List of Papers

Paper title Author View Validation status
Eloesser window epithelization Lucaciu Oana View abstract

Eloesser window epithelization

First author: Lucaciu Oana

Coauthors: Hogea T , Boțianu PV-H , Pisica R , Boțianu A-M

Keywords: hyperchronic empyema epithelization Eloesser open window

Background: The modified Eloesser procedure or open-windowthoracostomy is an operation for chronic pleural empyema in which a permanent drainage opening is created in the chest wall. Material and Method: During the last 10 years we had 3 cases referred toour unit with the diagnosis of tuberculousis pleural empyema, and one with a  empyema after a left intrapericardicpneumonectomy performed for lung cancer. In one case we performed from the beginingan Eloesser window. In the other 3 cases we performed innitialy a single step Boţianu thoracopleuroplasty with closed circuit irrigation-aspiration system  associated with the transposition of  latissimusdorsi muscle and serratus anterior on a common vascular pedicle and intercostal flaps. Results: Due tothe wound suppuration and skin necrosis we performed a wide soft tissuedebridation equivalent to an open window.We performed daily dressings at all patients in the operating room with favourable outcome and progresive healing of the wound by reepitalisation (6 months up to 6 years). Conclusions: Open chest drainage it was well tolerated by our patients, allowing the wound to granulate and close over time. Despite the fact that the incidence of chronic empyema dropped significantly because of the noticeable improvement of the antibiotic treatment, these types of laffections continue to create serious problems of surgical therapy.„ACKNOWLEDGEMENT: This paper is partly supported by the Sectorial Operational Programme Human Resources Development (SOP HRD), financed from the European Social Fund and by the Romanian Government under the contract number POSDRU 80641".

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SURGICAL APPROACH OF VASCULAR INJURY IN TRAUMA Mathe Zsombor View abstract

SURGICAL APPROACH OF VASCULAR INJURY IN TRAUMA

First author: Mathe Zsombor

Coauthors: Suciu H. , Nagy O.

Keywords: vascular injury trauma orthopedic

Background: Despite the modern techniques, trauma remains a challenging problem, primarily because the great risk of loss of limbs. In this study we present the results in this type of surgery of 14 consecutive patients, who underwent surgical revascularization in The Transplant and Cardiovascular Disease Center of Targu Mures between 2010-2012. Material and Method: Between January 2010 and December 2012, we operated 14 patients with acute traumatic lower and upper-extremity arterial injuries. In all cases surgical revascularization was performed as soon as possible. All of them were men. Mean age was 38 years (range, 17-66). We used different techniques for reconstruction of the vessels like: bypass with autogenous saphenous vein graft in 6 of 14 cases(43%), reconstruction with vein patch in 1 of 14 cases(7%), bypass with prosthesis also in 1 of 14 cases(7%), primary reconstruction in 4 of 14 cases(29 %) and trombembolectomy with Fogarty catheter in 2 of 14 cases(14 %) patients. Results: 4 of 14 patients(29%) had lower limb ischemia and 10 patients(71%) had upper limb ischemia. The mortality in this group was 14% (2 of 14 cases), one of the patients died with neurological problems and the other with severe metabolic acidosis and multiple organ failure.   In 5 cases we recognize the compartment syndrome and perform fasciotomy. Conclusions: Early and appropriate surgical intervention in trauma with peripheral ischemia is successful in most cases, managing to save the patient’s limbs and life. In combination with bone fractures, primary vascular access is required.

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Incidence of impacted teeth- a radiographic study Muică(Nagy-Bota)Monica-Cristina View abstract

Incidence of impacted teeth- a radiographic study

First author: Muică(Nagy-Bota)Monica-Cristina

Coauthors: Jurcă Anamaria , Hălmaciu Ioana , Păcurar Mariana

Keywords: impacted tooth orthopantomography x- rays dental inclusion

Background: Failure of eruption of permanent teeth its very common.Developmental disturbances can be the result of genetic and environmental factors. The aim of this study is to study the tooth impaction in a dental population of Târgu Mureș, given the high frequency of dental anomalies of position. Material and Method: We studied the records and orthopantomography x-rays of 685 pacients, who presented to Pediatric Dentistry and Orthodontics Department in Târgu Mureș, between 2005-2013. Results: After applying the exclusion criteria, remained 149 pacients, with tooth impaction, with ages between 10 and 18 years. The frequency of dental inclusion in the dental support area has the highest rate in the 12- 14 years age group. There were more cases of total maxillary (112) impacted teeth than total mandibular impacted teeth(74).Regarding sex distribution,there was a higher frequency of impacted teeth in women (112) than in men (74). The prevalence of impaction in different parts of dental arch was: 94 impacted canines, 64 impacted premolars, 17 impacted incisives and 13 impacted molars. Conclusions: The most frequently impacted teeth were the canines, and dental inclusion is more common in femailes than in males. ACKNOWLEDGEMENT:This paper is partly supported by the Sectorial Operational Programme Human Resources Development (SOP HRD),financed from the European Social Fund and by the Romanian Government under the contract number POSDRU 80641.

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Development of a Capillary Electrophoresis Method for the Separation of Fluoroquinolone Derivatives in Acidic Background Electrolyte Rusu Aura View abstract

Development of a Capillary Electrophoresis Method for the Separation of Fluoroquinolone Derivatives in Acidic Background Electrolyte

First author: Rusu Aura

Coauthors: Hancu Gabriel , Gyéresi Árpád

Keywords: fluoroquinolones capillary zone electrophoresis acidic background electrolyte separation

Background: Antibacterial quinolones class comprises a series of synthetic antibacterial agents, following the model of nalidixic acid. Because of their common 6-fluorosubtituent on the quinolone ring, fluroquinolones are the most potent analogues with extended spectrum of activity and great pharmacokinetic properties. The large majority of capillary electrophoresis separation methods for quinolone derivatives are using a basic pH of the background electrolyte while an acidic one is less used. The applicability of capillary zone electrophoresis for the separation of fluoroquinolones in acidic background electrolyte has been studied, our aim being the development of a capillary zone electrophoresis method for the simultaneous separation of six fluoroquinolones and also to optimize the analytical conditions.  Material and Method: The six studied fluoroquinolones were ciprofloxacin, enoxacin, enrofloxacin, moxifloxacin, ofloxacin and sarafloxacin. Preliminary, we studied the electrophoretic behavior of six fluoroquinolones in an acidic pH, which highlighted the possibility of developing a separation method in this area of pH. Electrophoretic parameters influencing separation performance were studied and optimized. Results: A fast and reliable method has been developed, using a background electrolyte containing 100 mM phosphoric acid and the following conditions: applied voltage: + 25 kV, temperature: 20°C, injection pressure 30 mbar – 5 sec., UV detection at 280 nm, capillary: 60 cm (52 cm effective length) x 50 μm, analyte concentration: 167 μg/ml. The separation of the studied fluoroquinolones was achieved in less than 8 minutes and the migration order was: enoxacin, ciprofloxacin, ofloxacin, enrofloxacin, sarafloxacin and moxifloxacin. Conclusions: Capillary zone electrophoresis using an acidic background electrolyte proved to be an efficient tool in the separation of fluoroquinolones from different generations. Also the proposed methods are particular environment-friendly replacement and improvement of a common high performance liquid chromatography determination with rapid analysis time without using any organic solvents.

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Assessment of periodontal status of surgically exposed and orthodontically aligned impacted maxillary canines cosarca adina View abstract

Assessment of periodontal status of surgically exposed and orthodontically aligned impacted maxillary canines

First author: cosarca adina

Coauthors: pacurar mariana , ormenisan alina , petrovan cecilia

Keywords: Oral and Maxillofacial Surgery Oral and Maxillofacial Surgery Impacted canine, periodontal, surgical-orthodontic

Background: It is known that maxillary canines remain impacted more often than the mandibular canines, and the inclusion can be buccal or palatal.The aim of this study was to compare the periodontal status of impacted canines after 5 years following completion of the combined surgical and orthodontic treatment. Material and Method: We examined 20 labially impacted canines and 20 palatally impacted canines at 5 years after the end of treatment. We assessed the periodontal status of these teeth.Gingival index, plaque index, probing depth and gingival recession were assessed. Results: Different outcomes were founded regarding the probing depth and the amount of keratinized gingiva in the two mentioned groups of teeth.Regarding the gingival recession index the average value in the first group was 1.600, with a standard deviation of 1.046 and a standard error of 0.2340 Conclusions: The assessed periodontal indices may signal the appearance of a periodontal disease around the teeth that were surgically and orthodontically treated.

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CLASSICAL VERSUS LAPAROSCOPIC APPROACH IN RETROPERITONEAL LESIONS -ADVANTAGES AND LIMITATIONS Craciun C. View abstract

CLASSICAL VERSUS LAPAROSCOPIC APPROACH IN RETROPERITONEAL LESIONS -ADVANTAGES AND LIMITATIONS

First author: Craciun C.

Keywords: retroperitoneum, laparoscopy, classical surgery

Background: The treatment of various retroperitoneal diseases requires multidisciplinary teams in which surgical treatment is essential. At present, the laparoscopic intervention in retroperitoneal primitive tumors, abscesses, haematomas and retroperitoneal effusions is still a challenge. The purpose of this paper is to identify the differences between laparoscopic and conventional surgical interventions in diseases of the retroperitoneum. It is based on the casuistry of Surgery Clinic 1 of Mureș County Hospital. Material and Method: The study follows a retrospective analysis of various retroperitoneal interventions performed on 62 patients between 2010-2012 in the Surgery Clinic 1 of Mures County Hospital. We have chosen from the casuistry the cases with tumoral diseases (primary tumors, metastases, cysts) or non-tumoral (effusions, abscesses, haematomas) and divided the patients into two groups: group I who had undergone classic interventions (51 patients) and group II (11 patients) who had undergone laparoscopic procedures. We studied the clinical medical records, surgical protocols and anatomopathological results. Results: For 2010 we extracted 23 cases (39,2% classical interventions),  for 2011-21 patients (31,4% classic) and for 2012 -18 cases (29,4% classical interventions). According to the type of the disease, 30 classical interventions were performed for tumoral formations (22 retroperitoneal tumors, 4 metastases and 4 cysts) and 21 interventions for non-tumoral formations (17 abscesses and 4 haematomas). Laparoscopic tumoral cases included three tumors and a retroperitoneal metastasis,while the non-tumoral were represented by 7  urohaematic effusions as a result of percutaneous nephrolithotomy procedures. Conclusions: Laparoscopic surgery of retroperitoneal lesions is minimally invasive,the postoperative evolution of patients is favorable, without majorcomplications. Laparoscopic technique has limitations in dealing withretroperitoneal lesions. Classical intervention of retroperitoneal lesions isindicated in large haematomas, abscesses, and big invasive tumors with vascularfactor which does not allow the use of laparoscopic technique.

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THE POSSIBILITIES OF HYPERBARIC OXYGEN THERAPY USE IN DENTISTRY Bechir Edwin Sever View abstract

THE POSSIBILITIES OF HYPERBARIC OXYGEN THERAPY USE IN DENTISTRY

First author: Bechir Edwin Sever

Coauthors: Spec. Phys. Ion Bogdan Cristian , Assoc. Prof. Ph.D. Bechir Anamaria , Prof. Ph.D. Buruian Mircea Marian

Keywords: hyperbaric oxygen therapy dental specialties The use of HBOT in dentistry

Background: The aim of this review was to investigate the possibilities of the hyperbaric oxygen therapy use in dental specialties and to give a brief overview of the rationale, existing trends and applications of this therapy. Material and Method: This article is a review, evaluating published clinical evidence of the efficacy of hyperbaric oxygen therapy (HBOT) in dentistry. The authors evaluated 323 citations, of which 35 reported original observational studies and randomized controlled trials on HBOT and healing outcomes. Results: The risks associated with hyper baric oxygen therapy are discussed, and cost analysis data are noted for specific conditions. Conclusions: All selected citations for full text review (35 articles) were evaluated according to GRADE criteria for high, medium, low, or very low level of evidence.

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Total phenolic, flavonoids, polysaccharides contents and antioxidant activity of Centaurea cyanus L. extracts Chiru Tatiana View abstract

Total phenolic, flavonoids, polysaccharides contents and antioxidant activity of Centaurea cyanus L. extracts

First author: Chiru Tatiana

Keywords: phytotherapy medicinal plants Antioxidant activity, iron chelating capacity, Cen

Background: Phenolic and polysaccharides extracts of Centaurea cyanus L. were prepared. In vitro antioxidant activity, total phenolic, flavonoids and polysaccharides contents of these extracts were studied. Material and Method: The extracts, obtained by different extraction techniques, were further analyzed to determine their total phenolic (Folin-Ciocalteau assay), flavonoids (with aluminum chloride), polysaccharides (phenol-sulfuric acid method) contents and antioxidant (DPPH scavenging, FRAP, ABTS assays; ferrozina test) activity. Results: In extracts the total phenolic content ranged from 156.63 to 388.81 mg/g dried weight, expressed as gallic acid equivalents. The content of flavonoids varied from 115.96 to 351.06 mg/g dried weight, expressed as rutin equivalents. The polysaccharides content was 2.66 % in Cyani herba and 1.59 % in Cyani flores extracts, expressed as glucose equivalents. In all assays, the ethanolic extracts of Cyani herba showed the highest values of antioxidant activity (DPPH – IC50 = 54.14 µg/ml; ABTS – 0.54 µM TE/g dried weight; FRAP – 52.43 µM TE/g dried weight). A high correlation was found between the values for the total phenolic content and antioxidant activity.The results revealed that polysaccharides extract had a significantly (P < 0.05) higher Iron chelating activity (95.66 %) than phenolic extracts. Conclusions: Our results confirmed that polyphenols extract can prevent activity of free radicals by scavenging or by inhibiting them. Polysaccharides extract has a strong capacity on chelating free iron. So, a combined extract having both the iron chelating and antioxidant activity is more preferable than that of having one of these activities.

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Oxidative stress changes in patients with psoriasis and psoriatic arthritis Negrei Carolina View abstract

Oxidative stress changes in patients with psoriasis and psoriatic arthritis

First author: Negrei Carolina

Coauthors: Boda D , Nicolescu Florica

Keywords: Farmacie (Pharmacy) Farmacie (Pharmacy) oxidative stress, psoriasis, psoriatic arthritis

Background: Reactive oxygen species can determine the impairment of the antioxidant defense systems and increase the oxidative stress in psoriasis and psoriatic arthritis. The aim is the evaluation some redox parameters (erythrocyte activity of glucose-6-dehydrogenase, susceptibility of erythrocyte to lipid peroxidation) in patients diagnosed with psoriasis or psoriatic arthritis compared to healthy controls. Material and Method: The study included 32 patients with psoriasis diagnosed according to clinical criteria and 34 patients with psoriatic arthritis diagnosed according to Moll and Wright criteria. None of them received any kind of treatment until the moment of diagnosis. All patients had active disease. The control group included 32 healthy volunteers, erythrocyte activity of glucose-6-dehydrogenase and susceptibility of erythrocyte to lipid peroxidation were assessed on red blood cells separated from venous blood samples (evaluated spectrophotometrically as erythrocyte activity of glucose-6-dehydrogenase activity and malondialdehyde concentration). Results: Erythrocyte activity of glucose-6-dehydrogenase was significantly lower in patients with psoriatic arthritis and psoriasis (25.32 ± 15.02 UI versus 29.43 ± 14.23 UI versus 36.23 ± 9.22 UI, p=0.01), susceptibility of erythrocyte to lipid peroxidation was higher in patients with psoriatic arthritis and psoriasis compared to controls (492.24 ± 115.23 mM malondialdehyde g/Hb versus 453.32 ± 140.82 mM malondialdehyde g/Hb versus 435.28 ± 54.24 mM malondialdehyde g/Hb, p=0.01). Conclusions: The mechanisms involved in psoriasis and psoriatic arthritis produce the impairment of antioxidant systems (decrease of the erythrocyte activity of glucose-6-dehydrogenase activity and  increase of susceptibility of erythrocyte to lipid peroxidation).

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Augmentation strategies for patients with Major Depressive Disorder with an inadequate response to antidepressant monotherapy MOICA T View abstract

Augmentation strategies for patients with Major Depressive Disorder with an inadequate response to antidepressant monotherapy

First author: MOICA T

Coauthors: Gabos Grecu I , Gabos Grecu Marieta , Ferencz Melinda , Buicu Elena Gabriela , Salcudean Andreea , Gabos Grecu C

Keywords: depression augmentation incomplete response

Background: Major Depressive Disorder is a chronic and debilitating disease characterized by a wide range of emotional and physical symptoms that coexist during a depressive episode and may reoccur at some point during the progression of the disease for the majority of patients. Material and Method: The purpose of the study was to investigate psychiatrists’ experience regarding the response to antidepressive treatment and their options regarding augmentation strategies in depression with incomplete response to antidepressant monotherapy. We have applied an 18-items questionnaire containing multiple choice questions to adult psychiatrists working in ambulatories, hospitals or mental health centers. The results were analyzed usig GraphPad. Results: 24 psychiatrists have agreed to answer to the questionnaire. The majority of them were psychiatry specialists, between 35 and 49 years, working into an outpatient unit. For the majority of doctors, SSRIs (Serotonin Reuptake Inhibitors) proved to be the first line treatment both for the first depressive episode and for recurrent depression, followed by SNRI (Serotonin and Noradrenalin Reuptake Inhibitors). Regarding the duration of maintenance treatment for the patients who achieved complete remission after the first episode of depression, the results showed a wide spectrum from 4 to 9 months. On average, incomplete response to antidepressive monotherapy was reported to be 25% in case of first depressive episode and 28% for recurrent depression. In case of incomplete response, psychiatrists use all available therapeutical strategies. Augmentation with atypical antipsychotics is the preferred method for augmentation. Quetiapine, olanzapine and aripiprazol are considered to be the most effective in this case. Conclusions: Incomplete response to antidepressive monotherapy is very frequent both for the first depressive episode and for recurrent depression. Given the pharmacological profile that some atypical antipsychotic have, augmentation with atypical antipsychotics in patients with inadequate response to antidepressant monotherapy is a useful therapeutic strategy that should be considered. Since currently there is relatively little data in this area, further clinical studies are needed to assess the risk-benefit of association of antidepressive medication and atypical antipsychotics for depressed patients without psychotic features.

