Background: There are only a few studies involving the use of melatonin for premedication for anaesthesia. The goal of our study was to compare the effects of melatonin and midazolam administered as premedication for laparoscopic cholecystectomy.Methods: This double-blind, placebo-controlled study included 53 patients (ASA I, II) undergoing laparoscopic cholecystectomy under general anaesthesia. The patients were divided into three groups: group 1 (n = 18) included patients receiving 3 mg melatonin the night before and as premedication; group 2 (n = 17) included the patients receiving 3,75 mg midazolam (1/2 of a 7,5 mg tablet) by the same protocol as for melatonin; and group 3 (n = 18) included patients receiving placebo tablets. Preoperatively, the anxiety and sedation scores, as well as the quality of preanaesthetic sleep, were evaluated. Postoperatively, the anxiety and sedation scores and the number of remembered pictures were evaluated at 15 and 60 minutes and 6, 12 and 24 hours respectively. The intra-anaesthetic opioid requirements were also evaluated.Results: Preoperatively the lowest anxiety score was registered in the midazolam group; also the difference between the melatonin and midazolam groups was not significant. In the placebo group the anxiety score was significantly higher as compared with melatonin or midazolam. Postoperatively anxiety scores were lowest in the melatonin group at every time interval. The scores for the remembered pictures were consistently better in the melatonin group. The sedation score was lower in the melatonin group as compared with midazolam, as were the intra-anaesthetic opioid requirements.Conclusions: Melatonin (3 mg) can be successfully used as premedication for laparoscopic cholecystectomy, especially for day case surgery. Advantages over midazolam and placebo include better perioperative anxiolysis, and a better recovery profile as assessed by sedation and memory.

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(1) Background: In the older population, depression often affects people with chronic medical illnesses, cognitive impairment, or disability. Frailty is another important issue affecting older adults, being difficult to clinically distinguish from frailty in advanced old age. Well-designed interventional studies and clinical strategies targeting both frailty and depression are rare or nonexistent. (2) Methods: We realized a retrospective study in which we included a total of 411 patients that were admitted to the Geriatric Clinic from “Dr. C. I. Parhon” Hospital from Iasi for a period of 13 months. The aim of our study was to investigate the relationship between depression and frailty in a geriatric population due to the fact that the quality of life is negatively influenced by both frailty and depression. (3) Results: The prevalence of the depressive symptoms screened by the GDS-15 was 66.7%, with women being more depressed than men. Furthermore, an obvious relationship between depression and the dependence degree in performing daily activities has been observed. In addition, the mean MMSE score decreased with an increasing degree of depression. (4) Conclusions: Our study demonstrates the association between frailty and depression, one of them being a risk factor in the development of the other. A poor acknowledgment of the problem and an underdiagnosis of these conditions are important public health concerns due to the high healthcare costs. Thus, an active primary prevention would be imperiously needed in order to diagnose frailty and depression at an early stage, increasing the quality of life of the elderly and also their successful aging.

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In this paper, we present a new complex electronic system for facilitating communication with severely disabled patients and telemonitoring their physiological parameters. The proposed assistive system includes three subsystems (Patient, Server, and Caretaker) connected to each other via the Internet. The two-way communication function is based on keywords technology using a WEB application implemented at the server level, and the application is accessed remotely from the patient’s laptop/tablet PC. The patient’s needs can be detected by using different switch-type sensors that are adapted to the patient’s physical condition or by using eye-tracking interfaces. The telemonitoring function is based on a wearable wireless sensor network, organized around the Internet of Things concept, and the sensors acquire different physiological parameters of the patients according to their needs. The mobile Caretaker device is represented by a Smartphone, which uses an Android application for communicating with patients and performing real-time monitoring of their physiological parameters. The prototype of the proposed assistive system was tested in “Dr. C.I. Parhon” Clinical Hospital of Iaşi, Romania, on hospitalized patients from the Clinic of Geriatrics and Gerontology. The system contributes to an increase in the level of care and treatment for disabled patients, and this ultimately lowers costs in the healthcare system.

