan and the lack of postoperative complications, as well as the lack of chronic diseases. Erectile dysfunction, urine incontinence were quite frequent after radical prostatectomy, while the urinary obstruction and the weak urinary stream were less frequent. In this regard, people noticed a significant decrease of life quality. Although the study addressed a small group of patients, the results are similar to those belonging to other clinical studies. Even if the aspect of life quality is more rarely taken into account, the questionnaires regarding the life quality are specific, useful and quite cheap in evaluating different therapies.
Introduction: Clostridium difficile infection stands nowadays as one of the major emerging health problems still underestimated. Only in 2009 the European Society of Clinical Microbiology and Infection (ESCMID) was able to publish guidelines for this serious disease. Actually the guidelines were updated in 2013 so we can speak of a united action towards the resolution of this healthcare problem. Methods: This is a review article aiming to shed light in various aspects of clostridium difficile infection as clinical presentation, symptoms and signs, therapeutic options and risk factors with a focus on urologic pathology. Conclusions: This type of infection represents a challenge from many points of view like treatment, relapse approach, mortality, morbidity, germ’ s adaptability to treatment and last but not the least the outbreak of different aggressive strains like B1,NAP1 or ribotype 027 toxinotype III.
Objectives: This review aims to provide practicing clinicians with the most recent knowledge of the biological nature of prostate cancer especially the information regarding neuroendocrine differentiation. Methods: Review of the literature using PubMed search and scientific journal publications. Results: Much progress has been made towards an understanding of the development and progression of prostate cancer. The prostate is a male accessory sex gland which produces a fraction of seminal fluid. The normal human prostate is composed of a stromal compartment (which contains: nerves, fibroblast, smooth muscle cells, macrophages) surrounding glandular acins – epithelial cells. Neuroendocrine cells are one of the epithelial populations in the normal prostate and are believed to provide trophic signals trough the secretion of neuropeptides that diffuse and influence surrounding epithelial cells. Prostate cancer is the most frequently diagnosed malignancy in men. In prostate cancer, neuroendocrine cells can stimulate growth of surrounding prostate adenocarcinoma cells (proliferation of neighboring cancer cells in a paracrine manner by secretion of neuroendocrine products). Neuroendocrine prostate cancer is an aggressive variant of prostate cancer that commonly arises in later stages of castration resistant prostate cancer. The detection of neuroendocrine prostate cancer has clinical implications. These patients are often treated with platinum chemotherapy rather than with androgen receptor targeted therapies. Conclusion: This review shows the need to improve our knowledge regarding diagnostic and treatment methods of the Prostate Cancer, especially cancer cells with neuroendocrine phenotype.
Introduction: UTI (urinary tract infections) represent a central pathology for a urological service. Antibiotic resistance is growing at a steady and alarming rate worldwide and especially in Romania. Method and materials: We have analyzed all the patients that were admitted to our clinic for continuous hospitalization between January 2015 and October 2015. All patients undergone urine culture and all cultures positive had an antibiogram worked up. We have selected all patients that had antibiotic resistance to at least an antibiotic. Results: From 1745 patients admitted for continuous hospitalization, we had 180 positive urine cultures at admission from which 125 had at least an antibiotic resistance. Conclusions: Antibiotic resistance is a serious phenomenon, with potential lethal complications, which we encounter daily in urological practice INTRODUCTION Uncomplicated UTI are probably the most common urological condition. It is estimated that at least 1 out of 3 females will develop an UTI during their lifetime. UTI frequency at young females is associated with sexual intercourse. When urological malformations, pregnancy, menopause, urolithiasis occur conditions for recurrence of the disease are met. Recurrences are defined as at least 2 episodes of UTI in 6 months or 3 episodes a year. Male patients develop UTI due to different mechanisms and at an elderly age. The most common mechanism that facilitates the development of UTI in men is bladder outlet obstruction caused mainly by prostatic enlargement. UTI are caused mainly by Gram negative enterobacteriacea. Escherichia Coli is the cause for about 80-90 % of community acquired UTI’s. In healthcare related infections E. Coli is still the leading cause but with a more modest percentage. Other pathogens that cause UTI are: Proteus mirabilis, Enterococous, Klebsiella pneumonie, Pseudomonas aeruginosa. METHOD AND MATERIALS Between January and October 2015, 1745 patients were admitted for continuous hospitalization in our Clinic. At admission all of these patients had their urine sent for culture. The urine culture was tested for antibiotic response for the following antibiotics: 1 Carol Davila Central Emergency Military Hospital, Bucharest 2 Carol Davila University of Medicine and Pharmacy, Faculty of Medicine, Bucharest 20
