ELECTRONIC CIGARETTE--A WAY OF SMOKING CESSATION?

Specialists have the ethical obligation to promote smoking cessation using evidence-based therapeutic strategies. In the context of the growing popularity of the electronic cigarettes (ECs), the smokers asking us about it and we must be ready to provide expert advice. With the evidence available to date we must be cautious in recommending of the smokers to use ECs for smoking cessation because these have not proven superiority over drugs used for smoking cessation approved by the Food and Drug Administration (FDA), ECs are not FDA approved, short-term safety data shows that they cause airway reactivity and health risk of exposure to ECs in the long term is unknown. Before the ECs to occupy a place in the standard clinical approaches for the treatment of tobacco addiction longer needed more data about their safety clinical and regulatory of their use.

[Etiology of ventilator-associated pneumonia at the Cardiovascular Surgery Clinic of Iasi]. / Etiologia pneumoniei asociata ventilatiei mecanice la clinica de chirurgie cardiovasculara din Iasi.

AIM: We want to assess the etiology of ventilator-associated pneumonia (VAP) and emergence of resistant phenotypes for greater efficiency of the first-line antimicrobial treatment post-cardiac surgery. The study focuses on patients with VAP post-cardiac surgery at the Institute of Cardiovascular Surgery between April 2nd 2002 and August 27th 2008, divided in two groups, before and after June 14th, 2005. MATERIAL AND METHODS: The tracheal aspirates were examined quantitatively (microscopy, culture). The isolates with clinical significance (> or = 106 CFU/mL) were identified by standard methods and tested by disk difussion or with the breakpoints method for susceptibility to antibiotics. RESULTS: Among the 1527 operated patients, 28 of them were diagnosed with VAP through the clinical pulmonary infection score > or = 6. The 9 most common pathogens in VAP etiology were Pseudomonas aeruginosa 23.81%, Acinetobacter baumannii 19.05%, Stenotrophomonas maltophilia 11.91%, Candida albicans 9.53%, while Klebsiella pneumoniae, Escherichia coli, Staphylococcus aureus, Corynebacterium striatum/amycolatum, Pneumocystis jirovecii amounted 4.76% each. Acinetobacter baumannii and S.maltophilia appear starting with June 15th, 2005. From that moment on we isolated with a higher frequency the gram-negative bacilli which produce extended-spectrum beta-lactamases 15.62%, with multidrug resistance (MDR) 46.86%. The MDR phenotype was more frequent at A.baumannii (15.62%), S. maltophilia (15.62%) and P. aeruginosa (12.50%) compared to K .pneumoniae (3.12%) or E. coli (0%). Methicillin-resistant S. aureus was isolated with a 6.25% frequency. CONCLUSIONS: The most common etiologic agents of ventilator-associated pneumonia post-cardiac surgery are Pseudomonas aeruginosa, Acinetobacter baumannii, Stenotrophomonas maltophilia and Candida albicans. The large use of antibiotics selects infectious agents with intrinsic resistance and multiresistant

[Fungi as emergent etiologic agents in ventilator-associated pneumonia after cardiac surgery]. / Fungii ca agenti etiologici emergenti ai pneumoniei asociata ventilatiei mecanice post-chirurgie cardiaca.

UNLABELLED: Evaluation of the fungal involvement in the etiology of ventilator-associated pneumonia (VAP) after cardiac surgery. The study had as target the patients diagnosed with VAP after cardiac surgery at the Institute of Cardiovascular Diseases in Iasi, between April 2nd 2002 and December 31st 2009. MATERIAL AND METHOD: Our study included only cases with fungal etiology of VAP. We examined quantitatively the tracheal aspirates with cytology quality score Q = 2+: microscopy and cultivation. The isolates with clinical significance (= 10(6)UFC/mL significantly associated to inflammatory cells) were identified by standard methods or based on the API system (bioMérieux) and tested by the breakpoints method for susceptibility to antifungal agents. RESULTS: Among the 2167 operated patients, 35 of them were diagnosed with VAP through the clinical pulmonary infection score = 6. Fungi caused 15 of 44 VAP episodes. With a frequency of 30.19%, fungi are on 2nd place within the etiologic agents of VAP after non-fermenting Gram-negative bacilli (45.28%). The fungi involved in VAP were: Candida albicans (16.97%), Pneumocystis jirovecii (3.77%), while Candida glabrata, Candida sake, Candida krusei, Geotrichum capitatum and Cryptococcus humicola, amounted 1.89% each. The widespread use of broad spectrum antibiotics led to the emergence of fungi as a common cause of ventilator-associated pneumonia. The involvement in the VAP etiology of P. jirovecii, an un-cultivable fungus with special sensitivity to antibiotics, requires a careful microscopy of specimens.