Effect of the COVID­19 pandemic on the management and outcomes of patients with traumatic injuries (Review).

During the COVID-19 pandemic, ~10% of the global population was officially affected, resulting in diverse changes, ranging from shopping habits to stringent hospital protocols. This article sought to provide a concise summary of relevant data concerning the interplay between COVID-19 and trauma, encompassing the entire trajectory from presentation to hospital discharge. Throughout the pandemic, there was a noticeable reduction in trauma presentations, while the ranking of injury mechanisms remained largely unchanged. To ensure essential surgical support, protocols were adjusted accordingly. Although there were some less significant changes in injury severity score, hospital length of stay, intensive care unit stay and mortality, the overall patient outcomes appeared to improve. In conclusion, the COVID-19 pandemic led to a decline in trauma cases and an enhancement in patient outcomes. However, regrettably, certain mechanisms of injury saw an increase in frequency. To cope with the epidemiological context, management strategies were adapted, and unutilized resources were redirected to cater to the care of COVID-19 patients.

[Diagnosis of nosocomial pneumonia: conventional and new indicators]. / Diagnosticul de pneumonie nozocomiala: indici conventionali si noi.

Nosocomial pneumonia is difficult to diagnose. Clinical criteria, saliva and tracheal specimen cultures can be sensitive to bacterial pathogeny, they are however nonspecific in patients with assisted mechanical ventilation; on the other hand, blood and pleural liquid cultures have very poor sensitivity. Fever and leukocytosis are not constant signs and are not compulsory for diagnosing nosocomial pneumonia (NP). Interleukine 1 (IL-1) is a proinflammatory cytokine produced by macrophages, but research studies failed to indicate some connection to the incidence or clinical outcome in nosocomial pneumonia. Tumoral necrosis factor (TNF) is considered one of the most important mediators of endotoxin induced effects: studies on acute inflammatory conditions such as severe sepsis indicated a link between the homozygosity of TNFb2 and the mortality or the incidence of nosocomial pneumonia in trauma patients. Procalcitonin (PCT) is a parameter different from other markers currently available to evaluate inflammatory response. PCT is induced by bacterial inflammation selectively and also appears in sepsis and in MODS. PCT values higher than 0.5 ng/mL always indicate acute infection or septic inflammation.