Pre- and Post-COVID-19 Antimicrobial Resistance Pattern of Pathogens in an Intensive Care Unit.

We aimed to determine the trend of the antimicrobial resistance pattern of pathogens isolated in samples collected from patients hospitalized in the intensive care unit (ICU) in selected periods before and after COVID-19. A retrospective study of bacterial pathogens was performed on 1267 patients. Positive bacterial culture data from 1695 samples from the pre-COVID-19 period and 1562 samples from the post-COVID-19 period were obtained. The most frequently isolated bacteria in both periods were Staphylococcus aureus and Klebsiella spp. The resistance rates of Klebsiella spp. Significantly increased against colistin (0.38% to 20.51%), gentamicin (44.62% to 64.85%), and aztreonam (56.35% to 3.60%). There was a significant increase in the resistance rate against colistin for E. coli strains (4.69% to 32.46%) and for Acinetobacter sp. strains (3.37% to 18.09%). More than 50% of the Staphylococcus aureus strains were MRSA, with statistically significant increases in the antimicrobial resistance rate against doxycycline (40.08% to 51.72%), linezolid (0.22% to 3.13%), rifampicin (53.16% to 64.93%), and teicoplanin (26.31% to 53.40%). The study revealed a significantly increasing trend in the antimicrobial resistance rate of Gram-negative pathogens against certain antibiotics, including those used only in cases where there are no other therapeutic options.

miR-499a rs3746444 A>G Polymorphism Is Correlated with Type 2 Diabetes Mellitus and Diabetic Polyneuropathy in a Romanian Cohort: A Preliminary Study.

Type 2 diabetes mellitus (T2DM) is a common metabolic disorder that results from complex interactions of both environmental and genetic factors. Many single nucleotide polymorphisms (SNPs), including noncoding RNA genes, have been investigated for their association with susceptibility to T2DM and its complications, with little evidence available regarding Caucasians. The aim of the present study was to establish whether four miRNA SNPs (miR-27a rs895819 T>C, miR-146a rs2910164 G>C, miR-196a2 rs11614913 C>T, and miR-499a rs3746444 A>G) are correlated with susceptibility to T2DM and/or diabetic polyneuropathy (DPN) in a Romanian population. A total of 167 adult T2DM patients and 324 age- and sex-matched healthy controls were included in our study. miRNA SNPs were detected by real-time PCR using a TaqMan genotyping assay. A significant association with T2DM was observed only for the miR-499a rs3746444 A>G SNP in all the tested models, and the frequencies of both the miR-499a rs3746444 AG and the GG genotypes were higher in the T2DM patients compared to the controls. No correlation was observed for the miR-27a rs895819 T>C, miR-146a rs2910164 G>C, or miR-196a2 rs11614913 C>T SNPs in any genetic model. When we assessed the association of these SNPs with DPN separately, we found a positive association for the miR-499a rs3746444 SNP in both codominant and dominant models (OR 6.47, 95% CI: 1.71-24.47; OR 2.30, 95% CI: 1.23-4.29, respectively). In conclusion, this study shows that miR-499a rs3746444 A>G may influence both T2DM and DPN susceptibility, with carriers of the GG genotype and the G allele being at an increased risk in the Romanian population.

Pathogenic Copy Number Variations Involved in the Genetic Etiology of Syndromic and Non-Syndromic Intellectual Disability-Data from a Romanian Cohort.