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The UV and IR Comparative Spectrophotometric Study of Some Saturated and Lacunary Polyoxometalates Grama Lavinia View abstract

The UV and IR Comparative Spectrophotometric Study of Some Saturated and Lacunary Polyoxometalates

First author: Grama Lavinia

Coauthors: Boda F. , Gaz Florea A.S. , Curticapean A. , Muntean Daniela-Lucia

Keywords: polyoxometalates spectroscopy bonds association

Background: The polyoxometalates, as transitional metal–oxygenclusters, are a class of inorganic compounds with controllable shapes and sizes, and with excellent properties that makes them attractive for various applications. This study is aimed on the comparative UV and IR spectra of Keggin type polyoxometalates.Sidgwick describes several types of coordinative bonds between addenda atoms (tungsten, molybdenum) and oxygen that are responsible for the appearance of peaks. Material and Method: Compounds under (UV and IR) investigations were divided into several groups to highlight similarities between compounds or classes of compounds for the same category. There are four types of saturated Keggin structures and six lacunar compounds included in this study. The study begins with the UV investigations on aqueous solutions with 10-5 M concentration for these compounds. IR spectra were recorded as KBr pressed pellets. Results: The UV spectra presents large strong peaks between 185-195 nm corresponding to W=Od bonds. For W-O-W bridge bonds the values are between 251-268 nm, depending on heteroatom types (As, Sb). The unsaturated cryptand ligand having Co2+ coordinated presents the most intense peak. This is due to the involvement of oxygen atoms from terminal W=Od coordinative bonds with high electronic densities in coordination of W-O-Co bond, which demonstrates the strengthening of chemical bonds on the later complex.The IR spectra present many peaks that are associated as follows: for terminal bonds W=Od, 955-970 cm-1; for W-O-W bridging bonds, 790-910 cm-1; for W-O-As/Sb bonds to heteroatom, 690-760 cm-1. Vibrations of the bonds between heteroatoms and oxygen (As/Sb-O) are found around 620-660 cm-1. Conclusions: Similarities are observed from the recorded spectra, between compounds of the same class, by category association. Very fine displacements of peaks that occur explain the influence of heteroatoms, addenda atoms or coordinated cations. ACKNOWLEDGEMENTS: This paper is partly supported by the Sectorial Operational Programme Human Resources Development (SOP HRD), financed from the European Social Fund and by the Romanian Government under the contract number POSDRU 80641.

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Combination of ropivacaine and lidocaine for long lasting locoregional anesthesia Lazăr Alexandra View abstract

Combination of ropivacaine and lidocaine for long lasting locoregional anesthesia

First author: Lazăr Alexandra

Coauthors: Szederjesi J , Copotoiu Sanda-Maria , Copotoiu Ruxandra , Azamfirei L

Keywords: regional anesthesia ropivacaine lidocaine brachial plexus ultrasound

Background: The aim of this study was to evaluate the clinical utility of Ropivacaine 0,5% and Lidocaine 05,% anestethic  combination in  performing locoregional anesthesia, using either peripheral nerve stimulator or ultrasounds for brachial plexus block. Material and Method: A prospective randomized clinical study was performed at Clinical County Emergency Hospital of Tirgu Mures, between January and May 2013 on patients undergoing surgical interventions, elective or emergency, on upper limbs, with indication for locoregional anesthesia. Brachial plexus block with axillary approach was performed in 65 patients using randomly the nerve stimulator or the ultrasound guided technique. The parameters recorded were the duration of the anesthetic technique, the installation time and the duration of anesthesia. All anesthetic incidents during and after anesthesia were observed as well. The recorded data were analyzed and statistically processed. Results: We enrolled 40 (61,5%) patients for the nerve stimulation technique and 25 (38,5%) patients for ultrasound guidance. The quality of the block was acceptable, in 9 patients (13,8%) an inadequate anesthesia was reported. The mean time of installation of anesthesia was 34,36 (±11,56) minutes, time recorded from the initiation of the anesthetic technique until complete motor block. The mean duration of the motor block was 481,3 (±128,6) minutes which represents over 8 hours. None of the patients required conversion of the anesthesia due to the extended period of the surgical intervention. One patient presented a mild allergic reaction to the anesthetic drugs. Conclusions: Combination of the ropivacaine and lidocaine can be safely used for locoregional anesthesia, especially in those cases where long surgical intervention time is anticipated or in order to achieve a better postoperative analgesia.  

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Bladder tumour associated with prostatic carcinoma - a multiple primary tumor case presentation and histopathologic study Ilie A View abstract

Bladder tumour associated with prostatic carcinoma - a multiple primary tumor case presentation and histopathologic study

First author: Ilie A

Keywords: prostatic adenocarcinoma urothelial carcinoma bladder tumor

Background: Bladder cancer counts for 7% of all cancers. Approximately 90% of malignant bladder tumors are urothelial tumors. In Romania, estimated incidence for year 2000 was 16,47 /100.000 inhabitants and mortality rate 5,15/100.000 inhabitants.   Material and Method: Male aged 78 years old, with episodes of gross hematuria, diagnosed in our department in 2012 with infiltrating urothelial carcinoma, has presented to the Department of Urology for evaluation and surgical treatment. Clinical examination and computed tomographic scan confirmed the presence of a bladder tumor with pelvic infiltration and secondary left urethero-hydronephrosis.Total cystoprostatectomy with bilateral urostomy was performed through anterior approach. Histopathologic examination of cystectomy specimen has confirmed the initial diagnosis but reveals a second synchronic tumor, a prostatic adenocarcinoma Gleason score 3+4, extended into seminal vesicles and with lymph node metastasis. The patient was sent to the department of Oncology, for further treatment. For this case presentation I have used data from patient’s file and histopathology report. Material and Method: For this case presentation I have used data from pacient' s clinical observations file number 4793/2013 and histopathology report number 4970-81/2013. Results: Invasive urothelial carcinoma (WHO 2004), with focal necrosis, infiltrative into bladder wall till the perivesical fat and focal infiltration into prostatic tissue. Lymphatic and perineural invasion. Peritumoral inflammatory infiltrate low/medium. Prostatic adenocarcinoma, combined Gleason score 3+4, infiltrative into both prostatic lobes, with infiltration of both seminal vesicles, with formation of secondary tumor nodules in the perivesical fat tissue and metastasis in one right iliac lymph node and two left iliac lymph nodes.pT4 N0 Mx pT3b N0 Mx Conclusions: The particularity of this case  is  the multiple primary tumor type, urothelial carcinoma of the bladder and adenocarcinoma of the prostate, also the fact that the last one, though unknown before surgery, had metastasis in lymph nodules, with practical significance in prognosis and chemotherapy.

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Experimental research on the interactions between some anxiolytics and dietary sodium monoglutamate Buzescu Anca View abstract

Experimental research on the interactions between some anxiolytics and dietary sodium monoglutamate

First author: Buzescu Anca

Coauthors: Cristea Nicoleta Aurelia , Chiriac Alexandra , Chirita Cornel

Keywords: Pharmacology E621 NMRI mice cross-labyrinth test monosodium glutamate

Background: The sodium salt of glutamic acid (MSG) is largely used as flavour enhancer. The glutamic acid represents the most important excitatory neurotransmitter, controlling synaptic excitability and plasticity in various brain circuits, including those involved in anxiety. In this study, we determine if monosodium glutamate, after repeated oral administration, can modify the degree of anxiety. Taking into account the interdependence between GABA-glutamate neurotransmissions, we studied possible  interactions of MSG with some representatives of benzodiazepines chemical class, diazepam and alprazolam, used as first line therapy for the treatment of anxiety. Material and Method: Materials Monosodium glutamate (Sigma-Aldrich), Alprazolam (Pfizer), Diazepam (Terapia) Experimental animals 60 NMRI adult mice, weighing 25±2g, were purchased from UMF biobase, Bucharest. For determining the degree of anxiety, the cross-labyrinth test was used. The medium time spent in the closed-arms of the cross-labyrinth is correlated with increased anxiety; the medium time spent in the opened-arms is correlated with a low degree of anxiety.  Results: The group receiving MSG showed a slight increase in the degree of anxiety. The groups receiving benzodiazepines alone presented a significant reduction of the degree of anxiety, proving their anxiolytic effect. When associating benzodiazepines with MSG, the anxiolytic effect of the benzodiazepines diminished significantly  (for MSG+Alprazolam,  the medium time spent in the closed-arms increased with 15-20%, vs. Alprazolam; for MSG+Diazepam, the medium time spent in the closed-arms increased with 30-42% vs. Diazepam)  Conclusions: The oral administration of MSG for 21 days increases slightly the degree of anxiety in mice, and significantly alters the response to the benzodiazepines therapy, antagonizing the effect of both alprazolam and diazepam, in cross-labyrinth test.

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Helicobacter pylori and human immunodeficiency virus: searching for risk factors Şincu Nina-Ioana View abstract

Helicobacter pylori and human immunodeficiency virus: searching for risk factors

First author: Şincu Nina-Ioana

Coauthors: Băţagă Simona , Tilea Brindusa , Georgescu Anca Meda , Garbovan Cristina , Chiriac Carmen Lucia

Keywords: Helicobacter pylori HIV risk / protective factors

Background: As Helicobacter pylori infects more than half of the world’s population, epidemiological risk factors associated to its presence represent an important preoccupation of the scientific community. Since several studies have detected lower prevalence of Helicobacter pylori in subjects infected with human immunodeficiency virus (HIV), searching for Helicobacter pylori risk factors among this category of patients seems useful. Objective: to identify risk / protective factors for Helicobacter pylori infection in HIV-positive subjects Material and Method: Retrospective, analytical, case-control study, over a 3-year time interval (July 2009 – June 2012) on two groups of HIV-infected patients. Group A consisted of 33 patients who tested positive for Helicobacter pylori infection on serology or stool antigen detection, group B of 56 Helicobacter pylori-negative subjects. We collected data regarding the patients’ level of education, occupation, immune status, recent use of antibiotics / antituberculosis and presence of esophageal candidiasis. Statistical analysis was performed by GraphPad program. Results: We did not find statistically significant associations between education level (p=0.2721), unemployment (p=1.000) and Helicobacter pylori infection. Our study emphasized the existence of negative associations, though not statistically significant, between recent use of antibiotics (p=0.3674, OR=0.5306) / antituberculosis medication (p=0.0539, OR=0.3477), impaired immune status (p=0.3858, OR=0.6138), Candida esophagitis (p=0.4060, OR=0.3188) and the presence of Helicobacter pylori. Conclusions: Recent use of antibiotic / antituberculosis drugs, digestive fungal infections and impaired immune status seem to be negatively associated with Helicobacter pylori infection; more research is needed in order to come clear about these issues. Acknowledgement. This paper is partly supported by the Sectorial Operational Programme Human Resources Development (SOP HRD), financed from the European Social Fund and by the Romanian Government under the contract number POSDRU 80641.

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The impact of immune and virologic status of HIV-positive patients upon the presence of Helicobacter pylori infection Şincu Nina-Ioana View abstract

The impact of immune and virologic status of HIV-positive patients upon the presence of Helicobacter pylori infection

First author: Şincu Nina-Ioana

Coauthors: Chiriac Carmen Lucia , Tilea Brindusa , Georgescu Anca Meda , Zaharia-Kezdi Erzsebet Iringo , Incze Andrea , Bataga Simona

Keywords: HIV Helicobacter pylori immune / virologic status

Background: The immune and virologic status of subjects infected with human immunodeficiency virus (HIV) seems to play an important role in the acquisition of Helicobacter pylori, as several authors state that patients in advanced stages of HIV, such as the acquired immunodeficiency syndrome (AIDS), are less likely to be co-infected with Helicobacter pylori. Objective: to study the impact of immunologic and virologic status of HIV-positive patients upon the existence of Helicobacter pylori co-infection. Material and Method: retrospective, analytical, case-control study over a 4-year period (March 2009-March 2013), upon two groups of HIV-positive patients admitted to the Clinic of Infectious Diseases I Tg-Mureş, tested for Helicobacter pylori infection either by serology or stool antigen detection. Group A was composed of 35 Helicobacter-positive subjects, group B - 63 Helicobacter-negative ones. We compared the two groups from the point of view of their CD4 T-cells and HIV-RNA plasma viral load levels. Data were processed by GraphPad statistical programme, performing Mann-Whitney nonparametric test for comparing means Results: Although the mean value of CD4 T-cells was higher (403 compared to 328/cmm) and mean viral load was lower (60549 compared to 128239 c/ml) in Helicobacter-positive than Helicobacter-negative patients, our study did not find statistically significant differences between the two groups (p=0.1579, p=0.2613). Conclusions: Helicobacter-infected HIV-positive patients tend to have higher CD4 T-cell count and lower HIV-RNA plasma viral load than Helicobacter-negative ones, but research upon larger groups would be useful in order to establish statistical significance. Acknowledgement. This paper is partly supported by the Sectorial Operational Programme Human Resources Development (SOP HRD), financed from the European Social Fund and by the Romanian Government under the contract number POSDRU 80641.

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The prognostic impact of Bcl-2 in breast carcinoma Bujor Sevilla View abstract

The prognostic impact of Bcl-2 in breast carcinoma

First author: Bujor Sevilla

Coauthors: Suciu C , Raica M

Keywords: Bcl-2 breast cancer immunohistochemistry

Background: Breast cancer remains one of the most frequent neoplasia among women, thus a new evaluation of prognosis markers was needed. In our study we assessed the prognostic impact of the antiapoptotic protein Bcl-2 on pacients diagnosed with breast cancer, taking into account the histological grade, lymph node involvement and hormonal status. Material and Method: 70 specimens obtained from patients diagnosed with breast cancer were included in our study. We assessed Bcl-2 expression, estrogen receptors and progesterone receptors using immunohistochemical stains . Results: A positive reaction for Bcl-2 (score of 2+ and 3+ ) were obtained in 76.9% (20 out of 26) of patients in premenopause and in 72.7% (32 out of 44) of patients in postmenopause. 63,6% (14 out of 22) of G3 tumors presented a positive 3+ reaction to Bcl-2. The majority of cases without lymph node metastasis, a total of 91.6% (22 out of 24), expressed Bcl-2 (score of 3+) and among the cases with lymph node metastais 65.2%(30 out of 46) expressed Bcl-2 (score of 2+ and 3+). We also observed that 89.2%(50 out of 56) of luminal type tumors express the marker with scores of 2+ and 3+, while only 14.3%(2 out of 14) of non-luminal tumors expressed Bcl-2. Conclusions: The results of our study show that the value of Bcl-2 expression is inversely correlated to the degree of tumoral differentiation. As such, the percentage of Bcl-2+ cases lowers as the degree of differentiation rises. We have found no significant differences of Bcl-2 expression between patients at premenopause and patients at postmenopause. The majority of luminal tumors express this marker. All our data suggests the prognosis potenital of Bcl-2 in breast cancer.

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Fluoxetine Effect on Gestation and Fetal Development Ősz Bianca Eugenia View abstract

Fluoxetine Effect on Gestation and Fetal Development

First author: Ősz Bianca Eugenia

Coauthors: Vari CE , Dogaru Maria

Keywords: Pharmacology Pharmacology fluoxetine, rat, teratogenicity, death embryos

Background: The prenatal exposure to selective serotonin reuptake inhibitors (SSRIs) is very controversial. There is no conclusive evidence for increased risk of malformations after SSRI use in pregnancy, although they might be associated with a slightly increased risk for cardiovascular malformations when used in early pregnancy. The aim of the study was to determine how fluoxetine is affecting gestation and fetal development in rats. Material and Method: Twenty sexually mature female Wistar rats weighting between 250-260 g received 20 mg/kg body weight fluoxetine from the first day of gestation and during the entire gestation period. The drug was suspended in distilled water and administered by oral route. Healthy, primipareus animals were selected along with 20 female Wistar rats, as control group. Mature males were caged with virgin females for an entire week. Rat’s behavior during gestation, after birth and rats body weight was examined. The number of healthy pups was also noted. The females not giving birth after 25 days to any pump were anesthetized (halothane through gas scavenging apparatus untilled death) and the gravid uterus were dissected out and examined. Results: Compared to the controlled group, in which weight gain was more significant, the animals from the experimental group had a slight increase in body weight. The weight gain normally induced by gestation, is less significant in fluoxetine treated rats due to the increase serotonin levels in the brain. The uteri examination of pregnant rats showed an increase in the number of dead and resorbed rat embryos. Conclusions: Preclinical studies suggest that the inclusion of fluoxetine in pregnancy category C is justified and the appropriateness of its administration in pregnancy is still an unresolved issue.

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Considerations on the DAA therapy at the patients having chronic hepatitis from Constanta County Stavar Angelica - Nela View abstract

Considerations on the DAA therapy at the patients having chronic hepatitis from Constanta County

First author: Stavar Angelica - Nela

Coauthors: S.Rugina,Irina - Magdalena Dumitru

Keywords: direct antiviral agents (DAA) standard therapy in HCV triple therapy

Background: The direct antiviral agents (DAA) have a direct action over HCV improve the virological reaction. The HCV NS3/4 A proteases inhibitors are approved by FDA (Foot and Drug Administration) form May 2011. Their adding to the standard therapy with interferon alfa2 (IFN) + ribavirina (RBV) has significantly improved the sustained viral reaction (RVS). Material and Method: I have selected a lot of 24 patients among those in studv within my doctoral thesis, who have concluded the DAA administration period, being now in the period of finalization of standard therapy. The patients have been evaluated in clinical and para clinical terms (laboratory, fibroscan, echography, etc). The study analyses the triple therapy in terms of tolerability and efficiency only while administering DAA. Results: The duration of the therapy association with DAA at the standard treatment was 3 months with remarkable virulogical results meaning that there was a high rate of negativation of viremia after the utilization of the triple therapy (99%). Tolerability was variable. Adverse reactions were recorded, among which the most important being: anemia 17 patients 70.8% (5 patients, 20.8% light anemia; 7 patients, 29.2% moderate anemia; 4 patients 12.5% severe anemia); leucopenia 10 patients 41.6% (7 patients, 29.1% light leucopenia, 3 patients 12.5% moderate leucopenia); thromobocitopenia 14 patients 58.3% (9 patients 37.4% light and 5 patients 20.8% moderate); hyperbilirubinemia 2 patients, 8.3%; hyperuricemia 9 patients (7 patients, 29.2%' light; 2 patients, 8.3% severe); hypocalcemia 4 patients, 16.6% (2 patients light form 8.3% and 2 patients severe form 8.3%), loss of weight 4 patients (12.5%); rash 3 patients (12.5%); among the 24 patients 2% have shown no remarkable adverse reactions. Conclusions: The triple therapy, with DAA added to the standard therapy proves its utility despite the various adverse reactions recorded, high rates of sustained viral reaction justifying its utilization.

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Sleep apnea and ischemic heart disease: is there a paradoxical benefit? Kocsis Ildikó View abstract

Sleep apnea and ischemic heart disease: is there a paradoxical benefit?

