17 research outputs found
The monograph “Aspects of patient safety in anaesthesia. Medication errors in anaesthesia and intensive care”.
Get PDFSympathetic-parasympathetic cardiac autonomic tonus during induction of anesthesia with propofol and fentanyl
Get PDFBackground: Administration of propofol and fentanyl for induction of general anesthesia is often associated with cardiovascular instability. This effect can be caused by changes in the cardiac autonomic tonus induced by the drugs. In the literature there is no consensus regarding the effect of propofol and fentanyl on sympathetic or parasympathetic balance of the heart.
Material and methods: There was performed a randomized prospective study which was approved by the Ethic Committee. Written informed consent was signed by all patients. The study group involved 47 patients scheduled for surgical intervention, anesthetic risk ASA I-II. The analysis of heart rate variability and the changes in cardiac autonomic tonus was performed with Holter ECG at rest, after premedication with fentanyl solution and after induction of general anesthesia with propofol and fentanyl.
Results: After administration of fentanyl in doses of 1.0 mkg/kg for premedication there were not significant changes of heart rate variability and autonomic heart tonus. Administration of propofol 2.5 mg/kg combined with fentanyl 1.0 mkg/kg for induction of general anesthesia leads to significant changes in heart rate variability. There was a considerable reduction of heart rate variability. The LFun (marker of sympathetic heart tonus) has enhanced by 6.8% compared with previous stage (67.1 (95% CI 63.1-71.1) vs 72.0 (95% CI 67.9-76.1) (p=0.004). The HFun (marker of parasympathetic cardiac tonus) has reduced by 19.8% (32.9 (95% CI 28.9-36.8) vs 26.4 (95% CI 20.4-34.3) (p=0.007). After administration of propofol and fentanyl for induction of general anesthesia the LFun/HFun ratio has enhanced by 30.8% (2.7 (95%CI 2.1-3.4) vs 3.9 (95%CI9 2.9-4.8) (p=0.003), signaling an enhanced sympathetic heart tonus.
Conclusions: Administration of fentanyl solution in doses 1.0 mkg/kg for premedication is not associated with significant changes of autonomic tonus of the heart. Administration of propofol 2.5 mg/kg in combination with fentanyl 1.0 mkg/kg for induction of general anesthesia leads to significant enhanced sympathetic cardiac tonus
Connotations Regarding Accounting Recognition of Intangibles in the Company's Performance
No full textAbstractNowadays the managers, investors and shareholders are seeking to identify the value sources of an economic entity in order to spot the most suitable destination for their investments. The context of the “new economy” concept stresses the importance of the intangibles assets that becomes greater and greater. Also, many international studies pointed out that performance and growth of the economic entities are driven by the intangibles assets owned, such as software, human capital, organizational structure, R&D investment. In spite of the increasing level of importance of these assets, many of them are not reported in the financial statements, are difficult trying to identify and also difficult to assess, but the endeavor should not be abandoned. This article is intended to show the way the intangibles assets are reported in financial statement of the Romanian economic entities and how they lead performance, growth and value for these companies
The anesthetic process of the geriatric patient (monograph) Author: Serghei Sandru Sirius Printing House, Chisinau, 2017; 167 p. ISBN 978-9975-57-236-1
Get PDFUSMF „Nicolae Testemițanu
Trauma scoring systems
Get PDFDepartment of Human Physiology and Biophysics, Valeriu Ghereg Department of Anesthesiology and Intensive Care, Nicolae Testemițanu State University of Medicine and Pharmacy, Chisinau, the Republic of MoldovaBackground: Worldwide, traumas represent an actual theme of discussion. The recognition and interpretation of severe traumas are essential for choosing
the right treatment strategy. There are two approaches to mark the patients with a high risk of unfavorable evolution and death. First, to use the terms
as “major trauma”, “severe trauma” and “polytrauma”, without ability to stratify the patients according the severity of lesions inside categories mentioned
above. Second, to implement the trauma scoring systems (anatomical, physiological or mixed), when a doctor uses a mathematical algorithm/model to
calculate the risks for each trauma patient. At the same time, according to the articles found on PubMed/Medline, Web of Science, and EBSCO databases,
there is no international consensus concerning the most accurate traumatic score. This article’s goal was to revise the existing trauma scoring systems to
highlight the potential scoring systems that in perspective can be validated in the Moldovan medical system.