The investigation of unexplained global developmental delay (GDD)/intellectual disability (ID) is challenging. In low resource settings, patients may not follow a standardized diagnostic process that makes use of the benefits of advanced technologies. Our study aims to explore the contribution of chromosome microarray analysis (CMA) in identifying the genetic etiology of GDD/ID. A total of 371 Romanian patients with syndromic or non-syndromic GDD/ID, without epilepsy, were routinely evaluated in tertiary clinics. A total of 234 males (63.07%) and 137 (36.93%) females, with ages ranging from 6 months to 40 years (median age of 5.5 years), were referred for genetic diagnosis between 2015 and 2022; testing options included CMA and/or karyotyping. Agilent Technologies and Oxford Gene Technology CMA workflows were used. Pathogenic/likely pathogenic copy number variations (pCNVs) were identified in 79 patients (21.29%). Diagnosis yield was comparable between mild ID (17.05%, 22/129) and moderate/severe ID 23.55% (57/242). Higher rates were found in cases where facial dysmorphism (22.97%, 71/309), autism spectrum disorder (ASD) (19.11%, 26/136) and finger anomalies (20%, 27/96) were associated with GDD/ID. GDD/ID plus multiple congenital anomalies (MCA) account for the highest detection rates at 27.42% (17/62). pCNVs represent a significant proportion of the genetic causes of GDD/ID. Our study confirms the utility of CMA in assessing GDD/ID with an uncertain etiology, especially in patients with associated comorbidities.

Cytogenetic Analysis of Sporadic First-Trimester Miscarriage Specimens Using Karyotyping and QF-PCR: A Retrospective Romanian Cohort Study.

It is well known that first-trimester miscarriages are associated with chromosome abnormalities, with numerical chromosome abnormalities being the ones most commonly detected. Conventional karyotyping is still considered the gold standard in the analysis of products of conception, despite the extended use of molecular genetic techniques. However, conventional karyotyping is a laborious and time-consuming method, with a limited resolution of 5-10 Mb and hampered by maternal cell contamination and culture failure. The aim of our study was to assess the type and frequency of chromosomal abnormalities detected by conventional karyotyping in specimens of sporadic first-trimester miscarriages in a Romanian cohort, using QF-PCR to exclude maternal cell contamination. Long-term cultures were established and standard protocols were applied for cell harvesting, slide preparation, and GTG banding. All samples with 46,XX karyotype were tested for maternal cell contamination by QF-PCR, comparing multiple microsatellite markers in maternal blood with cell culture and tissue samples. Out of the initial 311 specimens collected from patients with sporadic first-trimester miscarriages, a total of 230 samples were successfully analyzed after the exclusion of 81 specimens based on unsuitable sampling, culture failure, or QF-PCR-proven maternal cell contamination. Chromosome abnormalities were detected in 135 cases (58.7%), with the most common type being single autosomal trisomy (71/135-52.6%), followed by monosomy (monosomy X being the only one detected, 24/135-17.8%), and polyploidy (23/135-17.0%). The subgroup analysis based on maternal age showed a statistically significant higher rate of single trisomy for women aged 35 years or older (40.3%) compared to the young maternal age group (26.1%) (p = 0.029). In conclusion, the combination of conventional karyotyping and QF-PCR can lead to an increased chromosome abnormality detection rate in first-trimester miscarriages. Our study provides reliable information for the genetic counseling of patients with first-trimester miscarriages, and further large-scale studies using different genetic techniques are required.

Prediction of labor outcome pilot study: evaluation of primiparous women at term.

BACKGROUND: Emergency operative delivery is associated with high fetal and maternal morbidity and mortality. It is of high importance to find means to predict the delivery mode before the onset of labor. OBJECTIVE: This study aimed to investigate the potential of combined sonographic and clinical determination to predict the mode of delivery at term. STUDY DESIGN: An observational prospective cohort study was deployed in a tertiary maternity hospital (Emergency County Hospital Craiova). Unselected low-risk primiparous pregnant women were evaluated weekly at term for ultrasound determinations (estimated fetal weight, head descent parameters, occiput posterior, cervical length), Bishop score, and maternal characteristics (age, height, weight). A thorough statistical analysis determined which variables were significantly correlated with the delivery mode. RESULTS: Data from 276 term primiparous women were analyzed. Head descent parameters were strongly and significantly correlated with each other, but only progression distance was correlated with the delivery mode (gestational weeks 37, 38, 41, and the week before delivery). In the week before delivery, measurements of head-to-perineum distance and angle of progression reached almost significant P levels of.055 and.07, respectively. The following variables were significantly correlated with the delivery mode: body mass index in all term evaluations; progression distance for weeks 37 and 38; maternal age for week 39; Bishop score, estimated fetal weight, and occiput posterior for week 40; and body mass index, estimated fetal weight, and progression distance for the week before delivery. We also provided logistic regression equations for each week with correct delivery mode prediction, except for week 38. Cutoff values were established for each significant parameter per week. The cutoff values must be read in conjunction with the area under the curve, which ranged from 0.55 to 0.73, depending on the variable. CONCLUSION: There are strong and significant correlations among the "head descent" ultrasound measurements at term. Body mass index is predictive of labor outcomes throughout term evaluations. Progression distance and body mass index measured at 37 to 38 weeks' gestation correlate with the delivery mode and apparently can be used to forecast the delivery mode when the pregnancy reaches term. For the week before delivery, measurements of estimated fetal weight and progression distance can be used to forecast the delivery mode, perhaps as part of a policy for pregnant women with prelabor clinical signs. Larger studies with more data, particularly better-balanced data, are needed.