First author: Kocsis Ildikó

Coauthors: Frigy Attila , Fehérvári Lajos , Caraşca Emilian

Keywords: obstructive sleep apnea ischemic heart disease ischemic preconditioning

Background: Severe forms of obstructive sleep apnea (OSA) significantly influence the quality of life of patients (excessive daytime sleepiness,  fatigue, decreased concentration, memory loss). At the same time, OSA is a well-known aggravating factor of many cardiovascular diseases. Our aim was to analyze the complex relationship between OSA and ischemic heart disease, keeping in mind the possibility of paradoxical beneficial effect due to ischemic preconditioning. Material and Method: By reviewing the literature we present the current data about the relationship  between  OSA and ischemic heart disease (role as a risk factor for atherosclerosis, triggering ischemic events by hypersympathicotonie – nocturnal bouts of increased heart rate and blood pressure on weakenings). However, there also data about the protective effect of repetetitive desaturations during night in patients with estabilished coronary diasease and OSA. This could be possible by increasing the collaterals and by ischemic preconditioning. Results: The relationship between nocturnal phenomena, both related to sleep and cardiac activity, are demonstrated using ambulatory poligraphy recordings and continuous ECG recordings  (performed in the same night) of patients with doccumented coronary disease and OSA. Our recordings revealed the lack of ST-segment dynamics during apnea, which could be explained by ischaemic preconditioning. Conclusions: Though OSA is a known risk factor for coronary disease, often the nighttime desaturations have a possible protective effect on the severity and frequency  of coronary events. This “natural” variant of ischemic preconditioning could influence the decision to initiate CPAP treatment in patiens with OSA and ischemic heart disease.

validated
Anastomotic Leaks after Colorectal Surgery: a Prognostic Score Caziuc Alexandra View abstract

Anastomotic Leaks after Colorectal Surgery: a Prognostic Score

First author: Caziuc Alexandra

Coauthors: Mironiuc A

Keywords: colorectal surgery anastomotic leak prognostic score

Background: Anastomotic leaks are one of the most dreaded complications in colorectal surgery. At the ground of this problem remain the nefarious prognostic over the patient’s life, the difficulties in early diagnosis and the optimal choice of therapeutical methods. The goal of our research was to evaluate the significance of possible risk factors in the postoperative evolution of patients following colorectal interventions and to design a prognostic score. Material and Method: We performed a retrospective study on 298 cases of patients with inflammatory, neoplastic or traumatic lesions for which there was chosen a digestive anastomosis including the colon. The presumed risk factors in our analysis were: age, comorbidity evaluated by Charlson Score, etiology, toxics, use of nonsteroidal anti-inflammatory substances or corticoids, parameters such as leucocytes, hemoglobin, urea, total seric bilirubin, glycaemia, albumins, neoadjuvant therapy, type of suture, quantity of fluids received intraoperatory. All data was analyzed using R-Commander. Results: All parameters for which we demonstrated a statistical significance (p under 0.05) for an unfavorable evolution were included in a prognostic score, designed in correlation with the statistical relation between the factors. We obtained values that certified a strong association (0.75) between a high prognostic score and an increased number of anastomotic leaks. Conclusions: The practical utility of the score is mainly for the anticipation of postoperative complications. A high level score underlines that prior to surgery is essential to balance the biochemical abnormalities and to choose properly the moment and type of surgical intervention.

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RNAscope, a New Horizon for the Molecular Diagnosis in Cancer Comsa S View abstract

RNAscope, a New Horizon for the Molecular Diagnosis in Cancer

First author: Comsa S

Coauthors: Olteanu GE , Cimpean Anca Maria , Raica M

Keywords: cancer in situ hybridization molecular diagnosis RNA RNAscope

Background: The analysis of in situ of biomarkers has a major importance in molecular pathology because it facilitates the assessment of the correlation between biomarker status and the histopathological context in clinical specimens. RNA biomarkers have become a useful tool in cancer, due to the evolving technologies that analyze the genome. Quantification of mRNA has historically been done by RT-PCR. Recently, RNAscope, a new robust method of mRNA detection utilizing in situ hybridization (ISH), has come to light. This method is linear and shows high specificity with low background noise. To cut it short, RNAscope holds significant promise for the future of RNA based molecular diagnostics. Material and Method: RNAscope permits the visualization of a single molecule in individual cells through use of a new probe design strategy and a hybridization-based signal amplification system which has the ability to both amplify signals and suppress background.  Results: To the moment RNAscope has proven its efficacy in few cancer fields such as the pathology of high-risk HPV (HR-HPV) or the evaluation of the HER2 status in breast cancer. Although demonstration of transcriptionally active HR-HPV in fresh tumour tissue has been considered to be the analytical 'gold standard', RNAscope demonstrates excellent analytical and prognostic performance against it. This new test could be developed to provide the 'clinical standard' for assigning a diagnosis of HPV-related carcinoma. Regarding HER2 status in breast cancer, RNAscope was proven to be superior to quantitative PCR in equivocal cases. This new assay might become the standard method for the evaluation of HER2 status in the clinical testing algorithms. Conclusions: RNAscope has brought new perspectives for RNA ISH. Its simple method, adaptable for routine gene expression evaluation, as well as the the quality of its results, represent rational reasons for implementing RNAscope into clinical use.

validated
EPIDEMIOLOGICAL SURVEY OF DENTAL FEAR AND ANXIETY IN ROMANIAN CHILDREN LIVING IN HUNGARY Gyergyay Réka View abstract

EPIDEMIOLOGICAL SURVEY OF DENTAL FEAR AND ANXIETY IN ROMANIAN CHILDREN LIVING IN HUNGARY

First author: Gyergyay Réka

Coauthors: Beck Anita , Székely Melinda , Mártha Krisztina

Keywords: Dentistry Dentistry Romanian minority from Hungary, Dental Anxiety Sca

Background: The purpose of our survey was to investigate anxiety and dental fear among children of the Romanian minority living in Hungary in order compare with the already existing data from Hungary and Romania. Material and Method: In this cross sectional study 311 schoolchildren of Romanian minority living in Hungary were investigated (n=311, 163 female, 148 male, age between 11-18 years). Questionnaires have been completed anonymously by children in five schools located in Bekes county, Hungary. The subjects` dental fear was evaluated with Corah’s Dental Anxiety Scale (DAS) and Kleinknecht’s Dental Fear Survey (DFS), the anxiety level with Spielberg`s State and Trait Anxiety Inventory (STAI-S, STAI-T) and their opinion about dentists with Getz’s Dental Beliefs Scale (DBS). The study was approved by the Ethical Comity of Semmelweis University from Budapest. For statistical analysis the t-test and Pearson’s correlation test was used by SPSS/PC statistics 17.0. Results: The mean (± SD) scores of the surveyed subjects (mean age 13.6±2.1 years) were high: DAS 11.8(±4.4), DFS 36.7(±13.9), DBS 37.3(±11.9), STAI-S, STAI-T 37.0(±11.0) and 38.8(±9.5), respectively. Except for DBS higher scores were found in females for every questionnaire, though the differences were statistically significant (p≤0.05) only in DAS and DFS. Dental Fear Scale and Spielberg`s State Anxiety Inventory showed a peak around the age of 12, from where they gradually decreased. There was a strong Pearson-correlation between DAS and DFS scores (r=0.73; p≤0.01), and a somewhat lower correlation between these scales and the general anxiety scores. Conclusions: Summing up the results, the obtained scores were higher than the international and some of the Hungarian ones, but lower in each case, than those measured in the Hungarian population from Romania. The differences might suggest different dental care systems.

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The Oscar Ramirez procedure, a solution for treating incisional hernias with big abdominal wall defect Gherghinescu M View abstract

The Oscar Ramirez procedure, a solution for treating incisional hernias with big abdominal wall defect

First author: Gherghinescu M

Coauthors: Popa D , Pantîru A , Russu C , Roșca C , Benedek Orsolya , Copotoiu C

Keywords: Oscar Ramirez technique incisional hernia tension free procedure

Background: Incisional hernias are important complications of abdominal surgery. Normally they are followed by the growth of the hernia sac and an increase of the abdominal wall defect with the loss of domain of the herniated organs. Material and Method: We report a case of a 51 year old female, admitted in the 1st Surgical Clinic of the Mures County Emergency Hospital with large median reducible incisional hernia with a wall defect of 10 /12 cm. Abdominal wall plasty was done using the Oscar Ramirez technique, which consists of a longitudinal incision along the aponeurosis of the external oblique muscle, at about 1-2 cm from the external edge of the rectus abdominis. Using this procedure the rectus abdominis muscles are closed together on the median line to a distance of 3-5 cm on both sides of the upper abdomen, 7-10 cm in the middle abdomen and 1-3 cm in the lower abdomen, permitting the closing of the abdominal wall without any tension. The aim of this study is to draw attention to a procedure that can be an alternative abdominal plasty. Results: Postoperative recovery was favorable, bowel movements were present on the second day after the surgery, the subcutaneous drains were shortened on the fifth day and removed on the sixth. There were no immediate postoperative complications or up to a month after the surgery. The patient was discharged on the seventh day. Conclusions: This technique can be used alone in case of large abdominal wall defect , or prequeling an on-lay mesh procedure adressed to a weak abdominal wall, in which case the functional result is superior to a substitutional mesh.

validated
Schoolchildren’s peculiarities of sleep habits Solyom Reka View abstract

Schoolchildren’s peculiarities of sleep habits

First author: Solyom Reka

Coauthors: Baghiu Maria Despina , Neagoș Adriana

Keywords: sleep habits children weekdays romanian life quality

Background: The international literature gives us a very variable data regarding sleep disorders and the complaints related to this pathology. However, interpreting these data is difficult because of the ethnical and cultural differences and the numerous possibilities of the assessments. In this paper the authors examined and evaluated the main parameters which characterize the sleep habits of children in Romania, as well as the complaints related to it, which could influence the quality of sleeping. The aim of this study was to evaluate the sleep habits of schoolchildren: time spent sleeping, quality of sleep, frequency of complaints related to sleeping. Material and Method: Distributing questionnaires amongst the children in Târgu Mureș. We used different questionnaires, based on Epworth and Conner’s scores, for children between 11-14, and 15-18 years and for their parents. After collecting and centralizing all data, these was processed with the help of the statistical software SPSS. Results: The results in the ratio of gender was approximately equal, the height and weight of the children was within the framework of Romanian standards. The most frequent nocturnal complaints were: problems with falling asleep, agitation, awakenings during the night. The most frequent daytime complaints: fatigue when in school, difficulty with waking up in the morning and mood swings. The results showed significant differences between weekdays sleeping hours and weekend sleep time (p=0,0022). Conclusions: Sleep habits change with age, which is a physiological effect. Other factors that modify the habits in a negative way, and the time spent sleeping gets reduced, plays a crucial role into leading to persistent fatigue, reduced quality of school performance and even to a depraved life quality. "ACKNOWLEDGEMENTS: This paper is partially supported by the Sectoral Operational Programme Human Resources Development, financed from the European Social Fund and by the Romanian Government under the contract number POSDRU/ 80641”

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Implantation of biventricular cardiac devices using a double venous approach - an alternative implantation technique Sosdean Raluca View abstract

Implantation of biventricular cardiac devices using a double venous approach - an alternative implantation technique

First author: Sosdean Raluca

Coauthors: Pescariu Sorin , Enache Bogdan , Macarie Razvan , Marca Raluca

Keywords: Cardiac resynchronization therapy Biventricular device Complication Implantation technique Double venous approach

Background: A standard technique regarding venous approach for implantation of biventricular cardiac electrical devices used for cardiac resynchronization therapy implementation has not yet been established. We analyzed the safety and efficiency of implanting these devices using a double venous approach (cephalic and subclavian) by comparing it with the simple approaches, in order to overcome some of their inconvenients. Material and Method: We retrospectively analyzed all 228 resynchronization patients implanted at Timisoara Institute of Cardiovascular Medicine between 01.01.2000 and 01.01.2013. The 204 patients successfully implanted with biventricular pacemakers or defibrillators were divided according to the implantation techniques, and compared by complication rates and values of acute stimulation-detection thresholds. Group A featured a subclavian approach (48 patients), group B a cephalic approach (81 patients) and group C a double venous approach (76 patients). Results: Adjusting for age, sex and device type there is no evidence in the data that complication rates are significantly different when using the different techniques: 6 complications (12,5%) in group A, 8 (9,87%) in group B and 5 (6,75%) in group C (p=0,51). A slight downward trend was observed by using double venous approach. Values of acute stimulation-detection thresholds had no statistically significant differences neither (p=0,36). Cephalic vein was of high quality in 59,8% of cases. Conclusions: Subclavian and cephalic double venous approach implantation technique for biventricular devices proved to be feasible and at least as safe as single venous approach using subclavian or cephalic vein alone, and it can be used as a first resort technique.

validated
Assessment of Ventricular Dissynchrony in Right Ventricular Single Chamber Pacing using Echocardiografic Parameters. Adriana Mitre View abstract

Assessment of Ventricular Dissynchrony in Right Ventricular Single Chamber Pacing using Echocardiografic Parameters.

First author: Adriana Mitre

Coauthors: Vita I. , Dobreanu D.

Keywords: echocardiography ventricular dis synchrony pacing

Background: From the early years of pace-makers, right ventricular apical pacing was used, despite the fact that it determined nonphysiological right-to-left and apical-to-basal ventricular depolarization. As medical technologies developed, septal lead implantation became feasible, in order to outrun the above mentioned inconveniences. The question whether the apical or septal lead position is better still gives rise to a lot of controversies. Different echocardiographic parameters, are currently used to asses the impact of specific sites of stimulation on ventricular function. Material and Method: 59 patients admitted between January 1st - December 31st 2012 either for battery changing or for first implant with a single chamber pace-maker, were included in this prospective study. 38 of them had the lead placed in the apex of the right ventricle and 21 on the interventricular septum. All were subjected to echocardiografic exam after device implantation. Measurements included complete chamber and valvular assessment, apart from the synchronicity evaluation, that comprised  interventricular mechanical delay ( IVMD), septal to posterior wall delay ( SPWMD)and electro systolic delays ( DES), in order to asses the presence and compare the importance of interventricular and intraventricular dissyncrony. Results:  Although preejection times were significantly different, there were no statistically significant differences (p=0, 06) between the values of IVMD in the two groups, as well as regarding the longitudinal intraventricular dyssincrony expressed by DES. Significant differences appeared though, between the values of SPWMD , reflecting the fact that radial intraventricular dissyncrony is present in apical stimulation. Conclusions: During apical right ventricular pacing, radial intraventricular dissyncrony appears, compared to septal pacing in which this parameter is close to normal. Surprisingly, although right ventricular pacing determines interventricular and longitudinal intraventricular dissincrony, we found no significant differences in this respect, between apical and septal pacing. Nevertheless, finding new echocardiografic parameters to explain left ventricular impairement during right ventricular pacing is important, and needs further studies.

validated
Prevalence and Characteristics of Tooth Agenesis in Permanent Dentition of Subjects from Tîrgu-Mureş Kerekes-Máthé Bernadette View abstract

Prevalence and Characteristics of Tooth Agenesis in Permanent Dentition of Subjects from Tîrgu-Mureş

First author: Kerekes-Máthé Bernadette

Coauthors: Mártha Krisztina , Székely Melinda

Keywords: tooth agenesis prevalence permanent dentition

Background: Identification of the characteristics of tooth agenesis is an important component in the understanding of the ethiology of this common developmental dental anomaly. The aim of the present study was to determine the prevalence and the characteristics of tooth agenesis among the patients from Tîrgu Mureş. Material and Method: The present study is retrospective and descriptive, based on the evaluation of the patient’s dental records from 2004 to 2012 belonging to a pediatric dental office from Tîrgu-Mureş. Orthopantomograms and anamnestic data of 947 children and young adults (365 male and 582 female) were analyzed. Statistical analysis was performed by Chi-square and Fisher’s tests using GraphPad Prism software. Results: The prevalence of tooth agenesis, excluding third molars, was 7.39%. The difference between the genders was statistically not significant (p=0,09). The most frequently missing teeth were the upper second incisors, followed by the lower second premolars. The difference between the distribution of agenesis in the upper and lower jaws was statistically significant (p<0,0001). The distribution of dental agenesis between the anterior region and the lateral region of the maxilla and the mandible showed significant differences (p<0,0001). Symmetrical distribution of tooth agenesis was found more frequently (54.54%) than assymetrical distribution. Oligodontia was found in three cases (0.32 %). Conclusions: Our results on prevalence of tooth agenesis were in accordance with data of dental literature. The maxillary anterior region and the mandibular lateral region were the most affected by dental agenesis in the permanent dentition of the studied population. The maxilla was more affected than the mandible and bilateral forms of agenesis were more frequently than unilateral forms. The more extreme forms of agenesis were found amongst female.

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THERAPEUTIC OPTION IN PATIENTS OVER 60 YEARS WITH ESOPHAGEAL AND ESOCARDIAL CANCER Rosca C View abstract

THERAPEUTIC OPTION IN PATIENTS OVER 60 YEARS WITH ESOPHAGEAL AND ESOCARDIAL CANCER

First author: Rosca C

Coauthors: Molnar C , Popa D , Serac G , Gherghinescu M , Voidazan S , Copotoiu C

Keywords: esophageal esocardial cancer management

Background: Treatment of esophageal and esocardial  cancer in patients over 60 years involves a particular management. Considering the comorbidities specific to this category of patients, recent data from the literature indicate an increased incidence of mortality and  morbidity following therapy. Material and Method: We retrospectively studied a group of 55 patients admitted to the Surgical Clinic I of the Emergency County Hospital Targu Mures, in the period 01.01.2007-31.12.2011 diagnosed with esophageal and esocardial cancer. Patients were divided into two groups: group I under age 60 years and over this age group II. Inclusion criteria were age, diagnosis (tumor location), following a series of parameters: demographics, type of surgery, the biological profile of patients, immediate postoperative morbidity and mortality. Results: No statistically significant differences were observed in terms of demographics: gender (p = 0.78), area of origin (p ​​= 0.69). Number of hospitalization days (p = 0.20) was influenced by the type of surgery as well as pre-and postoperative comorbidities. Immediate postoperative mortality was 16.56% (n = 55 patients operated) data comparison between the two groups was not statistically significant (p=0.58). Parameters with statistical significance were found to be: age (p <0.0001), tumor location,type of surgery (p = 0.0031) and radical versus palliative surgery (p=0.03). Conclusions: Therapeutic attitude in patients over 60 years should be correlated with specific particularities to this category. Selection of patients for surgery and type of surgery is dictated by the patient's condition and quantified by anesthesia and surgery team.

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Total and subtotal colectomy in colon cancer - Indications and postoperative results A. Panțîru View abstract

Total and subtotal colectomy in colon cancer - Indications and postoperative results

First author: A. Panțîru

Coauthors: C. Molnar , D. Popa , C. Sărăcuț , C. Russu , S. Voidăzan , C. Copotoiu

Keywords: total subtotal colectomy cancer colon

Background: Indications of extended colectomy (subtotal and total) are well coded (multiple neoplasms of colon, familial polyposis colon diverticulitis with local complications, Crohn's disease, ulcerative colitis). Emergency surgery for left colon cancer obstruction is an additional indication agreed in literature. Material and Method: We performed a retrospective cross-sectional study analyzing the patients data records, operative protocols, histopathological examinations on a sample of 31 patients admitted to the Surgical Clinic SCJU Tg. Mures in period 1.01.2000 - 31.12.2010, to whom were performed total and subtotal colectomies for cancer. We investigated demographic parameters, elective or emergency nature of surgery, postoperative evolutions. Results: Of all patients (n = 31) in 29 (93.54%) cases were performed subtotal colectomies with ileo-sigmoidostomy and total colectomies with ileo-recto anastomosis in 2 (6.46%) cases. Postoperative evolution is closely related to patient age, associated flaws and occlusive nature of the tumor. Conclusions: Postoperative results superior to other colonic interventions for the same diagnosis in emergency condition, make total and subtotal colectomy indications to broaden, including patients with primary colon obstruction.

