Background: Multiple agents are used for laparoscopic cholecystectomy since laparoscopic cholecystectomy is routinely performed surgery and desirable to have a stable intraoperative hemodynamic status by avoiding hypotension, hypertension or tachycardia. The search for ideal agent is still ongoing, alpha -2 adrenergic agonist have created interest in manner. So, the present study was conducted to compare the beneficial effect of clonidine and dexmedetomidine during laparoscopic cholecystectomy in maintain perioperative cardiovascular stability.  Methods: The present double blind randomized, prospective clinical study was carried out among patients scheduled for elective laparoscopic cholecystectomy under general anaesthesia for a duration of 2 years. The sample size was calculated as 90 using formula: n=4pq/d2 and were divided equally into groups A (control), group B (clonidine) and group C (dexmedetomidine). Preanesthetic assessment of all the selected patients were done with complete history, general examination, airway assessment, systemic examination along with laboratory investigations. During perioperative period, hemodynamic parameters such as heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure (MAP) were recorded various intervals.  Results: Increase in heart rate was statistically insignificant in all the groups at baseline (B) and just after induction (D0).After infusion of drugs, increase in heart rate was significantly lower in all the intervals in Dexmedetomidine group and Clonidine group comparing with Control group.On comparing dexmedetomidine group with clonidine group, insignificant fall (p>0.05) in DBP were observed at all intervals except at 30 minutes after pneumoperitoneum (APN30) and after reversal(DBP_AR).While comparing Dexmedetomidine group with clonidine group, insignificant fall (p>0.05) in SBP and MAP were observed at all intervals except at 50 minutes after pneumoperitoneum (APN50).While comparing Clonidine with Dexmedetomidine, significantly decrease heart rate was observed in dexmedetomidine group.  Conclusion: Creation of pneumoperitoneum in laparoscopic abdominal surgeries produces significant increase of heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure (MAP). During pneumoperitoneum in laparoscopic abdominal surgeries both intravenous clonidine and intravenous dexmedetomidine results to attenuate in all hemodynamic parameters (HR, SBP, DBP and MAP) During pneumoperitoneum in laparoscopic surgeries heart rate is better controlled by dexmedetomidine.

Background: The emergence of minimally invasive surgical techniques has led to a rise in ambulatory surgeries, which in turn has increased the demand for fast tracking. The present study was conducted to compare Sevoflurane and Desfluranefor recovery profile and airway responses.  Materials & Methods: 70 patients of both genders were divided into 2 groups of 35 each. Group I patients received sevoflurane for maintenance of anaesthesia, and group II patients received desflurane for maintenance of anaesthesia Baseline hemodynamic, and biochemical variables were evaluated.  Results: The mean age in group I patient was 45.2 years and in group II was 45.3 years. The mean weight was 68.2 kgs and 696.1 kgs. The mean height was 174.2 cms and 175.4 cms in group I and II respectively. The difference was non- significant (P> 0.05). Opening of eyes was 10.2 minutes in group I and 6.7 minutes in group II, response to verbal commands was 13.6 minutes and 6.4 minutes, orientation to time and place was 15.8 minutes and 7.2 minutes and total recovery time was 48.2 minutes and 32.5 minutes in group I and II respectively. The difference was significant (P< 0.05). Adverse events reported were hiccups seen in 1 in group II, laryngospasm 2 in group I and 1 in group II and cough 1 in group I and 3 in group II. The difference was non- significant (P> 0.05).  Conclusion: Desflurane is vastly better than sevoflurane. Desflurane allows for quicker awakening compared to sevoflurane, and does not lead to a rise in negative airway incidents.