The Value of Fetal Head Station as a Delivery Mode Predictor in Primiparous Women at Term before the Onset of Labor.

OBJECTIVE: Our objective was to demonstrate the role of the clinical determination of fetal head station (FHS) at term to predict the delivery mode in primiparous women before the onset of labor. METHODS: This prospective study included unselected primiparous women at term who presented at our tertiary maternity. We excluded multiparous patients, pregnancies with a planned Cesarean section, non-cephalic presentations, and multiple pregnancies. The protocol included weekly clinical examinations to assess the FHS. The results were used to describe the clinical fetal head descent at term. We correlated the fetal head station determinations at each week with labor outcome, including the evaluations performed within the week before delivery. RESULTS: The data show no significant differences between vaginal (VD) and Cesarean section delivery (CS) cases regarding FHS determined at each week at term. The median determinations at the gestational ages (GW) from 37 to 41 were -2 and -3, similar between the two groups, with a more consistent difference at 41 GW: station -1 for VD compared to -3 for CS. There were significant differences between the "week before delivery" evaluations of the two groups. The determinations showed for both groups similar minimum (-5), maximum (+1), and median (-2) FHS values. Most vaginal deliveries cases presented at weekly examinations with increasing rates toward more advanced stations: from 10% at station -4 to 35% at station -1. Although we investigated a low-risk group, we found significant differences between the vaginal and Cesarean groups in terms of age, weight, and BMI. We provided a multiple logistic regression equation that considered the predictive clinical variables at term: the fetal head situation, age, weight, height, and BMI. CONCLUSION: The clinical evaluation of fetal head station in primiparous before labor onset has a limited value regarding the prediction of the delivery mode. There is a potential benefit for the determinations performed within the week before delivery, but such a policy would require weekly assessments of the FHS at term, which is unlikely to be implemented. Another potential benefit would involve estimating labor outcomes in late-term or prolonged pregnancy. The fine tuning of the logistic prediction should be achieved by increasing the studied population and the number of centers involved before counseling primiparous women at term based on the clinical fetal engagement data.

Sonographic Evaluation of the Mechanism of Active Labor (SonoLabor Study): observational study protocol regarding the implementation of the sonopartogram.

INTRODUCTION: Over the last decades, a large body of literature has shown that intrapartum clinical digital pelvic estimations of fetal head position, station and progression in the pelvic canal are less accurate, compared with ultrasound (US) scan. Given the increasing evidence regarding the advantages of using US to evaluate the mechanism of labour, our study protocol aims to develop sonopartograms for fetal cephalic presentations. They will allow for a more objective evaluation of labour progression than the traditional labour monitoring, which could enable more rapid decisions regarding the mode of delivery. METHODS/ANALYSIS: This is a prospective observational study performed in three university hospitals, with an unselected population of women admitted in labour at term. Both clinical and US evaluations will be performed assessing fetal head position, descent and rotation. Specific US parameters regarding fetal head position, progression and rotation will be recorded to develop nomograms in a similar way that partograms were developed. The primary outcome is to develop nomograms for the longitudinal US assessment of labour in unselected nulliparous and multiparous women with fetal cephalic presentation. The secondary aims are to assess the sonopartogram differences in occiput anterior and posterior deliveries, to compare the labour trend from our research with the classic and other recent partogram models and to investigate the capability of the US labour monitoring to predict the outcome of spontaneous vaginal delivery. ETHICS AND DISSEMINATION: All protocols and the informed consent form comply with the Ministry of Health and the professional society ethics guidelines. University ethics committees approved the study protocol. The trial results will be published in peer-reviewed journals and at the conference presentations. The study will be implemented and reported in line with the Strengthening the Reporting of Observational Studies in Epidemiology statement. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov Registry (NCT02326077).