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PHYTOTOXICITY ASSESSMENT OF CERTAIN PHYTOCHEMICAL PRODUCTS CONTAINING PYRROLIZIDINE ALKALOIDS Seremet Oana View abstract

PHYTOTOXICITY ASSESSMENT OF CERTAIN PHYTOCHEMICAL PRODUCTS CONTAINING PYRROLIZIDINE ALKALOIDS

First author: Seremet Oana

Coauthors: Olaru O , Ilie Mihaela , Negres Simona , Balalau D

Keywords: Toxicology Pharmacognosy pyrrolizidine alkaloids phytotoxicity methyl orange

Background: Tussilago farfara (coltsfoot), Petasites hybridus (common butterbur), Senecio vernalis (eastern groundsel) and Symphytum officinale (comfrey) are species traditionally used in phytotherapy that beside the therapeutic compounds contain toxic pyrrolizidine alkaloids. The aim of the paper is to determine the total pyrrolizidine alkaloids (PAs) content and the phytotoxicity of the above species. Material and Method: The quantitative determination of pyrrolizidine alkaloids is based on the stoichiometric reaction of protonated alkaloids with methyl orange. In acidic conditions the dye is released from the complex and its color is assessed spectrophotometrically using a linear regression curve of senecionine as a standard. The phytotoxicity was assessed by Triticum bioassay that studies the effect of the extracts (0,001 – 5, 00 %, w/v) upon root elongation (inhibitory concentration – IC50) and on the karyokinetic film. Results: The highest amount of total PAs was found in Senecio vernalis (654,8±50,85 μg/g dry plant) and the lowest in Petasites hybridus. The lowest IC50 was found for Petasites hybridus, followed by Senecio vernalis, Tussilago farfara and Symphytum officinale. The results were supported by microscopic examination. Conclusions: The results of the spectrophotometric assay are consistent with the ones found in the literature. All extracts inhibited the elongation of the main root of wheat karyopses, however, no correlation between phytotoxicity and the PAs concentration could be emphasized.

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Why pituitary adenomas blood vessels are different? Balinisteanu B View abstract

Why pituitary adenomas blood vessels are different?

First author: Balinisteanu B

Coauthors: Cimpean Anca Maria , Ceausu Raluca , Raica M

Keywords: pituitary adenomas angiogenesis CD 34 MVD

Background: Pituitary adenomas are usually less vascularized than the normal pituitary, and the role of angiogenesis, a fundamental process for the development and growth of a tumor, remains a contentious issue. In our study we analyzed the correlation between the pituitary blood vessels phenotype, microvessel density and the immunohistochemical hormonal profile as well as the hormone values in serum and cerebrospinal fluid. Material and Method: 39 specimens obtained from patients diagnosed with pituitary adenomas were included in our study. Immunohistochemical stains with specific antibodies against each of the pituitary hormones (GH, PRL, ACTH, FSH, TSH, and LH) were performed on the selected specimens. The endothelial cells were labeled with anti CD34 antibodies and the perivascular cells with smooth muscle actin antibodies (SMA). Results: Microvessel density was found to be the highest in GH secreting adenomas (48.51±12.15) and the lowest in prolactinomas (29.15 ± 18.78). Based on a double immunostainig with the endothelial marker CD34 and the perivascular cell marker-smooth muscle actin (SMA), a predominance of immature and intermediate blood vessels was observed. We have found a significant correlation between the immature blood vessels and the expression of tissue prolactin assessed by immunohistochemistry (p=0,044) and partial correlations between serum (p=0,036), cerebrospinal prolactin values (p=0,006) and immature and intermediate blood vessels and between mature blood vessels and cerebrospinal fluid values of prolactin (p=0,008). Conclusions: The results of our study suggest an important effect of prolactin upon endothelial and perivascular cells, thus prolactin being directly involved in the pituitary adenomas angiogenesis. The assessment of the pituitary adenomas blood vessels based on their phenotype correlated with their hormonal profile might partially explain the clinical and biological discrepancies found in these tumors.

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Herlant’s Tetrachrome staining, a useful tool for pituitary adenoma diagnosis Chinezu Laura View abstract

Herlant’s Tetrachrome staining, a useful tool for pituitary adenoma diagnosis

First author: Chinezu Laura

Coauthors: Trouillas Jacqueline , Loghin Andrada , Borda Angela

Keywords: pituitary adenoma Herlant’s tetrachrome immunohistochemistry

Background: The morphologic diagnosis of pituitary adenomas (PA) is based on immunohistochemistry (IHC). In Romania, because the use of all specific antibodies is very expensive, IHC diagnosis of PA is restricted. A histochemical staining, Herant’s tetrachrome (HTCS), was described some years ago, but it was not widely use for diagnostic purposes because of technical difficulties. The aim of this paper is to bring into discussion this staining, to highlight its benefits, to improve the technical procedures and to establish a protocol, which combining both HTCS and IHC, facilitate the diagnosis of PA and, especially, substantially reduces the costs. Material and Method: HTCS was performed using normal pituitary glands, obtained from autopsy cases from the Department of Pathology, Emergency County Clinical Hospital Tirgu Mures. Tissue processing was carried out in the Histology Department of the UMF Tirgu Mures. The optimal time of staining and the optimal concentration of different solutions were established for each step of the staining. Results: The improved technical procedure of HTCS is described. The staining features of all cellular types of the pituitary gland are depicted and illustrated: the chromophore cells, GH-secreting cells stained in orange, PRL-secreting cells in red-violet and ACTH-cells in dark blue, while cromophobe cells stained light blue. These staining features can be extrapolated to the diagnosis of PAs, as they consist of a proliferation of such cells. Conclusions: HTCS’s benefit is in functional PAs: it can identify GH, PRL, ACTH and TSH-adenomas, according to the cell type staining. Unfortunately it cannot differentiate gonadotroph adenomas from null cell adenomas and from GH, PRL and ACTH-adenomas with sparsely granulated cells. In these cases only IHC can make the precise diagnosis. A two-step diagnostic protocol is proposed, allowing the use of two, maximum three antibodies, instead of six: first step HTCS, and second step IHC. ACKNOWLEDGEMENT: This paper is partly supported by the Sectorial Operational Programme Human Resources Development (SOP HRD), financed from the European Social Fund and by the Romanian Government under the contract number POSDRU 80641

validated
Effects of children’s anxiety and self-confidence on orthodontic treatment Bucur Sorana View abstract

Effects of children’s anxiety and self-confidence on orthodontic treatment

First author: Bucur Sorana

Coauthors: Pacurar Mariana , Chibelean Manuela

Keywords: anxiety self-confidence orthodontic compliance

Background: Before initiating any orthodontic treatment it is relevant to evaluate the clinical cooperation of the patients. Less compliance could be associated to the person’s self concept and personality. Any orthodontist could expect a certain fear or anxiety from the child patient but these become a problem when they are exaggerated. The goal of the study was to determine the anxiety level in orthodontic patients and their self confidence as well. Material and Method: The material of the study consists in psychological test forms filled in by 80 patients aged from 8 to 13, divided in two equal groups of compliant and non-compliant ones. The patients answered two questionnaires: Spielberger’s State-Trait Anxiety Inventory and Piers Harris’ Children’s Self Concept Scale. We used the t-test to estimate comparatively the anxiety levels and also the self-confidence of the two groups. Statistical significance was previously settled at p<0.05. Results: Taking into account the levels of anxiety in the involved groups we found out that there was no statistical difference in case of trait anxiety. Regarding the state anxiety, the statistical difference found was significant. There were no significant differences between the studied groups as far as their self concept is concerned. Conclusions: There were no differences between the two groups regarding the self concept. Patients from the non-compliant group reached a higher state anxiety. They responded to the orthodontic treatment with fear and this might have been the reason for the lack of collaboration with the doctor. No differences regarding the trait anxiety levels were found between groups.ACKNOWLEDGEMENTS: This paper is partly supported by the Sectorial Operational Programme Human Resources Development (SOP HRD), financed from the European Social Fund and by the Romanian Government under the contract number POSDRU 80641.

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Clinical features and echocardiographic findings in children with hypertrophic cardiomyopathy Blesneac Cristina View abstract

Clinical features and echocardiographic findings in children with hypertrophic cardiomyopathy

First author: Blesneac Cristina

Coauthors: Toganel Rodica , Benedek Theodora , Benedek I

Keywords: hypertrophic cardiomyopathy children

Background: Hypertrophic cardiomyopathy (HCM), one of the most common inherited cardiomyopathy, is a heterogeneous disease resulting from sarcomeric protein mutations, with an incidence in the adult population of 1:500. Current information on the epidemiology and outcomes of this disease in children is limited. Material and Method: 34 children diagnosed with HCM in the Pediatric Cardiology Department from Tirgu Mures were evaluated concerning familial and personal history, clinical, paraclinical and therapeutic aspects. HCM was defined by the presence of a hypertrophied, nondilated ventricle in the absence of cardiac or systemic disease that could produce ventricular hypertrophy. Results: Among the 34 children diagnosed with HCM, the youngest one was a neonate, a total of 7 patients being diagnosed until 1 year of age. There was no sex difference in infants, but a higher incidence of HCM was found in boys than in girls ≥ 1 year of age (18 versus 9 cases).  In 6 cases a familial history of HCM was found; Noonan syndrome was found in 2 cases. Only 21 patients were symptomatic, the predominant symptom being reduced exercise tolerance; syncope was found in 1 case. Left ventricular outflow tract obstruction was present in 23 cases (67%). 20 patients were on beta-adrenoreceptor antagonist therapy, while 3 patients underwent septal myectomy. Conclusions: HCM is a heterogeneous disorder in terms of evolution, the age of onset, type and extent of hypertrophy, and the risk of sudden death. It can affect children of any age, including neonates. There is a need for a complex clinical evaluation, including familial and personal anamnesis, clinical examination, electrocardiogram and echocardiography of all patients diagnosed with HCM. It is highly important to develop screening strategies, including genetic testing, for an early diagnosis, especially in asymptomatic patients with positive familial background.

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The association of cholelithiasis and colorectal cancer Saracut C View abstract

The association of cholelithiasis and colorectal cancer

First author: Saracut C

Coauthors: Molnar C , Pantiru A , Russu C , Rosca C , Voidazan S , Copotoiu C

Keywords: colorectal cancer cholelithiasis cholecystectomy

Background: In the literature there are a number of studies that suggest o possible correlation between cholelithiasis/cholecystectomy and colorectal cancer. The exposure of the colon mucosa to the action of bile acids that potentially have a carcinogenic effect due to the change in anatomy after cholecystectomy, seems to be the explanation of this association. The purpose of this paper was to search for such a correlation in our study group. Material and Method: We performed a retrospective cross-sectional study, analyzing the patients admitted in First Surgical Clinic of the Emergency County Hospital Targu-Mures, between 1.01.2005 - 31.12.2010. Analyzing the medical records, operation protocols and histopathological results, we  paid attention to  demographics, location of neoplasia, the time elapsed since the  cholecystectomy to the discovery of neoplasia, histological types, trying to perform correlations between these parameters and lithiasic factor. Results: Out of  the 724 patients admitted and operated with the diagnosis of colorectal cancer, 14.7% (n = 106) showed a history of gallbladder stone affection. Most patients came from urban areas, the average age was 65.8 (range 39-88 years), female were more affected. The most common location were: the sigmoid colon (32.3%) , rectum (36.3%) and  the most  common histological form was moderately differentiated adenocarcinoma. Conclusions: Similar to other studies, our work suggests a slight increase in the incidence of colorectal cancer in patients that underwent a cholecystectomy, without drawing a firm conclusion. We deem it necessary to see if diet changes in Romanian population affect this relationship.

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Quantitative Determination of Arsenic in Bottled Drinking Water Using Atomic Absorption Spectroscopy Gutu Claudia Maria View abstract

Quantitative Determination of Arsenic in Bottled Drinking Water Using Atomic Absorption Spectroscopy

First author: Gutu Claudia Maria

Coauthors: Balalau Dan , Ilie Mihaela , Purdel Nicoleta Carmen , Gubandru Miriana

Keywords: bottled drinking water total inorganic arsenic atomic absorption spectroscopy

Background: For the past few years, many studies have been performed to determine arsenic (As) speciation in drinking water, food chain and environment because its well-recognized carcinogenic and toxic mainly in its inorganic species. The instrumental techniques used for arsenic determination, such as hydride generation atomic absorption spectrometry (HGAAS), graphite furnace atomic absorption spectrometry (GFAAS) and inductively coupled plasma mass spectrometry (ICP-MS), can yield with a great sensitivity only total amount rather than its chemical forms.The aim of this study was to develop a simple and rapid method and to analyze the concentration for the determination of total inorganic arsenic in bottled drinking water. Material and Method: Total arsenic was determined in samples from six different type of commercially available bottled drinking water using atomic absorption spectrometry with electorthermal or hydride generation vaporisation. All drinking water samples were acidified with 0.1M nitric acid to match the standards acidity. The working standards solutions used were in the range 1-5µg/L. Results: The method was linear within the studied range (1-5 μg/L, R = 0.9943). The quantification limits for arsenic determination were 0.48 μg/L (HGAAS) and 0.03 μg/L (GFAAS). The evaluated arsenic content in drinking water was within the accepted limits provided by law. Conclusions: A simple and sensitive method for the quantification of As in drinking water using atomic absorbtion spetroscopy (AAS) was described, which can be further used in toxicological studies. As an additional advantage, the system is very fast, efficient and environmental friendly. 

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Botanical investigation of Fallopia dumetorum (L.) Holub (Polygonaceae) and qualitative and quantitative assessment of its polyphenolic compounds Olaru O. T. View abstract

Botanical investigation of Fallopia dumetorum (L.) Holub (Polygonaceae) and qualitative and quantitative assessment of its polyphenolic compounds

First author: Olaru O. T.

Coauthors: Ancuceanu R. V. , Anghel Adriana Iuliana , Dinu Mihaela , Seremet Oana Cristina , Istudor Viorica

Keywords: Fallopia dumetorum phenolic compounds thin layer chromatography spectrophotometry microscopy

Background: Considering the continuous need to find new sources of polyphenolic compounds, we have proceeded to investigate through pharmacognostical examination the species Fallopia dumetorum  (L.) Holub sin. Polygonum dumetorum L. (Polygonaceae). The plant is common in the plain regions of Romania and has not been exploited therapeutically. The pharmacognostical examination was carried out by microscopic examination, by qualitative chemical analysis and by the assay of phenolic compounds. Material and Method: Microscopic examination was performed on cross-sections, surface preparations and on powder derived from the aerial parts of the flowering plant. Qualitative chemical analysis was realized by chemical reactions (phytochemical screening) and thin layer chromatography (TLC) of the phenolic and sterolic compounds. Phenolic compounds were assayed by spectrophotometric methods: flavonoids expressed as rutin (with aluminium chloride), phenol-carboxylic acids expressed as chlorogenic acid (Arnow’s method) and proanthocyanidins expressed as cyanidin chloride (in acidic medium, by conversion to anthocyanins). Results: The species has the following microscopic characters: anomocytic stomata, druses of calcium oxalate, sessile, pluricellular glandular hairs and pollen grain with smooth exine. By phytochemical screening polysaccharides, reducing compounds, coumarins, sterols/triterpenes, phenol-carboxylic acids, flavones, proanthocyanidins and tannins, carotenoids were identified; chlorogenic acid, caffeic acid, quercetin and stigmasterol/beta-sitosterol were detected by TLC. F. dumetori herba has a content of 1.49 ± 0.105 polyphenol-carboxylic acids, 0.40 ± 0.087g% flavonoids and 0.18 ± 0.002 g% proanthocyanidins (mean ± standard deviation). Conclusions: We have characterized pharmacognostically the native species F. dumentorum. Due to its content in phenolic compounds it may serve as a source of polyphenols.

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Betulinic acid effects on A375 melanoma cells in chorioallantoic membrane assay Avram Stefana View abstract

Betulinic acid effects on A375 melanoma cells in chorioallantoic membrane assay

First author: Avram Stefana

Coauthors: Cimpean Anca Maria , Gheorgheosu Dorina , Danciu Corina , Ciurlea Sorina , Peev Camelia , Dehelean Cristina

Keywords: Pre-Clinical Medicine Pre-Clinical Medicine melanoma, A375, betulinic acid, angiogenesis, chor

Background: Melanoma is the most agressive form of malignant skin cancer. The latest advances, especially in molecular therapy show good results, though resistance has been signaled. Better therapeutical approaches for advanced melanoma are still to be developed. The natural compound betulinic acid (BA) is known for its antiproliferative, proapoptotic activity, especially on melanoma cells, as well as antiangiogenic. Aiming the specific targeting of melanoma, we performed the chorioallantoic membrane (CAM) assay using A375 melanoma cells, studying BA in a nanoemulsion formulation on the developing tumor microenvironment. Material and Method: The in vivo CAM model was performed in ovo on fertilized eggs, by inoculating A375 cells on the 10th day of incubation inside a sterile ring. BA formulations were applied on top of the developing tumors; the specimens were submitted to histological processing after 7days from the inoculation. The evaluation was performed in vivo by means of stereomicroscopy, and by light microscopy for morphological and imunohistochemical staining. Results: After three days from cell inoculation, for the control samples, we visualized the formation of highly vascularized, unpigmented tumors on the chorionic epithelium. Progressively higher number of capillaries was noticed forming spokes wheel pattern around the cell application areas, and on secondary tumor formation, as well. In contrast,d BA samples showed areas with fewer new formed vessels around the ring. BA in nanoemulsion showed the highest survival rate and a low angiogenic index around primary and secondary tumors. Conclusions: Betulinic acid in nanoemulsion is well tolerated and reduces growth and angiogenic process involved in the in vivo development of A375 malignant melanoma.