Background Changes in glucidic metabolism characteristic of diabetes are a contributing factor in causing vulvovaginal candidiasis. Purpose The objective of this study was evaluating the prevalence of morbidity through vaginal candidiasis with Candida albicans in diabetic women and instituting of specific antifungal therapy. Materials and methods The study was conducted on 140 women (aged between 22-40 years) with diabetes, admitted in the Diabetes and Nutrition diseases clinic from Clinical Emergency Hospital of Craiova, Romania, from who were harvested blood and vaginal secretions. Blood sugar levels were determined by biochemical methods. The vaginal secretions were subjected to mycological diagnosis (Gram stain, isolation on Sabouraud media, identification by using chromogenic differential media specific for Candida). The isolates strains were subjected to fungal sensitivity test, using commercial kits: ATB Fungus 3 (BioMerieux, Marcy l’Étoile, France) and Candifast (EliTech France SAS) (5-Fluorocytosine, Amphotericin B, Fluconazole Itraconazole, Voriconazole, Econazole, Miconazole, Ketoconazole and Nystatin). The data was analysed using the Student's t-test. Results The authors isolated 98 strains of Candida albicans, thus the morbidity by candidiasis was 70%, most of the patients had blood sugar levels between 130–180 mg/dl. The condition was more common in patients aged between 51-60 years (39.80%) and 41-50 years (31.63%). The results of antifungigram showed susceptibility to: Ketoconazole (95.92%), Econazole (89.80%), Fluconazole (85.71%) and Itraconazole (85.71%). Conclusions These results demonstrate the existence of a correlation between hyperglycaemia and vaginal candidiasis. Most of the vulvovaginal candidiases were treated successfully with new antifungal drugs. Although regarded as a banal infection by some, the increased incidence of vaginal candidiasis associated with diabetes raises additional issues regarding prevention and patient management.

Background This article explores elder abuse in a hospitalised population. We wanted to identify details related to psychological and emotional abuse in the older population in our region and to determine the importance of the Elderly Abuse Suspicion Index (EASI©) in comprehensive geriatric assessments. Methods This cross‐sectional study conducted between March 2015 and May 2016 included 386 consecutive hospitalised patients over 65 years of age. All patients underwent a geriatric assessment, data were collected about their medical history, and the EASI© was administered to each. The main outcome was identifying the presence, the type of abuse and the factors associated with abuse. Results There were 21.5% of patients who suffered any form of abuse. Women were more frequently abused than men. Emotional abuse was the most common (60.2%) followed by neglect (53%) and physical abuse (22.91%); sexual abuse was absent in our study group. The abused patients had an impaired cognitive function (P = 0.034). They were also malnourished (P ≤ 0.001) and depressed (P = 0.001). The presence of peripheral artery disease, stroke, pneumonia, chronic kidney disease, musculoskeletal diseases and anxiety correlated with the presence of abuse. No statistically significant correlation was found between the degree of independence in instrumental activities of daily living and the presence of abuse (r = 0.105, P = 0.051). Conclusions EASI is a tool for detecting elder abuse and should be included in the standard geriatric assessment to prevent ageism. The number of abused elderly patients is significant, and the multiple factors associated with abuse are diverse.

Burnout in healthcare professionals remains an ongoing concern. There are a number of variables associated with reactivity to stress in healthcare staff. This study wants to identify risk factors which predispose healthcare professionals to burnout. Material and Methods: The cross-sectional study included a group of 200 subjects, medical staff and auxiliary staff from the national health units, who gave their free consent to answer the questions regarding the level of perceived stress at work. The screening tool used was disseminated through the Google Forms platform, maintaining the anonymity of the participants. Results: Resident doctors (42%) responded predominantly, reporting the highest level of burnout, with nurses (26.5%) being the least affected (χ2 = 36.73, p < 0.01). Less work experience is correlated with increased burnout (rho = 0.29, p < 0.01). Reactivity to stress was highly associated with workplace, with ambulance staff being the most vulnerable (χ2 = 6.58, p < 0.05). Participants’ relationship status significantly influenced the burnout rate, the unmarried, with or without a partner, being more affected (χ2 = 16.14, p < 0.01). There are no significant differences between male and female gender, regarding the average level of burnout (U = 1.47; p > 0.05), nor between living in a house or apartment (U = 4.66; p > 0.05). Positive associations were identified between the level of burnout and variables such as: management pressure, administrative work, routine, regretting decisions regarding patients, harassment at work and sacrifice of personal time. Conclusions: The results of this study identify age, profession, workplace seniority and relationship status as factors associated with burnout in medical personnel.