Can We Use the Bishop Score as a Prediction Tool for the Mode of Delivery in Primiparous Women at Term Before the Onset of Labor?

The Bishop score serves as an evaluation system performed by digital vaginal examination (DVE) to determine cervical ripening. The scoring system includes cervical dilatation, position, effacement and consistency of the cervix and fetal head station1. Nowadays, the Bishop score is frequently used as an important parameter for the prediction of successful induction of labor. OBJECTIVE: Our objective was to demonstrate the role of the Bishop scoring system in prediction of the mode of delivery in primiparous women at term before the onset of labor. METHOD: We included in this study unselected primiparous women at term, after 37 weeks of gestation, who presented to the Prenatal Diagnostic Unit (PDU) of the University Emergency County Hospital of Craiova. We excluded from the study multiparous patients, pregnancies with a planned Caesarean section delivery (CD), non-cephalic presentations and multiple pregnancies, twin pregnancies and those with detected fetal anomalies. The protocol included weekly DVEs until delivery for all patients, to determine the evolution of the Bishop score at term and in the week before delivery, and potential correlations with delivery outcome. To reduce clinical bias, the DVEs were performed by three experienced obstetricians involved in the research. RESULTS: Statistical analysis yielded a 4 to 6 Bishop score in all weekly examinations. At 37 weeks of gestation, the majority of primiparous women had a Bishop score of 4, with no significant differences between the primiparous who delivered vaginally and the ones where Caesarean section was necessary. During the following weekly evaluations, we noted a slight turn to a Bishop score of 6 for most of them, without any significant differences between the two groups. However, at 41 weeks of gestation, there was a significant higher Bishop score in the group of primiparous women who delivered vaginally. CONCLUSION: In our study, the use of the Bishop score failed as a prediction tool for the mode of delivery in primiparous women at term before the onset of labor, at a gestational age less than 40 weeks. Therefore, Bishop score should not be used to counsel regarding the probability of an uncomplicated vaginal delivery (VD) before the onset of labor.

The Implications of the First Trimester 2d and Volumetric Ultrasound in Pregnancy Outcome.

BACKGROUND: The purpose is to investigate the role of the first trimester ultrasound markers: cown rump lengh (CRL), gestational sac volume (GSV), embryonic volume (EV) and yolk sac volume (YSV) as parameters for outcome. METHODS: Observational clinical study that was carried out in the Obstetrics and Gynecology Clinic. The study included a number of 81 unselected patients evaluated from the first trimester. Patients were evaluated in the first trimester by transvaginal ultrasound and followed up during pregnancy. Correlations between the GSV, EV, YSV and CRL was made for assessing outcome. RESULTS: Our study results show that patients with abnormal early ultrasound parameters had a higher incidence of pregnancy complications. CONCLUSIONS: An early pregnancy evaluation can be a helpful tool in predicting outcome.

Evaluation of the psychoneurotic tendencies risk using the woodworth mathews personality inventory in non-institutionalized persons.