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The importance of identification of M-BCR-ABL oncogene and JAK2V617F mutation in myeloproliferative neoplasms Szántó Annamária View abstract

The importance of identification of M-BCR-ABL oncogene and JAK2V617F mutation in myeloproliferative neoplasms

First author: Szántó Annamária

Coauthors: Pap Zsuzsanna , Pávai Z , Lázár Benedek Erzsébet , Köpeczi Judit Béata , Horváth Emőke , Benedek I

Keywords: myeloproliferative neoplasms JAK2V617Fmutation M-BCR-ABL oncogene

Background: The myeloproliferative neoplasms form a heterogeneous group characterized by the uncontrolled proliferation of one or more myeloid (granulocytic, erythroid, megakaryocytic or mastocytic) lineages. The discovery of the genetic background of these disorders completely changed the diagnostic approach: the diagnosis of chronic myeloid leukemia (CML) is based on the presence of Philadelphia chromosome and/or BCR-ABL oncogene and the identification of JAK2 gene’s mutations are useful in the management of polycytemia vera (PV), essential thrombocytemia (ET) and myelofibrosis (PMF). Material and Method: Between April 2008 and February 2013 at the Molecular Biology Laboratory, University of Medicine and Pharmacy of Târgu Mureş we examined 117 patients’ blood sample from the Hematology and Transplant Center of Târgu Mureş. To detect the M-BCR-ABL oncogene we performed real time quantitative PCR (RQ-PCR) and for the identification of JAK2V617F mutation we used allele-specific PCR. Results: 30 patients presented the M-BCR-ABL oncogene, in case of 16 patients we performed regular RQ-PCR analysis to monitorize the applied therapy:  the majority of chronic phase patients presented decreasing or stable values, while in case of accelerated phase and blast phase the M-BCR-ABL values increased or remained at the same level. 20 patients were identified with the JAK2V617F mutation: 8 patients with PV, 4 with ET, 3 with PMF, 4 with unclassifiable chronic myeloproliferative disease and 1 with chronic myelomonocytic leukemia. No patient presented concomitantly both molecular marker. Conclusions: Molecular analysis plays an important role in the management of myeloproliferative neoplasms: the identification of the molecular markers confirm the final diagnosis, excluding secondary causes of elevated blood count parameters. Regular monitorization of M-BCR-ABL expression level is useful in the follow-up of therapy efficiency.

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CORRELATION OF SERUM AND SYNOVIAL OSTEOCALCIN, OSTEOPROTEGERIN AND TNF-α WITH THE DISEASE SEVERITY SCORE IN KNEE OSTEOARTHRITIS Csifo Enikő View abstract

CORRELATION OF SERUM AND SYNOVIAL OSTEOCALCIN, OSTEOPROTEGERIN AND TNF-α WITH THE DISEASE SEVERITY SCORE IN KNEE OSTEOARTHRITIS

First author: Csifo Enikő

Coauthors: Katona Tímea , Arseni Júlia , Horváth Emőke , Nagy E. , Gergely I.

Keywords: knee osteoarthritis osteocalcin osteoprotegerin bone metabolism IKDC score

Background: In the pathology of osteoarthritis synovial inflammation plays an important role (mediated by TNF-α, IL-6) and subsequent metabolic changes in the subchondral bone often occur. Bone markers: osteoprotegerin (OPG) and osteocalcin (OC) are secreted also by cartilage chondrocytes. The available information about the involvement of these biomarkers in the establishment of osteoarthritis activity are limited. Material and Method: We enrolled 20 patients with different stages of knee osteoarthritis. For each patient was determined the IKDC score (International Knee Documentation, 2000). Based on this data patients were divided into two groups: group 1 (advanced osteoarthritis), group 2 (early osteoarthritis). Serum and synovial fluid levels of OPG, OC, TNF-α were determined. Results: For the entire group the level of OC in serum showed higher values than in synovial fluid. We found statistically significant difference in the serum levels of OC between the two groups (group 1: 2,18± 0,54 ng/ml, group 2: 6,07± 1,98 ng/ml, p=0,019). Serum and synovial OC in the whole group could not be correlated with the disease score, however we observed a tendency towards significant negative correlation between the serum OC and IKDC score for group 1 and between synovial OC and IKDC score in group 2. Synovial OPG concentration was six times higher than serum OPG level (p<0,0001) and TNF-α showed higher circulating levels than local concentrations, when the entire group was tested. Conclusions: In the advanced osteoarthritis group the serum and synovial OC show lower values than in the early osteoarthritis group, which means that along with worsening of the disease, the bone anabolism decreases. In the OPG’s case was not detected an important difference between the two groups. ACKNOWLEDGEMENT: This paper is partly supported by the Sectorial Operational Programme Human Resources Development (SOPHRD), financed from the European Social Fund and by the Romanian  Government under the contract number POSDRU 80641.

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Primary cleft palate repair using two-stage closure Stoicescu Simona View abstract

Primary cleft palate repair using two-stage closure

First author: Stoicescu Simona

Coauthors: Enescu DM

Keywords: Surgery Plastic Surgery cleft palate, two-stage closure, palate fistula, V

Background: Although cleft lip and palate (CLP) is one of the most common congenital malformations, occurring in 1 in 700 live births, there is still no generally accepted treatment protocol. Numerous surgical techniques have been described for cleft palate repair; these techniques can be divided into one-stage (one operation) cleft palate repair and two-stages cleft palate closure. The aim of this study is to present our cleft palate team experience in using the two-stage cleft palate closure and the clinical outcomes in terms of fistula rate. Material and Method: A retrospective analysis was performed on medical records of 80 patients who underwent palate repair in the last five years (from 2008 to 2012). All consecutive cleft (lip and) palate patients were incorporated. Information on patient’s gender, cleft type, age at repair, type of cleft repair were collected and analyzed. Results: Fifty-three (66%) and twenty-seven (34%) patients underwent two-stage and one-stage repair, respectively. According to Veau classification, more than 60% of them were Veau III and IV, while 25% were Veau II. Fistula occurred in 34% of the two-stage repairs versus 7% of one-stage repairs, with an overall incidence of 24%. Conclusions: Our study has shown that a two-stage cleft palate closure has a higher rate of fistula formation when compared with the one-stage repair. Two-stage repair is the technique of choice in wide complete cleft lip and palate cases, while one-stage procedure is a good option for cleft palate alone, or some specific cleft lip and palate cases (narrow cleft palate, older age at surgery). 

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Rectal Cancer - Sphincter Saving Techniques Russu C View abstract

Rectal Cancer - Sphincter Saving Techniques

First author: Russu C

Coauthors: Molnar C , Pantiru A , Saracut C , Gherghinescu M , Voidezan S , Copotoiu C

Keywords: rectal cancer resection anastomosis

Background: Rectal cancer management has as the principal component the surgical treatment. The purpose of the paper is to point out the advantages and disadvantages of sphincter saving techniques, respecting the oncological principles. Material and Method: A cross-sectional, retrospective study was performed on a group of 69 patients admitted and surgically treated for rectal cancers in Surgical Clinic I of the Targu Mures Emergency County Hospital, for a period of one year (April 2012 - April 2013) and to whom rectal resections were performed. We followed the immediate postoperative evolutions in these patients, making a comparative analysis between those with the sphincter saving surgery and those in which other operations were performed. Results: From the total of 69 patients (N = 69) diagnosed with rectal cancer, sphincter saving procedures with restoration of digestive continuity by coloanal anastomosis were performed in 12 patients (17.39%) using the peranal or transanal approach; in 42 patients (60.86%) anterior recto-sigmoidian resections with low and very low colorectal anastomosis („very low” Dixon procedure) were performed. In 15 cases (21.74%) the Miles type of rectal resections, using the abdomino-perineal way, were performed. Out of the 12 cases with peranal or transanal anastomosis, 4 cases had postoperative complications. Conclusions: Rectal resection procedures, which are restoring the digestive tract continuity using low anastomosis (colorectal, coloanal, peranal or transanal), are representing viable and „physiological” alternatives, if they respect the oncologic principles. In well selected cases, the immediate postoperative evolution is favorable, relieving the patient from the psychological and physical trauma due to the presence of a colostomy.

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CLINICAL FEATURES AND HISTOPATHOLOGICAL SPECTRUM IN ADOLESCENT ONSET NEPHROTIC SYNDROME IN A ROMANIAN CHILDREN POPULATION Gall Zsuzsanna View abstract

CLINICAL FEATURES AND HISTOPATHOLOGICAL SPECTRUM IN ADOLESCENT ONSET NEPHROTIC SYNDROME IN A ROMANIAN CHILDREN POPULATION

First author: Gall Zsuzsanna

Coauthors: Duicu Carmen , Kiss Eva , Egyed-Zs. I , Cucerea Manuela , Simon Marta

Keywords: Pediatrics Pediatrics nephrotic syndrome, adolescent, biopsy

Background: In the literature, there are very few studies addressing the problem of nephrotic syndrome (NS) in adolescents. The adolescent population signifies the transitory period where the frequent occurrence of different histopathological lesions in patients with nephrotic syndrome is different from that seen in young children as well as that seen in adults. This study was conducted to analyze the clinical features and histopathological spectrum of adolescent-onset NS. Material and Method: We retrospectively evaluated clinical features, biochemical investigations and histopathology of 93 children with idiopathic NS (fulfilling the ISKDC criteria) seen at the 2nd Pediatric Clinics from Târgu-Mureş. Results: 18 patients (55.55% girls, average age at diagnosis 13.64+/-1.94 years) with NS having its onset between 12 and 18 years of age were included in this study. 6 patients were diagnosed with steroid-resistant nephrotic syndrome and one patient with steroid-dependent nephrotic syndrome. 13 patients had impure nephrotic syndrome, microscopic haematuria was present in 5 (27.77%) patients, hypertension in 13 (72.22%) patients. Percutanous renal biopsy was performed in 7 cases (38.88%), presenting focal segmental glomerulosclerosis (FSGS) 3 patients (16.66%), membranoproliferative glomerulonephritis (MPGN) 2 patients (11.11%), membranous glomerulopathy (MGN) and minimal change disease (MCD) one (5,55%) patient each. Conclusions: The impure form of NS is more frequent than in younger patients. Adolescent nephrotics with microhaematuria, hypertension at presentation as well as a steroid-resistant state have other lesions than MCD. According to literature data the incidence of FSGS has increased in the second half of last decade, confirmed in our study. Identificating the pathogenic mutations is time-consuming and expensive, but it is important: to avoid adverse effects of steroid- and immunosuppressive treatment, to encourage living donor kidney transplantation, to perform a prognosis depending on which gene is mutated and which kind of mutations are detected, and to offer the possibility of presymptomatic, prenatal and preimplantation genetic diagnosis.

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PREVALENCE OF THE METABOLIC SYNDROME IN PATIENTS WITH PSORIATIC ARTHRITIS AND RHEUMATOID ARTHRITIS Craciun Lucia View abstract

PREVALENCE OF THE METABOLIC SYNDROME IN PATIENTS WITH PSORIATIC ARTHRITIS AND RHEUMATOID ARTHRITIS

First author: Craciun Lucia

Keywords: medicina clinica metabolic syndrome psoriatic arthritis

Background: The psoriasis patients have an increased number of associated comorbidities, the cardiovascular diseases presents the highest incidence and severity. The understanding of the cardiovascular risk in patients with psoriatic arthritis was extended from the rheumatoid arthritis studies suggesting that the patients with psoriatic arthritis have a similar risk of cardiovascular diseases compared with those who have rheumatoid arthritis. The presence of the metabolic syndrome increase the risk of cardiovascular disease. The purpose of the study is to determine the prevalence of metabolic syndrome and its components in the both groups of patients Material and Method: The study included two groups of patients, one with 40 patients with psoriatic arthritis defined by Moll and Wright criteria, respectively the second group with 51 patients with rheumatoid arthritis defined by ACR criteria. The metabolic syndrome was defined according to the consensus definition (incorporating IDF and AHA/NHLBI definitions).  Results: The prevalence of metabolic syndrome varies depending on definition criteria of the metabolic syndrome, but remains increased in psoriatic arthritis patients. We have taken in study 81 patients divided in 2 groups (40 psoriatic arthritis, 51 rheumatoid arthritis) with a total median age of 57,7±10,4SD (54,7±10,2SD psoriatic arthritis, 60,01±10,0SD rheumatoid arthritis). The mean disease duration was about 4,12±4,1SD for psoriatic arthritis and 6,7±7,8SD for rheumatoid arthritis. The prevalence of the metabolic syndrome was 67,5% in the group with psoriatic arthritis, 37,2% in rheumatoid arthritis. The psoriatic patients had a higher prevalence of impared fasting glucose 52,5%, tryglicerides 25% than those with rheumatoid arthritis (27,4%, p=0,018, respectively 11%-p=0,0004). Conclusions: The prevalence of metabolic syndrome is increased in patients with  psoriatic arthritis then in those with rheumatoid arthritis.

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Examination of drug use in Romania and Targu Mures Ferencz Iozsef Loránd View abstract

Examination of drug use in Romania and Targu Mures

First author: Ferencz Iozsef Loránd

Coauthors: Ábrám Zoltán , Gabos Grecu Iosif , Bálint József

Keywords: public health hygiene ethnobothanics drug consumption spice shop

Background: In Romania, in 2008,  the first stores „of dreams” were opened in which over three years have been sold under the cover name of „ethnobotanical”, various psychotropic chemicals. This phenomenon has surprised and  found unprepared both lawmakers, and the public health system. This is resulting in increased ethno-botanical agents, number of consumers, and the EU into the distinguished got fourth place. Material and Method: The study examined the national, and local data on the number of persons admitted for treatment, Following drug consumption, by sex, age group and type of drug addressed period to 2005-2012. The official data are published and provided by CIADO, ANA and the GPI of the MIA, and the Psychiatry Clinic no. 1  in Targu Mures. Results: Between 2007-2009, the number of consumers has increased  which resulted in doubling the number of  hospitalization. After changing law in 2010, the number of  consumers decreased in similar degree. It can be observed, increasing number of female consumers (25%), and the age group under 35 years (89.5%).   Examining, other substances, which are in content  "ethnobotanical products"  the ratio of hospitalized consumers has increased. New registered cases was 74.7% in 2009, After changing the law the number of consumers  decreased in large extent. In 2012,  after the consumption of "ethnobotanical products" and cannabis treated consumers  reached to  57.6%. The Data of Targu Mures Psychiatric Hospital followed the  nationwide trend. Conclusions: The Change of legislation reduced the number of consumers who receive treatment in the health system but it is estimated an increase among young consumers. In Romania, the causes of the increasing number of consumers is due to the reason that the subject is treated as taboo, and to the fact that currently, the access to drugs is quite easy, and in this sense, efforts made to prevent and giving up becomes vitally.

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Correlation of cytomorphology and flowcytometric immunophenotyping in acute myeloid leukemia Selicean Elena-Cristina View abstract

Correlation of cytomorphology and flowcytometric immunophenotyping in acute myeloid leukemia

First author: Selicean Elena-Cristina

Coauthors: Patiu Mariana , Cucuianu A , Dima Delia , Dobreanu Minodora

Keywords: acute myeloid leukemia immunophenotyping morphology

Background: Morphological analysis of peripheral blood and bone marrow are mandatory investigations in the diagnosis of acute leukemia. Cytology and immunophenotyping complement each other primarily because they have as common object malignant cell phenotype as a whole. The aim of our study was to analyze correlations between cytology and immunophenotyping on a group of patients investigated for acute myeloid leukemia (AML). Material and Method: We have studied 88 patients admitted to the Department of Hematology of the Oncology Institute "Prof. Dr. Ion Chiricuta" in Cluj between 2006-2009, with a diagnosis of acute myeloid leukemia. All patients were investigated at diagnosis by complete blood count, blood smear, biochemistry and coagulation studies. Other investigations performed at diagnosis were immunophenotyping by flow cytometry, karyotyping and molecular biology. For comparison of immunophenotyping and morphology, depending on the available data, we analysed a homogenous group of 53 patients. Results: In our study the degree of correlation between blast percentage determined by cytology and immunophenotyping was low (r=0,049). The degree of correlation between myeloperoxidase positivity in cytochemistry and immunophenotyping was also low, with better results for cytochemistry. Expression of immunophenotypic markers was consistent with the composition of our group, except for HLA-DR (49,0%), TdT (3,77%), CD14 (5,66%), CD15 (5,66%). We also discuss the importance of interpreting with caution positivity for erythroid and megakaryocytic markers and differential diagnosis of cases simultaneously expressing CD7 and CD56. Conclusions: In conclusion, immunophenotyping is still mandatory in AML, interpretation should be done in close conjunction with morphology, standardization and harmonization of large immunophenotpic panels would allow both appropriate diagnosis and follow-up.

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The loss of correction in thoracolumbar burst fracture treated by surgery. Can we predict it? Anghel Stelian View abstract

The loss of correction in thoracolumbar burst fracture treated by surgery. Can we predict it?

First author: Anghel Stelian

Coauthors: Marton Denes

Keywords: loss of correction thoracolumbar burst fracture short segment fixation

Background: The surgical treatment of thoracolumbar burst fracture is sometimes followed by significant loss of correction which impairs the daily activities performance, induces pain and may even require another operative correction. This paper aims to differentially depict potential patterns of loss of correction in surgically treated thoraco-lumbar burst fractures. These may eventually serve to foreseeing and even forestalling loss of correction. Material and Method: The cohort of 253 patients with surgically treated thoraco-lumbar fractures was clustered after the type of surgical intervention (posterior short segment fixation or anterior approach) and, further on, after the affected spinal level (T11-L1 or L2-L3). Correlation, regression and determination tests were performed on extracted data (the post-operative (Kpo), and the last follow-up (Kf), kyphosis angles for each statistical unit) and a best-fit regression equation was delineated for each subgroup of patients. Results: There was possible to identify patterns of loss of correction for each subgroup. They may be represented through the following equations: Kf = 0,95*Kpo + 3.2° for T11-L1 level fractured vertebrae treated by posterior short segment fixation; Kf = 0,98*Kpo + 3.4° for L1-L2 level fractured vertebrae treated by posterior short segment fixation; Kf = 1,1*Kpo + 1.6° for T11-L1 level fractured vertebrae treated by anterior approach; and Kf = 0,7*Kpo + 2.8° for L1-L2 level fractured vertebrae treated by anterior approach. Conclusions: To a certain extent, the pattern for loss of correction may be predicted for surgically treated thoraco-lumbar fractured vertebrae with best fit regression equations depicted for both types of surgery and both spinal segments. They are, however, significantly different than the equations delineated, in the literature, for the collapse of non-surgically treated fractures.Acknowledgement:  This paper is partly supported by the Sectorial operational Programme Human Resources Development  (SOP HRD), financed from the European Social Fund and by the Romanian Government under the contract number POSDRU 80641.

