Central European Annals of Clinical Research

We present the case of a 54-year old woman diagnosed with chronic suppurative otitis media, who was admitted to the ENT Department with four-week-old, sudden-onset, left-sided facial nerve paralysis, and ipsilateral otalgia and hemicrania. Physical examination revealed positive signs of acute postaural inflammation. The patient’s facial nerve paralysis was scored as VI, according to the House-Brackmann scale. A cranio-facial computer tomography examination revealed mastoid cavity opacification, mucosal hypertrophy, and signs of chronic osteitis, with minimal mucous accumulation. The patient underwent a radical modified mastoidectomy with type-I tympanoplasty to verify the presence of a cholesteatoma, and to remove the offending lesions. Post-operatively, patient evolution was favorable, and prognosis remained encouraging. The patient’s evolution will be followed by check-ups every three months to assess progress and benefits of the treatment. Full article

Prostatic abscesses are a rare clinical entity in current practice due to the widespread use of antibiotics. Management usually imposes a challenge to urologists that is due to the difficult diagnosis, as it may mimic other diseases of the lower urinary tract and the lack of guidelines for treatment. Prostate abscess (PA) usually develops in immunocompromised patients, including diabetic and HIV patients, as a consequence of acute bacterial prostatitis. The reason for the lack of guidelines as regards PA is that most of the published data in the literature are case reports due to the declining incidence of the disease today. We presented a male patient who was not foreknown with pathological or personal antecedents or a promiscuous lifestyle. He was hospitalized in the urology section with subfebrility and lumbar pain. His general condition changed rapidly within the span of a few hours, the patient entering septic shock without an etiology or a determined infection. After careful serial investigations, hemocultures (atypical germs) for IgM antibodies Chlamydia Pneumoniae were found in the serological complement fixation (cf) test. The patient responded well to empirically initiated antibiotic treatment upon admission to Intensive Care. Due to a favorable evolution, the patient was declared clinically healthy upon discharge. This was a rare case in medical literature of septic shock of initially unspecified etiology but which, upon thorough investigations and urological reevaluation, revealed a prostatic abscess with Chlamydia Pneumoniae, exteriorized through the urethra and highlighted through positive hemocultures only. Full article

A 26 year old woman was admitted to the emergency room 2 weeks after delivery of a healthy baby by cesarean(C) section, presenting right hemiparesis and speech disturbances, preceded by headaches. Clinical examination, biochemical tests, magnetic resonance imaging (MRI) and MRA (magnetic resonance angiogram) confirmed the diagnosis of ischemic stroke due to a cerebral venous thrombosis with secondary hemorrhage transformation. Further coagulation work-ups revealed a possible thrombogenic condition with important protein S deficiency. Many therapeutic challenges have been encountered. Multiple seizures attacks further complicated the whole clinical picture, but a gradually recovery was slowly achieved. By the day of discharge, her neurological status greatly improved. A temporary headache was reported after hospital discharge with alleviation in time. Full article

Emergency medicine specialists’ mental and physical health may be threatened if they experience burnout, sleep disorders, and secondary traumatic stress (STS). We aimed to investigate whether Emergency Medical Services (EMs) professionals’ mental and physical health status, depression, and anxiety are associated with burnout, STS, and sleep disorders. We hypothesized that burnout, STS, and the severity of sleep disorders would raise the risk of impaired mental, and physical health, depression, and anxiety in emergency medical clinicians. A cross-sectional multicentric study was conducted. In total,178 EMs specialists completed validated surveys to assess mental health complaints (Mental Health Inventory, MHI-5 screening test), physical health complaints (Ware scale), depression, and anxiety (Depression, Anxiety and Stress Scale-DASS), burnout (Maslach Burnout Inventory-general survey, MBI-GS), sleep disorders (Insomnia Severity Index, ISI), and STS (STS scale). This study aimed to analyze the influence that work-related factors can have on EMs specialists’ mental and physical health, depression, and anxiety. Specifically, mental health was predicted by exhaustion (β = 0.16), cynicism (β = 0.21), insomnia severity (β = 0.13), and STS (β = 0.35); physical health was predicted by exhaustion (β = 0.33) and insomnia severity (β = 0.18); depression was predicted by cynicism (β = 0.21) and STS (β = 0.46); and anxiety was predicted by STS (β = 0.63) and inefficacy (β = 0.20). Work-related stress symptoms such as burnout, STS, and sleep disorders were found to predict emergency medicine clinicians’ mental and physical health, as well to increase the risk of depression and anxiety. It is of most importance to develop practices to prevent such symptoms and to promote mental health and well-being among the emergency medicine personnel. Full article

Nurses in Intensive Care Units (ICU) may be exposed to considerable stress of work. High levels of stress in ICU nurses affect the quality of nursing and the quality of life at work. Determination of occupational stress levels, burnout syndrome and overall job satisfaction among ICU nurses. The research was conducted in Intensive Care Unit of Emergency Clinical County Hospital of Oradea, Romania. Data were collected from the questionnaires, 29 nurses (of the 35) were selected for this study. Professional stress factors have been assessed through Expanded Nurses Stress Scale (ENSS), burnout syndrome through Maslach Burnout Inventory-Human Services Survey (MBI-HSS), while overall job satisfaction was measured by a 7-step Likert scale. The highest levels of stress were associated with workload and conflicts with other health professionals, professional relationship between nurses have been described as the least stressful. About burnout levels: a high score for emotional exhaustion and depersonalization, and a low score for professional achievements. Professional satisfaction has reached an average level. The fidelity of the scales was verified by the Cronbach’s alfa coefficient: Expanded Nurses Stress Scale (ENSS) (0.98) and Maslach Burnout Inventory-Human Services Survey (MBI-HSS) (0.73). Full article

The optimisation of DO₂, within the Goal-Direct Therapy Protocol (GDTP) in high-risk surgical patients, improves their outcome. Haemodynamic and haemoglobin monitoring become crucial to achieve optimal DO₂. Our study compared Hb as measured by three methods: Coulter Counter (standard laboratory method) and CO-Oximetry (Masimo rainbow SET Radical 7 Pulse CO-Oximetry (SpHb) and Blood Gas Analysis) to establish the utility of the Hb continuous intraoperative monitoring, within the GDTP, in high-risk bleeding surgery. We studied 72 patients undergoing open abdominal aortic aneurysm repair. We compared the accuracy and the trending ability in measuring the haemoglobin concentration between the three methods (Coulter Counter, BGA and Masimo). We collected three simultaneous haemoglobin measurements: after induction of anaesthesia, pre- and post-aortic cross-clamping and at the end of the surgery. SpHb showed an excellent r-value for all samples (0.952, CI-95% (0.939, 0.961), p-value < 0.0001) compared to laboratory measurements. The results of the linear regression between SpHb and laboratory, for each time considered, demonstrated that SpHb showed excellent r and R² value. All data were statistically significant, with a p-value <0.0001. A Bland-Altmann analysis for SpHb vs. laboratory showed a bias of −1.45 g/dL (CI-95% −1.51 and −1.39 g/dL, LOA from −2.42 to −0.48 g/dL) with a precision of 0.49 g/dL. Four-quadrant plot trend analyses showed a high concordance rate ≥90%. During elective high-risk surgery, Masimo Pulse CO-Oximetry is not enough sufficiently accurate to assess the current value of haemoglobin but may be useful for the trend value ensuring DO₂ within intraoperative GDTP. Full article