INTRODUCTION: Multiple factors of vulnerability may lead to development of abnormal social behaviour and to important psychiatric diseases. The psychopathological characteristics present at individual level can lead to a pattern of population groups that are subject to developing mental illness risks. MATERIAL AND METHODS: Multidisciplinary study (2009-2011) to assessing the current situation of mental health and identifying population risk groups for developing psychiatric disorders in a non-institutionalised population. We used the Woodworth Mathews Inventory (76 items) to a randomly selected sample of 1,200 men and women, residents in urban and rural areas. RESULTS: The extreme scores for emotiveness had a frequency more than triple for women, and we found a similar situation for obsessive-neurasthenic and depressive tendencies. People aging over 35 years had a double score (limit and poignancy) for depression than younger people, meanwhile correlation between age under 35 years and instability and antisocial tendencies is highly statistically significant (p<0.001), the frequency of extreme scores being almost double than in the older people. CONCLUSIONS: Female gender has a vulnerability for develop depressive and emotional disorders and age over 35 is also significant correlated with depressive tendencies. Younger people (under 35 years) are predisposed for pathological antisocial behaviour, fact revealed by the high scores for instability and antisocial tendencies. It is necessary to develop a program focused on the two risk categories to prevent the possible occurrence of psychiatric disorders.

Socio-economic factors influencing the nutritional behaviour of pupils.

The purpose of the study was to evaluate the quality of morning nutrition of children in primary school, related to the residence environment and the family educational level. We included in our study 220 children in the age group 8-10, studying in urban and rural schools. They answered a 24-itemed questionnaire regarding their morning nutrition. Nutrition state, health state and school performance were evaluated. We found that 9.1% of all the children skip breakfast and midmorning snack. Most frequently they have margarine, salami, jam or cheese sandwiches and tea as breakfast. The free "milk and roll" are daily consumed by less than 45 % of the subjects. We did not find significant disorders in their nutrition and health state. Educational activities for a healthy nutrition are necessary.

[Smoking, alcohol consumption and pregnancy in a population of south-western Romania]. / Fumatul, consumul de alcool si sarcina la populatii din sud-vestul României.

UNLABELLED: The purpose of the study was to evaluate the amplitude of tobacco and alcohol consumption among two populations living in urban, respectively rural areas in the South-Western part of the country. The presence of the two risky behaviours during the pregnancy was also analysed. MATERIAL AND METHOD: A number of 1,200 people, men and women, aged 18-75 years, with different educational levels, living in urban and rural communities were asked to answer a questionnaire with 111 items regarding their knowledge and attitudes about the sexual-reproductive health; 11 items referred to tobacco smoking and alcohol drinking. RESULTS: About half of the subjects have never smoked. The mean age of starting smoking was 16.97 years. A number of 295 subjects (24.6%) were daily active smokers, men more frequently than women (p < 0.001). A percentage of 77.3% of the subjects used to drink alcohol, 16.4% of them daily. The daily alcohol consumption was more frequent among men, low educated people and rural inhabitants comparing to women, respectively high educated or urban inhabitants (p < 0.001); 11.2% of the respondents got frequently drunk. During the last pregnancy in the couple, women and high educated people stopped smoking and drinking more frequently then men, respectively low educated people. CONCLUSIONS: The above findings indicate the need to start in school effective health promotion campaigns to reduce tobacco and alcohol consumption and the need for support of population-based educational interventions aimed at smoking cessation in both parents.

The effects of an essential oil and an amine fluoride/stannous fluoride mouthrinse on supragingival plaque regrowth.

BACKGROUND: The side effects of chlorhexidine (CHX) have stimulated the search for alternative antiplaque agents such as amine fluoride/stannous fluoride (ASF) and essential oils (EO). The aim of the study was to investigate the plaque-inhibiting effects of two commercially available mouthrinses containing ASF and EO, respectively. METHODS: The study was an observer-masked, randomized, 5 x 5 Latin square cross-over design, balanced for carryover effects, involving 15 volunteers in a 4-day plaque regrowth model. A 0.12% CHX rinse and a saline solution served as positive and negative controls, respectively. On day 1, subjects received professional prophylaxis, suspended oral hygiene measures, and commenced rinsing with their allocated rinses. On day 5, subjects were scored for disclosed plaque. The ASF rinse was tested at two dosages: 10 and 20 ml (ASF-10 and ASF-20, respectively). RESULTS: The ASF and EO rinses showed a significant inhibition of plaque regrowth compared to saline (P <0.0001), but the lowest plaque indices were obtained with the CHX product (P <0.01). There were no significant differences among products containing ASF-10, ASF-20, and EO (P >0.05). There was no correlation between the occurrence of side effects and the use of a particular rinse product (P >0.2). CONCLUSIONS: ASF and EO mouthrinses exerted effective and similar plaque inhibition. The two dosages tested for ASF did not differ in plaque reduction. These findings, together with those from long-term trials, suggest that ASF and EO rinses may represent effective alternatives to CHX rinse as adjuncts to oral hygiene.