Introduction: Radical retropubic prostatectomy represents in its various forms (open, laparoscopic and robotic) the "gold standard" treatment for adenocarcinoma of the prostate. Unfortunately like al treatment solutions it has its shortcomings. Retropubic radical prostatectomy, external beam radiation therapy and brachytherapy are the curative options. Materials and Method: The experience of Clinic of Urology from Central Military Hospital representing more than 100 cases was analyzed . Classical open retropubic prostatectomy was performed in all cases. We focused in this paper on intraoperative complications and also precocious and late postoperative complications. Results: Our results are matching the other centers in terms of intraoperative complications (blood loss), early postoperative complications (hematuria, urinary tract infection, lymphatic drainage) or late postoperative complications (erectile dysfunction and urinary incontinence). However none of these complications are to be underestimated Conclusions: The limits of this intervention can be pushed a litle bit further, in our opinion the age factor is a relative one, some of these patients having a longer than 10 years life expectancy. It provides good oncological outcome with manageable complications most of the times.
Radical prostatectomy is the gold standard treatment for patients with localized prostatic cancer, but often the pathological diagnosis reveals a locally advanced stage. The aim of this paper is to present the oncological follow-up after radical prostatectomy on a group of 42 patients, patients which have been diagnosed after surgery with a more aggressive stage, locally advanced PCa. Over a period of four years 136 patients have undergone radical prostatectomy. The pathological examination has established that 42 patients presented extracapsular invasion and/or lymph node invasion. 18 patients (pT3-4N0M0) have undergone radiotherapy alone and 24 patients (8 pN1 and 16 pT3-4N1M0) have received androgen deprivation therapy in association with radiotherapy. Over the next two years 15 patients presented biochemical recurrence. For these patients chemotherapy was initiated, but in two cases PSA increase has been observed during periodic evaluation. Although it is not uncommon that postoperatively the histopathological examination establishes a more aggressive disease stage than that established before surgery, radical prostatectomy remains the solution for the localized prostate cancer, solution that can be boosted by radiotherapy and/or androgen deprivation therapy.
Introduction: Erectile dysfunction(ED) is a serious condition which can affect men of all ages, with an important impact over the quality of life. When conservative therapy fails, a viable solution is the penile prosthesis implantation (PPI). Objective: The purpose of this paper is to present data from recent literature regarding the satisfaction rates of men who have undergone penile PPI and as well as the partners satisfaction rates, ease of use, informations regarding long term survival of these prosthesis, postoperative complications and long distance complications, the effectiveness and the way that penile prosthesis have influenced the quality of life of the men who have opted for this solution. Material and methods: We have analyzed recent long term studies concerning the outcomes of the PPI, studies which were made retrospectively, over a period of time of 10 to 15 years. Results: Compared with the conservative treatment for ED, the satisfaction rates achieved after penile prosthesis implantation are higher. According to these studies, the overall patient’s satisfaction is 70-90%. The difference between patient and their partners’ satisfaction rate is negligible, this difference ranging between 2 to 8%. The satisfaction rate regarding the adequate erection for sexual intercourse is 80-90%. The overall satisfaction rates for the malleable prostheses are lower compared with inflatable devices, 30-75%, respectively 75-90% for the inflatable prosthesis. The mechanical and overall survival rates for the malleable prosthesis range between 65-80% at 10 years, and 58-75% for the inflatable devices. Overall ease of use is rated as 78%. Complications after implantation can be encountered in less than 5% of cases and infections in less than 2%. The likelihood of continued use is higher in the group of the patients with the inflatable prosthesis compared with the malleable ones 70-80%, respectively 50-60%. Up to 85- 90% of patients with inflatable prosthesis would recommend them. is a high effective treatment for erectile dysfunction, refractory to Conclusions: PPI pharmacological treatment. The inflatable penile prosthesis (IPP) provides more overall satisfaction than the malleable ones. The patients with IPP are more likely to continue using their devices than those with the malleable prosthesis. PPI improves significantly the quality of life for patients with erectile dysfunction.
