Spitalul Clinic de Recuperare

La presente investigación se realizó con el propósito de conocer la viabilidad para crear una empresa de turismo ecológico en la reserva natura bosque del Agüil, en Aguachica, Cesar, a fin de la recuperar una de las reservas naturales más importantes del municipio y al mismo tiempo aprovechar una gran oportunidad convirtiendo este pulmón natural en un lugar para la recreación y esparcimiento de los pobladores de esta región, aprovechando la ubicación estratégica del lugar. El estudio se realizó bajo un enfoque cuantitativo, basado en un tipo de investigación descriptivo y el instrumento para la recolección de la información se basó en una encuesta, la cual se aplicó a los habitantes del municipio. El objetivo general de esta propuesta es “Analizar el mercado para crear una empresa de turismo ecológico de la reserva natural bosque del Agüil, en Aguachica, Cesar” para el logro de esté, fue necesario desarrollar un estudio de mercado en el cual se demostró la viabilidad comercial del proyecto; un estudio técnico y administrativo para definir la localización, equipos, procesos y la estructura organizacional que permita el correcto funcionamiento de la misma. Finalmente se desarrolló el estudio que demostró que económicamente el proyecto es viable. Por lo tanto, esta investigación deja ver que el turismo y de manera especial el ecológico, es una de las actividades con mayor proyección e impacto en el desarrollo económico y social de un territorio.

One of the special human qualities is the compassion shown towards our fellow, in special situations, people who live certain states determined by the moments of life they go through. Self-compassion refers to the ability to show compassion, understanding and protection to oneself. It is operationalized by researcher Kristin Neff. Self-efficacy, proposed by Albert Bandura, refers to the perception of self and is related to the belief in one's own abilities, in one's own ability to solve situations. The interest of the study aims the relationship between self-compassion and self-efficacy in the case of a distinct category, that of therapists, professionally faced with situations that require personal resources. Methods: The level of self-compassion was assessed with the Self-Compassion Scale, 26 items, proposed by Kristin Neff. The level of self-efficacy was assessed using the New General Self-Efficacy Scale, the 8-item scale proposed by Gilad Chen & co (2001). Both questionnaires were distributed electronically. The data obtained were statistically analyzed and interpreted. Results: In the professional categories investigated, there are underline links and relations between the two constructs, with professional implications. The results show (1) Therapists have high values in assessing selfefficacy; (2) Therapists have high values of self-compassion; (3) Therapists have a high level of self-compassion and a low level of self-criticism as indicated by the self-compassion sub-scales; (4) There is a direct relationship between self-efficacy and self-compassion; (5) Therapists with high level of self-compassion also have a high level of self-efficacy (6) The level of self-efficacy is influenced by age and professional experience. (7) The level of self-compassion is influenced by age and professional experience Conclusion: The two concepts discussed are important in relation to certain professional categories and under the auspices of situations considered stressful and with emotional burden.

Spontaneous bacterial peritonitis is one of the most commun complication of decompensated liver cirrhosis. We report the case of a 44-year-old man, chronic alcohol user, who was hospitalized with progressive abdominal distention, fatigue and jaundice, the symptoms worsening in the last year. Physical examination revealed an intense sclero-tegumentar jaundice, vascular stars on the anterior chest, palmar erythema, collateral circulation of the anterolateral abdominal wall, a large volume ascites and hepatosplenomegaly. Blood tests showed anaemia, macrocytosis, thrombocytopenia and an abnormal liver function tests with an unfavorable evolution in one year. The outcome of the paracentesis was compatible with the diagnosis of spontaneous bacterial peritonitis (SBP) and Cefort (Ceftriaxone) 2 g once daily was administered.

Obiective. Stabilirea profilului de rezistenţă al tulpinilor de Escherichia coli (EC) izolate în Clinica de Boli Infecţioase Craiova. Material şi metodă. Studiu retrospectiv (ianuarie 2017-decembrie 2018); EC au fost identificate cu ajutorul sistemului automat Vitek 2, care a stabilit ulterior sensibilitatea acestora la antimicrobiene (testare uzuală la 17 antibiotice, testare extinsă la alte 9); pentru fiecare tulpină, a fost calculat indicele de rezistenţă MAR (limite: 0-1); informaţiile au fost introduse într-o baza de date Excel. Au fost testate 128 de tulpini în 2017 şi 592 în 2018. Procentul de tulpini MDR a fost calculat pe baza definiţiilor internaţional acceptate. Rezultate. Au fost identificate 720 de tulpini, marea majoritatea izolate prin urocultură (493 tulpini – 68,47%). Date demografice: 508 tulpini (71%) au fost izolate la subiecţi adulţi, 441 (61%) la pacienţi de sex feminin, 411 (57%) la bolnavi ce trăiesc în mediul urban. Valoarea globală a MAR a fost de 0,23 (faţă de 0,32 pentru ansamblul tulpinilor germenilor Gram negativi izolaţi). Peste 80% dintre tulpinile de EC a fost sensibile la Ertapenem, Meropenem, Amikacină, Polimixina E, Gentamicină, Tobramicină, Cefoxitin; sensibilităţi între 60 şi 79% au fost observate pentru Cefepimă, Ceftriaxonă, Ciprofloxacină, Ceftazidimă, Levofloxacin, Imipenem, Nitrofurantoin, Cefazolin, iar între 40 şi 59% pentru Trimetoprim-Sulfametoxazol şi Minociclină. Sub 39% dintre tulpini sunt sensibile la Ampicilină (±Sulbactam), Piperacilină (±Tazobactam), Ticarcilină (±Acid clavulanic), Aztreonam, Pefloxacină. Rezistenţa la principalele clase de antibiotice este în concordanţă cu datele europene şi naţionale, cu excepţia unui procent mult mai mare de tulpini rezistente la carbapeneme. Peste 50% dintre izolate sunt multidrog-rezistente; 48,3% dintre tulpini provin din surse în care există un contact important cu substanţele antimicrobiene. Concluzii. Peste 80% dintre tulpinile izolate sunt sensibile la Ertapenem, Meropenem, Amikacină, Polimixina E, Gentamicină, Tobramicină, Cefoxitin; un procent de peste 4,5% dintre tulpini demonstrează rezistenţă la clasa carbapenemelor; peste 50% dintre izolate sunt multidrog-rezistente; 48,3% dintre tulpini provin din surse în care există un contact important cu substanţele antimicrobiene.