The effects of sugar-free chewing gums on dental plaque regrowth: a comparative study.

UNLABELLED: Sugar-free chewing gum has been claimed to be a useful means of reducing dental plaque accumulation. The incorporation of additives, such as enzymes, abrasives and divalent metal ions, into gum formulations might improve their antiplaque activity, particularly at the buccal and lingual surfaces of the teeth. OBJECTIVES: The aim of this study was to investigate the plaque inhibitory effects of three sugar-free chewing gums each containing lactoperoxidase (LP), micro granules of silicon dioxide (SD), and zinc gluconate (ZG). METHODS: The study was an observer-masked, randomized cross-over design balanced for carryover effects, involving 12 healthy volunteers in a 4-day plaque regrowth model. An additive-free (AF) gum served as positive/negative control for occlusal and smooth surfaces, respectively. On day 1, subjects received professional prophylaxis, suspended oral hygiene measures, and commenced chewing their allocated product. Gum chewing was one piece chewed for 30min 4 times a day. On day 5, subjects were scored for disclosed plaque. RESULTS: There were no significant differences in antiplaque activity of the gums tested, neither for the smooth nor for the occlusal surfaces (P=0.447 and P=0.418, respectively). Similar results were obtained for the anterior and posterior sites of smooth surfaces (P>0.05), and for the lower and upper sites of occlusal surfaces (P=0.451 and P=0.53, respectively). CONCLUSIONS: These findings suggest that the chewing gums containing LP, SD and ZG would provide no plaque inhibitory effects on smooth surfaces. The gums containing these additives, therefore, should not be recommended as adjuncts to mechanical oral hygiene.

The effects of an amine fluoride/stannous fluoride and an antimicrobial host protein mouthrinse on supragingival plaque regrowth.

BACKGROUND: Chlorhexidine (CHX)-containing mouthrinses are recommended as adjuncts to mechanical oral hygiene. The problem associated with side effects, however, has stimulated the search for alternative antiplaque agents. The aim of this study was to investigate the plaque inhibitory effects of two mouthrinses containing amine fluoride/stannous fluoride (ASF) and antimicrobial host proteins (lactoperoxidase, lysozyme and lactoferrin; LLL), respectively. METHODS: The study was an observer-masked, randomized 4x4 Latin square cross-over design balanced for carryover effects, involving 12 healthy volunteers in a 4-day plaque regrowth model. A 0.12% CHX mouthrinse and a saline solution served as positive and negative controls, respectively. On day 1, subjects received professional prophylaxis, suspended oral hygiene measures, and commenced rinsing with their allocated rinses. On day 5, subjects were scored for disclosed plaque. RESULTS: The ASF rinse showed a significant inhibition of plaque regrowth in comparison to both saline and LLL solutions, but the lowest plaque indices were obtained with the CHX formulation (P<0.01). There were no significant differences between LLL rinse and saline (P>0.05). Such pattern of efficacy was the same in anterior and posterior teeth and in vestibular and lingual surfaces as well, with the exception of the lingual anterior surfaces. In these sites, differences between the CHX and ASF rinses were not significant (P>0.05). A significantly higher prevalence of side effects was found in subjects using the CHX product (P<0.0042). CONCLUSIONS: Although the effect on plaque regrowth observed with 0.12% CHX rinsing was superior to that with ASF, the ASF rinse was not associated with side effects. These findings, together with those from long-term trials, suggest that the ASF rinse may represent an effective alternative to CHX rinse as an adjunct to oral hygiene. On the contrary, the LLL rinse did not significantly inhibit plaque regrowth.