Conclusions: Different traumatic scores are used worldwide (different continents, countries or regions) to estimate the severity of trauma patients in
relation to the anatomical, physiological or combined criteria. All of them could be potentially validated for the Moldovan medical system. A part of
these scores could be validated and compared to identify those ones that have the best determination, calibration and discrimination abilities to predict
the outcomes for the local medical system. As a result, the coefficients from the mathematical equations belonging to the scores could be adjusted to the
conditions of the national medical system of the Republic of Moldova
Indirect lung injury predictive model in experimental trauma
Get PDFDepartment of Human Physiology and Biophysics, Valeriu Ghereg Department of Anesthesiology and Intensive Care, Nicolae Anestiadi Department of Surgery, Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, the Republic of MoldovaAbstract
Background: Trauma remains a medical-social problem, still having high lethality rate. Indirect lung injury (ILI) occurs in trauma due to systemic
neutrophils activation and proteases release into primarily intact tissues. There are no data in the literature regarding ILI predictive models in trauma.
Material and methods: In the experimental study (19 traumatized male rabbits), the proteases, antiproteases and the pulmonary morphological changes,
assessed according to the SAMCRS score (Semiquantitative Reflected Qualitative Changes Assessment Scale) were followed. There were used two statistical
instruments – correlational analysis and multivariate linear regression.
Results: Initially, a correlational analysis between the values of the SAMCRS score and the proteases/ anti proteases was performed. The null hypothesis
was rejected (F = 7.017, p = .002). The correlation coefficient of the predicted results and the real values of SAMCRSlungs was .854, the determination
coefficient being .626. The final model included the following parameters: constant (B = 9.427; 95% CI 7.341, 11.513; p <.001); α2-macroglobulin0
(B = -4.053; 95% Cl -6.350, -1.757; p = .002); AEAMP0
(B = .002; 95% CI .000, .004; p = .075); AEAMP24 (B = -. 006; 95% CI -.010, -.002; p = .003); AECG2
(B = .081; 95% CI .040, .122; p = .001); AEE0
(B = -. 026; 95% CI -.040, -.011; p = .002).
Conclusions: In this research, a predictive model for indirect lung injury in experimental trauma was developed, the predictors being some elements
of the proteases/antiproteases system. This, in turn, allows the hypotheses emission regarding the pathophysiology, prophylaxis and treatment of ILI
Factors to consider when assessing the severity of COVID-19
Get PDFBackground: Analysis and evaluation of the multitude of parameters that impact and mirror clinical evolution of COVID-19 infection. Narrative literature review type of study. Bibliographic search of the PubMed database, applying the keywords: ”SARS-CoV-2”, ”COVID-19”, ”risk score”, ”laboratory
parameters”, ”pathophysiology”, ”cytokine storm”, ”imaging evaluation”, “outcomes”, “clinical evolution”, which were combined with each other. There
were selected English-language publications, in extenso, published in recognized journals from March 2020. Priority in the analysis was given to articles
of critical synthesis of literature, randomized studies, those with large samples of patients. One of the clinically important symptoms that reflects severe
or critical clinical evolution is persistent fever during the time. The presence of comorbidities, especially associated with obesity, represents a high risk of
severe evolution. Proinflammatory, prothrombotic and systemic endothelial damage processes are represented by changes in platelet count, lymphocytes,
neutrophil / lymphocyte ratio, C-reactive protein, D-dimers, fibrinogen, procalcitonin, urea, creatinine, ALS, AST, interleukin-6 and serum ferritin. Bacterial and fungal infections negatively influence clinical evolution. Common prediction scores have low value in COVID-19 patients and need adaptation.
Imaging evaluation identifies the type of lung injury and correlates with the severity degree and outcome.
Conclusions: COVID-19 disease caused by SARS-CoV-2 virus includes a multitude of pathophysiological changes that through its mechanism represent
a systemic nosology. The complete analysis of all the factors and parameters that can influence its clinical evolution is a basic component of the decisionmaking steps and treatment approach
Prognostic value of D-dimers in patients with COVID-19: narrative synthesis
Get PDFIntroduction. Contemporary researchers have suggested and demonstrated the hypothesis that the elevated level of D-dimers, which is a valuable marker of coagulation and fibrinolysis activation, can predict the severity of COVID-19, pulmonary complications, and thromboembolic events before they occur.