Helicobacter pylori la copil i utilitatea acestuia -un studiu prospectiv

Abstract Background The optimal endoscopic target in early Crohn’s disease (CD) that limits long-term disease complications is unknown. Methods We analysed medical records from patients who had follow-up data since the end of CALM. Patients with Crohn’s disease endoscopic index of severity (CDEIS) scores at the end of CALM were included. The primary outcome was a composite of major adverse outcomes reflecting CD progression: new internal fistula/abscess, stricture, perianal fistula/abscess, CD hospitalisation, or CD surgery since the end of CALM. We compared median CDEIS and per cent improvement from baseline CDEIS. Youden index analysis was used to identify optimal CDEIS cut-off score associated with CD progression. Kaplan–Meier and Cox regression methods were used to compare rates of progression by different CDEIS targets. Multivariable models were adjusted for age, prior surgery, and stricturing behaviour. Results 110 patients with median age 28 (IQR 22–38) years, disease duration 0.2 (0.1–0.5) years, and median follow up of 3.1 (1.9–4.4) years were included. Eleven per cent had a history of stricture, 5.5% history of surgery, and 52% were originally in the tight control arm of the CALM study. Median CDEIS score at end of CALM was 3 (0–5.4) and 32 (29%) patients had disease progression. Baseline median CDEIS score was similar between those with and without progression [10.9 (7.5–15.5) vs. 11.9 (8–17.5)]. Median CDEIS score at the end of CALM was higher among those with progression [1.3 (0–5.1) vs. 4.9 (3–9.1), p < 0.001)]. Patients within higher quartiles of CDEIS score had higher rates of progression over time (Figure 1). Patients without disease progression had a greater median decrease in CDEIS score from baseline to end of CALM [90% (60–100%) vs. 50% (30–80%), p < 0.001]. The optimal CDEIS score cut-off was 2 with sensitivity 84%, specificity 60% and NPV 90% for progression. Patients with CDEIS ≤ 2 had less progression over time compared with patients with > 50% improvement from baseline CDEIS (not reaching CDEIS ≤ 2) and those not meeting either endpoint (Figure 2). On adjusted analysis, CDEIS score ≤ 2 was associated with a decreased risk of progression (aHR 0.23, 95% CI 0.09–0.56). Conclusion In early CD, a CDEIS score ≤ 2 is optimal cut-off associated with a lower risk of disease progression.

Sindromul Potter reprezintă o asociere dintre un fenotip specific şi hipoplazie pulmonară ca rezultat al oligohidramniosului, care poate surveni în anumite condiţii patologice. Astfel, sindromul Potter de tip I sau boala renală polichistică autozomal recesivă este o patologie cu incidenţă relativ rară şi prognostic infaust atunci când este diagnosticată în timpul vieţii intrauterine. Prezentăm cazul unei femei în vârstă de 24 de ani, internată în clinica noastră prezentând o sarcină în evoluţie, 22/23 săptămâni gestaţionale, la care ecografia fetală de rutină a evidenţiat oligohidramnios, displazie renală polichistică şi hipoplazie pulmonară. Antecedentele personale patologice au relevat faptul că, în urmă cu 2 ani, pacienta a suferit un avort terapeutic la vârsta de 16 săptămâni gestaţionale pentru aceleaşi motive. Ecografia maternă a arătat agenezie renală maternă unilaterală. Din cauza faptului că malformaţia evidenţiată era incompatibilă cu viaţa, s-a indus avortul terapeutic. Particularitatea cazului constă în diagnosticarea sindromului Potter la două sarcini consecutive la o femeie în vârstă de 24 de ani, fără antecedente heredocolaterale cunoscute, însă care este diagnosticată cu agenezie renală unilaterală.