Background: Intravitreal injections (IVIs) are a common treatment for diabetic macular edema (DME). The choice of anesthesia used during the procedure can impact both patient comfort and clinical outcomes. Objective: To evaluate the impact of different anesthesia techniques on pain, visual acuity, central retinal thickness (CRT), intraocular pressure (IOP), and adverse events in patients receiving IVIs for DME. Methods: A total of 135 patients with DME were prospectively assigned to one of three anesthesia groups: topical anesthesia (n = 45), peribulbar block (n = 45), and retrobulbar block (n = 45). Pain perception was assessed using the Visual Analog Scale (VAS) at three time points: before, during, and immediately after the injection. Visual acuity, CRT, and IOP were measured at baseline, 1 month, 3 months, and 6 months after the injection. Adverse events were recorded throughout the study period. Results: The retrobulbar block group reported the lowest pain scores at all time points, with mean VAS scores of 1.3 before, 2.2 during, and 0.8 immediately after the injection. The peribulbar block group showed moderate pain levels, while the topical anesthesia group had the highest pain scores. Clinically, the retrobulbar block group demonstrated the greatest improvement in visual acuity, reaching a mean of 20/60 at 6 months, and the most significant reduction in CRT (140 µm). Conclusions: Retrobulbar block anesthesia provided the most significant reduction in pain and the best clinical outcomes in terms of visual acuity and CRT for DME patients undergoing IVIs. The peribulbar block was also effective, but less so than the retrobulbar block, while topical anesthesia was associated with higher pain levels and less favorable clinical outcomes.

Sepsis is an abnormal host response to infection that leads to a dysfunction of one or several organs. The Third International Sepsis Consensus has recently revised the definition of sepsis and septic shock, and has proposed the use of the sequential organ failure assessment (SOFA) score to evaluate acute organ dysfunction.1 The use of SOFA is preferred over qSOFA (quick sequential organ failure assessment) or SIRS (systemic inflammatory response syndrome) criteria in intensive care unit (ICU) patients, but outside the ICU, qSOFA can be easily used in clinical practice as its validity appears to be higher than that of SOFA and SIRS.2

Introduction Multiple evolutionary pathways have led to the development and transfer of antimicrobial resistance in bacteria. The resistance of E. coli to currently available antimicrobials is worrisome, with different figures being reported in different parts of the world. This is a brief meta-analysis, summing up relevant studies published in field literature in order to better characterize E. coli resistance. Review methods By using the search terms "E. coli” and "resistance” on PubMed and narrowing the search down to the publication timespan 2010-2016, 27 relevant articles have been extracted, reporting studies performed in 15 different countries. Analysis of results Not surprisingly, the resistance of E. coli to currently available beta-lactam drugs is highest to aminopenicillins, somewhat lower but still worryingly high to cephalosporins (around 40% resistance to third generation cephalosporins and around 30% to fourth generation cephalosporins), while remaining consistently below 1% in carbapenems, with the exception of a few studies that reported higher resistance rates. Nitrofurantoin and fosfomycin appear to remain active agents, with resistance rates generally below 5%, and could be considered in the first intention treatment of uncomplicated urinary tract infections. Conclusion In conclusion, antimicrobial resistance rates in E. coli are diverse, with wide variations between different studies and therefore empiric treatment decisions should be based on educated choices taking into account, when available, local resistance patterns.

Background Peginterferon and ribavirin treatment has been the standard of care for chronic hepatitis C for a long time, but it has started to be replaced by newer therapeutic regimens, including direct-acting antivirals with better tolerability and higher efficacy rates. Despite the changing landscape of antiviral therapy, patient adherence remains essential to obtaining a sustained viral response. Methods We performed an open, single center, non-interventional prospective study, which included 78 adult patients with chronic hepatitis C treated with peginterferon and ribavirin during 2012-2013 in Romania. The patients completed questionnaires at weeks 12, 24 and 48 of treatment, and at a follow-up at 48 weeks after the end of treatment. The following items were assessed: treatment adherence, patient’s health, quality of life, adverse reactions, symptoms and treatment administration. Results From the 78 patients included in this study, at week 12 93.59% were still under treatment, 76.92% at week 24, and 70.51% at week 48. Patient counseling regarding treatment administration had an important impact on treatment adherence and specifically on finishing all 48 weeks of treatment, with 74.29% of the instructed patients versus 37.50% of non- or partially-instructed patients completing treatment, p<0.001. Rapid viral response was recorded in 43.33% of patients and sustained viral response in 30%. The influence of antiviral treatment on patients’ quality of life was symmetrically distributed between patients who reported no, or minimal interference and patients who reported moderate or high impact 47.44% vs 46.16% at week 12, 39.74% vs 37.18% at week 24, and 30.77% vs 24.36% at week 48. Conclusion In patients with chronic hepatitis C treated with peg-interferon and ribavirin in Romania, treatment adherence reached relatively high levels, constantly over 70%, and was statistically associated with pre-treatment counseling regarding the correct administration of the medication.