Material and methods. The bibliographic resources were analyzed and selected from databases such as PubMed, Hinari, SpringerLink, and Google Search using keywords such as “COVID-19,” “SARS-CoV-2,” “coronavirus,” “D-dimers,” “biomarkers,” and “severity prediction,” which were used in various combinations to maximize search efficiency. Therefore, the manuscript contains 51 representative articles for the purpose of this synthesis article.
Results. The D-dimer levels are significantly higher in patients with severe forms of COVID-19 compared to those with non-severe forms, in patients with acute respiratory distress syndrome compared to those without acute respiratory distress syndrome, and in deceased patients compared to those who have survived. D-dimers positively correlate with the degree of severity and the increased risk of progression to severe disease, inversely proportional to the survival rate. They can predict prognosis, determine therapeutic strategies, prevent complications, positively influence the disease’s course, and monitor the prognosis.
Conclusions. D-dimers should be used as a pre-radiographic screening tool as early as possible after admission and as an indicator for risk stratification of venous thromboembolism in hospitalized patients with COVID-19. Based on the increase in D-dimer levels, adjusting therapeutic doses of anticoagulants is more beneficial for patients compared to administering prophylactic doses
Prognostic value of D-dimers in patients with COVID-19: narrative synthesis
Get PDFIntroduction. Contemporary researchers have suggested and demonstrated the hypothesis that the elevated level of D-dimers, which is a valuable marker of coagulation and fibrinolysis activation, can predict the severity of COVID-19, pulmonary complications, and thromboembolic events before they occur.
Material and methods. The bibliographic resources were analyzed and selected from databases such as PubMed, Hinari, SpringerLink, and Google Search using keywords such as “COVID-19,” “SARS-CoV-2,” “coronavirus,” “D-dimers,” “biomarkers,” and “severity prediction,” which were used in various combinations to maximize search efficiency. Therefore, the manuscript contains 51 representative articles for the purpose of this synthesis article.
Results. The D-dimer levels are significantly higher in patients with severe forms of COVID-19 compared to those with non-severe forms, in patients with acute respiratory distress syndrome compared to those without acute respiratory distress syndrome, and in deceased patients compared to those who have survived. D-dimers positively correlate with the degree of severity and the increased risk of progression to severe disease, inversely proportional to the survival rate. They can predict prognosis, determine therapeutic strategies, prevent complications, positively influence the disease’s course, and monitor the prognosis.
Conclusions. D-dimers should be used as a pre-radiographic screening tool as early as possible after admission and as an indicator for risk stratification of venous thromboembolism in hospitalized patients with COVID-19. Based on the increase in D-dimer levels, adjusting therapeutic doses of anticoagulants is more beneficial for patients compared to administering prophylactic doses
3D-Workbench : Design and Development of a 3-Dimension Computer Numerical Controlled Machine
Get PDFThe purpose of this thesis was to examine and develop a multipurpose Computer Numerical Controlled (CNC) device which would satisfy industrial requirements, but could also be implemented at universities for students to improve and apply their knowledge in different scopes. The topic was specifically chosen because of its close relation to a summer job at a metal factory the author completed and his personal fascination with 3D printers.
The project presented in this thesis was commissioned by HAMK University of Applied Sciences. The design and development of the prototype took place in the automation laboratory of HAMK UAS, Valkeakoski unit. Literature and product documentation established the main sources of in-formation, although online resources were used as well. At the first stage, a research was carried out concerning 3D-printing related topics, such as interpolation and G-Code. Afterwards, a suitable control and motion system needed to be found. Once a list with suitable components was established, the machine design could take place. By using the design tool Autodesk Inventor it was possible to obtain a 3D model of the device.
Following the design, a prototype was built. A number of challenges were faced as major design changes had to be performed to the prototype. Still, the resulting prototype offered essentially the same functionality as the original design. For this prototype, a metal engraving tool was used at first for testing purposes, followed by a milling or drilling tool.
All in all, the results met and even surpassed the author’s expectations. Recommended further improvements include an automated tool exchange system, additional tools, a reinforcement of the structure and the implementation of a user-friendly Human Machine Interface