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OFF-PUMP CORONARY ARTERY BYPASS GRAFTING IN ACUTE CORONARY SYNDROMES Jerzicska Erno View abstract

OFF-PUMP CORONARY ARTERY BYPASS GRAFTING IN ACUTE CORONARY SYNDROMES

First author: Jerzicska Erno

Coauthors: Farcas Felix , Gyorbiro Laszlo , Chitic Anca , Banceu Cosmin , Suciu Horatiu

Keywords: off pump coronary artery bypass acute coronary syndromes short term survival

Background: The emergency myocardial revascularization remains a major problem of nowdays cardiac surgery, with inferior outcomes compaired with elective primary coronary artery bypass grafting. In OPCAB, there is thought to achieve a better myocardial protection. Hemodynamic stability is required for OPCAB, so if needed, we try to achieve it with IABP or on-pump revascularization. The aim of this study was to asses the benefits of OPCAB in Acute Coronary Syndromes (ACS), by comparing the outcomes of urgent OPCAB vs. CABG in our institution. Material and Method: An analytical observational retrospective study was conducted, including 24 patients hospitalized between January  2010-April 2013 in Cardiovascular Surgery Clinic Tg. Mures, treated surgically for ACS.  Indications for revascularization: unstable angina not responsive to medical treatment, hemodynamical instability, PCI not possible. The patients were divided into 2 groups, according the type of myocardial revascularization-OPCAB/CABG. For statistics we have used Graph Pad Instat- Fisher T test, Man-Whitney test. Results: The mean age was lower in OPCAB group (57 years vs.61.4 years); the sex distribution was similar in the two groups (80% men in OPCAB group,60% men in CABG group). In OPCAB group we have used more arterial grafts (44,4% vs 13.6%), but we have realized a lower number of anastomosis per pacient (1.8 vs 2,2). In OPCAB group we have found 1 postoperative in-hospital death of noncardiac etiology (8,33%), while the mortality rate in CABG group was 33,3%. Conclusions: The outcomes reveals  the importance of  avoiding induced myocardic  arrest with secondary myocardial ischemia in the settings of urgent myocardial revascularization. Off-pump myocardial revascularization offers an advantage of myocardial protection, which leads to o superior short-term survival.

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Comparative analysis between posterior short segment fixation, short segment fixation with kyphoplasty and short segment fixation with intermediate screws. Effectiveness in preventing loss of correction. Stelian Anghel View abstract

Comparative analysis between posterior short segment fixation, short segment fixation with kyphoplasty and short segment fixation with intermediate screws. Effectiveness in preventing loss of correction.

First author: Stelian Anghel

Keywords: loss of correction burst fracture posterior short segment fixation kyphoplasty

Background: The most frequent surgical treatment for a single level thoracolumbar burst fracture is posterior short segment fixation (SSF). In order to lower the frequency and severity of complications but to take advantage of SSF benefits, various procedures have been designed, among which this article would refer to: Short segment fixation with ballooned kyphoplasty (SSF+K) and Short segment fixation with one or two intermediate screws at the fracture level (SSF+IS). This article intends to comparatively assess the three surgical methods, especially with regards to their specific effectiveness in preventing loss of correction. Material and Method: Amongst relevant literature published between 2000 and 2012, 20 articles referring to 586 patients were rigorously selected and clustered in three subgroups according to the treatment applied. For each subgroup, data regarding post operative and follow up kyphosis angles, blood loss and operative time were statistically processed and compared. Given lack of sufficient data for variance values and high homogeneity between studies, we applied a non-weighted fixed-effect integration method.  Results:  Even though there is no statistically significant difference between the post-operative kyphsosis angles of each subgroup, with regard to the degree of loss of correction, the difference is statistically significant between SSF+K and the other two (SSF and SSF+IS). Also, we have noted considerable similiarity between the SSF and SSF+IS, regarding complications and their frequency order.  Conclusions: Short segment fixation with kyphoplasty leads to a somewhat better fracture reduction and to a significantly lower loss of correction than the other two operative methods. It seems to be the most effective in preventing loss of correction, while the posterior percutaneous approach ensures lowest blood loss and operative time.Acknowledgement: This paper is partly supported by the Sectorial operational Programme Human Resources Development  (SOP HRD), financed from the European Social Fund and by the Romanian Government under the contract number POSDRU 80641.

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Prostate Stromal Mast Cells Globa Tatiana View abstract

Prostate Stromal Mast Cells

First author: Globa Tatiana

Coauthors: Șaptefrați L. , Ceaușu Raluca Amalia , Gaje Pușa , Cimpean Anca Maria , Raica M.

Keywords: Pre-Clinical Medicine Pre-Clinical Medicine mast cells, tryptase, chymase, CD117, prostate.

Background: Molecular phenotype heterogeneity of mast cells makes them attractive as potential therapeutic targets in the anti-cancer adjuvant therapy. Mast cell aggregations observed in tumors suggested their involvement in tumor pathogenesis. Despite numerous studies using mast cell tryptase, it has not been demonstrated the mast cells involvement in the prostate tumors progression. The aim of our study was quantitative and qualitative characterization of mast cells in the benign and malignant lesions of the prostate, as well as identification of the phenotypic heterogeneity of mast cells in these lesions.  Material and Method: Our study included 7 cases of normal prostate, 25 cases of benign epithelial hyperplasia and 64 cases of adenocarcinoma, which were characterized by immunohistochemical study using three markers: tryptase, chymase and CD117. Mast cells were quantified intratumoral and peritumoral. The results were analyzed statistically. Results: Based on the analysis of data in the benign lesions were identified two immunophenotypes of mast cell: tryptase+CD117+chimază- and chimază+CD117+tryptase-, which characterized the peritumoral areas. The phenotype of mast cells, in the intratumoral areas of malignant lesions, was characterized by tryptase+chymase+CD117+, while in the peritumoral areas were identified three different phenotypes of mast cells: tryptase+chymase+CD117-, tryptase+CD117+chymase-, chymase+CD117+tryptase-.  Conclusions: Our results suggest the involvement of chymase positive mast cells in the peritumoral areas and CD117 positive mast cells in the intratumoral areas in the grading of tumors. These markers were partially correlated with Gleason score.

validated
Role of transurethral resection of the prostate in management of the prostate cancer Szöllösi A View abstract

Role of transurethral resection of the prostate in management of the prostate cancer

First author: Szöllösi A

Coauthors: Borda Angela , Loghin Andrada , Vida Á O , Maier A , Pávai Z , Mártha Orsolya

Keywords: prostate cancer transurethral resection of the prostate prostate specific antigen bladder outlet obstruction transrectal ultrasound guided prostate biopsy.

Background: Prostate cancer is the second most diagnosed cancer in men, after the lung cancer. In diagnosis of prostate cancer (CaP) the gold standard procedure is the ultrasound guided prostate biopsy. Transurethral resection of the prostate (TURP) used in solving the bladder outlet obstruction, can have a role in detection of CaP. Aim of this retrospective study is to examine the role of transurethral resection of the prostate in diagnosis and therapy of prostate cancer in the Urology Clinic of Targu Mures. Material and Method: In a 2 year period (2011-2013) in the Urology Clinic of Targu Mures we performed a total of 474 TURP, in 105 (22.151%) cases, patients with a mean age of 71.857 years the indication being CaP with bladder outlet obstruction or bladder outlet obstruction with unknown causes, but with suspicion of CaP. Results: In the cases of selected patients (105-100%) with TURP performed for bladder outlet obstruction, the histopathological findings were the following: 23 cases already hormone treated prostate cancer, 32 cases newly diagnosed CaP (5 cases were with a small prostate cancer of the transitional zone with Gleason 2- 6 in spite of normal PSA value), while in 50 cases TURP was preceded by prostate biopsy (in 8 cases with increased PSA and several negative biopsies we could confirm CaP of the peripheral zone of the prostate with Gleason 7-9). Conclusions: TURP remains the elective surgical therapy of the bladder outlet obstruction, caused by BPH and even prostate cancer. Obtaining a greater volume of prostate tissue can help in the detection of prostate cancer in its early stages, especially in the transitional zone.ACKNOWLEDGEMENTS: This paper is partly supported by the Sectorial Operational Programme Human Resources Development (SOP HRD), financed from the European Social Fund and by the Romanian Government under the contract number POSDRU 80641.

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High calcium score predicts severity of the culprit lesions in patients with acute coronary syndromes Jako Beata View abstract

High calcium score predicts severity of the culprit lesions in patients with acute coronary syndromes

First author: Jako Beata

Coauthors: Benedek Theodora , Benedek I.

Keywords: plaque burden calcium scoring cardiovascular risk score

Background: Coronary calcium score, as determined by Angio CT multislice, has been proved to represent a reliable parameter which reflects the global cardiovascular risk. We aimed to study the characteristics of culprit lesions in Acute Coronary Syndrome (ACS) patients with low versus high calcium score. Material and Method: A total of 45 patients with ACS underwent 64-slice CCTA. Group 1- 19 patients with Ca score below 400HU, gr.2 - 26 with calcium score >400HU. In all patients a complex CT analysis of the culprit plaque was performed.  Results: There were no significant differences between the groups at baseline as regard to age, gender, cardiovascular risk factors (p>0.2). In patients with high calcium score, culprit lesions presented a significantly larger amount of plaque burden than in patients with low calcium score (82.8ml versus 131.81ml, p<0.0001). This was also true when assessing in a subanalysis different cut-off points for definition of relatively higher calcium score (89.66ml versus 137.93ml, p<0.0001, for calcium score cut off 600HU, 97.88ml versus 137.57ml, p<0.0001 for calcium score cut-off of 1000HU). Conclusions: Our data shows that patients with high calcium score who develop an acute coronary syndrome present larger atheromatous plaque than those with low calcium scores, and the severity of the culprit lesions correlates with global cardiovascular risk as expressed by a high calcium score.ACKNOWLEDGEMENT: This paper is partly supported by the Sectorial Operational Programme Human Resources Development (SOP HRD), financed from the European Social Fund and by the Romanian Government under the contract number POSDRU 80641".

validated
Correlations between regional accumulation of calcium in the culprit arteries and plaque burden in acute coronary syndromes Jakó Beáta View abstract

Correlations between regional accumulation of calcium in the culprit arteries and plaque burden in acute coronary syndromes

First author: Jakó Beáta

Coauthors: Benedek Theodora , Benedek I.

Keywords: plaque burden calcium scoring cardiovascular risk score culprit arteries

Background: The association between a high calcium score at the level of the unstable coronary lesions and the different characteristic of culprit lesions which result in an acute coronary syndrome (ACS) has not been described yet. We aimed to study the correlation between the accumulation of calcium within the vessel wall of a coronary artery and the plaque burden of culprit lesions that develop an acute coronary event.  Material and Method: A total of 45 patients with ACS (22 unstable angina, 23 nonST elevation myocardial infarction) underwent 64-slice CCTA. In all patients  a complex CT analysis of the culprit plaques was performed and the calcium score for each coronary artery was computed. Results: We found a significant correlation between a calcium score higher than 100 and the plaque volume (r=0.85. p=0.01). Selecting a cut-off value of 100 HU for regional calcium score at the level of the coronary artery, we found that those arteries with Ca score higher than 100 presented significantly larger plaque volumes than the ones with calcium score below 100 (110.8 ml vs 82.4 ml, p<0.0001 for left anterior descending artery, 111.09 ml vs 82.5 ml, p=0.0005 for circumflex artery, and 132.78 ml vs 76.23 ml for right coronary artery). Conclusions: The severity of the culprit lesions correlates with regional accumulation of calcium within the vessel wall. ACKNOWLEDGEMENT: This paper is partly supported by the Sectorial Operational Programme Human Resources Development (SOP HRD), financed from the European Social Fund and by the Romanian Government under the contract number POSDRU 80641.

validated
Correlations between severity of coronary calcification and impairment of Left Ventricular Ejection Fraction Suciu Zsuzsanna View abstract

Correlations between severity of coronary calcification and impairment of Left Ventricular Ejection Fraction

First author: Suciu Zsuzsanna

Coauthors: Benedek Theodora , Jakó Beáta , Benedek Imre

Keywords: multislice 64 computed tomography left ventricular ejection fraction coronary calcium score

Background: 64 multislice CT angiography is a recently introduced imaging technique, increasingly being used as a tool to show the coronary arteries in three-dimensional visualization. One of the advantages of this method is the ability to estimate the degree of calcification of atheromatous plaques via coronary calcium score calculation, which correlates with the severity score of ateromatous systemic burden. The aim of this study was to evaluate the relationship between the severity of coronary calcification, expressed by calcium score, and the left ventricular ejection fraction (LVEF). Material and Method: This retrospective study included 81 patients with symptoms of angina and ECG modifications (at rest or during exercise). Echocardiography and 64 multislice CT angiography were performed in all patients to assess the LVEF and Ca scoring. Results: Calcium score was lower than 100 in 62 patients (50,22%), between 100 and 400 in 11 patients (8,91%), and higher than 400 in 8 patients (6,48%). Mean LVEF was 53,52%, 17 patients having an LVEF of less than 50%. In patients with calcium score less than 100, the corresponding ejection fraction was normal: 55,29%, while in coronary arteries with extensive calcifications (calcium score > 400), the LVEF was significantly lower, 50,5% (p=0.004). Conclusions: High Calcium score is positively correlated with LVEF reduction, and a high value for calcium score indicates an increased probability of reduced left ventricular ejection fraction. ACKNOWLEDGEMENT: This paper is partly supported by the Sectorial Operational Programme Human Resources Development (SOP HRD), financed from the European Social Fund and by the Romanian Government under the contract number POSDRU 80641.

validated
Role of antibiotic prophylaxis in ureteroscopy for ureteral lithiasis Maier A View abstract

Role of antibiotic prophylaxis in ureteroscopy for ureteral lithiasis

First author: Maier A

Coauthors: Vida O , Szollosi A , Golea O , Todea C , Boja R , Martha Orsolya

Keywords: retrograde ureteroscopy urinary infection ureteral lithiasis, antibiotic prophylaxis hydronephrosis

Background: One of the most common pathology in urological praxis is urinary lithiasis. Extracorporeal shock wave lithotripsy or frequently retrograde ureteroscopy are modern procedures for the treatment of this kind of pathology. Some problems may develop after ureteroscopy such as infection with fever complication. Material and Method: This retrospective study evaluate for a period of two years (2011 -  2012), the health records of 164 (100%) patients who underwent to ureteroscopy. We compared the infectious complication episode in patients with antibiotic prophylaxis 33 (20.12%) (group A) versus patients without prophylaxis 131 (79.87%) (group B). Patients were divided according to the  size of the  stones, the grade of hydronephrosis and the location of the stones. Results: Depending of the stones location we found: 56 (34.14%) lumbar stones, 18 (10.97%) iliac stones, 90 (54.87%) pelvic stones.  From 164 patients 24 (14.63%) patients had fever. According to hydronephrosis classification  most  febrile patients were those with grade two of hydronephrosis: 16 (66.66%) of which 2 (6.06%) patients from group A and 14 (10.68%) patients from group B and just 7 (29.16%) patients with grade three of hydronephrosis were febrile. From the group A, 3 (12%) patients with stones below 10mm had fever, while 18 (14.87%) from group B develop this complication. In patients with stones size over 10mm, one (14.28%) patient from group A and 2 (25%) patients from group B had fever.   Incriminated infectious germs following ureteroscopy were: E. Coli, Enteroccocus spp., Proteus  and Pseudomonas. Antibiotics used for prophylaxis were: amoxicilinum and ac. clavulanic, cephalosporines of generation I, II. Conclusions: All patients undergoing ureteroscopy should be investigated before the procedure in order to identify the presence of bacteria in the urinary tract to avoid complications like infection associated with fever. Antibiotic prophylaxis may reduce the incidence of postoperative infection in ureteroscopy.ACKNOWLEDGEMENTS: This paper is partly supported by the Sectorial Operational Programme Human Resources Development (SOP HRD), financed from the European Social Fund and by the Romanian Government under the contract number POSDRU 80641.

validated
Evaluating the equivalence between home blood pressure measurement and automatic blood pressure measurement in the diagnosis of hypertension Laszlo M.I. View abstract

Evaluating the equivalence between home blood pressure measurement and automatic blood pressure measurement in the diagnosis of hypertension

First author: Laszlo M.I.

Coauthors: Kikeli PI , Preg Z

Keywords: home blood pressure hypertension monitoring

Background: Office blood pressure measuring is biased by the white coat effect; we aimed to establish weather two measurements that eliminate this bias - the home blood pressure measurements and the ambulatory blood pressure measuring - provide similar result Material and Method: We included in the study a number of 260 hypertensive patients examined at the procardia cardiology clinic between 2009-2011 The sex distribution of the patients was 118 female and 142 male patients, most of them from an urban setting 176 patient compared to 84 patients from a rural setting. These patients were evaluated by an automatic ambulatory blood pressure monitoring device and after with home self measurements done by a standardized device provided. The data was subjected to a statistical analysis with the aid of the GraphPad InStat application, using the T test for paired data.  Separate analysis was conducted for the systolic blood pressures and for the diastolic blood pressures. Results: Analyzing the systolic blood pressure we obtained a mean difference of 5.75mmHg between the two measurement procedures ( a mean of 137.07mmHg for the automatic measurements versus a mean of 142.82 mmHg for the self measurements) this difference being statistically significant p=0.0001. As for the diastolic values a mean difference of 0.46mmHg (86.91mmhg versus 87.37mmhg) with no statistically significant difference p=0.61 Conclusions: Although both types of measurement avoid the white coat effect there is no equivalence between the two and both should be used in the diagnosis and monitoring of the blood pressure

validated
The biomechanics of spondilolisthesis and normal spine. A comparative approach Marton Denes View abstract

The biomechanics of spondilolisthesis and normal spine. A comparative approach

First author: Marton Denes

Coauthors: Anghel Stelian

Keywords: spondylolisthesis spinal biomechanics spondylolisthesis slip angle

Background: The treatment for spondylolisthesis is challenging and difficult, especially if it requires surgical intervention. Thus, it is important to thoroughly understand the mix of predictive factors, the responsible forces, mechanical processes and tissual modifications. Our presentation introduces an observational comparative study of the biomechanics of spondilolisthetis versus the normal spine. Material and Method: We analysed 30 cases of spondilolisthesis surgically treated in our medical unit, between 2005 and April, 2013. Relevant information was retained, such as age, gender, level and degree of spondilolisthesis, the angles with horizontal of the superior plate of S1, and of the inferior and superior plates of L4 and L5 vertebral bodies. Similar data were taken for 60 cases of trauma with lumbosacral X-Rays displaying no osteo-articular lesions. All data was statistically processed. The translational forces occurring in the case of both the morphologically normal spine, and the modified spine were compared. Results: We have noticed a correlation between the sacral inclination degree and the deformation of the L4 and L5 vertebral bodies. We have also found the growth rate of forces, directly affecting the bone structures and the stabilizing ligamenture system, related to the inclination level. It is also apparent that the superior plate of the L5 vertebral body maintains its physiological angle with horizontal, despite sacral slope. This physiological correction comes at the expense of the shape of the L5 vertebral body, which undergoes deformation.  Conclusions: For optimal stabilization and for the reduction of translational forces occurring at intervertebral level, it is important that, in the pre-operative stage, all these measurements be obtained and standardized. We consider this an instrumental step in proper surgery planning. Acknowledgement: This paper is partly supported by the Sectorial operational Programme Human Resources Development  (SOP HRD), financed from the European Social Fund and by the Romanian Government under the contract number POSDRU 80641.

validated
FACIAL PROFILE CHARACTERISTICS EVALUATION IN A POPULATION OF CENTRAL ROMANIA REGION Chibelean( Cires-Marginean) Manuela View abstract

FACIAL PROFILE CHARACTERISTICS EVALUATION IN A POPULATION OF CENTRAL ROMANIA REGION

First author: Chibelean( Cires-Marginean) Manuela

Coauthors: Jurcă Anamaria , Bucur Sorana-Maria , Pantazi Madalina , Gheorghiu Milicin Emilia , Blaj Sorina , Păcurar Mariana

Keywords: facial profile dentistry photographic examination, facial

Background: Objectives. The aim of the study was to evaluate the variables that define the facial profile of a sample of the population in the centre of Romania and to include it in the East-European Caucasian constitutional type. Gender differences were analysed too. These values could be useful in elaborating the aesthetic objectives for treating the population in this area. Material and Method: 50 subjects were included in the study – patients and students of UMF Tg-Mures (29 females and 21 males) between 18 to 28 years of age, having dental class I and a balanced profile. The photographs were taken in the natural head position (NHP). The anthropometric points were recorded and four of the angles that characterize a harmonious profile were traced and measured: the nasofrontal angle (G-N-Nd), the nasolabial angle (Cm-Sn-Ls), the mentolabial angle (Li-Sm-Pg), the facial angle (G-Sn-Pg). Results: The values obtained for the two sexes were compared. To compare the sexes the t-student test was used. All angles had values that were bigger for females (nasofrontal: girls 137,1 degrees; boys 135,79 degrees, p=0,0019; nasolabial: girls 105,3 degrees; boys 102,19 degrees, p=0,00002; mentolabial angle: girls 126,07 degrees; boys 118,27 degrees, p=0,000009; facial angle: girls 170,32 degrees; boys 168,85 degrees, p=0,0033). Conclusions: Differences between the two sexes were obtained, all angles were statistically significant larger in females. These results show that for the population in the centre of Romania the treatment objectives are different for girls than for boys. The angular values range between those that characterize the East-European Caucasian population.ACKNOWLEDGEMENTS: This paper is partly supported by the Sectorial Operational Programme Human Resources Development (SOP HRD), financed from the European Social Fund and by the Romanian Government under the contract number POSDRU 80641.