Introduction Hepatitis C virus (HCV) infection in the Romanian population has increased, with high mortality due to liver disease. The study aimed to contribute in finding the possible relationship between the frequencies of certain HLA class II alleles DQB1 and response to PegIFN-α/RBV therapy in a group of Romanian patients infected with HCV genotype 1b, allowing a rational approach to identifying the patients who would be most likely to achieve SVR with the current treatment. Methods A selected group consisting of 51 patients infected with HCV and 102 controls (healthy subjects from the same ethnic origin) were genotyped for HLA DQB1 loci using SSO (sequence-specific oligonucleotide) in order to assign the corresponding alleles. Assuming that there is no relationship between host alleles and viral persistence or spontaneously/induced viral clearance the allele’s frequency was compared between different groups to highlight which of these alleles act as a risk factor or provide protection during disease progression and treatment. Results Treatment-induced viral clearance was achieved by more than 50% of the patients (SVR, n=32). HLA-DQB1*O201 was found to have high frequency in non-responders patients (16.7%), and was considered a risk factor of non response to PegIFN-α/RBV therapy in this case. HLA DQB1*0301 (19.6%) was found to be increased in patients who achieved SVR, being associated with protection and viral clearance in this study (p=0.017, OR 0.25, 95%CI: 0.08 -0.82). Conclusion The results of the present study showed that there may be HLA-DQB1* alleles associated with response to PegIFN-α/RBV therapy, and the importance of genotyping for those alleles increases when this analysis is cumulated with other disease predictors. This may help in selecting patients with the chance to respond to therapy achieving SVR.

Introduction The aim of the study was to evaluate the prevalence of erectile dysfunction (ED) in a cohort of HIV-positive men and to analyze if factors such as HIV-RNA level, tobacco smoking, drug consumption or protease inhibitors therapy were associated with developing ED. Methods A cohort of HIV-infected men monitored in the National Institute for Infectious Diseases "Prof. Dr. Matei Balș” Bucharest, Romania was included in this cross-sectional study. They completed the International Index of Erectile Function (IIEF) questionnaire and offered data about their medical history, therapy regimen, tobacco smoking and drug consumption. Results In this study 63 patients completed the IIEF questionnaire, their mean age and standard deviation were 36.6±9.4 years (range: 20-56 years). From the study group 62 (98%) patients were on antiretroviral therapy of which 41 (66%) were receiving at least one protease inhibitor. Most of the patients 49 (78%) self-reported smoking and 10 (15%) reported that they were drug consumers. A number of 44 (69.8%) patients from the cohort had undetectable levels of HIV-RNA. A number of 30 patients (47.6%) had some degree of ED, as follows: 18 (60%) patients had mild ED, 7 (23.3%) had mild to moderate ED, 4 (13.3%) patients had moderate ED and 1 (3.3%) patient had severe ED. We found no statistical correlation between ED and the level of HIV-RNA (p=0.378) tobacco smoking (p=0.312), drug consumption (p=0.222) and therapy with protease inhibitors (p=0.064). The only factor that was positively correlated with ED was the age of the participants (p=0.040). Conclusion Our study revealed a worrisome prevalence of erectile dysfunction in young HIV-positive men. However, we found no correlation between ED and risk factors such as drug consumption, smoking or therapy with protease inhibitors, suggesting that non-modifiable factors might play an important role in the pathogenesis of ED in HIV infection.

Pregnancy is a physiological state that requires a perfect balance of all organs and systems. However, certain systems of the human body are more prone to dysregulation during pregnancy, particularly the immune system, which comes in contact with multiple germs and needs to eradicate infectious agents while avoiding a state of hyperactivation that might do more harm than good, particularly to the fetus, which is, essentially, half self and half non-self. Similarly, the coagulation system undergoes significant strain during pregnancy, exhibiting a state of physiological hypercoagulability, coupled with endothelial activation and venous stasis. If these changes occur on a particular genetic background, the balance between physiological and pathological can easily be altered and thrombophilia can become manifest, associating adverse pregnancy outcomes.