Infections in patients with major burns are among the most frequent causes of complications and an increase in mortality. In particular, a group of bacteria abbreviated ESKAPE, consisting of Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa and Enterobacter species, has increasingly become problematic in recent times due to their fast capacity to develop antibiotic resistance. The aim of this study was to analyse ESKAPE pathogens from the Major Burn Units in Clinical Emergency Hospital Bucharest through a retrospective crosssectional study, given the high mortality rate of these patients. Our findings revealed that a large percentage (75%) of patients presented with an ESKAPE pathogen during either direct admission or transfer from another healthcare unit; however, this did not influence mortality. The most frequent isolate was Staphylococcus aureus; however, Acinetobacter baumannii had the highest tendency to develop multidrug or extensive-drug resistance. In particular, ESKAPE bacteria tended to exhibit higher antibiotic resistance properties, as there were more ESKAPE MDR and XDR variants than non-ESKAPE strains. RezumatInfecțiile au fost printre cele mai frecvente cauze ale complicațiilor și mortalității crescute în cazul pacienților cu arsuri grave. În particular, un grup de bacterii abreviat ESKAPE, din care fac parte Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumanii, Pseudomonas aeruginosa și speciile genului Enterobacter, a devenit din ce în ce mai problematic în zilele noastre, din cauza capacității lor rapide de a dezvolta rezistență la antibiotice. Scopul acestei lucrări este de a analiza agenții patogeni ESKAPE din Centrul de Arși Grav al Spitalului Clinic de Urgență București, realizând un studiu retrospectiv de tip "cross-sectional" având în vedere mortalitatea ridicată a acestor pacienți. În urma acestui studiu, rezultatele arată că o mare parte dintre pacienți (75%) prezintă un agent patogen ESKAPE fie la admisia directă în spital, fie la admisia prin transfer dintr-o altă unitate spitalicească, fără a influența mortalitatea. Cea mai frecvent izolată bacterie a fost Staphylococcus aureus, în timp ce Acinetobacter baumanii a prezentat cea mai mare tendință de a dezvolta rezistență antibiotică de tip "multi-drug" sau "extensive-drug". O descoperire particulară a fost că bacteriile ESKAPE tind să prezinte proprietăți de rezistență antibiotică mai dezvoltate, întrucât au fost mai multe variante MDR și XDR ESKAPE, comparativ cu bacteriile non-ESKAPE.

Peripheral nerve lesions represent debilitating conditions that determine sensitive, motor and associated psychosocial losses, deeply and severely affecting the quality of life. Despite adequate microsurgical repair, functional results are variable and often dissatisfying. This study aimed to analyse and discuss peripheral nerve lesion cases from our clinic, involving the upper limb, an anatomical segment with impactful functional importance. We followed the distribution of nerve lesions throughout a three-year period, describing the patients’ characteristics and the therapeutic protocols. Furthermore, we reviewed the relevant literature to identify potential therapeutic strategies that may help optimize functional results. In the presented clinical study, most of the patients benefited from direct microsurgical repair of the nerve injury. However, we had a series of cases of nerve defects that could not be approached with primary repair. When a nerve cannot be repaired by direct neurorrhaphy, there are different options for bridging the nerve gap, each with its indications and advantages. Autografts still represent the gold standard in treating nerve gaps, but other procedures, such as vascularized nerve grafting, nerve conduits, allografts and nerve transfers, can be successfully used in some cases. The current focus in the field is the development of nerve conduits. Textile technologies represent a promising field in creating nerve conduits, given the ease of the manufacturing process, the affordable production cost and good mechanical properties.

Diabetic foot ulcer represents a very severe complication of diabetes mellitus, often requiring foot amputation, leading to morbidity and higher mortality rates. Around one in six diabetic patients develops foot ulcers over their lifetime. Promoting a series of preventive measures including systemic control of diabetes and other comorbidities along with local foot care proved to be a valuable strategy. In addition to rigorous, active prevention, multidisciplinary therapeutic management of diabetic ulcers includes offloading techniques, ulcer debridement, advanced dressings and diabetic foot surgical treatment. In this article, we analyze each component of this sequential treatment plan, with emphasis on current indications and resources, having as main goals decreasing complication rate and morbidity, improving the quality of life and life expectancy of diabetic patients.