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Morphological aspects and distribution of interstitial cells of Cajal in human upper urinary tract Prisca R A View abstract

Morphological aspects and distribution of interstitial cells of Cajal in human upper urinary tract

First author: Prisca R A

Coauthors: Loghin Andrada , Gozar H , Moldovan C , Moso Tekla , Derzsi Z , Borda Angela

Keywords: interstitial cells of Cajal upper urinary tract pyeloureteral junction obstruction immunohistochemistry CD117

Background: The mechanism by which the ureter propels urine towards the bladder has a myogenic origin, through peristaltic contractions. This pyeloureteral autorhythmicity is generated by specialized, electrically active cells, the interstitial cells of Cajal (ICC), located in the proximal regions of the upper urinary tract. Objective. The aim of this study is to describe the exact location and the distribution of ICCs in the human upper urinary tract and to analyze their normal number and morphology. This is a preliminary study, which will allow the study of these cells in different urinary tract pathologies. To our knowledge, this is the first study of ICCs in human urinary tract performed in Romania. Material and Method: Urinary tract fragments were sampled at different levels, from 13 autopsy cases. Cases with clinical evidence of renal disease, and with histological changes in the kidney or in the urinary tract tissue samples, visible in hematoxylin-eosin staining, were excluded. To highlight the ICCs, immunohistochemistry with anti-CD117 antibody 1:600 was performed. Results: ICCs were indirectly highlighted by the presence of a finely granulated cytoplasm indicating immunoreactivity. These cells were spindle-shaped or stellate, with cytoplasmic extensions at one or both poles of the cell and large oval nucleus. We found that ICCs are located at all upper urinary tract levels, with a higher predominance in the calyces and pyelon. ICCs were observed mostly between the two layers of the muscularis, but also between the muscle bundles. Most often, these cells were parallel to the muscle fibers. Conclusions: Our study describes the method of detection of ICC’s in normal human urinary tract. Its results can be used to analyze the number, the morphology and the location of these cells in different congenital pathologies, such as vesicoureteral reflux, pyeloureteral junction obstruction or primary obstructive megaureter.

validated
Endothelial cell proliferation and vascular endothelial growth factor expression in primary colorectal cancer compared with corresponding liver metastases Ceausu Amalia Raluca View abstract

Endothelial cell proliferation and vascular endothelial growth factor expression in primary colorectal cancer compared with corresponding liver metastases

First author: Ceausu Amalia Raluca

Coauthors: Cimpean Anca Maria , Gaje Pusa , Cretu O , Mederle O , Raica M

Keywords: Histology Oncology liver metastasis, RNA VEGF, endothelial cell proli

Background: To study the endothelial cells proliferation and VEGF expression in primary colon cancer compared with corresponding liver metastasis Material and Method: The present study included primary tumors and liver biopsies from 12 patients. The proliferation of endothelial cells was evaluated by using double immmunostaining CD34/Ki67. For VEGF RNA evaluation, in situ hybridization for RNA was used. Results: Histopatological evaluation releaved liver metastasis from well (4 cases), moderately (4 cases) and poorly differentiated adenocarcinoma (4 cases). Endothelial cell proliferation in primary tumors showed closely values between intra and peritumoral areas in well and moderately differentiated types. In poorly differentiated type, endothelial cell proliferation was higher in peritumoral area. The highest values were found in intratumoral area and in poorly differentiated type.  The same aspect was found in poorly differentiated type. The highest expression in both, primary tumor and metastasis was found in moderately differentiated type.  Conclusions: The endothelial cell proliferation rate was lower in liver metastasis comparative with primary tumors for all histopatological types. VEGF RNA score in well differentiated type was heterogeneous, moderately expressed in primary tumor and it has lower expression in corresponding metastasis

validated
The Wide Grip Lat Pull Down Exercise: Clinical Anatomy Assessment On How To Maximize Back Muscle Activity Without Causing Injury Bob MH View abstract

The Wide Grip Lat Pull Down Exercise: Clinical Anatomy Assessment On How To Maximize Back Muscle Activity Without Causing Injury

First author: Bob MH

Coauthors: Antzoulas P , Ariqat Maissoun , Azad A , Schmidt Nadia

Keywords: fitness kinetic chain lat pull down shoulder injury

Background: The wide grip lat pull down is a basic open-kinetic chain exercise widely used in fitness training. The anterior and the posterior techniques of this exercise are compared. Material and Method: The anatomically-correct techniques were established through literature search and kinesio-therapic and orthopedic expertise. Angular kinematic analysis of the movements involved in the exercise was performed on healthy subjects with no history of shoulder injury. Direct inspection and palpation of superficial bony landmarks and high-definition video recordings were used. The risk of injury related to each technique was investigated. Results: Before performing the complex closed-chain exercises, the general population must start by the open kinetic chain exercises to fortify the deficient muscles. The compared pull-down techniques differ only at the end stage of the active phase: the posterior technique requires flexion of the trunk in order to keep the cranio-vertebral axis straight. This brings the humerus into extreme lateral rotation, extension and horizontal abduction, which is the typical mechanism for anterior scapulo-humeral dislocation. The anterior technique involves arm movements in an almost frontal plane. Dorsal tilting of the thorax through enhancement of lumbar lordosis shifts the focus of the exercise from upper to lower latissimus dorsi fibers. Conclusions: The wide grip pull down exercise is one of the basic open kinetic chain exercises for back muscles. For the general population, they should be practiced until gaining enough strength to pass to the closed kinetic chain pull up exercise. The anterior technique is shoulder-safe and solicits back and chest muscles at least as much as the posterior technique. The posterior technique has a higher potential for shoulder injury.

validated
The management of the patient with elevated PSA and a negative initial prostate biopsy Vida Á O View abstract

The management of the patient with elevated PSA and a negative initial prostate biopsy

First author: Vida Á O

Coauthors: Szollosi A , Maier A , Boja R M , Loghin Andrada , Martha Orsolya

Keywords: prostate cancer PSA biopsy atypical small acinar proliferation

Background: The prostate cancer is the second  most  common cancer amongst men. The diagnosis is certified by the histopathological findings, after the prostate biopsy (PBP) were performed. Not all increased prostate specific antigen (PSA) level means prostate cancer. Material and Method: In this retrospective study we processed the results of ultrasound guided PBP performed at the Clinic of Urology Târgu- Mureş, between 2011-2012. Our study includes patients with at least one negative PBP and an elevated value of PSA. Results: In a two year period, we performed 422 PBP (100%), with 179 (42.42%) cases having “negative” result. The biopsies were performed under digital guidance in 14% (25 cases), in the remaining cases 154 (86%) with ultrasound guidance. Initially, in most of the 98 (54.74%) cases, 6 cores were harvested at the first biopsy. The average PSA was 13.45 ng/ml (0.49-100 ng/ml). The histological findings were: normal prostatic tissue in 141 cases (78.77%), atypical small acinar proliferation in 12 cases (6.70%), prostate atrophy in 11 cases (6.14%), benign prostatic hyperplasia in 10 cases (5.59%) and prostatitis in 5 cases (2.80%). In 30 cases (16.75%) rebiopsy was performed. The incidence of prostate cancer was 52.58%, that broadly corresponds with the incidence rate found in other studies. There are several questions requiring answers: How could we improve our results? What is the strategy for a patient with initial negative biopsy but an elevated or rising PSA? Should we  rebiopsy every patient, with elevated PSA value without any sign of malignancy on digital rectal examination? Conclusions: The traditional sextant PBP is no longer valid. If there is any kind of suspicion for prostate cancer the biopsy should be repeated after 6 to 8 weeks from the initial biopsy. Patient’s compliance plays a vital role in the follow-up of the procedure. There is no generally accepted follow-up protocol.ACKNOWLEDGEMENTS: This paper is partly supported by the Sectorial Operational Programme Human Resources Development (SOP HRD), financed from the European Social Fund and by the Romanian Government under the contract number POSDRU 80641.

validated
Accuracy in predicting patterns of loss of correction in surgically treated thoracolumbar burst fracture. Marton Denes View abstract

Accuracy in predicting patterns of loss of correction in surgically treated thoracolumbar burst fracture.

First author: Marton Denes

Coauthors: Anghel Stelian

Keywords: thoracolumbar burst fracture post-traumatic kyphosis short segment fixation

Background: Surgically treated thoracolumbar burst fracture is often followed by loss of correction, which may be significant enough to require another correctional surgery. We identified and compared predictive patterns of loss of correction associated with posterior short segment fixation (SSF) and anterior approach (AA). We also supplementarily verified their reliability. Material and Method: We conducted an analysis on primary data from 10 selected articles, comprising 248 individual cases of single level burst fracture at T11-L5 level. The patterns of loss of corrections were delineated through best fit regression equations for post-operative (Kpo) and last follow-up (Kf) kyphosis angle for the two groups of patients (treated with SSF or AA). In order to further verify the representativeness of forementioned equations, we applied them to summary mean values obtained from 30 other papers (967 patients) concerned either with SSF treatment (19 papers) or AA surgery (11 papers). Results: The best-fit regression equations are: Kf = 0.96*Kpo + 3.3, standard error = 4.328 for the SSF group, and Kf = 0.97*Kpo + 3, standard error = 4.1 for AA group. On the scattered plot, most of the intersection points associated to the mean values are on the regression lines determined with raw data. Standard errors calculated for the two groups of mean values of summary studies were 1.58 for AA and 3.54 for SSF. Conclusions: The two equations are very similar and displaying significant standard errors for the raw data. Yet, both equations present much lower (by 20% for SSF and 60% for AA) standard errors for the mean values extracted from the 30 summary studies. This infers high accuracy, especially of the AA regression equation. Acknowledgement: This paper is partly supported by the Sectorial operational Programme Human Resources Development  (SOP HRD), financed from the European Social Fund and by the Romanian Government under the contract number POSDRU 80641.

validated
Working in a Romanian bank: a healthy experience? Patronea AS View abstract

Working in a Romanian bank: a healthy experience?

First author: Patronea AS

Coauthors: Bocsan IS , Hatu Giorgiana , Lapusan Dana Luminita , Bocsan IS

Keywords: bank employees occupational health health risk factors

Background: Romanian bank system is a professional domain recently developed in our country, which drew generally young people and/or unexperienced, exposing them to stress. Stress at work is believed to be responsible for the appearance of a large number of diseases: heart diseases, digestive, endocrine, psychiatrical, neurological, diabetes mellitus. This paper aims to show how professional experience in banking environment, seniority in the department and age of the bank workers ' is associated with these diseases among them. Material and Method: In this study we have included 303 of 800 employees of a banking institution in Romania, from 10 counties of Transylvania. Were asked them to answer an anonymous questionnaire regarding the specifics of their activity, the length in the banking environment, in the department as well as the presence of illnesses diagnosed prior to employment or after engaging in the banking environment. Results: Of the 300 responders, 27(9%) had less than 1 year experience in the department, 147(49%) between 1-5 years, 96(32%) between 6-10 years, 22(7.3%) between 11-15 years, 8(2.7%) over 16 years.  135(45%) of employees accused diseases after engaging in environment, 22.2% of those under 1 year experience in the department, 27.5% with 1-5 years experience, 27.2% of 6-10 years, 75.0% of 11-15 years, and 72.7% among those with over 16 years experience in the department. Conclusions: The proportion of young employees with seniority under 10 years in banking and already suffering from various diseases in this period draws attention to a more rigorous surveillance of the health status of these persons from employment. It is necessary to deepen the study on the diagnostic categories and age groups.

validated
Fibro-hyaline involution of a papillary thyroid carcinoma metastasis in a lymph-node consecutive to radioiodine therapy, mimicking a parathyroid adenoma, case presentation Deé Edith View abstract

Fibro-hyaline involution of a papillary thyroid carcinoma metastasis in a lymph-node consecutive to radioiodine therapy, mimicking a parathyroid adenoma, case presentation

First author: Deé Edith

Coauthors: Loghin Andrada , Neagoe R , Paşcanu Ionela , Angela Borda

Keywords: papillary thyroid carcinoma psammoma body radioiodine ablation parathyroid adenoma metastases

Background: The aim of the study is to present the unusual changes that a lymph node metastasis of papillary thyroid carcinoma (PTC) underwent after radioiodine therapy, leading to the confusion with a parathyroid adenoma (PA). Material and Method: Eight years after a total thyroidectomy and radioiodine ablation with 73.35 mCurie 131I for PTC, a 67 years-old female presented with an enlarged, painless, nodular mass in the left lateral neck region. Clinical examination revealed a firm nodule placed on the site of the left inferior parathyroid gland. Elevated serum parathyroid hormone level (120 pg/ml) and parathyroid scintigraphy led to a suspicion of PA. A minimally-invasive surgical procedure was performed to remove the mass, which was sent to the pathology department as left PA. It was fixed and processed for microscopic evaluation. Results: On macroscopic examination the surgical specimen was oval; it had 13 mm at the largest diameter and a weight 2 g.  On microscopy the lesion appeared as a fibro-hyaline, intensely acidophilic, acellular mass, with calcifications. It was limited by a delicate capsule in which one typical psammoma body was present. At the periphery, on only one level a small mass of cells of indefinite origin was noticed. Immunohistochemistry (IHC) was done to ascertain the origin of these cells: they were negative for Pan-Citokeratine, Parathormone and Thyroglobuline antibodies, but positive for Leukocyte Common Antigen (LCA) antibody, proving that they were residual lymphocytes from a lymph node. Conclusions: These IHC data, together with the microscopic feature, the presence of the psammoma body and the patient’s history, excluded a PA and concluded for a fibro-hyaline involution of a PTC metastasis in a lymph node, consecutive to radioiodine therapy. Without careful microscopic examination and accurate clinical information this lesion could represent a real diagnostic challenge.

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Increase in the usage of hypertension medication over 2 weeks for increasing blood pressure control Laszlo M.I. View abstract

Increase in the usage of hypertension medication over 2 weeks for increasing blood pressure control

First author: Laszlo M.I.

Coauthors: Kikeli PI , Preg Z

Keywords: drug therapy telemetry blood pressure control

Background: Uncontrolled hypertension is a major cause of morbidity and mortality. Up until now the control rates for the blood pressure are low, but adjusting the medication could increase the level of control Material and Method: We included in the study a number of 100 patients with hypertension examined in the Procardia ambulatory clinic between 2009-2011 The patients received for a period of two weeks a certified blood pressure monitor with a telemetric data transmission unit allowing instant data collection and evaluation. Based on the received data medication adjustments were made if necessary within 1 week and we continued the data collection. We evaluated the use of medication in therapy based on the major groups of blood pressure lowering drugs: B blockers, Ca channel inhibitors, diuretics, angiotensine conversion enzyme inhibitors, angiotensine receptor blockers and alpha receptor blockers. We also evaluated the use of multiple drug association at the start and end of the study also taking in consideration the diagnosed grade of hypertension. Results: We found an increase in the usage of all classes of medication but statistical significance was achieved only in the increase of the angiotensin conversion enzyme inhibitors from 52% to 67% p=0.04. Although there were increases in the usage of all the drug categories- B blockers35% to 45%, Ca channel inhibitors39% to 49%, diuretics 40 to 47%, angiotensine receptor blockers 10 to 19 %  and alpha receptor blockers 0 to 1% they did mot reach statistical significance but it generated a decrease in the mean blood pressure from 145.50/89.41mmHg to 136.72/84.69mmHg. We also noted a need for the association of 2 or more drugs especially in grads 2 and 3 of hypertension Conclusions: The achievement of a higher rate of blood pressure control was possible due to a slight increase in medication usage but mostly due to a multi drug therapeutic approach.

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Percutaneous nephrolitotomy (PCNL) in patients over 70 years old. Is it safe? Todea-Moga C View abstract

Percutaneous nephrolitotomy (PCNL) in patients over 70 years old. Is it safe?

First author: Todea-Moga C

Coauthors: Boja RM , Porav-Hodade D , Nedelcu S , Maier A , Martha Orsolya

Keywords: Urology Urology percutaneous nephrolitotomy, kidney stone, elderly

Background: PCNL represent the main indication for patients with kidney stones, even in the presence of various comorbidities. In our clinic open surgery for this pathology is less than 0.5% of all procedures for renal stones. The objective of this paper is to assess the safety and efficacy of this procedure in patients over 70 years. Material and Method: A retrospective study was performed for a period of 16 years (1997-2012), A totally of 323 patients entered in this study (162 women, 161 men), aged over 70 with renal stones They were treated endoscopically by PCNL or anterograde ureteroscopy. 85 patients (26.31%) had comorbidities that were preoperatively diagnosed and treated where necessary. Results: Overall status of "stone free" at the end of surgery was present in 263 patients (81.42%). 60 patients (18.58%) had residual fragments. Residual stones were solved by a new PCNL session, spontaneous elimination or ESWL. The most common complications were bleeding and infection. We had no deaths. No hemostasis nephrectomy was necessary. Conclusions: Recognized preoperative comorbidities do not represent risk factors in elderly patients, but it requires a rigorous evaluation in the preoperative period. The number, size and complexity of the stones directly influences the "stone free" state at the end of the surgery.

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EVALUATING MYOCARDIAL ISCHAEMIC PRECONDITIONING MEASUREING SPONTANEOUS MECHANICAL AND ELECTRICAL ACTIVITY IN A MURINIC EX-VIVO MODEL. Marginean M View abstract

EVALUATING MYOCARDIAL ISCHAEMIC PRECONDITIONING MEASUREING SPONTANEOUS MECHANICAL AND ELECTRICAL ACTIVITY IN A MURINIC EX-VIVO MODEL.

First author: Marginean M

Coauthors: Perian M , Barbat G , Dobreanu D

Keywords: preconditioning ischemic preconditioning myocardial preconditioning IPC

Background: It has been suggested that the myocardial preconditioning effect of ischemia could be quantified by evaluating both electrical and mechanical activity of the heart.  We obtained continuous recordings of electrical heart activity and intraventricular pressure curves during the immediate period following an  ischemic insult. Material and Method: For this experiment we used 30 Wistar rats randomized in two groups: with ischemic preconditioning  (IPC n=15) and without ischemic preconditioning  (control n=15). The animals were anesthetized, iv anticoagulant was given and the hearts were carefully excised. The aorta was cannulated and Krebs-Hanseleit solution was perfused in a retrograde manner using the Langendorff apparatus. All hearts in the IPC group were subjected to a preconditioning protocol consisting of 5 min. of ischemia followed by 5 min. of reperfusion before a sustained period of ischemia (30 min.). The control group only received a 30 min. period of ischemic injury. Results: Regarding the mechanical activity of the heart we did not find a significant difference between the two groups (p=0,08). The period in which the hearts maintained a measurable electric activity after the prolonged ischemic insult differed significantly (p=0,01). Conclusions: We concluded that the electrical activity of rat hearts can be used for the purpose of quantifying myocardial preconditioning effect of ischemia. On the other hand, this preconditioning protocol had no effect on mechanical activity of the heart.ACKNOWLEDGEMENTS: This paper is partly supported by the Sectorial Operational Programme Human Resources Development (SOP HRD), financed from the European Social Fund and by the Romanian Government under the contract number POSDRU 80641.

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Using Abdominal CT Data for Visceral Fat Evaluation. Pop M. View abstract

Using Abdominal CT Data for Visceral Fat Evaluation.

First author: Pop M.

Coauthors: Pop Raluca Monica

Keywords: Computed tomography Visceral Fat MATLAB ImageJ Obesity

Background: Quantitative assessment of body fat is important for the diagnosis and treatment of diseases related to obesity. However, the standard evaluation methods do not measure body fat quantitatively. Computed tomography (CT) is becoming the standard procedure for measuring the abdominal fat distribution and various methods and software are being used Material and Method: The retrospective study included 111 inpatients, who underwent routine abdominal CT exams in the Radiology Laboratory of Tg.Mures Clinical Emergency Hospital (February-April 2013). CT (SOMATOM AS 64 MDCT) was performed using a section linking the posterior-inferior aspect of L4/L5 intervertebral disc and the umbilicus. Images were processed using a custom written MATLAB R2009b software.  ImageJ was used for tracing the contour of visceral fat area (VFA). Patient data (including blood glucose, cholesterol and triglycerides) were statistically analyzed using MO Excel and GraphPad Inprism5. Results: The Visceral Fat percentage varied in population from 14.59-68.69(SD= 11.83) with significant difference between sexes (male vs. female, 46.98vs.31.62, p <0.01). Cholesterol values >220mg% and triglycerides >150mg% are significantly associated with the VF percent (p<0.05). Overall there is a weak correlation between the lab variables and the measured fat, the strongest one being between TG and the VFA (r=+0.23). However, when looking at certain samples there is a higher positive correlation between age and VFA percentage. Conclusions: The technique used decreases the human error in marking of the fat areas providing a better estimation of the VF and VF percentage. Visceral fat measured by CT relates with certain lab variables. Further analysis, including different blood tests and clinical data are required for a better understanding of the CT role in obesity related pathology diagnosis and treatment. Acknowledgement:This paper is partly supported by the Sectorial Operational Program Human Resources Development (SOP HRD), financed from the European Social Fund and by the Romanian Government under the contract number POSDRU 80641.

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Surgical treatment of carotid dolichoarteriopathies Voicu Bianca View abstract

Surgical treatment of carotid dolichoarteriopathies

First author: Voicu Bianca

Coauthors: Suciu H. , Sin Anca

Keywords: Internal carotid artery carotid dolichoarteriopathy surgical teatment kinking coiling

Background: Carotid dolichoarteriopaties (tortuosity, kinking and coiling) represents a common angiographic and Duplex scanning finding, but choosing the right method for treatment is still a subject of numerous debates.The aim of this study was to analyze the clinical features of the patients with carotid dolichoarteriopathies who referred for surgery to Clinic of Cardiovascular Surgery from Targu Mures and the type of surgery performed. Material and Method: From January 2009 to December 2012 there were 220 patients reffered to Clinic of Cardiovascular Surgery from Targu Mures for internal carotid artery revascularization, 16 of them being with carotid dolichoarteriopathyCarotid dolichoarteriopathies were classified according to Weibel-Fields and Metz as tortuosity, kinking and coiling. Results: Surgical techniques varied by the individual anatomic findings. There were three types of surgical techniques: segmental resection of the internal carotid artery with end-to-end or end-to-side anastomosis; endarterectomy of carotid bifurcation with segmental resection of carotid artery and then reimplantation of internal carotid artery in common carotid artery; angioplasty of internal carotid artery with vein or synthetic graft. Conclusions: Choosing the right treatment of carotid dolichoarteriopathy remains a controversy issue. When these anomalies are the cause of cerebrovascular insufficiency surgical treatment is indicated and the surgeon must be familiarized with all the techniques and choose the right one tailored to each patient.

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Comparative Results of Kyphoplasty and Vertebroplasty as Cement Augmentation Procedures in Minimally Invasive Spinal Surgery Borz T View abstract

Comparative Results of Kyphoplasty and Vertebroplasty as Cement Augmentation Procedures in Minimally Invasive Spinal Surgery

First author: Borz T

Coauthors: Vesa S , Jakab G , Bataga T

Keywords: percutaneous vertebroplasty kyphoplasty osteoporosis vertebral compression freactures

Background: Osteoporosis affects millions of women and also men in Europe. The fractures give the illness its significance, among them numerous vertebral fractures occur annually. One fifth of the patients suffering from vertebral compression fracture (VCF) sustaine another VCF within a year. The intense pain cannot always be controlled under conservative care and an efficient and fast intervention is needed to restore the quality of life of the patients. Material and Method: Based upon the data of numerous operated cases, the authors wish to present the comparative short and long-term results of the two specific procedure, regarding the quality of life (VAS pain-scale), and also a specific complication, i.e.fracture of a neighbouring vertebra (probably due to the increased rigidity of the cemented one). Results: The two procedures have similar short and long-term results regarding the decrease of pain (evaluated by the visual-analogue scale), with a slightly higher rate of secondary adjacent VCFs in the vertebroplasty group, which was by the other hand more cost-effective. Conclusions: The cement augmentation (vertebroplasty or kyphoplasty) may be a very helpful minimally invasive procedure in spinal surgery.

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Assessing the patient with abdominal obesity: metabolic and nutritional factors Pop Raluca View abstract

Assessing the patient with abdominal obesity: metabolic and nutritional factors

First author: Pop Raluca

Coauthors: Pop M , Dogaru G

Keywords: abdominal obesity food pyramid nutritional assessment

Background: Abdominal obesity is a confirmed factor risk and the variables influencing it are subject for research and intervention. The available nutritional evaluation methods are time consuming, subjective and a standardized approach is missing. Material and Method: Aim: Standardized evaluation of patients with abdominal obesity. Type of study – cross-sectional. Target population – patients with abdominal obesity. Sample – convenience, 85 patients who were evaluated in the Endocrinology Outpatient Clinic of the Emergency Mures County Hospital between February – April 2013. Variables: age, sex, environment, BMI, waist, blood glucose, triglycerides, HDL Cholesterol, blood pressure. Each patient filled a food frequency questionnaire with 129 items and the personal food pyramid was constructed using a web application. Statistical analysis was performed using GraphPad and MO Excel. Results: None of the subjects had a “normal” food pyramid. Sex has no influence on the food pyramid. The meat and protein food group is the only one significantly influenced by the environment (p=0.04). Patients with dyslipidemia consume lower amounts of concentrated sweets and fat (1.13 vs. 1.83 servings, p=0.007). Patients requiring metabolic treatment have significant higher waist values (101.32 vs. 93.07 cm, p=0.03). There’s a linear trend between waist and sweet consumption (p=0.03). Patients without other metabolic risk factors apart from abdominal obesity consume significant lower amounts of meat and protein and higher amounts of fruit and vegetables. Conclusions: A standardized approach to the patient with abdominal obesity using nutritional assessment tools and metabolic evaluation helps to identify those at risk and to give more tailored recommendations. ACKNOWLEDGMENTS: This paper is partly supported by the Sectorial Operational Program Human Resources Development (SOP HRD), financed from the European Social Fund and by the Romanian Government under the contract number POSDRU 80641. Project partly supported through an Internal Research Grant of University of Medicine and Pharmacy Tirgu Mures.

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White matter anatomy demonstrated by fiber dissection technique Cristina Goga View abstract

White matter anatomy demonstrated by fiber dissection technique

First author: Cristina Goga

Coauthors: Klara Brânzaniuc , Ioan Ștefan Florian , Ugur Ture

Keywords: fiber dissection white matter microsurgical anatomy

Background: Fiber dissection technique involves peeling away the white matter fibers of the brain to display its three-dimensional arrangement. The purpose of this study was to study the myelinated fiber bundles of the brain to achieve a clearer conception of their configuration and location. Material and Method: Twenty previously frozen, formaline-fixed human brains were dissected, from lateral and medial aspects, under the operating microscope by using a fiber dissection technique. Results: The association, projection and commissural fibers were exposed and studied. Analysis of their organization provided a unique knowledge of their anatomical features and an enhanced perception of their spatial relations. Conclusions: The white matter fiber tracts of the brain are eloquently revealed when fiber dissection technique is used. The resulting three-dimensional knowledge is especially relevant for planning strategies and tactics of neurosurgical procedures.ACKNOWLEDGEMENTS: This paper is partly supported by the Sectorial Operational Programme Human Resources Development (SOP HRD), financed from the European Social Fund and by the Romanian Government under the contract number POSDRU 80641.

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The role of sustained slow pathway conduction (SSPC) during incremental atrial pacing in evaluating radiofrequency slow pathway ablation in patients with atrioventricular node reentrant tachycardia Rudzik Roxana View abstract

The role of sustained slow pathway conduction (SSPC) during incremental atrial pacing in evaluating radiofrequency slow pathway ablation in patients with atrioventricular node reentrant tachycardia

First author: Rudzik Roxana

Coauthors: Beke Ildiko , Dobreanu D

Keywords: supraventricular tachycardia atrioventricular node catheter ablation atrioventricular nodal reentrant tachycardia sustained slow pathway

Background: Atrioventricular node reentrant tachycardia (AVNRT) is the most frequent form of supraventricular paroxysmal tachycardia.  The purpose of this study was to evaluate the usefulness of incremental atrial pacing  in patients undergoing radiofrequency ablation for AVNRT and compare it to dual atrioventricular node physiology (DAVNP) in terms of tachycardia inducibility and recurrence. Material and Method: We assessed 98 patients with AVNRT admitted to the hospital during 01.01.2008-30.04.2012. Electrophysiological testing and radiofrequency ablation was performed to all patients. 42 patients were included to the study because of technical difficulties to measure all parameters and they were compared to a control group of 48 patients without AVNRT who underwent electrophysiological testing. The presence of sustained slow pathway conduction (SSPC) was assessed by incremental atrial pacing by decreasing the pacing cycle length rapidly until the PR interval exceeded RR interval, reaching the Wenckebach point and AV block occurred . DAVNP was determined by programmed atrial stimulation using standard criteria.   The endpoint was the noninducibility of the arrhythmia and changing the atrioventricular node physiology.   The persistence of DAVNP and SSPC was evaluated before and after radiofrequency ablation. Results: The two groups (AVNRT group and control group) were homogenous regarding the sex and age of the patients enrolled. DAVNP was present in 90 % of the patients before ablation and SSPC in 95,45%. The procedural success was obtained in all of the patients with no recurrences (mean follow up 12,68 months  ± 7,28). After the ablation the DAVNP persisted in 7 patients  and SSPC in 1 patient. Conclusions: Incremental atrial pacing and  SSPC evaluation is well correlated with atrioventricular node physiology modification (DAVNP)during slow pathway radiofrequency ablation in patients with typical AVNRT. Furthermore it is a good predictor for  recurrences after the ablation.

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Complications and comorbidities in relation to the severity of inflammatory bowel diseases in our region Ciorba M View abstract

Complications and comorbidities in relation to the severity of inflammatory bowel diseases in our region

First author: Ciorba M

Coauthors: Bataga Simona

Keywords: Crohn's disease Ulcerative colitis Complications Comorbidities Inflammatory bowel disease

Background: Patients with inflammatory bowel diseases can be affected by complications of the main disease and by other unrelated diseases. The importance of these conditions is based on the facts that they can significantly change medical strategies, clinical manifestations can be modified or mistook by associated diseases, prognosis can be influenced and treatment is limited by the pharmacologic effects on a person with comorbid conditions. Material and Method: In order to reach our goals we have studied the medical charts of patients with IBDs admitted to the Mures County Emergency Clinical Hospital over a period of 5 years. Patients were divided between Crohn’s disease and ulcerative colitis, grouped by gender and age. The most frequent complications and comorbidities were grouped in: hematology, cardiovascular, diabetes and metabolic disorders, arthritic and perianal pathology. The collected data was analyzed through observational and statistical methods. Results: In the years studied we found 203 cases of IBDs, 82 cases of Crohn,s and 121 colitis, to which were diagnosed 168 instances of complications or comorbidities. The number of complications and comorbidities, both in absolute number (16 to 54) and in ratio (54% to 90%). Patients with colitis had 92 complications while Crohn’s 76. Overall, 90% of Crohn's cases presented complications compared to 80% of colitis cases. Women presented 97 complications while men just 71.  The most frequent complications were hematologic (65, 38.6%), followed by cardiovascular (31) and metabolic disorders (30). Anemia frequency doubled in the years studied but cardiovascular diseases rose from 1 to 15 per year. Conclusions: Complications of IBDs have been increasing to present day suggesting a more severe evolution of the diseases. Women are more frequently affected by these conditions than men. IBDs have a significant hematologic resonance and, along with cardiovascular disease and metabolic disorders, have to be taken into consideration in the management strategies of IBD cases.

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Evaluation of anthropometric and biochemical status in children with nutritional deficiency Man Lidia View abstract

Evaluation of anthropometric and biochemical status in children with nutritional deficiency

First author: Man Lidia

Coauthors: Pitea Ana Maria , Chincesan Mihaela Ioana , Marginean Oana , Man A , Baghiu Maria Despina

Keywords: Nutritional Status Anthropometry Insulin-Like Growth Factor I Child Blood proteins

Background: It seems that insulin growth factor I and serum proteins are related to the nutritional status. We have evaluated the anthropometric and biochemical status in children with nutritional deficiency (children with under -2 standard deviations in body mass index - BMI, according to WHO). Material and Method: We have conducted a prospective study on 196 children admitted in Pediatric Clinic I, divided in two groups: one of 49 children with nutritional deficiency (BMI < -2SD) and one control group (147 children). We have followed aspects regarding personal data, anthropometric indices evaluated as standard deviations (weight, height, middle upper arm circumference, tricipital skin fold), biochemical proteic status (IGF-1, albumin, total proteins). We also followed aspects of general nutritional biochemistry (transaminases, lipids). Results: The mean age for underweight children was 5.8 years, lower than in control (7.8 years). The weight of the children in the first group was significantly lower than in control, but not the height (p<0.001). We have also found significant differences in BMI, MUAC and TSF, all of them with low SDs in nutritional deficient children. Regarding the biochemical markers, we have found significantly lower values in transaminases (p<0.005) and IGF-1 (p=0.02). Most IGF-1 values were in normal range on both groups, but with a higher percent of low values in nutritional deficient children (37.5% vs 14.2%, p=0.0046). There were no significant differences in height, total proteins, albumin, cholesterol, and triglyceride levels between the two groups. Conclusions: The anthropometric measurements are the most precise methods in evaluating the nutritional status. Of the studied biochemical markers, only the IGF-1 is correlated with deficiencies in nutritional status. Other serum biochemical markers, even the proteins or lipids that are directly related to the nutrition habits, cannot be used as indicators of nutritional status.ACKNOWLEDGEMENTS: This paper is partly supported by the Sectorial Operational Programme Human Resources Development (SOP HRD), financed from the European Social Fund and by the Romanian Government under the contract number POSDRU 80641.

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Risck factors for Candida albicans and Candida non-albicans bloodstream infections Sular Floredana-Laura View abstract

Risck factors for Candida albicans and Candida non-albicans bloodstream infections

First author: Sular Floredana-Laura

Coauthors: Bilca Doina , Dobreanu Minodora

Keywords: invasive infection fungal infection risck factor

Background: Invasive fungal infection has gradually become a more common pathology in the last years as a consequence of more frequent use of immunosuppressive agents, an increase in the number of immunosuppressed patients undergoing various transplant procedures and use of more invasive means of therapy. The 30-40% mortality quoted by literature that accompanies the invasive fungal infections suggests that the diagnosis of Candida spp. bloodstream infections should be carefully approached. Material and Method: The objective of the present study was to determine and evaluate the risk factors for bloodstream infections  with Candida albicans (CA)(13 episodes) and Candida non-albicans species (CNA) (18 episodes) in 31 consecutive episodes of candidemia diagnosed during January 2011-December 2012 in the Microbiology Department  of the Clinical County Emergency Hospital of Tg.Mures.We performed a retrospective observational study of 31 consecutive patients diagnosed with  CA and ANA bloodstream infection that formed 2 case groups. Data collected included demographics,  length of hospitalization, exposure to antifungals and antibiotics, invasive and surgical procedures, intubation and mechanical ventilation, corticosteroid therapy, chemiotherapy, use of antiacids, antifungal sensitivity results and clinical outcome. We tried to determine the influence of these factors on the probable type of developed candidemia. Results: Associated morbidities and usually bacterial coinfections proved to accompany both CA and CNA bloodstream infections (69,23% vs.61,11%). Mechanical ventilation seemed to slightly favour CNA infections (66,66% vs.53,84%), and venous or arterial catheters were present in all cases of CNA (100% vs.76,92 % in CA). The use of antiacids seemed to preced more often CNA infections (72,22% vs.58,84%). Antifungals were used in more than half of the cases that were followed by a CA or CAN infection (53,84% vs.61,11%). Conclusions: Many of the evaluated risk factors were common for both CA and NCA bloodstream infections. Based on clinical characteristics alone we could not differentiate between the two groups.

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